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
FLORIDA PROTON THERAPY INSTITUTE INC
Employer identification number
01-0554709
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.") .
307,662
259,558
387,591
1,304,810
149,720
2,409,341
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......
45,512,243
47,910,037
50,423,687
46,077,595
48,046,641
237,970,203
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
111,228
122,494
154,696
173,614
162,770
724,802
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.
45,931,133
48,292,089
50,965,974
47,556,019
48,359,131
241,104,346
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.)
241,104,346
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...
45,931,133
48,292,089
50,965,974
47,556,019
48,359,131
241,104,346
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
24,968
95,554
258,844
160,686
155,596
695,648
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
24,968
95,554
258,844
160,686
155,596
695,648
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.)
..
923,825
1,025,445
1,039,090
995,463
950,318
4,934,141
13
Total support. (Add lines 9, 10c, 11, and 12.)..
46,879,926
49,413,088
52,263,908
48,712,168
49,465,045
246,734,135
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
97.720 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
97.540 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.280 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.340 %
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
FLORIDA PROTON THERAPY INSTITUTE INC
Employer identification number
01-0554709
Return Reference
Explanation
FORM 990, PART III, LINE 2
DURING THE CURRENT YEAR, THE COMPANY'S PATIENT SERVICE DEPARTMENT BEGAN A MUSIC THERAPY PROGRAM TO PROMOTE HEALING AND WELL-BEING IN OUR OUTPATIENT ENVIRONMENT. THE PROGRAM'S GOAL IS TO FACILITATE RELAXATION, DECREASE ANXIETY AND STRESS, ENHANCE WELLNESS, IMPROVE PAIN MANAGEMENT AND PROVIDE COMFORT AND SUPPORT FOR CANCER PATIENTS AND THEIR CAREGIVERS. MUSIC THERAPY IS PROVEN TO REDUCE STRESS AND PAIN LEVELS ASSOCIATED WITH ILLNESS AND HOSPITALIZATION. A MAJORITY OF THE YEAR HAS TO BE INVOLVED IN AN ENHANCED EFFORTS IN THE RESEARCH AREA, DEVELOPING AND REFINING PROTOCOLS AND OTHER RESEARCH PROGRAMS. THE COMPANY HAS SPENT APPROXIMATELY $1,875,000 IN THIS EFFORT.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 WILL FIRST BE REVIEWED AND APPROVED BY THE CHIEF FINANCIAL OFFICER. SUBSEQUENT TO THE CFO'S APPROVAL, FORM 990 WILL BE PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING IT WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION'S GOVERNING BODY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY ANNUALLY. THE GOVERNING BODY REVIEWS ACTUAL CONFLICTS, IF ANY, THAT ARE IDENTIFIED BY THE ANNUAL DISCLOSURE PROCESS AND PROHIBITS OFFICERS AND DIRECTORS FROM VOTING ON MATTERS WHERE ACTUAL CONFLICTS OF INTEREST EXIST.
FORM 990, PART VI, SECTION B, LINE 15
THE ORGANIZATION'S INDEPENDENT BOARD APPROVES COMPENSATION OF THE CHIEF EXECUTIVE OFFICER, EXECUTIVE DIRECTOR OR OTHER TOP MANAGEMENT OFFICIALS.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AVAILABLE UPON REQUEST.
FORM 990, PART IX, LINE 11G
CONSULTING: PROGRAM SERVICE EXPENSES 9,974. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,974. MARKETING: PROGRAM SERVICE EXPENSES 96,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96,000. BILLING/COLLECTIONS: PROGRAM SERVICE EXPENSES 1,236,204. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,236,204. MEDICAL DIRECTOR: PROGRAM SERVICE EXPENSES 125,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 125,000. PHYSICIANS: PROGRAM SERVICE EXPENSES 7,832,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,832,943. PHYSICS: PROGRAM SERVICE EXPENSES 1,552,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,552,000. TEMP AGENCIES: PROGRAM SERVICE EXPENSES 78,998. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 78,998. TRANSCRIPTIONS: PROGRAM SERVICE EXPENSES 36,398. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,398. TRANSLATION: PROGRAM SERVICE EXPENSES 13,744. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,744. CRT SERVICES: PROGRAM SERVICE EXPENSES 711,156. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 711,156. RADIATION SAFETY: PROGRAM SERVICE EXPENSES 28,244. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,244. OTHER CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 27,745. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 27,745.
FORM 990, PART XI, LINE 9:
CHANGE ON FAIR VALUE OF SWAP AGREEMENT 231,000.
FORM 990, PART XII, LINE 2C
OVERSIGHT OF AUDIT AND SELECTION OF INDEPENDENT ACCOUNTANT: THE GOVERNING BODY IS RESPONSIBLE FOR THE SELECTION, MONITORING AND EVALUATION OF AN INDEPENDENT AUDIT FIRM AND OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS. THERE WAS NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR.
GENERAL DISCLOSURE
CHARITY CARE: THE INSTITUTE PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE INSTITUTE DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS NET PATIENT SERVICE REVENUE. DURING THE YEARS ENDED JUNE 30, 2014 AND 2013, THE INSTITUTE RECOGNIZED WRITE-OFFS FROM CHARITY CARE OF APPROXIMATELY $848,000 AND $1,286,000, RESPECTIVELY. THE DIRECT AND INDIRECT COSTS OF THESE SERVICES WERE APPROXIMATELY $1,152,000 AND $1,712,000 FOR THE YEARS ENDED JUNE 30, 2014 AND 2013, RESPECTIVELY.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.