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
2010
Open to Public Inspection
Name of the organization
NETWORK HEALTH INC
Employer identification number
04-3476565
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
CAMBRIDGE PUBLIC HEALTH COMMISSION (SEE PART IV)
043320571
03
Yes
0
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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—2010.
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—2009.
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—2010.
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—2009.
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
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—2009.
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
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
AMOUNT OF SUPPORT NETWORK HEALTH, INC. IS A SUPPORT ORGANIZATION FOR ITS PARENT, THE CAMBRIDGE PUBLIC HEALTH COMMISSION (D/B/A CAMBRIDGE HEALTH ALLIANCE) WHICH IS A PUBLIC INSTRUMENTALITY AND A COMPONENT UNIT OF THE CITY OF CAMBRIDGE PURSUANT TO INTERNAL REVENUE CODE SECTION 115. IN DOING BUSINESS TO SUPPORT CAMBRIDGE HEALTH ALLIANCE, THE ORGANIZATION LEASES ITS FACILITIES FROM CAMBRIDGE HEALTH ALLIANCE. ALSO, THE ORGANIZATION PAYS CAMBRIDGE HEALTH ALLIANCE FOR CERTAIN ADMINISTRATIVE SERVICES THAT ARE RENDERED ON ITS BEHALF SUCH AS PAYROLL AND ACCOUNTS PAYABLE SERVICES. THE PARENT PAYS NETWORK HEALTH, INC. FOR THE MANAGEMENT OF ITS CONTRACT WITH MASSHEALTH (MASSACHUSETTS MEDICAID). SEE SCHEDULE R FOR THE AMOUNTS OF THESE TRANSACTIONS.
Schedule A (Form 990 or 990-EZ) 2010
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
2010
Open to Public Inspection
Name of the organization
NETWORK HEALTH INC
Employer identification number
04-3476565
Identifier
Return Reference
Explanation
FORM 990, PART I, LINE 6
NETWORK HEALTH, INC.'S VOLUNTEERS INCLUDE UNCOMPENSATED DIRECTORS WHOSERVE ON A VOLUNTARY BASIS.
FORM 990, PART VI, LINE 6
ORGANIZATIONAL MEMBERS CAMBRIDGE PUBLIC HEALTH COMMISSION (CPHC) D/B/A CAMBRIDGE HEALTH ALLIANCE IS THE SOLE CORPORATE MEMBER OF NETWORK HEALTH, INC.
FORM 990, PART VI, LINE 7A
ELECTION OF THE BOARD OF DIRECTORS CAMBRIDGE HEALTH ALLIANCE HAS THE RIGHT TO APPOINT MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, LINE 7B
DECISION APPROVAL CERTAIN ACTIONS OF THE BOARD OF DIRECTORS MUST BE APPROVED BY CAMBRIDGE HEALTH ALLIANCE, NETWORK HEALTH INC.'S SOLE CORPORATE MEMBER, AS SET FORTH IN THE BY-LAWS, INCLUDING ADOPTION OF THE BUDGET, ANY MERGER, CONSOLIDATION, JOINT VENTURE, OR AFFILIATION WITH NETWORK HEALTH INC., ANY CAPITAL TRANSACTION, AND INCURRENCE OF DEBT. CAMBRIDGE HEALTH ALLIANCE HAS AUTHORITY TO APPROVE OR DENY ANY DECISION MADE BY NETWORK HEALTH INC.'S BOARD OF DIRECTORS. ITEMS CAN BE RECOMMENDED TO THE BOARD OF CAMBRIDGE HEALTH ALLIANCE OR ITS COMMITTEES FOR REVIEW AND APPROVAL.
FORM 990, PART VI, LINE 11A
FORM 990 REVIEW PROCESS NETWORK HEALTH, INC.'S FORM 990 IS PREPARED WITH THE ASSISTANCE OF ITS OUTSIDE TAX ACCOUNTANTS (PRICEWATERHOUSECOOPERS). NETWORK HEALTH, INC.'S INTERNAL MANAGEMENT AND CAMBRIDGE HEALTH ALLIANCE EMPLOYEES REVIEW THE FORM 990 AND PROVIDE COMMENTS AND CHANGES. ONCE THE RETURN HAS BEEN UPDATED THE FORM 990 WILL BE PRESENTED FOR FURTHER REVIEW TO EACH VOTING MEMBER OF THE GOVERNING BODY AND CAMBRIDGE HEALTH ALLIANCE'S FINANCE COMMITTEE. PRICEWATERHOUSECOOPERS WILL THEN FINALIZE THE FORM 990. COPIES OF THE COMPLETED FORM 990 WILL BE DISTRIBUTED IN ELECTRONIC OR PAPER FORM TO MEMBERS OF THE GOVERNING BODY PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, LINE 12C
CONFLICT OF INTEREST POLICY THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY WITH ITS OFFICERS, DIRECTORS AND KEY EMPLOYEES BY ANNUALLY SURVEYING EACH SUCH PERSON AND SHARING THE RESULTS WITH EACH GROUP. OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE ALSO GIVEN A COPY OF THE CONFLICT OF INTEREST POLICY ALONG WITH THE ANNUAL SURVEY AND ARE REMINDED OF THEIR OBLIGATION TO PROMPTLY REPORT ANY NEW POTENTIAL CONFLICTS THAT ARISE. THE COMPLIANCE OFFICER REVIEWS THE RESPONSES. IF A CONFLICT OF INTEREST IS DETERMINED, THE COMPLIANCE OFFICER WILL EXERCISE THEIR JUDGEMENT ON THE BEST COURSE TO FOLLOW.
FORM 990, PART XI, LINE 5
DURING 2010, CAMBRIDGE HEALTH ALLIANCE MADE A CAPITAL CONTRIBUTION TO THE ORGANIZATION IN THE AMOUNT OF $1,000,000. THIS AMOUNT WAS RECORDED AS PAID IN CAPITAL AND USED TO FUND AN INSOLVENCY RESERVE REQUIRED UNDER THE ORGANIZATION'S CONTRACT WITH THE MASSACHUSETTS EXECUTIVE OFFICE OF HEALTH AND HUMAN SERVICES.
FORM 990, PART VI, LINES 15A AND 15B
PROCESS FOR DETERMINING COMPENSATION CAMBRIDGE HEALTH ALLIANCE'S (CHA) COMPENSATION COMMITTEE IS THE AUTHORIZED BODY FOR REVIEWING THE PRESIDENT'S COMPENSATION. THE COMMITTEE RELIED UPON COMPARABILITY DATA OBTAINED BY AN INDEPENDENT CONSULTANT WHEN APPROVING THE PRESIDENT'S 2010 COMPENSATION AND DISCUSSED THEIR FINDINGS WITH THE ORGANIZATION'S BOARD AND DOCUMENTED THEIR DECISIONS IN THE BOARD MINUTES. FOR 2010, THE CHA COMPENSATION COMMITTEE WAS AUTHORIZED TO REVIEW AND DID REVIEW THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION. THE COMPENSATION COMMITTEE CONSISTS OF INDEPENDENT MEMBERS WHO REVIEW AND RECOMMEND COMPENSATION BASED ON MARKET DATA AND BENCHMARKS PROVIDED BY INDEPENDENT CONSULTANTS.
FORM 990, PART VI, LINE 19
GOVERNING DOCUMENTS THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST EITHER BY MAIL OR IN PERSON AT THE ORGANIZATION'S OFFICE, DEPENDING ON THE FORM OF REQUEST.
FORM 990, PART VII
THE FOLLOWING INDIVIDUALS BOTH WORK AN AVERAGE OF 50 HOURS PER WEEK AT CAMBRIDGE HEALTH ALLIANCE AND ITS RELATED ORGANIZATIONS. DENNIS KEEFE DOUGLAS THOMPSON (WAS EMPLOYED BY NETWORK HEALTH , INC. THROUGH SEPTEMBER 30, 2010 AND THEN TRANSFERRED TO CAMBRIDGE HEALTH ALLIANCE IN A DIFFERENT ROLE).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.