Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
UNIVERSITY OF WASHINGTON |
916001537 | 6 | Yes | 0 | 0 | |
| Total 1 | 0 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART I, LINE 11G(V): | THE NETWORK WAS ESTABLISHED BY THE UNIVERSITY OF WASHINGTON, AS PART OF UW MEDICINE, TO PROVIDE PRIMARY CARE SERVICES THROUGHOUT KING COUNTY AND THE SURROUNDING AREA AND TO PROVIDE PRACTICE CLINICS FOR UW MEDICINE RESIDENTS. THEREFORE, NO MONETARY SUPPORT IS PROVIDED TO THE UNIVERSITY. |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART I, LINE 6, VOLUNTEERS: | THERE ARE FOUR 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 UW MEDICINE BOARD, PRESIDENT OF UW PHYSICIANS, AND CHAIRS OF THE UNIVERSITY OF WASHINGTON DEPARTMENT OF PEDIATRICS, MEDICINE AND FAMILY PRACTICE. ONLY FOUR 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: BRADLEY ANAWALT, THOMAS NORRIS, MIKA SINANAN, JOHNESE SPISSO, LOUISE SIMPSON, KAREN SCHILLER, LORI MITCHELL, CYNTHIA HECKER, MATTHEW THOMPSON, ANNE BURTON, DEBRA GUSSIN, MAUREEN BROOM, AND BRIAN JOHNSTON. MIKA SINANAN IS THE PRESIDENT AND PETER MCGOUGH IS THE VICE-PRESIDENT OF UW PHYSICIANS. THE FOLLOWING INDIVIDUALS ARE ALSO EMPLOYED BY UW PHYSICIANS: VICTORIA FANG, EVA KISS, THOMAS NORRIS, ANNE PLATZNER, JOHNESE SPISSO, LORI MITCHELL, PAUL RAMSEY, PAMELA SHEFFIELD, PAMELA YUNG, MATTHEW THOMPSON, CYNTHIA HECKER, 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 MAINTAINS A CONFLICT OF INTEREST POLICY 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 IS 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 UW MEDICINE 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. |
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