Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
The American Oncologic Hospital
Employer identification number
23-1352156
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (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 to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
The American Oncologic Hospital
Employer identification number
23-1352156
Identifier
Return Reference
Explanation
THE AMERICAN ONCOLOGIC HOSPITAL ALSO DOES BUSINESS UNDER "THE HOSPITAL
OF THE FOX CHASE CANCER CENTER" OR "FOX CHACE CANCER CENTER." FORM 990, PART VI, SECTION A, LINE 2 Louis Della Penna is the father of Elizabeth Rizor. FORM 990, PART VI, SECTION A, LINE 3 MARK JOHNSON, AN EMPLOYEE OF FTI CONSULTING, WAS IN THE CAPACITY OF INTERIM SENIOR VICE PRESIDENT, CLINCIAL SERVICES AND BUSINESS DEVELOPMENT DURING FISCAL YEAR 2012. FTI CONSULTING RECEIVED COMPENSATION IN CONNECTION WITH SERVICES PROVIDED BY MARK JOHNSON TO THE ORGANIZATION, THE DETAILS OF WHICH ARE DISCLOSED IN SCHEDULE O. FORM 990, PART VI, SECTION B, LINE 11 the Form 990 is prepared by PwC and reviewed by the finance department (including the VICE PRESIDENT OF FINANCE AND MEMBERS OF THE ACCOUNTING STAFF), MEMBERS OF THE SENIOR LEADERSHIP COMMITTEE AND THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. After review by management and outside tax counsel, the 990 and 990T (if any) are posted to the website of the Secretary's Office. Each Board member is contacted and provided with the web address. A Board member without internet access is provided a paper copy to review. The website and paper mailing have an overview of the 990 and 990T preparation process and internal reviews. Each Board member is asked to review the 990 and 990T within 2 weeks and contact the Chief Financial Officer with any questions. FORM 990, PART VI, SECTION B, LINE 12C In the case of potential conflict of interest or commitment, the President of FCCC shall be responsible for administering all matters. All disclosures shall be kept confidential, in a separate file under the control of the Office of the President. They shall not be made part of any personnel record or the basis for any review of the performance of the individual staff member. Access to these records shall be made available only to Board members, the President or his designee or a properly authorized governmental body, acting under statutory or regulatory authority. Records will be maintained for three years unless the materials are subject to governmental action. Disclosures shall be required of all staff and board members as follows: By Board Members: All Board Members of FCCC shall be required to complete a Conflict of Interest Disclosure form at the time of appointment, annually and whenever a new potential conflict arises. By Employees: All scientists, physicians and administrative employees at the management level and above of FCCC shall be required to complete a Conflict of IntereSt form at the time of employment, annually and whenever a new potential conflict arises and submit such disclosure forms to the Chief Academic Officer or his designee. By Consultants and Subcontractors: Consultants and Subcontractors shall certify to FCCC that they are not in a position to influence Center business, research or other decisions in ways that could lead to any form of personal gain from them or their family or give improper advantage to others to the Center's detriment. improper advantage to others to the Center's detriment.
FORM 990, PART VI, SECTION B, LINE 15B
THE ORGANIZATION'S COMPENSATION POLICY FOR THE POSITIONS OF CEO, EXECUTIVE DIRECTORS, SENIOR MANAGEMENT, OFFICERS AND OR KEY EMPLOYEES IS TO UTILIZE A NATIONAL SURVEY FACILITY FOR COMPENSATION INFORMATION. ANNUALLY, IT IS REVIEWED BY THE ORGANIZATION'S EXECUTIVE COMMITTEE AS WELL AS THE FULL BOARD FOR APPROVAL.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC WHEN REQUESTED.
FORM 990, PART VII
FORM 990, PART VII MARK JOHNSON WAS IN THE CAPACITY OF INTERIM CHIEF SENIOR VICE PRESIDENT, CLINCIAL SERVICES AND BUSINESS DEVELOPMENT DURING FISCAL YEAR 2012 WHILE EMPLOYED BY FTI CONSULTING. INDIVIDUAL COMPENSATION IS NOT AVAILABLE FROM FTI. IN CONNECTION WITH SERVICES PROVIDED BY MARK JOHNSON TO THE ORGANIZATION FTI WAS PAID $220,119 BY FOX CHASE CANCER CENTER FOUNDATION, AN AFFILIATE OF THE AMERICAN ONCOLOGIC HOSPITAL.
FORM 990, PART XI, LINE 5
INVESTMENT RETURN, NET OF EARNINGS ALLOCATION 1,346,794 CHANGE IN FAIR MARKET VALUE OF INTEREST RATE SWAP (1,250,760) UNREALIZED DEPRECIATION (2,097,953) DECREASE/INCREASE IN POST RETIREMENT PLAN LIABILITY 10,976,894 AFFILIATE TRANSFERS (16,284,999) CHANGE IN INVESTMENT IN AFFILIATE 3,870,235 ____________ TOTAL (3,439,789)
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:David G. Marshall TITLE:CHAIRMAN HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Louis E. Della Penna Sr. TITLE:VICE CHAIR HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:W. Thacher Brown TITLE:VICE CHAIR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Margot Keith TITLE:VICE CHAIR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Peter McCausland TITLE:VICE CHAIR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Donald E. Morel, Jr., Ph.D. TITLE:VICE CHAIR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:William J. Avery TITLE:CHAIR, EXECUTIVE COMMITTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Michael V. Seiden, MD, Ph.D. TITLE:PRESIDENT & CEO HOURS:31
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:John W. Conway, Jr. TITLE:DIRECTOR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:G. Morris Dorrance, Jr. TITLE:DIRECTOR HOURS:3
NAME:MARK JOHNSON TITLE:INTERIM, SR. VP CLINICAL SERV. HOURS:24
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
TY 2011 AffiliatedGroupAttachment
Name:
The American Oncologic Hospital
EIN: 23-1352156
Explanation:
FOX CHASE CANCER CENTER FOUNDATION, EIN: 23-2003072, ADDRESS: 333 COTTMAN AVE., PHILA., PA 19111, EXPENSES: $52,168,006, EXCESS LOBBYING EXPENDITURES: $0 THE AMERICAN ONCOLOGIC HOSPITAL, EIN: 23-1352156, ADDRESS: 333 COTTMAN AVE, PHILA., PA 19111, EXPENSES: $224,586,477, EXCESS LOBBYING EXPENDITURES: $0 THE INSTITUTE FOR CANCER RESEARCH, EIN: 23-6296135, ADDRESS: 333 COTTMAN AVE., PHILA., PA 19111, EXPENSES $29,742,314, EXCESS LOBBYING EXPENDITURES: $0 HEALTH SERVICES OF FOX CHASE CANCER CENTER, EIN: 23-2328543, ADDRESS: 333 COTTMAN AVE., PHILA., PA 19111, EXPENSES $50,790,383, EXCESS LOBBYING EXPENDITURES: $0