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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CENTRE COUNTY CANCER CENTER
Employer identification number
80-0866636
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
If the organization did not check a 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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
0
0
0
0
0
0
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......
11,237,638
11,237,638
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
0
0
0
0
11,237,638
11,237,638
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
8
Public support (Subtract line 7c from line 6.)
11,237,638
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
0
0
0
0
11,237,638
11,237,638
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
0
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
0
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
0
0
0
0
11,237,638
11,237,638
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
0 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CENTRE COUNTY CANCER CENTER
Employer identification number
80-0866636
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
MEMBERS OR STOCKHOLDERS: THE MEMBERS OF THE CORPORATION SHALL BE PENN STATE MILTON S. HERSHEY MEDICAL CENTER (HERSHEY) AND MOUNT NITTANY MEDICAL CENTER (MNMC), BOTH OF WHICH ARE PENNSYLVANIA NONPROFIT CORPORATIONS.
FORM 990, PART VI, SECTION A, LINE 7A
MEMBERS OR STOCKHOLDERS WHO CAN ELECT MEMBERS OF THE GOVERNING BODY: THE MEMBERS ARE RESPONSIBLE FOR THE APPOINTMENT OF EQUAL NUMBERS OF DIRECTORS OF THE CORPORATION AND THE REMOVAL OF SUCH DIRECTORS (SUCH REMOVAL POWER BEING RESERVED TO THE MEMBER WHO APPOINTED THE DIRECTOR) WITH OR WITHOUT CAUSE.
FORM 990, PART VI, SECTION A, LINE 7B
DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS: IN ADDITION TO THE APPOINTMENT AND REMOVAL OF DIRECTORS, THE MEMBERS HAVE THE FOLLOWING POWERS TO APPROVE RESERVED BEFORE THE CORPORATION SHALL TAKE ACTION: -THE ADOPTION, REVOCATION, OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION. -ANY MATERIAL CHANGE IN THE PURPOSES OF THE CORPORATION OR THE NATURE OR SCOPE OF THE BUSINESS CONDUCTED BY THE CORPORATION. -ANY FUNDAMENTAL CHANGE, INCLUDING: (I) THE MERGER OR CONSOLIDATION OF THE CORPORATION WITH OR INTO ANY OTHER ENTITY; (II) THE DIVISION OF THE CORPORATION; (III) THE EXCHANGE OF MEMBERSHIP INTERESTS IN THE CORPORATION FOR EQUITY INTERESTS OF ANY OTHER ENTITY; (IV) THE GRANT OF RESERVED POWERS OR ANY OTHER GOVERNANCE INTEREST TO A THIRD PARTY; OR (V) THE SALE OR LEASE OF ANY MATERIAL PORTION OF THE ASSETS OF THE CORPORATION OTHER THAN IN THE ORDINARY COURSE OF BUSINESS. -THE CORPORATION'S CREATION OF, OR PARTICIPATION BY THE CORPORATION IN, A SUBSIDIARY, JOINT VENTURE, PARTNERSHIP, LIMITED LIABILITY COMPANY OR OTHER SIMILAR ARRANGEMENT. -ANY MATERIAL CHANGE IN THE ACCOUNTING METHOD AFFECTING THE FINANCIAL STATEMENTS OR TAX RETURNS OF THE CORPORATION, OTHER THAN A CHANGE REQUIRED UNDER GENERALLY ACCEPTED ACCOUNTING PRINCIPLES. -ANY ISSUANCE OF ADDITIONAL, OR TRANSFER OF EXISTING, MEMBERSHIP INTERESTS IN THE CORPORATION (EXCEPT FOR TRANSFERS DESCRIBED IN SECTION 2.03). -ANY LOAN TO ANY PERSON OR ENTITY OTHER THAN FOR PAYABLES AND RECEIVABLES IN THE ORDINARY COURSE OF BUSINESS. -ANY DISTRIBUTIONS BY THE CORPORATION TO ITS MEMBERS, EXCEPT AS AUTHORIZED IN THE CORPORATE MEMBERSHIP AGREEMENT. -THE APPOINTMENT AND REMOVAL OF THE EXECUTIVE DIRECTOR OF THE CENTER. -THE EMPLOYMENT, CONTRACTING, OR LEASING OF A PHYSICIAN TO PROVIDE PROFESSIONAL OR ADMINISTRATIVE SERVICES AT THE CENTER; PROVIDED THAT MEMBER CONSENT SHALL NOT BE REQUIRED FOR LOCUM TENENS PHYSICIANS. -ANY MANDATORY CAPITAL CONTRIBUTIONS OF THE MEMBERS IN EXCESS OF CAPITAL CONTRIBUTIONS REQUIRED BY THE CORPORATE MEMBERSHIP AGREEMENT. -VOLUNTARY DECLARATION OF BANKRUPTCY OR SEEKING OF REORGANIZATION UNDER THE INSOLVENCY LAWS BY THE CORPORATION. -ANY OTHER MATERIAL TRANSACTION INVOLVING THE CORPORATION OR ITS BUSINESS NOT IN THE ORDINARY COURSE OF BUSINESS, EXCEPT THAT EITHER MEMBER AT ANY TIME MAY ELECT TO DISSOLVE THE CORPORATION PURSUANT TO SECTION 4 OF THE CORPORATE MEMBERSHIP AGREEMENT. -IN ADDITION TO THE FOREGOING, THE MEMBERS WILL APPROVE THE EXECUTION OF ANY THIRD PARTY PAYOR CONTRACT WHERE THERE IS DISAGREEMENT AMONG THE DIRECTORS. HOWEVER, WITH RESPECT TO ANY NON-MEDICARE, NON-MEDICAID THIRD PARTY PAYOR CONTRACT PROPOSED BY EITHER MEMBER OR THE DIRECTORS APPOINTED BY SUCH MEMBER, THE NON-PROPOSING MEMBER WILL NOT WITHHOLD OR DELAY APPROVAL UNLESS THE TERMS OF SUCH PROPOSED MANAGED CARE OR THIRD PARTY PAYOR CONTRACT ARE, IN THE AGGREGATE, LESS THAN 125% OF MEDICARE.
FORM 990, PART VI, SECTION B, LINE 11B
990 REVIEW PROCEDURES: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANAGEMENT OF THE ORGANIZATION. THE COMPLETED 990 IS MADE AVAILABLE TO BOARD MEMBERS FOR REVIEW AND QUESTIONS PRIOR TO SUBMISSION.
FORM 990, PART VI, SECTION B, LINE 12C
CONFLICT OF INTEREST POLICY: THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY WHICH COVERS INTERESTED PERSONS. AN INTERESTED PERSON IS ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER THE BUSINESS, OPERATIONS, ETHICAL, AND/OR COMPETITIVE POSITION. THIS INCLUDES, BUT IS NOT LIMITED TO, ANY DIRECTOR, EXECUTIVE, KEY EMPLOYEE, AND MEMBER OF THE MEDICAL STAFF. THE BOARD MAY ALSO DETERMINE THAT A PERSON OTHER THAN AN INTERESTED PERSON SHALL BE TREATED AS AN INTERESTED PERSON WITH RESPECT TO A PARTICULAR CONTRACT TRANSACTION, OR ARRANGEMENT. AN INTERESTED PERSON MUST DISCLOSE ALL MATERIAL FACTS RELATED TO THE EXISTENCE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST TO DIRECTORS CONSIDERING THE PROPOSED TRANSACTION, ARRANGEMENT, OR POLICY. DIRECTORS, EXECUTIVES, AND KEY EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE STATEMENT. MEMBERS OF THE MEDICAL STAFF COMPLETE A DISCLOSURE STATEMENT EVERY OTHER YEAR, COINCIDING WITH THEIR APPLICATION FOR REAPPOINTMENT TO THE MEDICAL STAFF. THESE INDIVIDUALS ARE ALSO REQUIRED TO DISCLOSE ANY TRANSACTION OR RELATIONSHIP WHICH ARISES BETWEEN SUBMISSIONS OF THE DISCLOSURE STATEMENT. THE BOARD ANNUALLY REVIEWS AND EVALUATES THE DISCLOSURE STATEMENTS AND DETERMINES IF THERE ARE ANY CONFLICTS THAT ARE SO PERVASIVE AS TO RENDER ANY DIRECTOR INELIGIBLE FOR SERVICE. IF A POTENTIAL CONFLICT OF INTEREST ARISES AS A RESULT OF A CONTEMPLATED BOARD ACTION, THE PRESIDENT OR THE INTERESTED PERSON, OR ANY OTHER DIRECTOR, SHALL RAISE THE QUESTION OF THE INTERESTED PERSONS CONFLICT OF INTEREST. THE BOARD WILL EVALUATE THE DISCLOSURE AND MATERIAL FACTS RELATED TO THE TRANSACTION AND WILL MAKE A DETERMINATION AS TO WHETHER THE INTERESTED PERSON HAS AN IMPERMISSIBLE CONFLICT OF INTEREST. BEFORE MAKING THIS DETERMINATION, AND DEPENDING UPON THE CIRCUMSTANCES, THE INTERESTED PERSON WILL BE ASKED TO LEAVE THE MEETING WHILE THE EVALUATION OF THE CONFLICT AND THE TRANSACTION IS DISCUSSED AND DECIDED UPON. IF THE DETERMINATION IS THAT A CONFLICT EXISTS, THE INTERESTED PERSON IS SO ADVISED. IF IT IS DETERMINED THAT A CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD MEETING CONCERNING THE TRANSACTION OR ARRANGEMENT UNDER CONSIDERATION AND MAY BE ASKED TO REMAIN FOR QUESTIONS ON THIS PRESENTATION; HOWEVER, AFTER THE PRESENTATION AND QUESTION PERIOD, THE INTERESTED PERSON IS ASKED TO LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST. IF AN INDIVIDUAL WHOSE COMPANY OR EMPLOYER HAS A BUSINESS RELATIONSHIP WITH THE ORGANIZATION, BUT THE INDIVIDUAL DOES NOT HAVE AN IMPERMISSIBLE CONFLICT OF INTEREST WITH RESPECT TO THIS BUSINESS RELATIONSHIP, THE INDIVIDUAL MAY NONETHELESS VOLUNTARILY RECUSE HIM/HERSELF FROM VOTING ON ANY MATTERS RELATED TO THIS RELATIONSHIP.
FORM 990, PART VI, SECTION C, LINE 19
DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: $ 482,238 PHARMACY MIX SERVICE 430,524 BILLING AGENCY 322,755 LOCUM PHYSICIAN 207,276 PROFESSIONAL SERVICES 159,652 PROJECT COSTS 60,976 PATIENT REGISTRATION FEES 8,283 LAUNDRY SERVICE 3,810 ARCHITECTURE/ENGINEER SERVICES 2,002 OTHER ----------- $1,677,516
FORM 990, PART XI, LINE 9
OTHER CHANGES IN NET ASSETS: $ 6,373,532 TRANSFERS FROM MEMBERS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.