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
JOHN MUIR PHYSICIAN NETWORK
Employer identification number
68-0360801
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)
JOHN MUIR HEALTH
941461843
3
Yes
Yes
Yes
0
Total
0
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
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
JOHN MUIR PHYSICIAN NETWORK
Employer identification number
68-0360801
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
JOHN MUIR PHYSICIAN NETWORK BOARD MEMBER RAVI HUNDAL MD IS THE CHIEF FINANCIAL OFFICER OF JOHN MUIR MEDICAL GROUP AND JOHN ZUORSKI MD IS A BOARD MEMBER OF JOHN MUIR MEDICAL GROUP. JOHN MUIR PHYSICIAN NETWORK BOARD MEMBERS WILLIAM HODDICK MD AND MICHAEL SCHIERMAN MD ARE ALSO BOARD MEMBERS AND PRESIDENT AND VICE PRESIDENT RESPECTIVELY OF MUIR MEDICAL GROUP IPA, INC.
FORM 990, PART VI, SECTION A, LINE 6
JOHN MUIR HEALTH IS THE SOLE CORPORATE MEMBER OF JOHN MUIR PHYSICIAN NETWORK, AND, IN SUCH CAPACITY, HAS THE RIGHT TO APPOINT AND APPROVE THE APPOINTMENT OF CERTAIN DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK, AS WELL AS THE RIGHT TO APPROVE CERTAIN SIGNIFICANT CORPORATE ACTIONS (AS DESCRIBED IN SCHEDULE O). THE PRESIDENT OF JOHN MUIR MEDICAL GROUP ("GROUP") SERVES EX-OFFICIO AS A MEMBER OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK, AND GROUP HAS THE RIGHT TO DESIGNATE ONE (1) ADDITIONAL PHYSICIAN TO SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK. IN ADDITION, GROUP HAS THE RIGHT TO NOMINATE ONE (1) PERSON TO SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK. THIS NOMINATION MAY BE ACCEPTED OR REJECTED BY JOHN MUIR HEALTH. THE PRESIDENT OF MUIR MEDICAL GROUP IPA ("IPA") SERVES EX-OFFICIO AS A MEMBER OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK, AND IPA HAS THE RIGHT TO DESIGNATE ONE (1) ADDITIONAL PHYSICIAN TO SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK. IN ADDITION, IPA HAS THE RIGHT TO NOMINATE ONE (1) PERSON TO SERVE AS A MEMBER OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK. THIS NOMINATION MAY BE ACCEPTED OR REJECTED BY JOHN MUIR HEALTH. GROUP AND IPA MAY EACH DESIGNATE, ON AN ANNUAL BASIS, ONE PHYSICIAN TO ATTEND EACH MEETING OF THE BOARD OF DIRECTORS AS A NON-VOTING REPRESENTATIVE.
FORM 990, PART VI, SECTION A, LINE 7A
REFER TO FORM 990, PART VI, SECTION A, LINE 6.
FORM 990, PART VI, SECTION A, LINE 7B
THE BYLAWS OF JOHN MUIR PHYSICIAN NETWORK PROVIDE THAT JOHN MUIR HEALTH (I) SHALL SELECT EIGHT (8) OF THE TWELVE (12) MEMBERS OF THE BOARD OF DIRECTORS OF JOHN MUIR PHYSICIAN NETWORK, (II) MAY REMOVE ANY OR BOTH OF THE TWO (2) JOHN MUIR HEALTH EMPLOYED DIRECTORS AT ANY TIME, (III) MAY REMOVE ANY OR ALL OF THE FOUR (4) JOHN MUIR HEALTH NON-EMPLOYED DIRECTORS AT ANY TIME IF SUCH DIRECTOR HAS BEEN A MEMBER OF JOHN MUIR HEALTH'S BOARD OF DIRECTORS AND THEREAFTER CEASES TO SERVE IN SUCH CAPACITY FOR ANY REASON, AND (IV) HAS THE ABSOLUTE RIGHT AT ANY REASONABLE TIME TO INSPECT ALL BOOKS, RECORDS, AND DOCUMENTS OF EVERY KIND AND THE PHYSICAL PROPERTIES OF JOHN MUIR PHYSICIAN NETWORK AND EACH OF ITS SUBSIDIARY CORPORATIONS. JOHN MUIR HEALTH, AS THE SOLE CORPORATE MEMBER OF JOHN MUIR PHYSICIAN NETWORK, ALSO HAS THE RIGHT TO APPROVE CERTAIN ACTIONS IN ACCORDANCE WITH THE CALIFORNIA NONPROFIT PUBLIC BENEFIT CORPORATION LAW, INCLUDING THE VOLUNTARY DISSOLUTION OF JOHN MUIR PHYSICIAN NETWORK, THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF JOHN MUIR PHYSICIAN NETWORK, AND THE MERGER OF JOHN MUIR PHYSICIAN NETWORK WITH OR INTO ANY OTHER ENTITY.
FORM 990, PART VI, SECTION B, LINE 11
THE COMPLETED FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS SUFFICIENTLY IN ADVANCE OF THE FILING DEADLINE TO ENABLE A DETAILED AND CONSCIENTIOUS REVIEW BY ALL MEMBERS. AN OVERVIEW OF THE FORM 990, WITH SUFFICIENT DETAIL, IS PRESENTED TO THE BOARD WITH THE COMPLETED FORM 990. ALL QUESTIONS AND CONCERNS OF THE BOARD OF DIRECTORS WILL BE ADDRESSED BY THE CHIEF FINANCIAL OFFICER OR THEIR DESIGNEE AND INCORPORATED INTO THE FORM 990 AS APPROPRIATE. AFTER ALL OF THE INPUT FROM THE BOARD OF DIRECTORS HAS BEEN APPROPRIATELY ADDRESSED, SENIOR MANAGEMENT OF THE JOHN MUIR PHYSICIAN NETWORK WILL FILE THE FINAL FORM 990 AS REQUIRED.
FORM 990, PART VI, SECTION B, LINE 12C
ANNUALLY, THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO BOARD MEMBERS, ALONG WITH A CONFLICT OF INTEREST DISCLOSURE FORM REQUIRED TO BE COMPLETED AND SIGNED. FOLLOWING DISTRIBUTION OF THE POLICY, JOHN MUIR HEALTH GENERAL COUNSEL ("GENERAL COUNSEL") PROVIDES AN EDUCATIONAL SESSION RELATING TO BOARD MEMBER FIDUCIARY DUTIES AND CONFLICTS OF INTEREST COVERING, AMONG OTHER THINGS, REQUIRED DISCLOSURES AND THE PROCESS FOR APPROVAL OF TRANSACTIONS INVOLVING A POTENTIAL CONFLICT. DISCLOSED CONFLICTS ARE COMPILED IN A DOCUMENT AND REVIEWED BY THE BOARD CHAIR, THE CHIEF EXECUTIVE OFFICER AND THE GENERAL COUNSEL. TOGETHER, THESE INDIVIDUALS MONITOR ANY POTENTIAL CONFLICTS AND THE GENERAL COUNSEL ATTENDS BOARD MEETINGS TO ENSURE COMPLIANCE. TRANSACTIONS INVOLVING A POTENTIAL CONFLICT ARE REVIEWED AND APPROVED IN ADVANCE BY COUNSEL, A BOARD COMPLIANCE COMMITTEE AND THE BOARD. THE POLICY ALSO REQUIRES BOARD MEMBERS TO DISCLOSE ANY POTENTIAL CONFLICTS ARISING DURING THE YEAR.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER AND KEY EMPLOYEES IS ESTABLISHED ANNUALLY BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS UTILIZES AN OUTSIDE CONSULTANT WHO IS A COMPENSATION EXPERT. THE OUTSIDE CONSULTANT PROVIDES MARKET DATA FOR EACH INDIVIDUAL BASED UPON THEIR LEVEL OF RESPONSIBILITIES AND THAT DATA IS USED BY THE BOARD OF DIRECTORS TO ESTABLISH THE ANNUAL COMPENSATION PACKAGE FOR EACH INDIVIDUAL. IT IS THE PHILOSOPHY OF THE ORGANIZATION TO ESTABLISH A COMPENSATION PACKAGE FOR EACH INDIVIDUAL THAT REFLECTS THE MEDIAN OF THE MARKET AS ESTABLISHED BY THE OUTSIDE CONSULTANT. COMPENSATION FOR THE CHIEF FINANCIAL OFFICER IS ESTABLISHED ANNUALLY BY THE COMPENSATION COMMITTEE OF JOHN MUIR HEALTH.
FORM 990, PART VI, SECTION C, LINE 19
JOHN MUIR HEALTH PROVIDES FINANCIAL INFORMATION ON A QUARTERLY BASIS THROUGH VARIOUS BOND DISCLOSURE DATABASES. THIS FINANCIAL INFORMATION IS AVAILABLE FOR JOHN MUIR HEALTH ON A CONSOLIDATED AND CONSOLIDATING BASIS, INCLUDING JOHN MUIR PHYSICIAN NETWORK AND OTHER SUBSIDIARIES. REQUESTS FOR THE PROVISION OF JOHN MUIR PHYSICIAN NETWORK'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE DIRECTED TO THE GENERAL COUNSEL FOR THE APPROPRIATE RESPONSE.
FORM 990, PART XII, LINE 2C:
IN 2010 JOHN MUIR PHYSICIAN NETWORK DELEGATED RESPONSIBILITY FOR ITS AUDIT MATTERS TO THE JOHN MUIR HEALTH AUDIT COMMITTEE. THIS DELEGATION ALSO PROVIDED FOR THE APPOINTMENT OF ONE JOHN MUIR PHYSICIAN NETWORK BOARD MEMBER TO BE A PARTICIPANT IN THE JOHN MUIR HEALTH AUDIT COMMITTEE MEETING INVOLVING JOHN MUIR PHYSICIAN NETWORK MATTERS AND TO REPORT TO THE JOHN MUIR PHYSICIAN NETWORK BOARD THE ADVICE AND RECOMMENDATIONS OF THE JOHN MUIR HEALTH AUDIT COMMITTEE. THE JOHN MUIR PHYSICIAN NETWORK BOARD RETAINS FINAL AUTHORITY OVER THE ULTIMATE RESOLUTION OF ITS AUDIT MATTERS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.