2012-10-12T10:15:36-05:00 2012-05-31 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-06-01 410693869 MEMORIAL BLOOD CENTERS MEMO 6513327000 737 PELHAM BOULEVARD ST PAUL MN 551141739 JOHN M BUSKE 6513327000 2012-10-11 1 JOHN TAUER P00294068 6123764500 2011 2016-02-24 21:20:13Z DONALD BERGLUND 737 PELHAM BOULEVARD ST PAUL MN 551141739 56222122 0 X WWW.MBC.ORG X 1947 MN SUPPLY BLOOD AND BLOOD COMPONENTS TO 32 HOSPITALS IN MINNESOTA AND WISCONSIN. 17 17 480 74000 0 0 462287 512135 47784057 51567060 60469 15595 733537 414242 49040350 52509032 0 0 0 0 20597469 22094613 0 0 147259 26329092 28374146 46926561 50468759 2113789 2040273 32476146 31274684 11667385 9252333 20808761 22022351 X TO HELP SAVE LIVES BY PROVIDING BLOOD AND BIOMEDICAL SERVICES. MEMORIAL BLOOD CENTERS IS A LOCALLY OPERATED, NONPROFIT COMMUNITY BLOOD CENTER THAT SERVES AS THE MAJOR SUPPLIER OF BLOOD AND BLOOD COMPONENTS TO 32 HOSPITALS IN THE TWIN CITIES METRO AREA, NORTHERN MINNESOTA AND NORTHWESTERN WISCONSIN. 0 0 43817370 0 51567060 MEMORIAL BLOOD CENTERS IS A LOCALLY OPERATED, NONPROFIT COMMUNITY BLOOD CENTER THAT SERVES AS THE MAJOR SUPPLIER OF BLOOD AND BLOOD COMPONENTS TO 32 HOSPITALS IN THE TWIN CITIES METRO AREA, NORTHERN MINNESOTA AND NORTHWESTERN WISCONSIN. MEMORIAL BLOOD CENTERS IS A LEADER IN TRANSFUSION MEDICINE, PROVIDING EXPERT TECHNICAL SERVICES TO CLIENTS THROUGHOUT THE COUNTRY. AMONG THE SERVICES MEMORIAL BLOOD CENTERS PROVIDES ARE CONSULTING, PARENTAGE TESTING, REFERENCE LABORATORY WORK, VIROLOGY TESTING, RESEARCH, AND ORGAN AND MARROW TRANSPLANTATION SUPPORT. 43817370 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 87 0 480 1 0 0 0 0 0 1 1 0 0 0 0 X 17 17 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MN WI X X JOHN M BUSKE CFO VP OF FINANCE 6513327000 737 PELHAM BOULEVARD ST PAUL MN 551141739 THOMAS F HEANEY 1.00 X X 0 0 0 PHILLIP MARTIN 1.00 X X 0 0 0 KENNETH E LACHANCE 1.00 X X 0 0 0 DANIEL BOULAY 1.00 X 0 0 0 THOMAS E BECKER MD 1.00 X 0 0 0 JAMES CHERVENY 1.00 X 0 0 0 PATRICK COURNEYA MD 1.00 X 0 0 0 MATTHEW DOKKEN 1.00 X 0 0 0 JAMES DOWIAK 1.00 X 0 0 0 ROGER GREEN MD 1.00 X 0 0 0 RITA KENYON JD SPHR 1.00 X 0 0 0 TIMOTHY KUCK 1.00 X 0 0 0 ERIK LINDELL 1.00 X 0 0 0 SCOTT LYNCH 1.00 X 0 0 0 JEFF NELSON 1.00 X 0 0 0 THOMAS WHELAN 1.00 X 0 0 0 BRENT WILDE 1.00 X 0 0 0 DONALD C BERGLUND 40.00 X 364229 0 76632 JOHN M BUSKE 40.00 X 200075 0 21995 ROVENA L CLAXTON 40.00 X 132223 0 20925 JED B GORLIN MD 40.00 X 324214 0 66346 JUDITH PETERSEN 40.00 X 159781 0 20669 KENNETH P KIEFFER 40.00 X 147807 0 9402 ELIZABETH H PERRY MD 40.00 X 200213 0 27681 KRISTINE A BELANGER 40.00 X 126712 0 14152 MARK A JANZEN 40.00 X 103158 0 15819 WENDY L CAPETZ 40.00 X 117354 0 16500 FREDERICK W TEETER 40.00 X 103350 0 24716 1979116 0 314837 11 0 1 0 MCGOUGH FACILITY MANAGEMENT 2737 FAIRVIEW AVENUE NORTH ST PAUL MN 55113 FACILITIES MANAGEMENT 688064 FEDERAL EXPRESS CORPORATION PO BOX 94515 PALATINE IL 600944515 COURIER SERVICES 440443 AEROTEK INC 3689 COLLECTION CTR DR CHICAGO IL 60693 STAFFING SERVICES 369453 OSU HUMAN IDENTITY TESTING LAB PO BOX 9576 TULSA OK 741570576 TESTING SERVICES 193800 MIDNITE EXPRESS 26305 NETWORK PLACE CHICAGO IL 606731260 COURIER SERVICES 190232 11 75958 436177 49638 512135 SERVICE FEE - UNIT 621500 36634152 36634152 LABORATORY SERVICES 621500 10095067 10095067 PLASMA AND ANTISERUM 621500 3306748 3306748 REAGENT SALES 621500 1196381 1196381 RESEARCH PROJECTS 621500 236958 236958 97754 97754 51567060 21959 21959 3545376 7322 3551740 7322 -6364 0 -6364 -6364 81525 75958 154028 -72503 -72503 MISCELLANEOUS 900099 486745 486745 486745 52509032 51567060 0 429837 1622497 688207 934290 15973319 14101915 1780769 90635 346135 314339 29863 1933 3054542 2366637 671553 16352 1098120 879047 213043 6030 37345 37345 315283 315283 44955 44955 531495 275472 249773 6250 227148 149815 55877 21456 1989858 1684217 305349 292 554427 426144 128283 1466875 1093450 372505 920 718708 620420 97429 859 90204 62093 28111 250080 250080 2111659 1933975 177684 222178 108477 113701 REAGENTS 10378640 10378640 0 0 MEDICAL SUPPLIES 5713367 5702748 10579 40 EQUIP RENTAL/MAINT 2361612 2276512 84201 899 DONOR & EMPL RECOGNITIO 620784 487606 133018 160 739528 267656 470439 1433 50468759 43817370 6504130 147259 6692195 5412490 6281271 6066593 1515814 1533747 319102 288893 23338003 10705962 13592367 12632041 3800397 5065920 275000 275000 32476146 31274684 6602458 4855648 113782 135013 3509694 3156082 1031102 802268 308994 243793 101355 59529 11667385 9252333 X 20790517 21914334 18244 108017 20808761 22022351 32476146 31274684 X 2040273 -826683 X 0 1 1 X 0 X 400532 525531 465428 462287 512135 2365913 44734432 48526003 48520947 47857318 51567060 241205760 45134964 49051534 48986375 48319605 52079195 243571673 8861 16801 11839 13570 12445 63516 22306781 25428275 24382504 25028021 27789998 124935579 22315642 25445076 24394343 25041591 27802443 124999095 118572578 68999 24280 3124 12692 2740 111835 68999 24280 3124 12692 2740 111835 146330 23475 630054 656016 445481 1901356 45350293 49099289 49619553 48988313 52527416 245584864 0.48280 0.47910 0.00050 0.00290 X SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: OTHER INCOME ASSET IMPAIRMENT LOSS RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 990396 990396 10713852 3318798 7395054 1787720 1442191 345529 9606095 5944973 3661122 239940 239940 12632041 DEFERRED COMPENSATION 17924 ASSET RETIREMENT OBLIGATION 41605 59529 52509032 50468759 2040273 -2148 -824535 -826683 1213590 52497672 -2148 29748 154028 181628 52316044 192988 192988 52509032 42682987 29748 154028 183776 42499211 7969548 7969548 50468759 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE BLOOD CENTER IS A NONPROFIT ORGANIZATION AND IS EXEMPT, AS A PUBLIC CHARITY, FROM TAXATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND APPLICABLE STATE STATUTES. THE BLOOD CENTER FOLLOWS THE ACCOUNTING STANDARDS FOR CONTINGENCIES IN EVALUATING UNCERTAIN TAX POSITIONS. THIS GUIDANCE PRESCRIBES RECOGNITION THRESHOLD PRINCIPLES FOR THE FINANCIAL STATEMENT RECOGNITION OF TAX POSITIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE BLOOD CENTER'S TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL AND STATE AUTHORITIES. THE TAX RETURNS FOR THE YEARS 2008 THROUGH 2011 ARE OPEN TO EXAMINATION BY FEDERAL AND STATE AUTHORITIES. PART XI, LINE 8 - OTHER ADJUSTMENTS: PENSION LIABILITY ADJUSTMENT -783,271. LOSS ON IMPAIRMENT OF FIXED ASSETS -41,264. TOTAL TO SCHEDULE D, PART XI, LINE 8: -824,535. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL FUNDRAISING EVENT EXPENSES 154,028. PART XII, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 13,447. IN-KIND CONTRIBUTIONS 79,386. DEBT FORGIVENESS 100,155. PART XIII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL FUNDRAISING EVENT EXPENSES 154,028. PART XIII, LINE 4B - OTHER ADJUSTMENTS: INTEREST EXPENSE 250,080. OPERATING EXPENSES 7,719,468. WHAT'S YOUR TYPE METRO 130217 54691 75526 15296 21292 3500 101633 WHAT'S YOUR TYPE NORTHLAND 27266 21267 5999 500 350 342 11115 157483 75958 81525 15796 21642 3842 112748 154028 -72503 X X X X X X 0 1 0 0 0 0 0 0 0 DONALD C BERGLUND 269312 0 43753 0 51164 0 45564 0 31068 0 440861 0 0 0 JOHN M BUSKE 176763 0 23312 0 0 0 0 0 21995 0 222070 0 0 0 ROVENA L CLAXTON 116361 0 15862 0 0 0 9516 0 11409 0 153148 0 0 0 JED B GORLIN MD 236193 0 27178 0 60843 0 44343 0 22003 0 390560 0 0 0 JUDITH PETERSEN 137232 0 14542 0 8007 0 8007 0 12662 0 180450 0 0 0 KENNETH P KIEFFER 139239 0 8568 0 0 0 0 0 9402 0 157209 0 0 0 ELIZABETH H PERRY MD 187344 0 12869 0 0 0 0 0 27681 0 227894 0 0 0 PART I, LINE 4B MEMORIAL BLOOD CENTERS HAS IN PLACE A 457(F) PLAN WHICH DOES COVER VARIOUS INDIVIDUALS OF MANAGEMENT. IN 2011, INVOLVEMENT IN THE PLAN OCCURED AS FOLLOWS: NAME CONTRIBUTIONS WITHDRAWALS DONALD C. BERGLUND $52,085 $45,564 JOHN M. BUSKE $32,363 $ 0 ROVENA L. CLAXTON $13,468 $ 9,516 JED B. GORLIN, MD $41,112 $43,343 JUDITH A. PETERSON $ 6,565 $ 8,007 CITY OF MINNEAPOLIS MN 416005375 584991AA1 2003-11-20 680000 BUILDING RENOVATION 2304 PARK AVENUE, MINNEAPOLIS, MN 0 0 0 PORT AUTHORITY OF THE CITY OF ST PAUL MN 416005524 584991AC7 2005-11-08 4500000 BUILDING ACQUISITION & RENOVATION 737 PELHAM BLVD, ST. PAUL, MN 0 0 0 558634 680000 680000 2003 0 0 1 1 1465284 4500000 30000 4500000 2005 0 0 1 1 0 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 1 9229 FAIR MARKET VALUE X 60 7719 FAIR MARKET VALUE X 62 9014 ESTIMATED VALUE X DVDS 14 525 ESTIMATED VALUE X GIFT CARDS 146 17415 FACE VALUE X ENTERTAINMENT TICKETS 31 5486 ESTIMATED VALUE X OTHER 1 180 ESTIMATED VALUE 0 0 1 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 WILL BE REVIEWED AND APPROVED BY THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. ONCE APPROVED BY THE FINANCE COMMITTEE, THE FORM 990 IS SHARED WITH THE BOARD OF DIRECTORS PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C DIRECTORS AND OFFICERS MUST DISCLOSE ALL CONFLICTS OF INTEREST AND MUST ANNUALLY COMPLETE AND RETURN TO THE NOMINATING AND GOVERNANCE COMMITTEE THE QUESTIONNAIRE WHICH IS A PART OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY. WHENEVER IN THE COURSE OF EVENTS A DIRECTOR'S OR OFFICER'S CIRCUMSTANCES CHANGE, SO THAT HE OR SHE KNOWS OR HAS REASON TO KNOW THAT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST MAY ARISE, SUCH DIRECTOR OR OFFICER SHALL PROMPTLY DISCLOSE THE POTENTIAL CONFLICT TO THE NOMINATING AND GOVERNANCE COMMITTEE. THE DIRECTOR OR OFFICER SHALL NOT PARTICIPATE IN, TAKE ANY ACTION UPON, OR VOTE UPON SUCH MATTERS UNTIL THE QUESTION OF THE EXISTENCE OF THE CONFLICT OF INTEREST HAS BEEN DETERMINED BY THE NOMINATING AND GOVERNANCE COMMITTEE. WHEN A CONFLICT OF INTEREST DOES IN FACT EXIST UNDER THE DEFINITION SET FORTH ABOVE, THE PERSON WITH THE CONFLICT OF INTEREST SHALL NOT BE COUNTED FOR DETERMINING THE PRESENCE OF A QUORUM, EVEN WHEN PERMITTED BY LAW AND SHALL NOT PARTICIPATE IN ANY WAY IN, OR BE PRESENT DURING, THE DELIBERATIONS AND DECISION-MAKING VOTE WITH RESPECT TO THE MATTER. NEVERTHELESS, THE INTERESTED PARTY SHALL HAVE AN OPPORTUNITY TO PROVIDE FACTUAL INFORMATION ABOUT THE MATTER. THE MINUTES OF THE MEETING SHOULD REFLECT THAT THE DIRECTOR OR OFFICER HAVING A CONFLICT DISCLOSED SUCH INTEREST AND ABSTAINED VOTING ON THE MATTER AND THAT A QUORUM WAS PRESENT FOR SUCH ACTION. FORM 990, PART VI, SECTION B, LINE 15 THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS, COMPOSED ENTIRELY OF INDEPENDENT PERSONS, OVERSEES EXECUTIVE COMPENSATION AND, IN DOING SO, RETAINS AN EXTERNAL PARTY TO CONDUCT AN INDEPENDENT MARKET SURVEY ON A REGULAR BASIS (EVERY 2 - 3 YEARS). THE PROCESS INCLUDED REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION IN 2010 FOR THE CEO, D. BERGLUND; CFO, J. BUSKE, VP OF HR AND ORGANIZATIONAL DEVELOPMENT, R. CLAXTON; VP OF MEDICAL & QUALITY AFFAIRS, J. GORLIN; VP OF TECHNOLOGY OPERATIONS, J. PETERSEN; VP OF RECRUITMENT, COLLECTION & PRODUCTION PLANNING, K. KIEFFER; AND ASSOCIATE MEDICAL DIRECTOR, E. PERRY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS OPEN TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -2,148. PENSION LIABILITY ADJUSTMENT -783,271. LOSS ON IMPAIRMENT OF FIXED ASSETS -41,264. TOTAL TO FORM 990, PART XI, LINE 5: -826,683.