2016-08-12T09:40:50-05:00 2015-12-31 Grant Thornton LLP 100 E Wisconsin Ave Milwaukee WI 53202 990 2015-01-01 350991629 Central Indiana Regional Blood Center % DEBRA QUALKENBUSH CENT 3179165010 3450 North Meridian Street Indianapolis IN 46208 CHARLES MIRAGLIA MD President & CEO 3179165010 2016-08-11 true Daniel V Romano P00504182 4142898200 2016-08-10 2015 2016-09-27 15:27:22Z Charles Miraglia MD 3450 North Meridian Street Indianapolis IN 46208 60799554 false X www.indianablood.org X 1952 IN To provide a continuous, safe, and adequate supply of blood products and testing services first to our own communities, then wherever our products and services are needed. 9 9 440 9 -29441 -29441 16187 345250 29148968 50299398 40048 729823 0 0 29205203 51374471 25002 50004 0 0 13844706 23268114 0 0 0 16988874 30060419 30858582 53378537 -1653379 -2004066 40933582 35154160 7447732 4135183 33485850 31018977 X STEWARDS OF INDIANA'S BLOOD SUPPLY, LINKING VOLUNTEER DONORS TO HOOSIER PATIENTS IN NEED BY RECRUITING, COLLECTING, PROCESSING, TESTING, LABELING AND DISTRIBUTING BLOOD TO HOSPITALS EVERY DAY. A COMMUNITY BLOOD PROGRAM, SUPPLYING FIRST IN INDIANA THEN WHEREVER THE LIFE-SAVING RESOURCE IS NEEDED. false false 29195311 50004 33722569 The blood banking unit has accomplished a continuous, safe, and adequate supply of blood products by educating and recruiting blood donors, providing accessible donation sites, and ensuring a healthy donor is drawn. 13984177 16576829 The testing unit provides a safe supply of blood products by strict adherence to the FDA, CLIA, AABB, OSHA, GMP, Etc. Guidelines to release a completely safe product. On an on-going basis the unit updates reagents used to perform tests for viral markers. 43179488 true true false false false false false false false true true false false false false true true true false false false false false false false false false true false true false false false false false true false false false false false false false true false false false true 41 0 true 440 true true true false false false false false false false false false X 9 9 false false true false true true true true true false false true true true true true true true true true true IN X DEBRA QUALKENBUSH 3179165010 3450 N MERIDIAN STREET Indianapolis IN 46208 X Gregory N Larkin MD Director 1.0 1.0 X 0 0 0 James F Austin Vice Chairman 1.0 X X 0 0 0 E Randall Wright Secretary 1.0 1.0 X X 0 0 0 Timothy P Robinson JD Treasurer 1.0 X X 0 0 0 Nancy Ahlrichs Director 1.0 X 0 0 0 Connie Danielson MD Director 1.0 X 0 0 0 John Myrland Director 1.0 X 0 0 0 James L Rice Director 1.0 X 0 0 0 L Alan Whaley Chairman 1.0 1.0 X X 0 0 0 Charles Miraglia MD CEO/President - As of 10/2015 55.0 X X 70653 0 5543 Dan Waxman MD Chief Medical Officer/EVP 55.0 X 407488 0 45075 Lora Poore VP Labratory Services 55.0 X 221083 0 21838 Wendy Mehringer VP Blood Services 55.0 X 214100 0 25323 Anthony Watkins Sr VP & CFO 5.0 55.0 X 42255 399744 45267 Maureen Kwiecinski asst corporate secretary 5.0 50.0 X 38572 364472 43301 Margaret McElligott VP Quality Services 5.0 50.0 X 25163 238042 61032 Sandi Lemons VP Human Resouce Services 4.0 51.0 X 21137 282989 47338 Lynne Briggs VP Information Svcs & CIO 4.0 51.0 X 17291 284477 58588 Tim Bryant CIO/VP - Thru 2/2015 55.0 X 261473 0 7704 Julie Cruz MD Assistant Medical Director 35.0 20.0 X 157847 88845 16187 Dipak Shah Director of Donor Testing Lab 55.0 X 135017 0 22906 Debra Qualkenbush Director Accounting 55.0 X 107282 0 11980 Beth Hughes Director of QA 55.0 X 103905 0 23070 Jeremy Watson Director of Donor Recruitment 55.0 X 102043 0 4390 Linda White Director of Clinical Services 55.0 X 100769 0 31063 Byron B Buhner Former CEO/President X 117974 0 0 2144052 1658569 470605 21 true true false NOW Courier 111 E McCarty INDIANAPOLIS IN 46225 Delivery 704433 Velox Express 243 S Madison Ave GREENWOOD IN 46142 Delivery 291710 Team MJV 115 farabee Drive LAFAYETTE IN 47905 Cleaning 170308 BE Smith 8801 Renner Avenue Suite 200 LENEXA MO 66219 Employee Recruitment 117046 4 200000 145250 345250 BLOOD BANKING FEES 900099 33674453 33674453 TESTING SERVICE FEES 621500 16576829 16576829 MISCELLANEOUS INCOME 900099 48116 48116 50299398 392738 -29441 422179 0 0 0 0 0 9760168 2000 9418695 6388 341473 -4388 337085 337085 0 0 0 0 51374471 50299398 -29441 759264 50004 50004 0 0 0 1613856 1160646 453210 0 16407761 11800063 4607698 521541 375080 146461 3466940 2933629 533311 1258016 930963 327053 0 60937 60937 119209 119209 0 0 60651 60651 1060918 311700 749218 372613 304893 67720 1100099 619199 480900 778605 534249 244356 0 1955798 1322522 633276 631488 549097 82391 0 0 338 338 0 1881565 961949 919616 321184 321184 TECHNICAL SUPPLIES 19477641 19242369 235272 DELIVERY SERVICES 1167665 1166970 695 DONOR EDUCATION/RECRUITMENT 747405 747095 310 DUES 238645 129598 109047 85658 39462 46196 53378537 43179488 10199049 0 500 500 6235528 4687390 0 0 7459632 5791088 0 0 0 0 0 0 2080930 1928586 1090985 673383 35164818 26214651 10448149 8950167 12743998 12367167 404544 286496 469316 469383 0 0 0 0 40933582 35154160 7447732 4135183 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7447732 4135183 X 33397060 30623370 28683 335390 60107 60217 33485850 31018977 40933582 35154160 X -2004066 -484839 22032 X false true X true false X 69969 85941 125555 16187 345250 642902 63865634 63098734 60480117 29148968 50299398 266892851 0 0 0 63935603 63184675 60605672 29165155 50644648 267535753 0 34770853 33642144 32113792 16021273 26560237 143108299 34770853 33642144 32113792 16021273 26560237 143108299 124427454 269099 340997 358869 226164 422179 1617308 0 269099 340997 358869 226164 422179 1617308 0 0 64204702 63525672 60964541 29391319 51066827 269153061 0.46229 0.99520 0.00601 0.00480 X Part III Public Support Test Calculation The filing organization has made some modifications to methodology for calculating the Part III public support percentage. Central Indiana Regional Blood Center has various contracts in place with hospitals that enable those hospitals to have the necessary blood product supplies on hand. However, due to various regulatory limitations the filing organization is not permitted to bill the hospital patients directly for these blood products. In order to clearly reflect the agency relationship with the hospitals, historical contracts have been and will continue to be revised to clarify that the patient is the actual consumer of these blood products. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60107 110 60217 60016 91 60107 59834 182 60016 59552 282 59834 59296 256 59552 1.00000 false false 1380724 1380724 18494455 12841069 5653386 16245 16245 0 14087558 12737498 1350060 1185836 619839 565997 8950167 0 0 X 50894020 -484839 -484839 51378859 -4388 -4388 51374471 53360893 -17644 -17644 53378537 53378537 Part V Endowments The intended use of the organization's endowment funds is to perpetuate the mission of Central Indiana Regional Blood Center. Part X Income Taxes The Organization has received a tax determination letter confirming that the Organization qualifies as a tax exempt organization under Section 501(c)(3) of the Internal Revenue Code (Code). Management believes that there are no material uncertain tax positions that require recognition in the financial statements. The Organization, while generally exempt from income tax, is subject to tax on income unrelated to their exempt purposes, unless that income is otherwise excluded by the Code. In years prior to 2014, the Organization filed federal unrelated business income tax returns to report a zero amount of unrelated business income. In 2014, the Organization filed a federal return to report an unrelated business loss. The Organization recognizes, if necessary, interest and penalties related to unrecognized tax benefits in the provision for income taxes. There were no interest or penalties related to income taxes that have been accrued or recognized as of and for the year ended December 31, 2015. Part XI, Line 4b Reconciliation of Revenue Loss on asset sale ($4,388) Part XII, Line 2d Reconciliation of Expenses Loss on Asset Sale $4,388 Gain on Employee Benefit Trust ($22,032) ----------- Total ($17,644) true Indiana University 420 University Blvd Indianapolis IN 46202 356001673 501(c)(3) 7425 Scholarships Purdue University 610 Purdue Mall West Lafayette IN 47907 356002041 501(c)(3) 5445 Scholarships 2 Part I, Line 2 Grants Once a high school student qualifies and is selected to be a recipient of a scholarship, paperwork is submitted to the Blood Center that details the Indiana college of choice the student will attend in the fall to begin their freshman year. The funding of the scholarships is paid and mailed directly to the Bursar office of each Indiana college selected by the student. X X X X true true false false false false false true false Byron B Buhner Former CEO/President 0 0 0 0 117974 0 0 0 0 0 117974 0 117974 0 Dan Waxman MD Chief Medical Officer/EVP 358821 0 36667 0 12000 0 14381 0 30694 0 452563 0 0 0 Tim Bryant CIO/VP - Thru 2/2015 18077 0 30000 0 213396 0 3038 0 4666 0 269177 0 18771 0 Lora Poore VP Labratory Services 184416 0 36667 0 0 0 6535 0 15303 0 242921 0 0 0 Wendy Mehringer VP Blood Services 177433 0 36667 0 0 0 8907 0 16416 0 239423 0 0 0 Anthony Watkins Sr VP & CFO 31550 298469 9328 88252 1377 13023 1958 18526 2369 22414 46582 440684 0 0 Maureen Kwiecinski asst corporate secretary 29500 278753 7289 68874 1783 16845 3440 32511 704 6646 42716 403629 0 0 Margaret McElligott VP Quality Services 18535 175339 4617 43677 2011 19026 3830 36230 2005 18967 30998 293239 0 0 Sandi Lemons VP Human Resouce Services 17102 228965 3976 53224 59 800 1958 26207 1333 17840 24428 327036 0 0 Lynne Briggs VP Information Svcs & CIO 13950 229511 3206 52739 135 2227 1977 32528 1379 22704 20647 339709 0 0 Julie Cruz MD Assistant Medical Director 134385 75640 23462 13205 0 0 4704 2647 5654 3182 168205 94674 0 0 Dipak Shah Director of Donor Testing Lab 135017 0 0 0 0 0 5435 0 17471 0 157923 0 0 0 Severance Payment Part I, Line 4A An individual left the organization and received severance payment in 2015. Due to a confidentality agreement, neither the name nor the amount will be listed. It is included in Schedule J, part II, Column B(III). Supplemental nonqualified retirement plan Part I, LIne 4B TO ENSURE BLOODCENTER OF WISCONSIN, INC. and its affiliates ACHIEVES their MISSIONs, IT IS ESSENTIAL TO ATTRACT LEADING EXPERTS IN TRANSFUSION MEDICINE, SCIENCE AND BUSINESS BY PAYING COMPETITIVE SALARIES AND BENEFITS. BLOODCENTER OF WISCONSIN, INC., Versiti, inc., and the affiliates' BOARD OF DIRECTORS FOLLOW NOT-FOR-PROFIT BEST PRACTICES BY HIRING AN INDEPENDENT COMPENSATION CONSULTANT TO ANNUALLY REVIEW THE OVERALL EXECUTIVE COMPENSATION PROGRAMS. Bryon Buhner and Tim Bryant PARTICIPATED IN A Section 457(f) plan. THE AMOUNTS paid out DURING 2015 were as follows: Bryon Buhner: $117,974 Tim Bryant: $ 18,771 Non-Fixed Payments Part I, Line 7 INCENTIVE PAYOUT OPPORTUNITIES, BASED ON PERCENTAGE OF BASE PAY RATE, ARE AVAILABLE TO CERTAIN EMPLOYEES OF THE FILING ORGANIZATION. WHILE LEVELS OF THE INCENTIVE PAYOUT OPPORTUNITY ARE FIXED AND DETERMINED PERCENTAGES OF BASE COMPENSATION; THE INCENTIVE PAYOUT IS SUBJECT TO THE REVIEW OF ACCOMPLISHMENTS/ OBJECTIVES AND THE ULTIMATE DETERMINATION OF INCENTIVE COMPENSATION IS SUBJECT TO PRESIDENT / CEO AND EXECUTIVE COMMITTEE OF THE BOARD APPROVAL. Terumo BCT Common ODTKE 2721358 Vendor false PART IV, COLUMN B BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS DAN WAXMAN, CHIEF MEDICAL OFFICER, IS A CONSULTANT FOR TERUMO BCT, A VENDOR THAT THE BLOOD CENTER PURCHASES DONOR KITS FROM. IBC PURCHASES, THROUGH A BUYING GROUP, PRODUCTS FROM TERUMO BCT. THE BUYING GROUP PLACES PRICE CONSIDERATIONS IN THE HANDS OF THE EMPLOYEES OF THE BUYING GROUP AND THE EXECUTIVE STAFF OF IBC. THE ACTUAL DECISION TO PURCHASE FROM TERUMO AND THE VOLUME OF THOSE PURCHASES IS A COLLABORATIVE EFFORT BY IBC STAFF OTHER THAN D. WAXMAN. Part VI, Section A, Line 4 Significant Changes to Governing Documents The filing organization's bylaws were amended on January 1, 2015 to appoint Versiti as the sole corporate member. Part VI, Section A, Line 6 Members or Stockholders VERSITI (A 501(C)(3) ORGANIZATION) IS THE SOLE CORPORATE MEMBER. Part VI, Section A, Lines 7a And 7B Member or Stockholder Powers VERSITI HAS RESERVE POWERS; INCLUDING THE ABILITY TO ELECT A MAJORITY OF DIRECTORS. Part VI, Section B, Line 11b Form 990 Review Central Indiana Regional Blood Center utilizes Grant Thornton LLP to complete the IRS Form 990 and related schedules. Following completion, they are reviewed by the Controller and CFO of Versiti. The draft forms are then reviewed by the Compliance and Audit Committee prior to submission to the IRS. The full board is provided a copy of the form 990 prior to filing. PART VI, Section B, Line 12C CONFLICT OF INTEREST POLICY CENTRAL INDIANA REGIONAL BLOOD CENTER MAINTAINS A WRITTEN CONFLICT OF INTEREST POLICY. ON AN ANNUAL BASIS, CURRENT DIRECTORS AND OFFICERS ARE ASKED TO COMPLETE A DISCLOSURE FORM BASED ON IRS REQUIREMENTS THAT INCLUDES THE FOLLOWING: WHETHER THEY HAVE ANY DIRECT OR INDIRECT RELATIONSHIP EITHER THROUGH BUSINESS OR FAMILY MEMBER WITH BLOODCENTER OF WISCONSIN. WHETHER THEY RECEIVED COMPENSATION FROM ANY ORGANIZATION THAT SHARES COMMON OWNERSHIP OR CONTROL WITH BLOODCENTER OF WISCONSIN. WHETHER THEY HAVE SERVED AS AN OFFICER, DIRECTOR, KEY EMPLOYEE, PARTNER OR MEMBER OF AN ENTITY (OR SHAREHOLDER OF A PROFESSIONAL CORPORATION) DOING BUSINESS WITH BLOODCENTER OF WISCONSIN. THESE ANSWERS ARE ACCUMULATED, SUMMARIZED AND EVALUATED BY MANAGEMENT TO DETERMINE IF ANY CONFLICTS EXIST. IDENTIFIED CONFLICTS ARE ADDRESSED IN ACCORDANCE WITH THE WRITTEN POLICY. PART VI, Section B, Lines 15A and 15B Compensation Process THE COMPENSATION COMMITTEE OF THE VERSITI BOARD OF DIRECTORS, ACTING IN ITS CAPACITY AS THE COMPENSATION COMMITTEE, SETS AND MONITORS THE COMPENSATION PHILOSOPHY FOR VERSITI AND THE RELATED ENTITIES THAT IT SUPPORTS, INCLUDING CENTRAL INDIANA REGIONAL BLOOD CENTER. OTHER THAN THE VERSITI PRESIDENT & CHIEF EXECUTIVE OFFICER, THE COMPENSATION COMMITTEE DOES NOT INCLUDE MEMBERS OF MANAGEMENT AND IS COMPRISED ENTIRELY OF INDIVIDUALS WHO DO NOT HAVE A CONFLICT OF INTEREST WITH RESPECT TO VERSITI OR CENTRAL INDIANA REGIONAL BLOOD CENTER COMPENSATION ARRANGEMENTS. THE VERSITI PRESIDENT AND CHIEF EXECUTIVE OFFICER RECUSES HER/HIMSELF FROM ALL DISCUSSIONS AND APPROVALS RELATED TO HER/HIS COMPENSATION. THE VERSITI COMPENSATION COMMITTEE REVIEWS CENTRAL INDIANA REGIONAL BLOOD CENTER EXECUTIVE COMPENSATION ARRANGEMENTS TO ENSURE SUCH ARRANGEMENTS ARE FAIR, REASONABLE, AND NOT EXCESSIVE WHEN COMPARED TO SIMILARLY-SITUATED EXECUTIVES. EXECUTIVE COMPENSATION ARRANGEMENTS ARE REVIEWED FOR REASONABLENESS AND APPROVED BY THE COMPENSATION COMMITTEE ANNUALLY IN ACCORDANCE WITH THE VERSITI REASONABLENESS REVIEW POLICY. THE COMPENSATION COMMITTEE ASSESSES THE REASONABLENESS OF EXECUTIVE COMPENSATION ARRANGEMENTS AFTER IT OBTAINS AND REVIEWS APPROPRIATE DATA FOR COMPARABILITY FROM THE HUMAN RESOURCE DEPARTMENT AND AN INDEPENDENT COMPENSATION CONSULTANT. THE COMPENSATION COMMITTEE ENGAGES A QUALIFIED INDEPENDENT COMPENSATION CONSULTANT ANNUALLY. THE INDEPENDENT CONSULTANT PERFORMS AN ANALYSIS OF COMPENSATION LEVELS AT REGIONAL AND NATIONAL ORGANIZATIONS OF COMPARABLE SIZE, SCOPE AND STRUCTURE AND PROVIDES THE COMMITTEE WITH COMPREHENSIVE DATA ON THE AVAILABILITY OF SIMILAR SERVICES WITHIN THE GEOGRAPHIC AREA, COMPENSATION SURVEYS, WRITTEN OFFERS FROM SIMILAR INSTITUTIONS, AND OTHER INFORMATION RELEVANT TO COMPARABILITY OF COMPENSATION. THE COMPENSATION COMMITTEE'S REVIEW, RECOMMENDATIONS AND APPROVALS ARE DOCUMENTED CONCURRENTLY IN THE COMMITTEE MINUTES, WHICH ARE SUBSEQUENTLY REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE AS REASONABLE, ACCURATE AND COMPLETE. VERSITI AND CENTRAL INDIANA REGIONAL BLOOD CENTER HAVE INCENTIVE PROGRAMS FOR THE CHIEF EXECUTIVE OFFICER AND OTHER CORPORATE OFFICERS DESCRIBED IN DETAILED WRITTEN POLICIES APPROVED BY THE COMPENSATION COMMITTEE ANNUALLY. EVALUATION AND COMPENSATION REVIEW -CEO - EACH YEAR, THE EXECUTIVE/COMPENSATION COMMITTEE EVALUATES THE VERSITI/CENTRAL INDIANA REGIONAL BLOOD CENTER CEO'S PERFORMANCE AGAINST ESTABLISHED OBJECTIVES, DETERMINES INCENTIVE PAYMENT AND MERIT INCREASE BASED UPON PERFORMANCE AND MARKET DATA PROVIDED BY THE THIRD PARTY COMPENSATION CONSULTANT, AND WORKS WITH THE CEO TO ESTABLISH OBJECTIVES FOR THE NEXT YEAR. -OTHER CORPORATE OFFICERS - EACH YEAR, THE VERSITI/CENTRAL INDIANA REGIONAL BLOOD CENTER CEO REVIEWS THE PERFORMANCE AND THE ACHIEVEMENT OF INDIVIDUAL GOALS AND OBJECTIVES OFEACH VERSITI/CENTRAL INDIANA REGIONAL BLOOD CENTER CORPORATE OFFICER. THE VERSITI/CENTRAL INDIANA REGIONAL BLOOD CENTER CEO PRESENTS HIS/HER RECOMMENDATIONS TO THE COMPENSATION COMMITTEE, WHICH REVIEWS AND APPROVES RECOMMENDED COMPENSATION RANGES, AND APPROVES FINAL SALARY AND INCENTIVE PAYMENTS. CORPORATE OFFICERS ARE POSITIONED WITHIN THE APPROPRIATE SALARY RANGE BASED UPON: -EXECUTIVE'S KNOWLEDGE, COMPETENCIES, AND EXPERIENCE, -PERFORMANCE OF THE EXECUTIVE'S AREAS OF RESPONSIBILITY, -THE EXECUTIVE'S CONTRIBUTION TO OVERALL PERFORMANCE, -THE IMPORTANCE OF RETAINING THE EXECUTIVE, -INTERNAL EQUITY CONSIDERATIONS, -THE FINANCIAL RESOURCES AVAILABLE, AND -EXECUTIVE BASE SALARY INCREASES PROVIDED IN THE COMPETITIVE MARKET Part VI, Section C, Line 19 Organization's Documents Open to the Public The organization's governing documents, conflict of interest policy, and financial statements are available upon request. Part VII Average Hours The hours listed on Form 990, Part VII are representative of an average for the officers and executive team. Each individual person's weekly tally may be greater or lesser per week based on their individual roles and responsibilities within the filing organization and related parties. Part XI, Line 9 Other Changes in Net Assets Gain on Employee benefit Trust ($22,032) Versiti Inc PO Box 2178 638 North 18th Milwaukee WI 53201 454675354 Supporting WI 501(C)(3) 11B NA false Bloodcenter of Wisconsin Inc 638 North 18th Milwaukee WI 532332121 390807235 Blood WI 501(C)(3) 07 VERSITI false Michigan Blood PO Box 1704 Grand Rapids MI 49501 381550001 Blood MI 501(C)(3) 09 VERSITI false Bloodcenter Research Foundation Inc PO Box 2178 638 North 18th Milwaukee WI 53201 391372542 Supporting WI 501(C)(3) 11B BLOODCENTER false Aurora Area Blood Bank DBA Heartland 1200 N Highland Avenue Aurora IL 60506 362179768 Blood IL 501(C)(3) 09 BLOODCENTER false false false true false false false true true false false false true true false true true true false false