Form
OMB No 1545-0047
Return of Organization Exempt From Income Tax
990
14
Under section 501(c ), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation )
2 0 10
• • -
•
Department of the Treasury
Internal Revenue Service
^ The or anization may have to use a co py of this return to satisfy state re p ortin g re q uirements.
June 30
, 20 11
, 2010 , and ending
For the 2010 calendar year , or tax year beginning
Jul y 1
D Employer identification number
Check if applicable C Name of organization Life and Health Benefits Plan of the American Red Cross
A
B
❑ Address change
Doing Business As
❑ Name change
Number and street (or P O box if mail is not delivered to street address)
52-6415790
E Telephone number
Room/suite
2023036850
2025 E Street , NW
City or town, state or country, and ZIP + 4
Q Initial return
❑ Terminated
❑ Amended return
❑ Application pending
G Gross receipts $
Washin g ton, DC 20006
F Name and address of principal officer
Gary Stradiotto (same as above)
❑
501(c)(3)
I
Tax-exem pt status
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Website : ^
K
Form of organization ❑ Corporation ❑ Trust
1
o
) 1 (insert no) ❑ 4947(a)(1) or
501(c) (
H(b) Are all affiliates included? ❑ Yes ❑ No
If "No," attach a list (see instructions)
❑ 527
H(c) Group exemption number ^
❑ Association ❑ Other
1989
L Year of formation
M State of legal domicile
Cd
.LD
Briefly describe the organization's mission or most significant activities: As component of attracting and retaining a
qualified workforce in order to achieve the mission of the American Red Cross_ this program of competitive employee benefits
has been established covering the employees , retirees and their eligible dependents of the Red Cross.
2
---------------------------------------------------------------------------------------------------------------------------------------------------Check this box ^ I-I if the oroanlzation discontinued its ooerations or disposed of more than 25% of its net assets.
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Number of voting members of the governing body (Part VI, line 1 a) .
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7a
b
Number of independent voting members of the governing body (Part VI,
Total number of individuals employed in calendar year 2010 (Part V, line
Total number of volunteers (estimate if necessary) . . . . . . .
Total unrelated business revenue from Part VIII, column (C), line 12
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Net unrelated business taxable income from Form 990-T, line 34
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line 1
2a)
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b)
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7a
7b
0
0
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0
Prior Year
^av
N
C
W
DC
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A
c
a
d
256,990,584.
H(a) Is this a group return for affiliates? ❑ Yes 21 No
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12
. . . . .
Contributions and grants (Part VIII, line 1 h) . . .
Program service revenue (Part VIII, line 2g)
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Investment income (Part VIII, column (A), lines 3, 4, and 7d) . . .
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
Total revenue-add lines 8 through 11 (must equal Part VIII, column (A),
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Grants and similar amounts pal
(Pa
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Benefits paid to or for member
(Part
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15
16a
b
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Salaries, other compensation, e pl ee
Professional fundraising fees
IX, L
Total fundraising expenses (P
c 6T
Other expenses (Part IX, colu n (
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Total expenses. Add lines 13
19
Revenue less ex p enses. Subtrac
es 1-3) .
^t) U E
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249,844 ,753
22,617
256, 990,584
19,814
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249,867 ,370
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257 ,010,398
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245 ,021,867
235 , 726,926
line 12)
L+dlumn ( ), lines 5-10)
n A , line 11 e
(
r^elp )
-11 d, 11f_24 W . . .
7 (n11i
8f1 IXr G
Current Year
mPf^ ), line 25 )
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17,442, 978
15 , 828,419
262,464 , 845
251,555,345
(12,597,75)
Mn'r1
Beginning of Current Year
8'.
5,455,053
End of Year
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4, 891,589
6 , 261,313
Total liabilities (Part X, line 26) . . . . . . . . . .
as 21
Net assets or fund balances. Subtract line 21 from line 20
zLL 22
Signature Block
L&M
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26,789 , 240
22 , 703,550
(21,897,651)
(16 ,442,237)
ym 20
Total assets (Part X, line 16)
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete, eclaration of preparer (other than officer) is based on all information of which preparer has any knowledge
c
Sign
Here
Signafire of officer
^
M.I1«r
'
Type or print name and title
Pnnt/Type preparer's name
U1 -.xi-
k:,-G
Preparer's sig
Paid
Preparer
Use Only
Firm's name
^
Firm's address ^
May the IRS discuss this return with the
parer shown above?
For Paperwork Reduction Act Notice, see the separate instructions.
Page 2
Form 990 (2010)
Statement of Program Service Accomplishments
1
14
Check if Schedule 0 contains a response to any question in this Part III
Briefly describe the organization's mission:
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0
As a component of attracting and retaining a qualified workforce in order to achieve the mission of the American Red Cross, this
-------------------------------------------------------------------------------------------program of competitive employee benefits has -been established covering the employees, retirees and their eligible dependents
of the Red Cross.
2
Did the organization undertake any significant program services during the year which were not listed on the
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prior Form 990 or 990-EZ? . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes," describe these new services on Schedule O.
Did the organization cease conducting, or make significant changes in how it conducts, any program
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No
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❑ Yes 2 No
If "Yes," describe these changes on Schedule O.
Describe the exempt purpose achievements for each of the organization's three largest program services by expenses. Section
501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to
others, the total expenses, and revenue, if any, for each program service reported.
services? .
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(Code: 525100 ) (Expenses $ ______________________ including grants of $ ________________________ ) (Revenue $
-----------Provided healthcare coverage including inpatient hospital and surgical services, outpatient services , behavioral -health- care ,
- ----------------------------------prescription durgs and special services (home health care, convalescent , and hospice care) to eligible employees, retiree, and
their dependents Benefits were provided through insured contracts with insurance companies and health maintenance organization
as well as through self-insured programs operated under administrative services only contracts with medical carriers and pharmacy
----------------------------benefit managers . The number of employees and former employees eligible under COBRA at June 30,201 1was 22, 037. In ----------------
---------------------------------------------------------------------------------------- ---------------- ----------------------------------------------addition , healthcare coverage was being provided to 1,334 qualified retirees.
------------------------ --------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
4b
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(Code: 525100 ) (Expenses $______________________ including grants of $ ________________________ ) (Revenue $
-----------Provided basic , supplemental , and dependent life insurance as well as basic and supplemental accidental death and
dismemberment (AD&D) insurance coverage to employees . Provided basic life insurance coverage - to- qualified retirees - As- of June
------- ------ -- ------- --------- ---------
2011 , 27,503 employees and 6 , 422 retirees were covered under this program.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
4c
including grants of $
) (Revenue $
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(Code : 525100 ) (Expenses $
--------------Provided dental care coverage for eligible employees , retirees and their dependents including preventative care , basic dental------------------------------- ----- ---------- -- -------- -- - ----------- - --------- -- --------------- --------------- - ------------------------- -------- ------ ------------ - -and major dental services including orthodontia benefits . Benefits were provided either through an insured DMO plan or via
- services
- --- ------ - -- - ---- - ---- -- -------- --- ------------ ------- ---- -- ---------- ----------------- -------------- - ----------- - -------------------------------------- - - - -----------a self- insured dental PPO under an administrative service contract As of June 30, 2011 , 21,701 employees and 1 , 375 retirees
-- --- --- --- - -- - ---- ---- --- ---------------- ---------- ------------------ - --------------- ------------------------ -- - ----- ----------- -------- ----------- - - -- --- -- - - - ----were covered under this program.
-------- --- ---- --------- ---- ------------ ----------------------------- --- -- ------------- ------------------------------------------------------- -- -------- ------------ ---------------------------------- ------ ------- ---------------------------- ----- --------------------------- -- -------------- -------------- - ------------ ------- - -- ----- - -- --- -------------------------------------------------------= -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ - ---------------------- ----------- - ------- ------ ------------------- - ------------- --------------- -- ---------- ---------------- - - ------------------ - - - - - - - - - -- - -- --- --- --- ---- -- - ------- ----------- - ----- - ------ ------------- ------------------ -- ------------ --- --------------- ------------ - --------------- ---------- -------- - --- ------- - ----- ---------- ----- - ----------- ---- ------ - ------ --------------- ---------------- ---------------- - -------------- - ----------- - - --------------- --------------------- ------- - - -- ---
----------------------------------------------------------------------------------------------------------------------------------------------------------------4d
4e
Other program services. (Describe in Schedule 0.)
including grants of $
(Expenses $
Total program service expenses ^
) (R ev e n ue $
Form 990 (2010)
3
Form 990 (2010)
Checklist of Required Schedules
Yes
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes,"
complete Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2
3
Is the organization required to complete Schedule B, Schedule of Contributors? (see instructions)
. . .
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
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Section 501 (c)(3) organizations . Did the organization engage in lobbying activities, or have a section 501(h)
election in effect during the tax year? If "Yes," complete Schedule C, Part 11 . . . . . . . . . . .
candidates for public office? If "Yes," complete Schedule C, Part I .
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No
1
2
✓
✓
3
✓
4
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III .
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5
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have
the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes,"
6
✓
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part 11
. . .
7
✓
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part 111 . .
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8
1?1
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part
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✓
10
✓
11a
✓
11b
✓
complete Schedule D, Part I .
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X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes,"
complete Schedule D, Part IV
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Did the organization, directly or through a related organization, hold assets in term, permanent, or quasiendowments? If "Yes," complete Schedule D, Part V
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If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI,
VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes,"
complete Schedule D, Part Vl . . . . . . . . . . . . . . . . . . . . . . . . . .
b
Did the organization report an amount for investments-other securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII . . . .
. . .
c Did the organization report an amount for investments-program related in Part X, line 13 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part Vlll . . . . . . . .
d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? If "Yes," complete Schedule D, Part IX . . . . . . . . .
. . . .
11c
e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes, " complete Schedule D, Part X
11d
11e
f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X .
11f
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI, XII, and Xlll
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b Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if
the organization answered ' No " to line 12a, then completing Schedule D, Parts Xl, XII, and Xlll is optional .
. . .
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
Did the organization maintain an office, employees, or agents outside of the United States?
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✓
✓
✓
✓
12a
13
14 a
✓
12a
✓
12b
13
14a
✓
✓
14b
✓
15
✓
16
✓
17
✓
18
✓
19
20a
✓
✓
20b
✓
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising,
business, and program service activities outside the United States'? If "Yes,"complete Schedule F, Parts I and IV
15
16
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Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any
organization or entity located outside the United States? If "Yes," complete Schedule F, Parts 11 and IV . .
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance
to individuals located outside the United States? If "Yes," complete Schedule F, Parts 111 and IV . . . .
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX, column (A), lines 6 and 11 e? If "Yes," complete Schedule G, Part I (see instructions)
. . . . .
Did the organization report more than $15,000 total of fundraising event gross income and contributions on
Part VIII, lines 1 c and 8a? If "Yes," complete Schedule G, Part// . . . . . . . . . . . . . . .
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
If "Yes," complete Schedule G, Part 111 . . . . . . . . . . . . .
. . . . . . . . .
20 a Did the organization operate one or more hospitals? If "Yes," complete Schedule H . . . . . . . .
b If "Yes" to line 20a, did the organization attach its audited financial statements to this return? Note. Some
Form 990 filers that operate one or more hospitals must attach audited financial statements (see instructions)
18
Form 990 (2010)
Page 4
Form 990 (2010)
Checklist of Required Schedules (continued)
Yes
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations
in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and 11 . . .
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States
on Part IX, column (A), line 2? If "Yes," complete Schedule 1, Parts 1 and 111 . . . . . . . . . . . .
22
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes," complete Schedule J . . . . . . . . . . . . . . . . . . . . . .
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b
through 24d and complete Schedule K. If "No,"go to line 25 . . . . . . . . . . . . . . . .
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . .
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? . . . . . . . . . . . . . . . . . . . . . . . .
d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? . .
25a Section 501(c)(3) and 501 (c)(4) organizations . Did the organization engage in an excess benefit transaction
with a disqualified person during the year? If "Yes," complete Schedule L, Part I . . . . . . . . .
No,
21
✓
22
✓
23
✓
24a
24b
✓
24c
24d
✓
✓
✓
25a
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior
year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?
If "Yes," complete Schedule L, Part I . . . . . . . . . . . . . . . . . . . . . . . .
25b
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or
disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part 11 . .
26
✓
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,
substantial contributor, or a grant selection committee member, or to a person related to such an individual?
. . . . . . . . . . . . .
If "Yes," complete Schedule L, Part 111
. . . . . . . . .
27
✓
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L,
28a
✓
28b
✓
28c
29
✓
b
Part IV instructions for applicable filing thresholds, conditions, and exceptions)a
b
c
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV
A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule L, Part IV
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, PartIV . . .
✓
29
30
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified
conservation contributions? If "Yes," complete Schedule M . . . . . . . . . . . . . . . .
30
✓
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31
✓
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"
complete Schedule N, Part 11 . . . . . . . . . . . . . . . . . . . . . . . . . .
32
✓
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part 1 . . . . . . . . . . .
33
✓
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts ll, 111,
IV, and V, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? . .
Did the organization receive any payment from or engage in any transaction with a
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✓
✓
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controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R.
. . . . . . . . . . .
❑ Yes ❑ No
make
any transfers to an exempt non-charitable
Section 501(c)(3) organizations . Did the organization
related organization? If "Yes," complete Schedule R, Part V, line 2 . . . . . . . . . . . . . .
Part V, line 2 .
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Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI , lines 11 and
19? Note . All Form 990 filers are required to complete Schedule 0 . . . . . . . . . . . . . .
Part VI .
38
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✓
37
38
✓
Form 990 (2010)
Form 990 (2010)
Page 5
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule 0 contains a response to any question in this Part V
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Yes
is
b
c
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable
-01a
. . . .
-0Enter the number of Forms W-2G included in line 1 a. Enter -0- if not applicable . . . .
lb
Did the organization comply with backup withholding rules for reportable payments to vendors and
reportable gaming (gambling) winnings to prize winners?
2a
b
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Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending with or within the year covered by this return
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0
No
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1c
2a
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✓
-0-
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note . If the sum of lines 1 a and 2a is greater than 250, you may be required to a-file. (see instructions)
2b
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?
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3a
b
If "Yes," has it filed a Form 990-T for this year? If "No,"provide an explanation in Schedule 0 .
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3b
✓
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority
over, a financial account in a foreign country (such as a bank account, securities account, or other financial
account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4a
✓
b
If "Yes," enter the name of the foreign country: ^
- -------------------------------------------- - See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . . .
5a
✓
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
If "Yes" to line 5a or 5b, did the organization file Form 8886-T? . . . . . . . . . . . . . . .
5b
5c
✓
6a
✓
b
c
6a
b
7
a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the
organization solicit any contributions that were not tax deductible? . . . . . . . . . . . . . .
If "Yes," did the organization include with every solicitation an express statement that such contributions or
gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . .
Organizations that may receive deductible contributions under section 170(c).
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods
and services provided to the payor? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to file Form 8282? . . . . . . . . . . . . . . . . . . . .
. . . . . .
d
If "Yes," indicate the number of Forms 8282 filed during the year
e
f
g
h
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? .
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
Sponsoring organizations maintaining donor advised funds and section 509 (a)(3) supporting
organizations . Did the supporting organization, or a donor advised fund maintained by a sponsoring
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organization, have excess business holdings at any time during the year?
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a
b
10
a
b
11
a
b
12a
b
13
a
b
c
14a
b
.
.
.
.
.
.
.
.
.
.
7a
7b
.
7c
7d I
.
.
.
6b
.
Sponsoring organizations maintaining donor advised funds.
Did the organization make any taxable distributions under section 4966? . . . . . . .
Did the organization make a distribution to a donor, donor advisor, or related person?
. .
Section 501(c)(7) organizations . Enter:
Initiation fees and capital contributions included on Part VIII, line 12
. . . . . . .
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
.
Section 501(c)(12) organizations . Enter:
Gross income from members or shareholders . . . . . . . . . . . . . . .
Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.) . . . . . . . . . . . . . . .
J
7e
7f
7g
7h
.
.
.
.
.
8
.
.
.
.
.
.
.
.
9a
9b
10a
10b
11a
-
11b
Section 4947 (a)(1) non -exempt charitable trusts . Is the organization filing Form 990 in lieu of Form 1041?
If "Yes," enter the amount of tax-exempt interest received or accrued during the year .
12b
Section 501(c)(29) qualified nonprofit health insurance issuers.
Is the organization licensed to issue qualified health plans in more than one state?
. . . . . . . .
Note . See the instructions for additional information the organization must report on Schedule O.
Enter the amount of reserves the organization is required to maintain by the states in which
the organization is licensed to issue qualified health plans
. . . . . . .
13b
Enter the amount of reserves on hand
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Did the organization receive any payments for indoor tanning services during the tax year? .
12a
13a
13c
.
.
.
If "Yes,' has it filed a Form 720 to report these payments? If °No, ° provide an explanation in Schedule 0
.
5a
14a
14b
Form 990 (2010)
, Page 6
Form 990 (2010)
LiEM
Governance , Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a
"No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule
0. See instructions.
.
Check if Schedule 0 contains a response to any question in this Part VI .
.
.
.
.
.
.
.
.
.
.
.
❑
Section A. Governing Body and Management
Yes
la
b
Enter the number of voting members of the governing body at the end of the tax year.
.
la
3
Enter the number of voting members included in line 1a, above, who are independent
.
lb
0
No
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with
2
✓
3
. . . . . . . . . . .
any other officer, director, trustee, or key employee ? . . . . . .
performed
by or under the direct
duties
customarily
management
delegate
control
over
Did the organization
supervision of officers, directors or trustees, or key employees to a management company or other person? . .
3
✓
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
✓
5
Did the organization become aware during the year of a significant diversion of the organization's assets?
5
✓
6
7a
Does the organization have members or stockholders? . . . . . . . . . . . . . . . . . .
Does the organization have members, stockholders, or other persons who may elect one or more members
. . . . . . . . . . . . . . . .
of the governing body? . . . . . . . . . . .
Are any decisions of the governing body subject to approval by members, stockholders, or other persons?
6
✓
7a
7b
✓
✓
b
Did the organization contemporaneously document the meetings held or written actions undertaken during
8
the year by the following:
a
b
The governing body? . . . . . . . . . . . . . . . . .
Each committee with authority to act on behalf of the governing body?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
8a
8b
.
.
✓
✓
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at
9
g
the organization's mailing address? If "Yes," provide the names and addresses in Schedule 0 . . . . .
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
10a
b
11a
b
12a
b
c
13
14
15
a
. .
.
.
. .
.
.
.
.
.
.
Does the organization have local chapters, branches, or affiliates ? . .
If "Yes," does the organization have written policies and procedures governing the activities of such
10a
chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? .
10b
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the
. . . . . . . . .
. . . .
. . . . . . . . . . . . . . . . . .
form?
review
this
Form 990.
organization
to
the
process,
if
any,
used
by
Schedule
0
the
Describe in
Does the organization have a written conflict of interest policy? If "No,"go to line 13 . . . . . . . .
Are officers, directors or trustees, and key employees required to disclose annually interests that could give
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
rise to conflicts?
Does the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes,"
describe in Schedule 0 how this is done . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
Does the organization have a written whistleblower policy?
retention
and
destruction policy? . . . . . . . . .
Does the organization have a written document
Did the process for determining compensation of the following persons include a review and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
If "Yes" to line 15a or 15b, describe the process in Schedule O. (See instructions.) .
.
.
.
.
.
.
.
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization . . . . . .
.
.
.
.
.
.
.
.
No
✓
11a
✓
12a
✓
12b
✓
12c
✓
15a ✓
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement
with a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . . . .
-16-a-1
b
If "Yes ," has the organization adopted a written policy or procedure requiring the organization to evaluate its
participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the
. . . . . . .
organization ' s exempt status with respect to such arrangements? . . . . . .
16b
✓
Section C . Disclosure
17
18
None
List the states with which a copy of this Form 990 is required to be filed ^
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990 T (501(c)(3)s only) available
for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule 0 whether (and if so, how), the organization makes its governing documents, conflict of interest policy,
and financial statements available to the public.
State the name, physical address, and telephone number of the person who possesses the books and records of the
organization: ^ Gary Stradiotto , American Red Cross , 2025E Street, NW, Washington DC 20006 (202)303-5343
- --------------------------------------------- -
❑ Own website
20
❑ Another's
Upon request
Form 990 (2010)
Form 990 (2010)
Page 7
Compensation of Officers, Directors , Trustees , Key Employees, Highest Compensated Employees,
and Independent Contractors
Check If Schedule 0 contains a response to any question in this Part VII . . . . . . . . . . . . . .
Section A. Officers, Directors , Trustees, Key Employees , and Highest Compensated Employees
la Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the
organization's tax year.
• List all of the organization' s current officers, directors, trustees (whether individuals or organizations), regardless of amount of
compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
• List all of the organization 's current key employees, if any. See instructions for definition of "key employee."
• List the organization 's five current highest compensated employees (other than an officer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.
• List all of the organization' s former officers, key employees, and highest compensated employees who received more than
$100,000 of reportable compensation from the organization and any related organizations.
• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
U Check this box it neither the organization nor any related organization compensa ted any curren t officer, director, or trustee.
(A)
-Name and Title
(B)
Average
hours per
week
(describe
hours for
related
organizations
in Schedule
0)
(C)
Position (check all that apply)
o _
Q = -n
a
o
S
m
1
2
C
m
(1) Melissa B. Hurst
Chair, Benefit Plan Administration Committee
'
✓
Ep
(D
is
'a
CD
3 o
a
N
3
m
3
aCD
N
°
a
(D)
Reportable
compensation
(E)
Reportable
compensation from
from
related
(F)
Estimated
amount of
other
the
organizations
organization
(W-2/1099-MISC)
(W-2/1099-MISC)
compensation
from the
organization
and related
organizations
305,642
-0-
50,719
355,408
-0-
61,454
372,747
- 0-
86,705
(2) Brian Rhoa
Member , Benefit Plan Administration Committee
✓
- (3) MaryElcano
Member , Benefit Plan Administration Committee
✓
(4)
---------------------------------------------------------------(5)
----------------------------------------------------------------(6)
---- -----------------------------------------------------------(7)
---------------------------------------------------------------(8)
---------------------------------------------------------------(9)
---------------------------------------------------------------(1 0)
--------------------------------------------------------------(11)
---------------------------------------------------------------(1 2)
--------------------------------------------------------------(1 3)
--------------------------------------------------------------(1-4)
--------------------------------------------------------------(15)
---------------------------------------------------------------(16)---------------------------------------------------------Form 990 (2010)
Form 990 (2010)
0:M-ILTAM
Page 8
Soctinn A Affix
(A)
rc nirc±r_tnrs Trustpas KPv Fmninvees_ and Hiahest Compensated Emniovees (continued)
(B) (D)
(F)
(C)
(E)
Reportable
Estimated
Reportable
Average
Position (check all that apply)
Name and title
amount of
hours per
05
CD = -n compensation compensation from
90 °
from
related
other
week
o N
(D
the
organizations
compensation
(describe
Q E.
a o
m
organization
(w-2/1099-MISC)
from the
hours for
o
a m N
0
O
57
organization
related
(W 2/1099-MISC)
organizations 1 2
and related
D
m
in schedule
organizations
CD
N
0)
a
CL
(1-7)
--------------------------------------------------------------(18)
---------------------------------------------------------------(19)
---------------------------------------------------------------(20)
----------------------------------------------------------------(21)
----------------------------------------------------------------(22)
---------------------------------------------------------------(23)
---------------------------------------------------------------(24)
----------------------------------------------------------------(25)
---------------------------------------------------------------(26)
----------------------------------------------------------------(27)
-----------------------------------------------------------------
(28)
lb
c
d
Sub-total . . . . . . . . . . . . . . . .
Total from continuation sheets to Part VII, Section A
.
.
.
.
.
.
.
.
Total (add lines lb and 1c) .
.
.
^
^
1,033,797
-0-
198,878
.
^
1,033,797
-0-
198,878
2
Total number of individuals (Including but not limited to those listed above) who received more than $100,000 in
reportable compensation from the organization ^ none
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated
Yes No
employee on line 1 a? If "Yes," complete Schedule J for such individual
4
.
.
.
.
.
.
.
.
.
.
.
.
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual
for services rendered to the organization? If "Yes," complete Schedule J for such person . . . . . .
Section B. Independent Contractors
✓
g
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the
organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4
.^
5
1
J
✓
5
Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
CareFirst BlueCross BlueShield of Maryland , Inc
Medical claims processing
7,402,778
Aon Hewitt Associates , LLC
Eligibility admin & actuary
4 , 219,899
Metropolitan Life Insurance Company
Dental & disability claims
2,430,469
Express Scripts , Inc
Pharmacy claims
2
936,894
Total number of independent contractors (including but not limited to those listed above) who
received more than $100,000 in compensation from the organization ^ 4
Form 990 (2010)
Form 990 (2010)
Page 9
Statement of Revenue
(A)
Total revenue
Y Y
la
Federated campaigns .
.
.
la
-0-
0) 0
E
b
c
Membership dues .
Fundraising events .
.
.
.
.
lb
1c
-0-0-
^,
d
e
f
Related organizations . . .
Government grants (contributions)
All other contributions, gifts, grants,
1d
le
-0-0-
and similar amounts not included above
if
-0-
0
r
0
g
h
ci
.
.
Noncash contributions included in lines 1a-1f. $
Total . Add lines 1a-1f . . . . .
.
.
.
-0^
.
(B)
Related or
exempt
(C)
Unrelated
business
(D)
Revenue
excluded from tax
function
revenue
revenue
under sections
512, 513, or 514
-0.
Business Code
2a
b
Medical claims & premiums
------- - -------------- --- - - - --------------------Dental claims & premiums
-------- ---------------------------- ------------
525100
213,112 , 984
213 , 112,984
525100
14,879,275
14 , 879,275
c
Disability claims & premiums
525100
11,603 , 742
11,603,742
d
Life insurance premiums
525100
8,377 , 553
8,377,553
E
e
Flexible spending account
525100
8,717 , 819
8,717,819
o
f
All other program service revenue .
525100
299,211
299,211
g
. ^
Total . Add lines 2a-2f
Investment income (including dividends, interest,
256, 990,584
^
19,814
19,814
257,010 , 398
257,010,398
3
and other similar amounts)
.
.
.
.
.
.
.
Income from investment of tax-exempt bond proceeds ^
Royalties .
. ^
4
5
6a
b
c
d
7a
(i) Real
(u) Personal
(i) Securities
(i) Other
Gross Rents
Less. rental expenses
Rental income or (loss)
Net rental income or (loss)
Gross amount from sales of
.
^
assets other than inventory
b
Less. cost or other basis
and sales expenses
c
d
Gain or (loss) .
Net gain or (loss)
8a
m
b
c
9a
c
10a
.
.
.
.
.
.
.
.
.
.
.
.
a
Less: direct expenses .
.
.
.
.
b
^
Net income or (loss) from gaming activities .
Gross sales of inventory, less
.
.
.
a
b
returns and allowances
Less: cost of goods sold .
.
.
b
c
Net income or (loss) from sales of inventory.
Miscellaneous Revenue
11a
^
a
Less: direct expenses . . . . b
Net income or (loss) from fundraising events
Gross income from gaming activities.
See Part IV, line 19
b
.
Gross income from fundraising
events (not including $
on line 1c).
of contributions reported
----------------See Part IV , line 18
0
.
.
^
.
^
Business Code
------------------------------------------------
b
-----------------------------------------------c
-----------------------------------------------d
e
12
All other revenue
. . . . .
Total . Add lines 11 a-11 d . . .
Total revenue . See instructions .
.
.
.
.
.
.
^
^
Form 990 (2010)
Form 990 (2010)
Page 10
WNWIFStatement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns.
All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
(A)
Total expenses
7b, 8b, 9b, and 10b of Part Vlll.
1
Grants and other assistance to governments and
organizations in the U.S. See Part IV, line 21
2
Grants and other assistance to individuals in
the U.S. See Part IV, line 22 . . . . . .
3
Grants and other assistance to governments,
organizations, and individuals outside the
U.S. See Part IV, lines 15 and 16 . . . .
4
5
. . . .
Benefits paid to or for members
Compensation of current officers, directors,
trustees, and key employees
. . . . .
6
Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B) . .
. . . . . .
Other salaries and wages
7
8
Pension plan contributions (include section 401(k)
and section 403(b) employer contributions) . .
9
Other employee benefits .
.
.
.
.
.
.
.
a
Payroll taxes . . . . . . . .
Fees for services (non-employees):
Management
. . . . . . .
.
.
.
b
c
d
e
Legal . . . . . . .
Accounting . . . . .
Lobbying . . . . . .
Professional fundraising services.
10
11
.
.
. . .
. . .
. . .
See Part
. .
. .
. .
IV, line
f
Investment management fees
.
.
.
.
g
Other
.
.
.
.
.
.
.
.
.
Advertising and promotion
.
.
.
.
.
.
Office expenses
.
.
.
.
.
.
14
15
Information technology
Royalties .
. . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
16
Occupancy
17
Travel
18
19
Payments of travel or entertainment expenses
for any federal, state, or local public officials
Conferences, conventions, and meetings
.
.
.
20
21
Interest
. . . . .
Payments to affiliates .
.
.
.
22
Depreciation, depletion, and amortization
.
23
Insurance .
.
24
Other expenses. Itemize expenses not covered
above (List miscellaneous expenses in line 24f. If
line 24f amount exceeds 10% of line 25, column
(A) amount, list line 24f expenses on Schedule 0.)
a
b
c
d
e
f
25
26
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
(o)
Fundraising
expenses
235,726,926
.
13
.
(c)
Management and
general expenses
.
.
.
17
12
.
( B)
Program service
expenses
Claims processing & ASO fees
-----------------------------------------------------------Enrollment & eligibility processing
----------------- - -- --------------- -------------------------
Salary reimbursement to plan sponsor
-----------------------------------------------------------Actuarial & benefit consulting
---------------------------------------------------------Audit fees
-----------------------------------------------------------All other expenses
--- - - --- -------------------------Total functional expenses . Add lines 1 through 24f
Joint costs . Check here ^ ❑ if following
SOP 98-2 (ASC 958-720). Complete this line
only if the organization reported in column
(B) joint costs from a combined educational
campaign and fundraising solicitation
.
6,488
8,071
10,234
I
10,770,140
3,709,313
672,250
510,587
122,000
19,336
251 ,555,345
Form 990 (2010)
Form 990 (2010)
Page 11
Balance Sheet
(A)
Beginning of year
1
2
3
4
5
Cash-non-interest-bearing
. . . . . . . . . . . . .
Savings and temporary cash investments . . . . . . . . .
Pledges and grants receivable, net . . . . . . . . . . .
. . . . . . . . . . . . . .
Accounts receivable, net
Receivables from current and former officers, directors, trustees,
employees, and highest compensated employees. Complete Part
. . . . . . . . . . . . . . .
Schedule L . . .
6
Receivables from other disqualified persons (as defined under section
4958(0(1)), persons described in section 4958(c)(3)(B), and contributing
employers and sponsoring organizations of section 501(c)(9) voluntary
employees' beneficiary organizations (see instructions)
.
.
.
.
2,906,445
1
2
3
4
-
5
7
Notes and loans receivable, net
.
.
.
.
.
.
.
.
.
.
.
-
7
8
9
Inventories for sale or use . . . . .
Prepaid expenses and deferred charges
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
-
8
9
11
12
13
14
15
16
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
17
Accounts payable and accrued expenses
.
.
.
18
Grants payable .
19
20
21
22
Deferred revenue . . . . . . . . . . . . . . . . . .
Tax-exempt bond liabilities . . . . . . . . . . . . . . .
Escrow or custodial account liability. Complete Part IV of Schedule D .
Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule L
. . . . . . . . . . . . .
23
24
25
26
Secured mortgages and notes payable to unrelated third parties
Unsecured notes and loans payable to unrelated third parties
. . .
Other liabilities. Complete Part X of Schedule D
Total liabilities . Add lines 17 through 25
Organizations that follow SFAS 117, check here ^ ❑ and complete
lines 27 through 29, and lines 33 and 34.
N
a
5
Z
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
- 10c
- 11
- 12
545,926 13
- 14
- 15
4,891,589 16
26,789 ,240 17
563,351
6 , 261,313
22,703,550
. 18
27
Unrestricted net assets
.
.
.
.
.
.
.
28
Temporarily restricted net assets .
.
.
.
.
.
.
29
Permanently restricted net assets . . . . . . . . . . .
Organizations that do not follow SFAS 117 , check here ^ ❑
complete lines 30 through 34.
30
31
32
33
34
Capital stock or trust principal, or current funds . . . . .
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other
Total net assets or fund balances . . . . . . . . . .
Total liabilities and net assets/fund balances
o
2,796,195
Land, buildings, and equipment: cost or
other basis. Complete Part VI of Schedule D
104
10b
Less: accumulated depreciation . . . .
Investments-publicly traded securities
. . . . .
Investments-other securities. See Part IV, line 11
Investments-program-related. See Part IV, line 11 . .
. . . .
Intangible assets . . . . . . . .
Other assets. See Part IV, line 11 . . . . . . . .
Total assets . Add lines 1 through 15 (must equal line 34)
b
817,767
2,084,000
6
y
'o
.
.
669,218
770,000
a
10a
.
.
.
.
.
key
II of
.
(B)
End of year
-
19
20
21
26,789 , 240
22
23
24
25
26
27
.
.
.
.
.
.
.
.
.
.
.
- 28
. .
and
-
29
. . .
. . .
funds
. . .
(21,897 , 651)
30
31
32
33
34
4,891 , 589
22,703,550
(16,442,237)
6,261,313
Form 990 (2010)
Form 990 (2010)
Page 12
Reconciliation of Net Assets
.
Check if Schedule 0 contains a response to any question in this Part XI
.
.
Total revenue (must equal Part VIII, column (A), line 12) . . . . . . . . . . . . .
. . . . . . . . . . . .
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1 . . . . . . . . . . . . . .
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
. . . . . .
Other changes in net assets or fund balances (explain in Schedule 0) .
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line
1
2
3
4
5
6
.
Financial Statements and Reporting
Check if Schedule 0 contains a response to any question in this Part XII
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Yes
Accrual
❑ Other
❑ Cash
Accounting method used to prepare the Form 990:
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
1
2a
b
c
❑
6,261,313
.
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.
6
.
.
.
257,010,398
251,555,345
5,455,053
3,414,609
.
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1
2
3
4
5
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33,
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column ( B))
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Were the organization's financial statements compiled or reviewed by an independent accountant? . . .
. . . . . . .
Were the organization's financial statements audited by an independent accountant ?
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant?
❑
No
ME 1
",; w
✓
2a
2b
✓
✓
2c
If the organization changed either its oversight process or selection process during the tax year, explain in
y°=
Schedule O.
d
If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were
issued on a separate basis, consolidated basis, or both:
❑ Separate basis ❑ Consolidated basis ❑ Both consolidated and separate basis
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133? . . . . . . . . . . . . . . . . . . . . .
b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule 0 and describe any steps taken to undergo such audits
3a
✓
3b
Form 990 (2010)
SCHEDULE D
(Form 990)
OMB No 1545-0047
Supplemental Financial Statements
2010
^ Complete if the organization answered "Yes," to Form 990,
Part IV , line 6, 7 , 8, 9, 10 , 11, or 12.
^ Attach to Form 990 . ^ See separate instructions.
Department of the Treasury
Internal Revenue Service
Name of the organization
Life and Health Benefits Plan of the American Red Cross
52-6415790
ons Maintaining Donor Advised Funds or Other Similar Funds or Accounts . Complete if the
n answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds
I
(b) Funds and other accounts
1
2
3
4
5
Total number at end of year . . . . .
Aggregate contributions to (during year) .
Aggregate grants from (during year) . .
Aggregate value at end of year . . . .
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? . . . .
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used
❑ Yes ❑ No
only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose
conferring impermissible private benefit?
. . . . . . . . . . . . . . . . . . . .
❑ Yes ❑ No
Conservation Easements . Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
❑ Preservation of land for public use (e.g., recreation or education) ❑ Preservation of an historically important land area
❑ Protection of natural habitat
❑ Preservation of a certified historic structure
❑ Preservation of open space
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation
easement on the last day of the tax year.
Held at the End of the Tax Year
a
b
c
d
6
Total number of conservation easements . . . . . . . . . . . . . . . . .
2a
Total acreage restricted by conservation easements . . . . . . . . . . . . . .
2b
Number of conservation easements on a certified historic structure included in (a)
. . .
2c
Number of conservation easements included in (c) acquired after 8/17/06, and not on a
historic structure listed in the National Register . . . . . . . . . . . . . . .
2d
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year ^
--------------------------Number of states where property subject to conservation easement is located ^
---------------------Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds? . . . . . . . . . .
. .
❑ Yes ❑ No
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
7
---------------------Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
8
---------------------Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)
(I) and section 170(h)(4)(B)(ii)? . . . . . . . . . .
. . . . .
. . . . . . . . .
3
4
5
j
❑ Yes ❑ No
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the
organization's accounting for conservation easements.
9
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet
works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of
public service, provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet
works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of
public service, provide the following amounts relating to these items:
(i) Revenues included in Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . ^ $
----------------------------(ii) Assets included in Form 990, Part X .
^ $
----------------------------If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
2
a
b
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
.
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For Paperwork Reduction Act Notice , see the Instructions for Form 990 .
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Cat No 52283D
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^
^
$
----------------------------$
Schedule D (Form 990) 2010
Page 2
Schedule D (Form 990) 2010
JU^ Organizations Maintaining Collections of Art, Historical Treasures , or Other Similar Assets (continued)
Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its
3
collection items (check all that apply):
5
Loan or exchange programs
Public exhibition
d ❑
❑
Other
Scholarly research
e ❑
❑
--------------------------------------------------------------Preservation for future generations
❑
Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part
XIV.
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar
la
assets to be sold to raise funds rather than to be maintained as part of the organization's collection ? . .
❑ Yes ❑ No
Escrow and Custodial Arrangements . Complete if the organization answered "Yes" to Form 990, Part IV,
line 9, or reported an amount on Form 990, Part X, line 21.
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
a
b
c
4
included on Form 990, Part X? .
b
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❑ Yes
❑ No
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c
d
e
f
2a
b
Beginning balance . . . . . . . . . .
Additions during the year
. . . . . . .
Distributions during the year
. . . . . .
Ending balance . . . . . . . . . . .
Did the organization include an amount on Form
If "Yes," ex p lain the arran g ement in Part XIV.
. . .
. . .
. . .
. . .
990, Part
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X,
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line 21?
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1c
1d
le
if
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❑ Yes
.
❑ No
Endowment Funds . Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a) Current year
la
b
c
losses
d
e
f
g
2
a
b
c
3a
b
4
(b) Prior year
(c) Two years back
(d) Three years back
(e) Four years back
Beginning of year balance . . .
Contributions
. . . . . . .
Net investment earnings, gains, and
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Grants or scholarships . . . .
Other expenditures for facilities and
programs . . . . . . . . .
Administrative expenses . . . .
End of year balance . . . . .
Provide the estimated percentage of the year end balance held as:
%
Board designated or quasi-endowment ^
------------------Permanent endowment ^
%
------------------%
--------------- ---Are there endowment funds not in the possession of the organization that are held and administered for the
Term endowment ^
organization by:
(i) unrelated organizations . . . . . . . . . . . . . . . . . .
(ii) related organizations . . . . . . . . . . . . . . . . . . .
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIV the intended uses of the organization's endowment funds.
Yes No
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3a(i)
3a (ii)
3b
Land_ Buildings . and Enuinment _ See Fnrm 990. Part X. line 10.
(a) Cost or other basis
(investment)
Description of investment
1a
b
Land . .
Buildings .
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c
Leasehold improvements
d
e
Equipment
Other . .
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(b) Cost or other basis
(other)
Total. Add lines la through le. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)
(c) Accumulated
depreciation
(d) Book value
. ^
Schedule D (Form 990) 2010
Schedule D (Form 990) 2010
LCUML-Investments -
Page 3
Securities . See Form 990, Part X, l ine 12.
(a) Description of security or category
(including name of security)
(b) Book value
(c) Method of valuation
Cost or end-of-year market value
(1) Financial derivatives
. . . . . . . .
(2) Closely-held equity interests . . . . . .
(3) Other
---------------------------------------------------- -(A)
----(6i ---------------------------------------------------------------------------- -- ----- - - - -- - -- - ------- - ----- --- -------- - --------(C)
-----------------------------------------------------------------(D)
-----------------------------------------------------------------(^
----------------------------------------------------------------- - -------------------------------------------------------------------
(G)
------------------------------------------------------------------(H)
------------------------------------------------------------------(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.) ^
^
Investments - Program Related . See Form 990, Part X, line 13.
(a) Description of investment type
( b) Book value
(c) Method of valuation
Cost or end-of-year market value
( 1 ) American Red Cross Select Investment Progr
120 , 191 Market value
American Red Cross Select Investment Progr
443,160 Market value
(3)
(4)
(5)
(6)
( 7)
( 8)
( 9)
( 10 )
Total. (Column (b) must equal Form 990, Part X, col. (B) line 13) ^
0
Other Assets . See Form 990, Part X, line 15.
563,351
(a) Description
Total . (Column (b) must equal Form 990, Part X, col. (B) line 15.) .
Other Liabilities . See Form 990 , Part X, line 25.
1.
(a) Description of liability
(b) Book value
.
.
.
(b) Amount
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Total. (Column (b) must equal Form 990, Part X, col (B) line 25.) ^
2. FIN 48 (ASC 740) Footnote . In Part XIV, provide the text of the footnote to
organ ization ' s liability for uncertain tax position s under FIN 48 (ASC 740).
e organization's
statements that reports the
Schedule D (Form 990) 2010
Schedule D (Form 990) 2010
Page 4
9715-79Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements
1
2
Total revenue (Form 990, Part VIII, column (A), line 12) .
Total expenses (Form 990, Part IX, column (A), line 25) .
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3
4
Excess or (deficit) for the year. Subtract line 2 from line 1
Net unrealized gains (losses) on investments . . . .
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5
Donated services and use of facilities
6
Investment expenses .
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Prior period adjustments .
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8
9
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2
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3
4
257 ,010,398•
251,555,345
5,455,053
362
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7
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Other (Describe in Part XIV.) . . . . . . .
Total adjustments (net). Add lines 4 through 8 . . . . . . . . . . . . . .
Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9
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8
9
10
362
5,455,415
Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
a
b
Total revenue, gains, and other support per audited financial statements . .
Amounts included on line 1 but not on Form 990, Part Vlll, line 12:
2a
Net unrealized gains on investments . . . . . . . . . . . .
2b
Donated services and use of facilities
. . . . . . . . . . .
c
d
e
Recoveries of prior year grants .
Other (Describe in Part XIV .) . .
Add lines 2a through 2d . . .
a
Subtract line 2e from line 1 . . . . . . . . . . . .
Amounts included on Form 990, Part VIII, line 12, but not on line 1 :
.
Investment expenses not included on Form 990, Part VIII, line 7b
b
Other (Describe in Part XIV.) .
c
Add lines 4a and 4b . . . . . . . . . . . . . . . . . . .
Total revenue. Add lines 3 and 4c. (this must equal Form 990, Part 1, line 12.)
1
2
3
4
5
LiCILM
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257, 010,760
1
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362 , '
in,
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362
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2e
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3
257 ,010,398
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4c
5
257, 010,398
4a
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4b
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2a
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2b
2c
b
c
Prior year adjustments
Other losses . . . .
d
e
Other (Describe in Part XIV.)
. . . . . . . . . . .
Add lines 2a through 2d . . . . . . . . . . . . . . .
Subtract line 2e from line 1 . . . . . . . . . . . . .
Amounts included on Form 990, Part IX, line 25, but not on line 1:
.
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIV .) . . . . . . . . . . . . . .
. . . . .
Add lines 4a and 4b . . . . . . . . . .
Total expenses Add lines 3 and 4c. (This must equal Form 990, Part
a
b
c
2c
2d
. .
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a
3
4
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Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
Total expenses and losses per audited financial statements . .
Amounts included on line 1 but not on Form 990, Part IX, line 25:
. . . . . . . . .
Donated services and use of facilities
1
2
5
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2e
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251,555,345
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4c
5
251 , 555,345
4a
4b
.
. . . .
line 18.) .
.
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1 a and 4, Part IV, lines 1 b and 2b;
Part V, line 4, Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide
any additional information.
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Schedule D (Form 990) 2010
Schedule D (Form 990) 2010
Page 5
Supplemental Information (continued)
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Schedule D (Form 990) 2010
9
Printed an recycled paper
SCHEDULE J
OMB No
Compensation Information
(Form 990)
For certain Officers, Directors, Trustees, Key Employees , and Highest
Compensated Employees
1545-0047
2010
^ Complete if the organization answered " Yes" to Form 990,
Part IV , line 23.
Department of the Treasury
^ Attach to Form 990.
Internal Revenue Service
^ See separate instructions.
Employer identification number
Name of the organization
Life and Health Benefits Plan of the American Red Cross
52-6415790
Questions Regarding Compensation
Yes
1a
b
2
No
Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
❑ First-class or charter travel
❑ Travel for companions
❑ Tax indemnification and gross-up payments
❑ Housing allowance or residence for personal use
❑ Payments for business use of personal residence
❑ Health or social club dues or initiation fees
❑ Discretionary spending account
❑ Personal services (e.g., maid, chauffeur, chef)
If any of the boxes on line la are checked, did the organization follow a written policy regarding payment
or reimbursement or provision of all of the expenses described above? If "No," complete Part III to
explain . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . .
lb
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? . . . . .
2
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
3
❑ Written employment contract
❑ Compensation survey or study
❑ Approval by the board or compensation committee
❑ Compensation committee
❑ Independent compensation consultant
❑ Form 990 of other organizations
During the year, did any person listed in Form 990, Part VII, Section A, line 1 a, with respect to the filing
organization or a related organization:
4
a
b
c
Receive a severance payment or change-of-control payment from the organization or a related organization?
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
. . . . . . .
Participate in, or receive payment from, an equity-based compensation arrangement?
. . . . . . .
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only section 501 (c)(3) and 501 (c)(4) organizations must complete lines 5-9.
For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any
5
compensation contingent on the revenues of:
a
The organization?
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b Any related organization?
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5b
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6a
6b
If "Yes" to line 5a or 5b, describe in Part III.
For persons listed in Form 990, Part VII, Section A, line 1 a, did the organization pay or accrue any
6
compensation contingent on the net earnings of.
a
b
7
8
The organization? . . . . . . . .
Any related organization?
. . . . .
If "Yes" to line 6a or 6b, describe in Part III.
For persons listed in Form 990, Part VII,
payments not described in lines 5 and 6? If
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Section A, line la, did the organization provide any non-fixed
"Yes," describe in Part Ill . . . . . . . . . . . . .
7
Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject
to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part Ill
9
.
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in
Regulations section 53.4958-6(c)?
. . . . . . . . . . . . . . . . . . . . . . . .
For Paperwork Reduction Act Notice , see the Instructions for Form 990 .
Cat No 50053T
8
9
Schedule J (Form 990) 2010
Schedule J (Form 990) 2010
Page 2
Officers , Directors , Trustees , Key Employees , and Highest Compensated Employees . Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (it). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (13)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1 a.
(B) Breakdown of W-2 and/or 1099-MISC compensation
(A) Name
Melissa Hurst
(I)
(ii)
Brian Rhoa
( I)
(ii)
1
2
Mary Elcano
(ii) Bonus & incentive
compensation
(i) Base
compensation
(C) Retirement and
305,198
444
354,598
810
- --------------------- 0 -----------------0.
0.
-----------------0. ----------------------- - 0 .
369.183:
( D ) N on t axa bl e
benefits
other deferred
compensation
(Iii) Other
reportable
compensation
(F) Compensation
( E ) T o t a l o f co l umns
(B)(i)-(D)
reported in prior
Form 990 or
Form 990-EZ
356,361- ----------------37,364 - ----------------13,355 --------------------------------- 0.
0.
0.
0.
0.
0.
43,051
- ---------------0.
3,564
0.
81,199-
----------------18,403 - ------------0.
5,506
416,862
.
0. ---------------------- -0.
459,452-
3
( i)
(ii)
4
(i)
- ------------------------- - - ------------------------------------------------- -------------------------------------------------- ------------------------- ------------------------(ii)
5
(ii)
6
(ii)
7
(ii)
(i)
(i)
(I)
(i)
8
(ii)
9
(ii)
0
(i)
(ii)
11
(ii)
2
(ii)
(i)
-------------
--------------------- 0- ---------------0.
0.
0.
------------------------- ------------------------- ------------------------------------------------- ------------------------- ------------------------- - - -------------------------
----------------
0.
----------------
0.
- ------------------------- - - -------------------------
- ------------------------- - - -------------------------
-------------
0. - --------------------- - -0.
------------------------- --------------------------
------------------------- ------------------------- --------------------------
------------------------- - ------------------------- - - ------------------------- ------------------------- --------------------------
------------------------- ------------------------- ------------------------- ------------------------ ------------------------- ------------------------- -------------------------------------------------- ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- -------------------------------------------------- ------------------------- -------------------------
- ------------------------- - - -------------------------
------------------------- --------------------------
(i)
(i)
(i)
3
(ii)
14
(ii)
15
(li)
16
(i)
(ii)
(I)
------------------------- ------------------------- - - ------------------------- - ------------------------- - - ------------------------- - ------------------------- - - --------------------------
-
------------ - - ------------------------- ------------------------- ------------------------- ------------------------- ------------------------- --------------------------
------------------------- ------------------------- ------------------------ ----------------------- ------------------------- ------------------------- --------------------------
(I)
------------------------- ------------------------- ------------------------- -------------------------
------------------------- - - ------------------------- -
--------------------------
------------------------- ------------------------- ------------------------- ------------------------- ------------------------- --------------------------- --------------------------Schedule J (Form 990) 2010
Schedule J (Form 990) 2010
LiE3W
Page 3
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1 a, 1 b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part jor
any additional information.
Schedule J (Form 990) 2010
SCHEDULE 0
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information .
No- Attach to Form 990 or 990 - EZ.
2 @ 10
0 _
0 . 0
llgj a l :4 "giele
Name of the organization
Life and Health Benefits Plan of the American Red Cross
OMB No 1545-0047
Employer identification number
I
52-6415790
Part VI_ Line 11a _On completion of the Form 990 by Human Resources department, it was reviewed by the American Red Cross Finance
-------- ------------------------------------------
Department and the Plan's external auditors, KPMG. A copy of the final Form 990 was submitted to the members of the Benefit Plan
------------------------------------------------------------------------------------------------------------------------------------------------------------------------Administration Committee prior to its filing with the IRS.
----- --- ----- ---- -------- ------ - -------- ------ -------------- ------------------------ --- ---------------- ------------ ------------------------------ - ------------------ - - - - - - - -- - --PartVI, Line 12c --The members of the- Benefit Plan Administration Committee are officers and key employees of the American National- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------Red Cross_ As such, -they - are -required - to- annually execute the Code of Business Ethics and Conduct and complete a conflict of interest
questionnaire :The questionnaire is reviewed by the Red Cross Office of Investigations, Compliance and Ethics_The questionnaire is
------------intended-to-monitor-conflicts
-of -i-nte-r-est - on an ongoing basis. Officers and key employees are instructed that they have a continuing
duty to update the questionnaire during the course of the year to reflect any changes in business, financial or personal conflicts- of-interest.
--------------------------------------------------------------------------------------------------------------------------------------------------PartVI, Line 15 - Members of the Benefit Plan Administration Committee are officers and key employees of the American National -Red
- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------Cross and their compensation is determined by the Compensation Committee of the Board of Governors of the American Red Cross
The Compensation Committee is composed entirely of boa rd members who do not have any conflicts of interest. The Compensation
- - - ------------------------------------------------------Committee annually reviews the compensation and benefits of executives based on comparable market data. The Compensation Committee
- retains an outside, independent compensation consultant to provide market data and reasonableness opinions and it relies on such market
data and reasonable opinions when determining compensation and benefits.
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------Part VI, Line 19 - The Plan's governing documents and policies are -available
available to beneficiaries of the Plan on request to the- Red-Cross-Benefits
- --------------------------- ------ - -- -- - ------ -
Summary financial information-is-mailed to all beneficiaries annually. Full financial information including the Form 5500 and
----------------------------------------------------------------------------------------------------------audited- financial statements are provided to beneficiaries of the Plan upon request. The Plan does not-routinely-make- information--------------------------------------------------------------------------------------------------------------------------------------------------------------- - available to persons who are- not- covered - by the Plan.
For Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990 -EZ.
Cat No 51056K
Schedule 0 (Form 990 or 990-EZ) (2010)
Schedule 0 (Form 990 or 990-EZ) (2010)
Name of the organization
Page 2
Employer identification numbei
Schedule 0 (Form 990 or 990-EZ) (2010)
OMB No . 1545-0047
SCHEDULE R
(Form 990)
Related Organizations and Unrelated Partnerships
2010 .
^ Complete If the organization answered "Yes" to Form 990, Part IV , line 33 ,34, 35, 36, or 37.
Department of the Treasury
Internal Revenue Service
Name of the organization
10, Attach to Form 990.
Open to Publh
Inspection
10, See separate instructions.
identification number
52-6415790
Life and Health Benefits Plan of the American Red Cross
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(b)
Primary activity
(a)
Name, address, and EIN of disregarded entity
(c)
Legal domicile (state
or foreign country)
(d )
Total income
(e)
End-of-year assets
(f)
Direct controlling
entity
1
--- -------------------------------------------------------------------------------------------------2
3
--------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------^s)--------------------------------------------------------------------------------------------------
J
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had
one or more related tax-exempt organizations during the tax year.)
(b)
Primary activity
(a)
Name, address, and EIN of related organization
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501 (c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13)
controlled
entity?
Yes
No
(1) American National Red Cross
430 17th Street, N.W., Washin g ton, DC 20006
Social Services
501(c)(3)
DC
7 N/A
--(2)
--------------------------------------------------------------------------------------
(3)
--------------------------------------------------------------------------------------4
-- ------------------------------------------------------------------------------------5
-- --------------------------------------------------------------------------------------6------------------------------------------------------------------------------------(^) -----------------------------------------------------------------------------------For Paperwork Reduction Act Notice , see the Instructions for Form 990.
Cat No. 50135Y
Schedule R (Form 990) 2010
Page 2
S chedule R (Form 990) 2010
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34
because it had one or more related organizations treated as a partnership durincq the tax year.)
(a)
Name, address, and EIN
of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or
foreign
country)
(d)
Direct controlling
entity
(e)
Predominant
income (related,
unrelated,
excluded from
tax under
sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproportionate
allocations?
f)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
Yes No
(1)
--
(2)
U)
General or
managing
partner?
(k)
Percentage
ownership
Yes No
---------------------------------------------
-3) -----------------------(4)
---------------------------(5)
---------------------------(6)
---------------------------(^) -----------------------r_^e^f
^f QeI f rI nrn ni,atj ., na T avzh l a ac n (n rnnratinn nr Trust ((mmnlete if the nrnanization answered "Yes" to Form 99 0. Part IV.
line 34 her at,se it had one or more related organizations treated as a corporation or trust during the tax year.)
Irlnn+i4in^tir r
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile
(state or
foreign country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of
end-of-year assets
(h)
Percentage
ownership
(1)-------------------------------------------------------------------------2)-------------------------------------------------------------------------3
-----------------------------------------------------------------------------4
------------------------------------------------------------------------------5
--------------------------------------------------------------------------------------------------------------------------------------------------------
R)
Schedule R (Form 990) 2010
• Page 3
Sc h e dule R (Form 990) 2010
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35, 35a, or 36.)
Yes
Note . Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
a
b
c
During the tax year, did the organization engage in any of the following transactions
Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity .
Gift, grant, or capital contribution to other organization(s) . . . . . . . . .
Gift, grant, or capital contribution from other organization (s) . . . . . . . .
d
Loans or loan guarantees to or for other organization( s)
e
Loans or loan guarantees by other organization(s)
f
g
h
i
Sale of assets to other organization(s) . .
Purchase of assets from other organization( s)
Exchange of assets . . . . . . . .
Lease of facilities, equipment, or other assets
1
2
with one
. . .
. . .
. . .
or more related organizations
. . . . . . . . . .
. . . . . . . . . .
. . . . . . . . . .
listed
. .
. .
. .
in Parts II-IV?
. . . . .
. . . . .
. . . . .
.
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A.
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1a
lb
1c
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if
ig
1h
1i
✓
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Lease of facilities, equipment, or other assets from other organization (s) . . . . . . .
Performance of services or membership or fundraising solicitations for other organization (s)
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1k
✓
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Performance of services or membership or fundraising solicitations by other organization (s)
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.
to
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. .
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. .
other
.
. . . . .
. . . . .
. . . . .
organization(s)
✓
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11
m Sharing of facilities, equipment, mailing lists, or other assets .
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1m
✓
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Sharing of paid employees .
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in
✓
o
p
Reimbursement paid to other organization for expenses
Reimbursement paid by other organization for expenses
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10
1p
✓
q
r
Other transfer of cash or property to other organization(s) . .
Other transfer of cash or property from other organization(s) .
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✓
If the answer to any of the above is "Yes." see the instructions for information on who must complete this line. including covered relationships and transaction thresholds.
(b)
Transaction
type (a-r)
(a)
Name of other organization
(c)
Amount involved
(d)
Method of determining
amount involved
American National Red Cross
1
n
672,250 actual costs
0
5,336 , 608 actual costs
American National Red Cross
(2)
(3)
(4)
( 5)
(6)
Schedule R (Form 990) 2010
Page 4
Schedule R (Form 990) 2010
GM
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets
or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address , and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Are all partners
section
501(c)(3)
organizations ?
Yes No
(e)
Share of
end-of-year
assets
(f)
Disproportionate
allocations?
Yes No
(g)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(h)
General or
managing
partner?
Yes No
1
--------------------------------------------------------------------------------2
--------------------------------------------------------------------------------(3^---------------------------------------------------------------------------4
--------------------------------------------------------------------------------5
--- ---------------------------------------------------------------------------6
-- ------------------------------------------------------------------------------Q)--------------------------------------------------------------------------8)---------------------------------------------------------------------------(9^--------------------------------------------------------------------------(10)--------------------------------------------------------------------------(11)-------------------------- ------------------------------------------------(12)--------------------------------------------------------------------------(13)--------------------------------------------------------------------------(14)--------------------------------------------------------------------------(15)--------------------------------------------------------------------------(16)--------------------------------------------------------------------------Schedule R (Form 990):2010
Schedule R (Form 990) 2010
Page 5
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see
instructions).
Schedule R (Form 990) 2010