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
UW PHYSICIANS NETWORK
Employer identification number
91-1715882
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)
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 monetary support
Yes
No
Yes
No
Yes
No
(A)
UNIVERSITY OF WASHINGTON
916001537
GOVERNMENT
Yes
0
Total
0
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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
UW PHYSICIANS NETWORK
Employer identification number
91-1715882
Return Reference
Explanation
FORM 990, PART I, LINE 6, VOLUNTEERS:
THERE ARE FIVE VOLUNTEER MEMBERS OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 1
THE NETWORK'S BOARD OF DIRECTORS IS GENERALLY COMPRISED OF THIRTEEN VOTING MEMBERS WHICH INCLUDES 1) THREE ELECTED COMMUNITY MEMBERS, 2) THREE ELECTED PRIMARY CARE PHYSICIANS FROM THE NETWORK CLINICS AND 3) SEVEN EX-OFFICIO MEMBERS INCLUDING THE CHIEF HEALTH SYSTEM OFFICER OF UW MEDICINE (CHAIR), PRESIDENT OF THE HARBORVIEW MEDICAL BOARD, CHAIRPERSON OF THE UNIVERSITY OF WASHINGTON ACADEMIC MEDICAL CENTER BOARD, PRESIDENT OF UW PHYSICIANS, AND CHAIRS OF THE UNIVERSITY OF WASHINGTON DEPARTMENT OF PEDIATRICS, MEDICINE AND FAMILY PRACTICE. ONLY FIVE OF THESE MEMBERS ARE INDEPENDENT BECAUSE THE REMAINDER ARE COMPENSATED BY A RELATED ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 2
PAUL RAMSEY, MD, IS THE CEO OF UW MEDICINE, EXECUTIVE VICE PRESIDENT FOR MEDICAL AFFAIRS AND DEAN OF THE SCHOOL OF MEDICINE, UNIVERSITY OF WASHINGTON. THE FOLLOWING INDIVIDUALS ARE ALSO EMPLOYED BY THE UNIVERSITY OF WASHINGTON AND REPORT DIRECTLY OR INDIRECTLY TO DR. RAMSEY IN THAT CAPACITY: JOHNESE SPISSO, MIKA SINANAN, THOMAS NORRIS, BRADLEY ANAWALT, JEFFREY WIGHT, JOANN TARICANI, MARGARET KERRIGAN, KAREN SCHILLER, AND LORI MITCHELL. MIKA SINANAN IS THE PRESIDENT AND PETER MCGOUGH IS THE VICE-PRESIDENT OF UW PHYSICIANS. THE FOLLOWING INDIVIDUALS ARE ALSO EMPLOYED BY UW PHYSICIANS: JOHNESE SPISSO, THOMAS NORRIS, VICTORIA FANG, ANNE PLATZNER, EVA KISS, PAUL RAMSEY, LORI MITCHELL, PATRICIA READ-WILLIAMS, PAMELA SHEFFIELD, TIMOTHY BURNER, AND SUZANNE EVANS.
FORM 990, PART VI, SECTION A, LINE 7A
THE DEAN OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE APPOINTS THE PRESIDENT OF UW PHYSICIANS NETWORK, OTHER OFFICERS AND BOARD MEMBERS OF UW PHYSICIANS NETWORK WHICH INCLUDE THE CHAIRS OF THE DEPARTMENTS OF PEDIATRICS, MEDICINE, AND FAMILY MEDICINE (WHO ARE ALSO APPOINTED BY THE DEAN OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE).
FORM 990, PART VI, SECTION A, LINE 7B
MOST DECISIONS OF THE NETWORK'S BOARD OF DIRECTORS ARE SUBJECT TO THE APPROVAL OF THE DEAN OF THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE.
FORM 990, PART VI, SECTION B, LINE 11
THE BOARD HAS BEEN PRESENTED WITH INFORMATION RELATED TO THE PURPOSE AND RELEVANCE OF THE FORM 990 TO TAX EXEMPT ENTITIES SUCH AS THE NETWORK, AND BOARD MEMBERS MAY REQUEST A COPY OF THE FORM 990 FROM THE NETWORK'S DIRECTOR OF FINANCE. THE COMPLETED FORM 990 IS REVIEWED BY THE NETWORK'S EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE, LEGAL COUNSEL AS WELL AS THE ENTERPRISE FINANCE OFFICER OF UW MEDICINE PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
THE NETWORK ADOPTED A CONFLICT OF INTEREST POLICY IN 2012 THAT REQUIRES THE BOARD OF TRUSTEES AND INDIVIDUALS TO DISCLOSE ANY CONFLICTS. THE NETWORK'S BOARD MEMBERS AND OTHER INDIVIDUALS WHO ARE EMPLOYED BY THE UNIVERSITY OF WASHINGTON AND SERVING ON THE NETWORK'S COMMITTEES ARE SUBJECT TO THE STATE OF WASHINGTON ETHICS IN PUBLIC SERVICE ACT, CHAPTER 42.52 RCW. THE ACT RESTRICTS ACTIVITIES INCOMPATIBLE WITH THE INDIVIDUAL'S ROLE AS A STATE EMPLOYEE AND ALSO LIMITS THE INDIVIDUAL'S INVOLVEMENT IN TRANSACTIONS WHERE A POTENTIAL CONFLICT MAY EXIST. THE NETWORK'S EMPLOYEE CODE OF CONDUCT (REQUIRED TO BE SIGNED ANNUALLY) ALSO ADDRESSES CONFLICTS OF INTEREST. IN ADDITION, THE NETWORK HAS POLICIES REGARDING THE ACCEPTANCE OF GIFTS AND NON-EMPLOYMENT OF FAMILY MEMBERS. ANNUALLY, THE NETWORK BOARD MEMBERS AND OTHERS ARE REQUIRED TO DISCLOSE CERTAIN RELATIONSHIPS AS PART OF THE PROCESS TO COMPLETE THE FORM 990. THE NETWORK ADDRESSES CONFLICTS AS THEY ARISE AND/OR ARE REPORTED TO THE NETWORK'S MANAGEMENT OR THE NETWORK'S BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION OF THE NETWORK'S EXECUTIVE DIRECTOR, DIRECTOR OF FINANCE, MEDICAL DIRECTOR, CLINIC CHIEFS AND OTHER KEY EMPLOYEES ARE REVIEWED BY REPRESENTATIVES OF UW MEDICINE. THE REVIEW RELIES ON COMPARISON OF COMPENSATION TO SIMILARLY SITUATED INDIVIDUALS, IN LIKE-SIZED ORGANIZATIONS ENGAGED IN SIMILAR ACTIVITIES. THE COMPENSATION COMPARISON DATA IS REVIEWED BY DISINTERESTED EMPLOYEES OF UW MEDICINE. THE REVIEW IS PERFORMED REGULARLY AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE. THE NETWORK'S BOARD MEMBERS, IN THEIR CAPACITY AS UNIVERSITY OF WASHINGTON FACULTY, INCLUDING THE MEDICAL DIRECTOR AND CLINIC CHIEFS, ARE EMPLOYED BY UW PHYSICIANS AND/OR THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE. THEIR COMPENSATION IS REVIEWED REGULARLY THROUGH A UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE PROCESS THAT INVOLVES DISINTERESTED SCHOOL OF MEDICINE EMPLOYEES WHO REVIEW COMPENSATION OF ALL SCHOOL OF MEDICINE FACULTY. FOR UW EMPLOYED PHYSICIANS, REVIEW OF COMPENSATION ALSO INCLUDES APPLICATION OF THE "UW PHYSICIANS NETWORK METHOD OR STANDARD REGARDING BASIC INDIVIDUAL CAPS UNDER THE INCOME DISTRIBUTION PLAN" (UWPN CAP POLICY). THE UWPN CAP POLICY LIMITS COMPENSATION OF THE NETWORK'S MEMBERS BY COMPARISON TO OBJECTIVE DATA SUCH AS THAT PUBLISHED BY THE MEDICAL GROUP MANAGEMENT ASSOCIATION. THE REVIEW IS PERFORMED REGULARLY AND DOCUMENTATION IS MAINTAINED BY THE SCHOOL OF MEDICINE.
FORM 990, PART VI, SECTION C, LINE 19
THE NETWORK MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST TO THE EXECUTIVE DIRECTOR AND/OR DIRECTOR OF FINANCE.
FORM 990, PART VI, LINE 14
THE NETWORK APPLIES THE UNIVERSITY OF WASHINGTON DOCUMENT RETENTION AND DESTRUCTION POLICY.
FORM 990, PART VII, COLUMN B
THE HOURS REPORTED REPRESENT THE AVERAGE WEEKLY TOTAL AMOUNT OF TIME EACH INDIVIDUAL SPENT WORKING ON ALL OF THE NETWORK'S RELATED MATTERS INCLUDING PHYSICIAN TIME SPENT IN THE CLINICS, ADMINISTRATION TIME AND TIME SPENT SERVING AS A BOARD MEMBER OF THE ORGANIZATION IF APPLICABLE.
FORM 990, PART IX, LINE 11G
CALL CENTER: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,163,421. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,163,421. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 363,732. MANAGEMENT AND GENERAL EXPENSES 33,026. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 396,758. INTERPRETER SERVICES: PROGRAM SERVICE EXPENSES 128,702. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 128,702. PAYROLL PROCESSING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 116,507. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 116,507. CUSTOMER SERVICE LINE: PROGRAM SERVICE EXPENSES 15,242. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 15,242.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.