2013-05-15T11:54:05-07:00 2012-09-30 990 2011-10-01 581990866 DCI DONOR SERVICES INC DCID 6152345251 1600 Hayes Street Suite 300 Nashville TN 37203 Teresa Thompson 6155643621 2013-05-15 2011 2016-02-24 21:20:13Z James Perry 1633 Church Street Suite 500 Nashville TN 37203 64929623 0 X www.dcids.org X 1991 TN DCI Donor Services supports a local focus on donors, donor families, and the lives of those we impact; we are a stable community member serving patients first in all that we do. Our core purpose is to save and enhance lives. 5 2 396 150 0 0 0 0 42803142 49101978 1215 940 5017325 5185504 47821682 54288422 0 0 0 0 20763564 21655118 0 0 0 24620706 28040660 45384270 49695778 2437412 4592644 31167758 33864795 20451323 18555716 10716435 15309079 X DCI Donor Services supports a local focus on donors, donor families, and the lives of those we impact; we are a stable community member serving patients first in all that we do. Our core purpose is to save and enhance lives. 0 0 35334109 0 54256689 DCI Donor Services, Inc. ("DCIDS") is a not-for-profit 501(c)(3) organization that operates three federally certified Organ Procurement Organizations (OPOs) and a full service Tissue Bank (TB). See schedule O for additional information. 0 0 0 35334109 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 198 0 1 396 1 0 0 0 0 0 0 0 0 0 0 X 5 2 0 0 0 0 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 0 X Teresa Thompson 6155643621 1600 Hayes Street Suite 300 Nashville TN 37203 H Keith Johnson 8 X X 25199 0 12341 James Perry 0 X X 0 84195 13073 Ed Attrill 0 X X 0 387623 29471 Thomas Boyle 0 X X 0 0 0 William A Sterling 3 X 12000 0 0 Cynda Rennie 0 X 0 0 0 Jill M Grandas 40 X 230818 0 20025 Teresa Thompson 40 X 117451 0 17139 Patricia Tencza 40 X 206644 0 19759 Monica Johnson-Tomanka 40 X 197455 0 4270 Louis Barnes 40 X 193188 0 13131 Quinton Beckham 40 X 199061 0 14037 Timothy Kern 40 X 139744 0 17008 Kelly Snyder 40 X 128249 0 6016 Deirdre McAdams 40 X 119734 0 16287 Wayne Dunlap 40 X 110591 0 8351 William McCartt 40 X 107678 0 16596 Susan Fredenberg Cross 0 X 104920 0 0 1892732 471818 207504 15 1 1 0 Labs Inc PO Box 843224 Kansas City MO 64184 Perform Laboratory Tests 1578133 ECI Two Creekside Oaks PO Box 742566 Los Angeles CA 90074 Landlord 365442 UT Medical Group 1407 Union Avenue Suite 720 Memphis TN 38104 Recovery Surgeons 419250 Bloodsource 10536 Peter A McCuen Blvd Mather CA 95655 Perform Laboratory Tests 348574 Examworks Review Services PO Box 492710 Redding CA 96049 Bill Review Services 247660 16 0 Organ Procurement Fees 621991 48551048 48551048 0 0 OPO Estimated Provider Payment 900099 550930 550930 0 0 0 0 0 0 49101978 940 940 0 0 0 0 0 0 0 0 0 0 0 0 0 0 15795912 10641201 5154711 5154711 0 0 30793 30793 0 0 30793 54288422 54288422 0 0 0 0 0 0 0 0 0 0 1181816 37199 1144617 0 0 0 0 0 15889777 11189368 4700409 0 219056 151777 67279 0 2956176 2048240 907936 0 1408293 975761 432532 0 0 0 0 0 150756 0 150756 0 290901 0 290901 0 0 0 0 0 0 0 0 0 0 0 1631535 324708 1306827 0 370193 370193 0 0 387643 0 387643 0 125246 0 125246 0 0 0 0 0 1086573 1012326 74247 0 1442379 463673 978706 0 0 0 0 0 397540 318032 79508 0 182431 0 182431 0 0 0 0 0 954232 93898 860334 0 598293 0 598293 0 Organ Procurement 15224292 15224292 0 0 Supplies (Program related) 2207548 2207548 0 0 Communications 781821 547222 234599 0 Equipment Rental and Maintenance 935785 94674 841111 0 1273492 275198 998294 0 49695778 35334109 14361669 0 466902 165132 0 0 0 0 13056005 14048393 0 0 0 0 0 0 8820769 10431093 572168 615220 14478221 6117515 8077170 8360706 0 0 0 0 0 0 174744 150281 0 93970 31167758 33864795 5672487 5151840 0 0 0 0 0 0 0 0 0 0 3133333 2973333 0 0 11645503 10430543 20451323 18555716 X 0 0 0 0 10716435 15309079 10716435 15309079 31167758 33864795 4592644 0 X 0 0 0 X 40532214 48632488 50702353 57061906 64897890 261826851 40532214 48632488 50702353 57061906 64897890 261826851 0 0 0 0 0 0 0 0 0 261826851 45729 9212 1342 1215 940 58438 45729 9212 1342 1215 940 58438 10079 17731 4057 30793 62660 40577943 48651779 50721426 57067178 64929623 261947949 0.99954 0.99962 0.00022 0.00025 X Part III, Line 12 - Miscellaneous Income 0 830783 830783 0 3754562 378134 3376428 0 1908674 716654 1192020 0 7984202 5022727 2961475 0 0 0 0 8360706 0 Payable to Related Organization 4900843 Short Term Liabilities 317266 Line of Credit 4925000 Deferred Rent Payable 287434 10430543 X X X 1 0 0 0 0 0 0 0 0 Ed Attrill 0 387623 0 0 0 0 0 0 0 29471 0 417094 0 0 Jill M Grandas 230818 0 0 0 0 0 0 0 20025 0 250843 0 0 0 Patricia Tencza 206644 0 0 0 0 0 0 0 19759 0 226403 0 0 0 Monica Johnson-Tomanka 197455 0 0 0 0 0 0 0 4270 0 201725 0 0 0 Quinton Beckham 199061 0 0 0 0 0 0 0 14037 0 213098 0 0 0 Louis Barnes 193188 0 0 0 0 0 0 0 13131 0 206319 0 0 0 Timothy Kern 139744 0 0 0 0 0 0 0 17008 0 156752 0 0 0 Susan Fredenberg Cross 0 0 0 0 104920 0 0 0 0 0 104920 0 0 0 SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Susan Fredenberg-Cross received severance payments totaling $104,920. Dr Oscar Grandas Family member of Jill Grandas 75000 Recovery Surgeon for organization 0 SchL_P04_S00_L00 Schedule L, Part IV Dr. Oscar Grandas is a family member to Jill Grandas, who is a key employee of DCI Donor Services. DCI Donor Services compensates Dr. Grandas for services he provides to the organization in his occupation as an organ recovery surgeon. F990_P03_S00_L04a Form 990, Part III, Line 4a DCI Donor Services, Inc. ("DCIDS") is a not-for-profit 501(c)(3) organization that operates three federally certified Organ Procurement Organizations (OPOs) and a full service Tissue Bank (TB). DCIDS promotes the donation of human organs and tissues, primarily for transplant, through education programs for the general public and health professionals, and through agreements with various hospitals and medical professionals provides the organs and tissues recovered by its member organizations. Each of the OPOs is certified by the Center for Medicare and Medicaid Services and designated by the US Secretary of Health and Human Services to participate in the Federal Medicare Program. Each OPO is an institutional member of both the Association of Organ Procurement Organizations as well as the United Network for Organ Sharing which holds the contract to function as the National Organ Procurement and Transplant Network mandated by federal law. The TB follows requirements set by the Centers for Disease Control, US Food and Drug Administration, as well as the standards established by the American Association of Tissue Banks and is a fully accredited member of that organization as well. Accordingly, the OPOs seek reimbursement for all expenses incurred in coordinating the recovery of organs that are sent to transplanting hospitals and annually file a federal cost report detailing and reconciling its revenue and expenses. The TB derives its cost-covering revenues from hospitals or dentists who are transplanting tissues processed and/or distributed by the TB. All program service expenses of DCIDS are incurred in support of the above stated tax exempt procurement and educational activities. For the year ended September 30, 2012, DCIDS procured 1,215 organs and recovered 2,418 tissue donors for transplantation. In addition, DCIDS sponsored a number of professional seminars for nurses and physicians concerning issues in transplantation, as well as several programs to educate and heighten awareness of the general public concerning organ and tissue donation and transplantation. F990_P04_S00_L12a Form 990, Part IV, Line 12a Dialysis Clinic, Inc. receives annual audited financial statements. The financial statements are presented as consolidated financial statements which includes: Dialysis Clinic, Inc., DCI Donor Services, Boxwood Dialysis LLC, DCI Renal Services of Pittsburgh LLC, and Independent Kidney Cooperative (collectively, "subsidiaries"). The majority of the activity presented in the consolidated financial statements is that of Dialysis Clinic, Inc. when compared to the subsidiaries. Dialysis Clinic, Inc. is a 501(c)(3) tax exempt organization and files Form 990. Each subsidiary files a separate return. F990_P06_S0A_L06 Form 990, Part VI, Section A, Line 6 The sole member of the corporation is Dialysis Clinic, Inc. F990_P06_S0A_L07a Form 990, Part VI, Section A, Line 7a Dialysis Clinic, Inc. as the sole member of DCI Donor Services has the power to nominate, elect, appoint, fill vacancies of, and remove members of the Board of Directors of the corporation. F990_P06_S0A_L07b Form 990, Part VI, Section A, Line 7b Dialysis Clinic, Inc. shall have the sole vote on all matters coming before the membership. F990_P06_S0A_L08b Form 990, Part VI, Section A, Line 8b There are currently no committees that act on behalf of the governing body. F990_P06_S0A_L09 Form 990, Part VI, Section A, Line 9 One officer and two directors cannot be reached at the organization's mailing address: 1) Thomas Boyle, 301 Grant Street, Pittsburgh, PA 15219. 2) William Sterling, 8912 Natalie Ave, Albuquerque, NM 87110. 3) Cynda Rennie, PO Box 7437, Citrus Heights, CA 95621. F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b A draft of Form 990 is supplied to each member of the governing body and adjustments are suggested and completed as necessary. Each board member is mailed a copy of the Form 990 draft and is given an appropriate amount of time to review and comment. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c On an annual basis, the Board of Directors sign a conflict of interest statement that states the directors have not violated the conflict of interest policy. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 DCI Donor Services belongs to the Association of Organ Procurement Organizations. AOPO completes a yearly survey of all salaried positions within an organ procurement organization, which includes CEO salaries, as well as the salaries for other key positions. This yearly survey is used to determine the salaries for the Executive Director and other key employees. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 DCI Donor Services does not make its governing documents, conflict of interest policy, and financial statements available to the public. Dialysis Clinic Inc 1633 Church Street Suite 500 Nashville TN 37203 620850498 Kidney Dialysis TN 501(c)(3) Line 9 N/A 0 0 0 0 0 0 0 0 0 0 1 0 1 0 1 1 1 0 0 Dialysis Clinic Inc j 507600 Actual records Dialysis Clinic Inc o 5075000 Actual records Dialysis Clinic Inc n 393482 Actual records Dialysis Clinic Inc l 228452 Actual records