2021-11-15T14:44:16-06:00 2020-12-31 930900579 MCDONALD JACOBS PC 520 SW YAMHILL ST STE 500 PORTLAND OR 97204 990 2020-01-01 930878074 FAMILYCARE INC FAMI 5034712103 2121 SW BROADWAY ST NO 115 PORTLAND OR 97201 JEFFREY HEATHERINGTON PRESIDENT/CEO 5034712103 2021-11-15 1 JEFFREY HEATHERINGTON XXX-XX-XXXX SANG AHN P00540880 5032270581 0 AAL1 IAL1 2020 2022-09-23 18:48:47Z JEFFREY HEATHERINGTON 2121 SW BROADWAY ST NO 115 PORTLAND OR 97201 75008325 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE 4 4 4 9 0 0 0 0 1832207 12783521 2182217 2103897 0 338528 4014424 15225946 4132940 2228000 0 0 1427248 1401951 0 0 0 2223542 1863510 7783730 5493461 -3769306 9732485 93794441 100087421 16335782 3640605 77458659 96446816 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 2229149 2228000 13122049 PRIOR TO 2020, FAMILYCARE INC. PROVIDED COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID (THE CONTRACT). THE CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID ENDED JANUARY 31, 2018. APPROXIMATELY106,000 MEMBERS WERE UNDER THE CONTRACT. SINCE THE END OF THE CONTRACT, FAMILYCARE INC. THE ORGANIZATION HAS BEEN WINDING DOWN OPERATIONS AS IT SATISFIES REMAINING OBLIGATIONS UNDER THE CONTRACT. FAMILYCARE INC. ANTICIPATES THE ORDERLY WIND DOWN OF OPERATIONS TO CONTINUE THROUGH AT LEAST 2021. 2229149 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 3 0 1 4 1 0 0 0 0 1 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X WILLIAM MURRAY 5037343147 2121 SW BROADWAY ST NO 115 PORTLAND OR 97201 ROBIN RICHARDSON DO CHAIR & BOARD MEMBER 1.00 1.00 X X 0 0 0 ROBERT CARUS SECRETARY & BOARD MEMBER 1.00 1.00 X X 0 0 0 JOE HROMCO BOARD MEMBER 1.00 1.00 X 0 0 0 CARL ERICKSON BOARD MEMBER 1.00 1.00 X 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 35.00 5.00 X 514301 0 36954 WILLIAM MURRAY COO 35.00 5.00 X 405563 0 48859 ARTUR SUCHORZEWSKI DIRECTOR, GOVERNMENT AFFAIRS 39.00 1.00 X 165507 0 29241 LISA JONES EXECUTIVE MANAGER 39.00 1.00 X 119771 0 25308 1205142 0 140362 4 0 1 0 PERKINS COIE LLP 1201 THIRD AVENUE SUITE SEATTLE WA 98101 LEGAL AND PROFESSIONAL 1237986 1 MEDICAID CONTRACTS 624100 12783521 12783521 12783521 408751 408751 61477525 59782379 1695146 1695146 1695146 CLAIM REFUNDS 624100 338528 338528 338528 15225946 13122049 0 2103897 2228000 2228000 1005678 1005678 285278 285278 30741 30741 23809 23809 56445 56445 1264843 1264843 96344 96344 40395 40395 30656 30656 48655 48655 90505 90505 11633 11633 104998 104998 EQUIPMENT RENTAL & MAIN 94281 94281 OTHER ADMINISTRATIVE EX 80051 80051 MEDICAL AND HOSPITAL EX 1149 1149 5493461 2229149 3264312 0 1206985 31480415 22339245 18185650 49350112 49807547 20898099 613809 93794441 100087421 16335782 3640605 16335782 3640605 X 77458659 96446816 77458659 96446816 93794441 100087421 X 9732485 7172847 2082825 X X 0 1 X 1 0 1000 0 0 1000 1000 1 PART I-A, LINE 1: MONETARY DONATIONS TO SUPPORT CANDIDATES FOR ELECTIVE PUBLIC OFFICE 0 X PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISION OF FASB ASC TOPIC OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. MANAGEMENT HAS EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH PROVISIONS OF THIS TOPIC. 1 AMERICAN OSTEOPATHIC FOUNDATION 142 EACH ONTARIO ST CHICAGO IL 60611 362170786 501(C)(3) 25000 GENERAL SUPPORT AND EDUCATION ASIAN HEALTH & SERVICE CENTER 9035 SE FOSTER RD PORTLAND OR 97266 931192100 501(C)(3) 75000 SERVICES BEUNDIVIDED LEBANON FOURSQUARE CHURCH 470 W C ST LEBANON OR 97355 930840053 501(C)(3) 10000 BACKPACK BOYS AND GIRLS CLUBS OF GREATER SANTIAM 305 5TH STREET LEBANON OR 97355 521043668 501(C)(3) 300000 CHILD CARE FRIENDS OF THE MILWAUKIE CNETER 5440 SE KELLOGG CREEK DRIVE MILWAUKIE OR 97222 930797550 501(C)(3) 20000 SPONSOR GLADSTONE SCHOOL DISTRICT 17789 WEBSTER RD GLADSTONE OR 97027 170(C)(1) 40000 CHROMEBOOKS KAIROSPDX 4915 N GANTENBEIN AVE PORTLAND OR 97217 460987167 501(C)(3) 150000 FOOD SUPPLIES LATINO NETWORK 410 NE 18TH AVENUE PORTLAND OR 97232 731675402 501(C)(3) 150000 FOOD SUPPLIES LEBANON SCHOOL DISTRICT 485 5TH STREET LEBANON OR 97355 170(C)(1) 70000 GENERAL SUPPORT AND EDUCATION LIFEWORDS NORTHWEST 14600 NW CORNELL RD PORTLAND OR 97229 930502822 501(C)(3) 160000 INTERNET MEALS ON WHEELS PO BOX 19477 PORTALND OR 97280 930584318 501(C)(3) 250000 GENERAL SUPPORT MUSLIM EDUCATIONAL TRUST 10330 SW SCHOLLS FERRY RD TIGARD OR 97223 931151949 63000 FOOD SUPPLIES NATIVE AMERICAN YOUTH & FAMILY CENTER 5135 NE COLUMBIA BLVD PORTLAND OR 97218 931141536 501(C)(3) 80000 FOOD AND BABY NATIVE AMREICAN REHABILITION ASSOC 1776 SW MADISON ST PORTLAND OR 97205 237098400 501(C)(3) 50000 TRUCK OREGON FOOD BANK 7900 NE 33RD DRIVE PORTLAND OR 97211 930785786 501(C)(3) 150000 GENERAL SUPPORT OREGON SYMPHONY ASSOCIATION 921 SW WASHINGTON PORTLAND OR 97205 930446527 501(C)(3) 125000 GENERAL SUPPORT PORTLAND BACKPACK 2683 NE OVERLOOK DR HILLSBORO OR 97124 821797993 501(C)(3) 40000 GENERAL SUPPORT SELF ENHANCEMENT INC 3920 N KERBY AVE PORTLAND OR 97227 931086629 501(C)(3) 160000 TECHNOLOGY SLAVIC COMMUNITY CENTER 10301 NE GLISAN PORTLAND OR 97220 272782319 501(C)(3) 45000 FOOD PROGRAM SOUP KITCHEN 170 E GRANT ST LEBANON OR 97355 455316397 501(C)(3) 20000 FOOD URBAN LEAGUEOF PORTLAND 10 N RUSSELL STREET PORTLAND OR 97227 930395590 501(C)(3) 160000 GENERAL SUPPORT VALLEY LIFE CHURCH 80 E VINE ST LEBANON OR 97355 043845204 501(C)(3) 10000 GENERAL SUPPORT VERDE 7001 NE COLUMBIA BLVD PORTLAND OR 97218 203685723 501(C)(3) 40000 GENERAL SUPPORT YES FOR CLACKAMAS KIDS PO BOX 1893 LAKE GROVE OR 97035 85000 GENERAL SUPPORT 22 2 PART I, LINE 2: GRANT RECIPIENTS SUBMIT PERIODIC REPORTS AS DEFINED BY THEIR AGREEMENTS. REPORTS INCLUDE INVOICES CONTAINING SERVICES RENDERED AND PERIOD COVERED. X 0 1 X X X X X 0 0 0 0 0 0 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 514301 0 0 0 0 0 25050 0 11904 0 551255 0 0 0 WILLIAM MURRAY COO 405563 0 0 0 0 0 25050 0 23809 0 454422 0 0 0 ARTUR SUCHORZEWSKI DIRECTOR, GOVERNMENT AFFAIRS 165507 0 0 0 0 0 17337 0 11904 0 194748 0 0 0 PART I, LINE 1A FIRST CLASS AIRLINE TRAVEL PAID FOR EXECUTIVES ON LONG DURATION FLIGHTS (I.E. TO EAST COAST) OR FOR OCCASIONAL LAST-MINUTE TRAVEL PLANS WHEN COACH SEATS ARE NOT AVAILABLE. NOT INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 1B THE POLICY IS DETERMINED BY THE CEO AND IS NOT IN WRITING. FORM 990, PART VI, SECTION A, LINE 6 SEE THE DESCRIPTION PROVIDED FOR PART VI, SECTION A, LINE 7B, BELOW. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS 4 CORPORATE MEMBERS. THE CORPORATE MEMBERS ELECT THE ORGANIZATION'S BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE POWERS RESERVED TO THE MEMBERS ARE THE FOLLOWING: (A) AMENDING THE ARTICLES OF INCORPORATION; (B) AMENDING THE BYLAWS (C) APPOINTING MEMBERS; (D) ELECTING THE BOARD OF DIRECTORS; (E) APPROVING EXPENDITURES OF MORE THAN 5% OF THE RESERVES OF THE ORGANIZATION; AND (F) APPROVING THE SALE, TRANSFER, MERGER, OR DISSOLUTION OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY REQUIRING THE OFFICERS, DIRECTORS OR TRUSTEES, AND KEY EMPLOYEES TO DISCLOSE ANNUALLY INTERESTS THAT COULD GIVE RISE TO CONFLICTS. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION METHODOLOGY: CEO: THE LEVEL AND ADEQUACY OF CEO TOTAL COMPENSATION IS DETERMINED AND APPROVED BY THE BOARD OF DIRECTORS. THE CEO PERFORMS UNDER AN EXECUTIVE EMPLOYMENT CONTRACT WHICH IS NEGOTIATED AND UPDATED BY THE BOARD. ONLY INDEPENDENT MEMBERS OF THE BOARD CONDUCT THE REVIEW AND MAKE DECISIONS REGARDING THE CEO'S SALARY. THE BOARD USES AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO REVIEW AND ESTABLISH THE CEO'S TOTAL COMPENSATION. THE TWO MOST RECENT REVIEWS COMPLETED BY THE CONSULTANT WERE IN MAY 2015 AND APRIL 2017. KEY EMPLOYEES: THE LEVEL AND ADEQUACY OF KEY EMPLOYEES TOTAL COMPENSATION IS DETERMINED BY THE CEO, WITH INPUT FROM THE VICE PRESIDENT OF HUMAN RESOURCES. THE CEO AND VICE PRESIDENT OF HUMAN RESOURCES USE AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO REVIEW AND ESTABLISH KEY EMPLOYEES TOTAL COMPENSATION. THE TWO MOST RECENT REVIEWS COMPLETED BY THE CONSULTANT WERE IN MAY 2015 AND APRIL 2017, INCLUDING SEVERANCE PACKAGES. FORM 990, PART VI, SECTION C, LINE 19 FAMILYCARE, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART XI, LINE 9: INCOME FROM SUBSIDIARY 2,082,825. FORM 990, PART XII, LINE 2C: THE ORGANIZATION IS WINDING DOWN OPERATIONS AND NO LONGER HAS A STAND-ALONE COMMITTEE THAT ASSUMES OVERSIGHT OF THE AUDIT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FAMILYCARE HEALTH PLANS INC 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 911829317 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) FAMILYCARE INC 1 HEATHERINGTON FOUND FOR INNOVATION AND EDUCATION IN HEALTH CARE 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 930988354 TO SUPPORT INNOVATION AND FUND HEALTHCARE EDUCATION OR 501(C)(3) PF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FAMILYCARE HEALTH PLANS INC S 22108819 FMV PART II FAMILYCARE, INC. IS RELATED TO FAMILYCARE HEALTH PLANS, INC. AND TO HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION IN HEALTH CARE, BOTH TAX-EXEMPT ORGANIZATIONS, BY VIRTUE OF HAVING BOARD MEMBERS IN COMMON. ALL MEMBERS OF THE RELATED ORGANIZATIONS' BOARDS ALSO SERVE ON FAMILYCARE, INC.'S BOARD OF DIRECTORS.