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
The Physician Network
Employer identification number
47-0780857
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)
CHI NEBRASKA
363233121
0
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
The Physician Network
Employer identification number
47-0780857
Identifier
Return Reference
Explanation
Significant program services undertaken during FY'11
Form 990, Part III, Q. 2
The following physician groups transferred from other affiliate hospitals during the fiscal year: - Grand Island Oncology transferred to The Physician Network in April, 2010. - Grand Island Emergency Physicians changed from a service provided to St. Francis Medical Center to The Physician Network practice in October, 2010. - St. Francis Medical Center Physician Clinics and Kearney - Good Samaritan Physician Clinics transferred to The Physician Network in January, 2011.
Ceased or made significant changes made to program services
Form 990, Part III, Q. 3
The Emergency Physicians for the Fremont Area Medical Center was discontinued on 8/31/2010 and the Women's Place Practice was closed also in March 2011.
Program Service Accomplishments
FORM 990, PART III, Q. 4A
ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE The Physician Network mission is - The Physician Network will provide convenient, patient access to quality, service oriented, cost effective care. Through the efforts of our physicians and staff, The Physician Network will increase regional market share and maintain our leadership position in an increasingly complex and competitive healthcare environment. We will work to create a healthier community, respond appropriately to patient needs, become a work community of choice, and will make the healing power and presence of Christ visible and tangible in the communities we serve. The Physician Network was founded to provide physician services for the community. As a member of Catholic Health Initiatives, we embrace the mission of a healthy community and to provide quality care for those in need. The Physician Network operates, staffs, and maintains 13 primary care, 28 specialty clinics, and 4 physical therapy clinics that increase the availability and enhance the quality of medical services provided to the Lincoln, Grand Island, Nebraska City and Kearney communities. During fiscal year 2011, these clinics had 389,125 provider encounters. It also provides and maintains the availability of qualified physicians and physician extenders necessary to provide urgent and emergency care services at hospitals and emergent care facilities. The 24 hour emergency rooms (located in Lincoln, Grand Island, Nebraska City, Kearney (starting 1/11), and Fremont (ending 8/11)) are open 365 days per year. They participate in Medicare and Medicaid, and have an active charity care program. During fiscal year 2011, the Lincoln, Grand Island, Kearney, and Fremont sites had 60,487 provider encounters. The three urgent care centers are located in Lincoln, NE. They provide quality care for extended hours to patients, with or without a primary care physician. They participate in Medicare and have an active charity care program. During fiscal year 2011, these centers had 43,418 encounters. The Physician Network was founded and granted tax exempt status in 1994. The board of directors is comprised of officers of CHI Nebraska, a related organization, and independent community representatives from the various communities served. COMMUNITY BENEFIT APPROACH The Physician Network is located in Lincoln, NE, a city with a population of 258,000. We serve Lancaster County, Nebraska and the surrounding states of Iowa, Kansas, and Missouri. We also provide Specialty services in Grand Island and Kearney, Nebraska. The Physician Network participates in governmental programs (such as Medicare and Medicaid), and has an active charity care program. We provide natural family planning for women of child bearing age in a couple clinic sites. This service is provided free of charge to all patients of the practice. The Physician Network provides support to People's Health Center, which serves a community that is composed of poor & unemployed households. The Physician Network provides physicians for the hospitalist, neonatology, pediatric cardiology, radiation therapy, anesthesia, and palliative care programs at CHI-Nebraska affiliated hospitals. QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY BENEFIT SUMMARY Fiscal Year 2011 Community Benefit for the Poor: Cost of Charity care provided......................$222,191 Unpaid costs of public programs, Medicaid and other indigent care programs......$2,980,240 Subsidized Health services.........................$300,312 Other Community benefit provided to the poor........$30,000 Community Benefit for the Broader Community: Community Health Improvement Services...............$16,200 Unpaid costs of Medicare.........................$7,413,723 Total Community Benefit including the Unpaid Costs of Medicare..................$10,962,666 The Physician Network encourages our associates to living out our values of reverence, integrity, compassion, and excellence. The associates participate in community blood drives, "adopts "families in need for the holidays, collect toiletries for city mission, and community food drives
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, Q. 6
THE SOLE MEMBER OF THE ORGANIZATION IS CHI NEBRASKA, A NEBRASKA NON-PROFIT CORPORATION.
MEMBERS WHO MAY ELECT MEMBERS OF THE GOVERNING BODY
FORM 990, PART VI, Q. 7A
THE SOLE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS.
DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL BY MEMBERS
FORM 990, PART VI, Q. 7B
The organization's corporate member is CHI Nebraska. Pursuant to ARTICLE V, Section 5.4 of the organization's bylaws, both CHI Nebraska and Catholic Health Initiatives ("CHI") (CHI Nebraska'S sole corporate member) have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the CHI Nebraska Board: - Approve members of the PHYSICIAN NETWORK board - Amendment of the corporate documents of THE PHYSICIAN NETWORK - Approve removal of a member of the governing body of THE PHYSICIAN NETWORK - Adoption of long range and strategic plans for THE PHYSICIAN NETWORK The following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: - Substantial change in the mission or philosophy of THE PHYSICIAN NETWORK - Removal of a member of the governing body of THE PHYSICIAN NETWORK - Approval of issuance of debt by THE PHYSICIAN NETWORK - Approval of participation of THE PHYSICIAN NETWORK in a joint venture - Approval of formation of a new corporation by THE PHYSICIAN NETWORK - Approval of a merger involving THE PHYSICIAN NETWORK - Approval of the sale of all or substantially all of the assets of THE PHYSICIAN NETWORK - To require the transfer of assets by THE PHYSICIAN NETWORK to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to ARTICLE V, Section 5.5.2 of the organization's bylaws, CHI Nebraska or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate.
FORM 990 REVIEW PROCESS
FORM 990, PART VI, Q. 11a
The CFO receives the Form 990 from the CHI Tax Department and reviews the return with the CEO. The reviewed return is e-mailed to the full board. The board then reviews and submits questions to the Board appointed committee for review with the CFO. Subsequent to the Board appointed committee review the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board.
Procedures for monitoring and enforcing the COI policy
FORM 990, PART VI, Q. 12C
THE PHYSICIAN NETWORK ("TPN") HAD IN EFFECT FOR FY 2011 A CONFLICT OF INTEREST POLICY COVERING ALL DIRECTORS AND OFFICERS HOLDING THE TITLE OF VICE PRESIDENT OR ABOVE. THE POLICY PLACES ON EACH DIRECTOR A GENERAL OBLIGATION TO DISCLOSE TO THE CHAIR OF THE BOARD OF DIRECTORS ANY SITUATION THAT MAY CREATE A CONFLICT AS SOON AS THEY BECOME AWARE OF SUCH SITUATION. COVERED OFFICERS MUST MAKE SUCH DISCLOSURES TO THE PRESIDENT AND CEO OF TPN WHO HAS A DUTY TO REPORT SUCH SITUATIONS TO THE BOARD CHAIR. IF ANY DOUBT EXISTS, DIRECTORS AND COVERED OFFICERS ARE REQUIRED TO MAKE A FULL DISCLOSURE TO PERMIT AN IMPARTIAL AND OBJECTIVE DETERMINATION. THE POLICY REQUIRES WRITTEN RECORD OF ALL DISCLOSURES. ADDITIONALLY, ALL DIRECTORS AND COVERED OFFICERS ARE REQUIRED TO, AT LEAST ANNUALLY, COMPLETE, SIGN AND SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE PRESIDENT AND CEO REVIEW THESE STATEMENTS WITH THE BOARD CHAIR. THE BOARD CHAIR OR A DESIGNEE CONDUCTS FURTHER INVESTIGATION OF CONFLICTS OF INTEREST DISCLOSURES AT THEIR DISCRETION. BASED UPON THE REVIEW AND EVALUATION OF THE RELEVANT FACTS AND CIRCUMSTANCES, THE BOARD CHAIR MAKES AN INITIAL DETERMINATION AS TO WHETHER A CONFLICT EXISTS AND WHETHER REVIEW, AN APPROVAL, OR OTHER ACTION BY THE BOARD IS REQUIRED. A WRITTEN RECORD OF THE BOARD CHAIR'S DETERMINATION IS KEPT. THE BOARD CHAIR THEN MAKES A REPORT TO THE EXECUTIVE COMMITTEE OF THE BOARD. DIFFERENCES OF OPINION BETWEEN THE BOARD CHAIR AND ANOTHER OFFICER OR DIRECTOR AS TO WHETHER THE FACTS AND CIRCUMSTANCES OF A GIVEN SITUATION CONSTITUTE A CONFLICT OF INTEREST OR WHETHER BOARD OF DIRECTORS REVIEW AND APPROVAL OR OTHER ACTION IS REQUIRED ARE SUBMITTED TO THE EXECUTIVE COMMITTEE TO MAKE A FINAL DETERMINATION AS TO THE MATTER. THE COMMITTEE MINUTES ARE maintained TO REFLECT THE DETERMINATION INCLUDING ALL RELEVANT FACTS AND CIRCUMSTANCES AND THEN the matter is REPORTED TO THE BOARD OF DIRECTORS. A DIRECTOR OR OFFICER IS PROHIBITED FROM VOTING OR USING HIS OR HER PERSONAL INFLUENCE ON THE MATTER UNDER CONSIDERATION. FURTHER, THEY ARE TO BE EXCUSED FROM THE MEETING DURING THE DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST.
DOCUMENT RETENTION & DESTRUCTION POLICY
FORM 990, PART VI, Q. 14
The organization has a document retention and destruction policy that it follows; however, the policy had not been formally adopted by the board of directors as of June 30, 2011.
PROCESS TO DETERMINE COMPENSATION OF TOP MGMT OFFICIAL & OTHER OFFICERS
FORM 990, PART VI, Q. 15a-b
COMPENSATION FOR THE CEO AND EXECUTIVES OF THE PHYSICIAN NETWORK WAS ESTABLISHED BY THE NEBRASKA SYSTEM CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS to establish the compensation: (1) COMPENSATION SURVEYS OR STUDIES (2) Independent compensation consultant and (3) Approval by the board Compensation committee.
DISCLOSURE OF GOVERNING DOCUMENTS, COI POLICY & FINANCIAL STATEMENTS
FORM 990, PART VI, Q. 19
The organization's governing documents are available on the Nebraska Secretary of State website. The Conflict of Interest Policy is available upon request. The Physician Network's Financial Statements are included in the Catholic Health Initiatives' consolidated Audited Financial Statements that are available at www. Catholichealthinitiatives.org or at www.dacbond.com.
ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONS
FORM 990, PART VII
The individuals listed in Part VII that report compensation paid by a related organization devote approximately 60 hours per week to the related organizations and receive compensation in exchange for their services provided.
Reconciliation of Net Assets: other changes in net assets or fund balances
990 Part XI Q. 5
Other changes in net assets or fund balances: Net unrealized gain/(loss) - $121,805
Executive Committee Composition & Authority
990 Part VI Q. 1a
Pursuant to Article VIII, Section 8.1 of the organization's bylaws, the board of directors may, by resolution adopted by a majority of the directors then in office, establish one or more committees, as needed or required to conduct and transact the business of the corporation. Except as otherwise provided in the organization's bylaws, the board of directors may set qualifications for membership on any committee it may establish; provided that each committee shall consist of at least two (2) directors of the corporation. Committees may include persons other than directors, except that a committee that has the authority to act on behalf of the board of directors must include only directors of the corporation. Minutes of all committee meetings shall be recorded and copies of such minutes shall be provided to the board of directors. Actions of committees shall e reported to the full board of directors, but actions of committees which include persons other than directors, shall be subject to ratification by the full board of directors. Sections regarding board of directors' regular meetings, special meetings, notice of meetings, waiver of notice, quorum, manner of acting, and action without meeting of the organization's bylaws shall also apply to all committees established by the board of directors.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.