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
Baptist Physician Network
Employer identification number
76-0453250
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)
(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 support?
Yes
No
Yes
No
Yes
No
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
BAPTIST PHYSICIAN NETWORK IDENTIFIED ITSELF AS A HOSPITAL OR COOPERATIVE HOSPITAL SERVICE ORGANIZATION UNDER SECTION 170(B)(1)(A)(III) IN SCHEDULE A. HOWEVER, BAPTIST PHYSICIAN NETWORK IS NOT REQUIRED TO COMPLETE SCHEDULE H BECAUSE IT IS NOT LICENSED AS A HOSPITAL.
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
Baptist Physician Network
Employer identification number
76-0453250
Identifier
Return Reference
Explanation
DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PART VI, LINE 6
THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS THE BAPTIST HOSPITAL OF SOUTHEAST TEXAS, A TEXAS NONPROFIT CORPORATION.
DESCR OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS
FORM 990, PART VI, LINE 7A & 7B
THE FILING ORGANIZATION HAS A SOLE CORPORATE MEMBER, THE BAPTIST HOSPITAL OF SOUTHEAST TEXAS. THE CORPORATE MEMBER RETAINS THE RIGHT TO APPROVE THE FOLLOWING ACTIONS: A. ADOPTION, AMENDMENT OR INTERPRETATION OF ANY STATEMENT OF MISSION, PHILOSOPHY, ROLE, OR PURPOSE OF THE CORPORATION; B. ADOPTION, AMENDMENT OR INTERPRETATION OF ANY STRATEGIC PLAN OR BUSINESS PLAN OF THE CORPORATION; C. ELECTION OR REMOVAL OF DIRECTORS OF THE CORPORATION; D. CREATION OF, DELEGATION OF AUTHORITY TO, AND APPOINTMENT OF THE MEMBERS OF COMMITTEES OF DIRECTORS; E. ELECTION, APPOINTMENT AND REMOVAL OF OFFICERS, ASSISTANT OFFICERS AND AGENTS OF THE CORPORATION; F. FIXING BY THE BOARD OF DIRECTORS OF THE COMPENSATION OF DIRECTORS OR OFFICERS OF THE CORPORATION; G. MAKING OF CONTRACTS OF THE CORPORATION INVOLVING ANY OF ITS DIRECTORS OR OFFICERS; H. MAKING OF LOANS BY THE CORPORATION TO ANY OF ITS OFFICERS OR EMPLOYEES; I. SELECTION OR CHANGE OF THE CORPORATION'S FISCAL YEAR; J. AMENDMENT OR REPEAL OF THE CORPORATION'S ARTICLES OF INCORPORATION; K. ADOPTION OR AMENDMENT OF ANY CAPITAL OR OPERATING BUDGET OF THE CORPORATION; L. BORROWING OR LENDING OF MONEY OR OTHER ASSETS BY THE CORPORATION; M. MAKING, AMENDMENT, RENEWAL, CANCELLATION OR TERMINATION OF CONTRACTS IN WHICH THE CORPORATION ASSUMES FINANCIAL RISK; N. ACQUISITION, SALE, LEASE, MORTGAGE, PLEDGE, HYPOTHECATION, TRANSFER, OR OTHER ENCUMBRANCE OR ALIENATION OF PROPERTY OF THE CORPORATION; O. SETTLEMENT OF ANY CLAIM OR LITIGATION INVOLVING THE CORPORATION; P. THE MAKING OR ACCEPTANCE BY THE CORPORATION OF ANY GRANTS OR CONTRIBUTIONS; Q. THE CORPORATION'S CREATION OF, ACQUISITION OF OWNERSHIP INTERESTS IN OR AFFILIATION WITH ANY OTHER ORGANIZATION; R. MERGER, CONSOLIDATION, REORGANIZATION, OR DISSOLUTION OF THE CORPORATION; S. THE DISPOSITION OF THE ASSETS OF THE CORPORATION TO ANYONE OTHER THAN THE MEMBER; T. TO ALTER, AMEND, OR REPEAL THE BYLAWS OF THE CORPORATION WITH APPROVAL OF MAJORITY OF THE BOARD OF DIRECTORS.
DESCRIPTION OF PRACTICES RE: DOCUMENTATION OF MTGS & ACTIONS OF COMMITTEES
FORM 990, PART VI, LINE 8B
BAPTIST PHYSICIAN NETWORK'S BOARD CONSISTS OF THREE MEMBERS AS SUCH THERE ARE NO COMMITTEES OR SUBCOMMITTEES.
DESC THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990
FORM 990, PART VI, LINE 11B
THE DETAILED REVIEW OF THE FORM 990 IS CONDUCTED BY THE CFO, CEO, CORPORATE CONTROLLER, AND HOSPITAL CONTROLLER, FOLLOWING THE PREPARATION AND REVIEW OF THE RETURN BY THE ORGANIZATION'S PAID PREPARER. AN ELECTRONIC COPY OF THE FINAL FORM 990 IS EMAILED TO EACH BOARD MEMBER PRIOR TO FILING WITH THE IRS.
DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST
FORM 990, PART VI, LINE 12C
THE COMPLIANCE OFFICER FOR BAPTIST HOSPITALS OF SOUTHEAST TEXAS MAINTAINS THE CONFLICT OF INTEREST STATEMENTS AND REGULARLY MONITORS THEM AS WELL AS ANY OTHER ACTIVITIES THAT MAY CONSTITUTE A CONFLICT OF INTEREST. THE ORGANIZATION'S PRACTICE IS TO SEND OUT ANNUAL DISCLOSURE QUESTIONNAIRES TO BOARD MEMBERS, SENIOR OFFICERS, AND DIRECTORS OF THE ORGANIZATION. THE RESPONSES ARE TAKEN TO THE AUDIT AND COMPLIANCE COMMITTEE OF BOARD MEMBERS TO DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF THERE IS ANY POSSIBILITY OF FINANCIAL GAIN BY A MEMBER FROM ANY DECISION THAT IS TO BE DELIBERATED ON, THEN THAT MEMBER IS REMOVED FROM THOSE DISCUSSIONS TO ENSURE THAT THE MEMBER WILL NOT TAKE PART IN ANY DELIBERATIONS THAT HE OR SHE MIGHT PERSONALLY GAIN FROM. THE MEMBER OPERATING UNDER A CONFLICT IS PROHIBITED FROM VOTING ON ANY MATTER TO WHICH THE CONFLICT RELATES.
AVAIL OF GOV DOCS, CNFLCT OF INTRST PLCY, & FIN STMTS TO GEN PUBLIC
FORM 990, PART VI, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY AVAILABLE AT ITS BUSINESS OFFICE UPON REQUEST.
AVERAGE RELATED HOURS DISCLOSURE
FORM 990, PART VII, SECTION A, COLUMN B
ESTIMATED HOURS WORKED BY OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES AT RELATED ENTITIES: DAVID PARMER: BAPTIST HOSPITALS OF SE TEXAS - 39 HOURS GARY TROUTMAN: BAPTIST HOSPITALS OF SE TEXAS - 39 HOURS GUY GIESECKE: BAPTIST HOSPITALS OF SE TEXAS - 39 HOURS GERALD BRYANT: BAPTIST HOSPITALS OF SE TEXAS - 39 HOURS
AUDITED FINANCIAL STATEMENTS
FORM 990, PART XII, LINE 2C
THE AUDIT COMMITTEE OF VHA SOUTHWEST COMMUNITY HEALTH CORPORATION, WHICH IS THE PARENT ORGANIZATION OF BAPTIST HOSPITALS OF SOUTHEAST TEXAS, IS RESPONSIBLE FOR OVERSEEING THE EXTERNAL AUDIT OF THE CONSOLIDATED FINANCIALS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.