2019-11-14T15:17:59-06:00 2018-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2018-01-01 911829317 FAMILYCARE HEALTH PLANS INC FAMI 5034712103 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 ROBERT K CARUS SECRETARY 5034712103 2019-11-13 1 CYNTHIA P BARTHOLOMEW P01313965 5032210336 2019-11-13 52.183.24.237 2019-11-13 13:09:57 PS P 107EDC9825E31507E2C414B50C50019CDA1077BD D2C01C9AB4B0B15F4225B95C8306F5C5D0622163 2018 2020-03-31 21:24:44Z X ROBERT K CARUS 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 49786338 0 X N/A X 1997 OR TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 9 8 326 0 0 0 0 0 41635232 25717658 312359 708806 0 0 41947591 26426464 0 0 0 0 664147 388796 0 0 0 51092094 22678382 51756241 23067178 -9808650 3359286 28806864 20100183 11897635 393367 16909229 19706816 X TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 20345301 25717658 DURING 2018, FAMILYCARE HEALTH PLANS, INC. (THE ORGANIZATION) CONTINUED TO PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS). THE ORGANIZATION SERVED APPROXIMATELY 4,058 MEMBERS MONTHLY UNTIL THE ORGANIZATION'S CONTRACT WITH CMS ENDED JULY 1, 2018. THE ORGANIZATION HAS BEGUN WINDING DOWN OPERATIONS AS IT SATISFIES THE REMAINING OBLIGATIONS UNDER THE CMS CONTRACT. THE WIND DOWN OF OPERATIONS WILL CONTINUE THROUGH AT LEAST THE END OF 2019; ONCE COMPLETED AND NO OTHER BUSINESS OPERATIONS ARE CONTINUING THE RESULTING NET ASSETS WILL BE DISTRIBUTED IN ACCORDANCE WITH THE ORGANIZATION'S BYLAWS. MANAGEMENT FOR THE ORGANIZATION BELIEVES THE ORGANIZATION HAS AN APPROPRIATE LEVEL OF CAPITAL AND SURPLUS TO MEET ALL REMAINING CLAIMS AND OTHER OBLIGATIONS UNDER THE CMS CONTRACT. 20345301 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 457 0 1 326 1 0 0 0 0 0 0 0 0 X 9 8 1 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 SUITE 115 PORTLAND OR 97201 ROBIN RICHARDSON DO CHAIR & BOARD MEMBER 1.00 1.00 X X 0 8250 0 MATT DASKALOS VICE CHAIR & BOARD MEMBER 0.00 1.00 X X 0 1250 0 PATRICIA PARKER SECRETARY (PART YEAR) & BOARD MEMBER 0.00 1.00 X X 0 750 0 JEFFREY PAWLOWSKI TREASURER & BOARD MEMBER 1.00 1.00 X X 0 6250 0 ROBERT CARUS SECRETARY (PART YEAR) & BOARD MEMBER 0.00 1.00 X X 0 2000 0 RICHARD BARSOTTI BOARD MEMBER 0.00 1.00 X 0 2750 0 JOE HROMCO BOARD MEMBER 0.00 1.00 X 0 1000 0 MICHAEL RILEY BOARD MEMBER 1.00 1.00 X 0 1250 0 CARL ERICKSON BOARD MEMBER 1.00 1.00 X 0 393 0 ROYAL E HARRIS BOARD MEMBER 0.00 1.00 X 0 1000 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 15.00 25.00 X 0 510181 32684 WILLIAM MURRAY COO 10.00 30.00 X 0 372474 24806 KEVIN CLANCY VP FINANCE 10.00 30.00 X 0 217956 10942 OSCAR CLARK VP COMMUNITY & HEALTH SERV 10.00 30.00 X 0 224214 13930 CHRIS JACOBSEN VP INFORMATION TECHNOLOGY 10.00 30.00 X 0 221794 15185 CHERI PFANNES VP CORPORATE COMPLIANCE 10.00 30.00 X 0 192661 5746 ANA JIMENEZ DIRECTOR 10.00 30.00 X 0 305480 16949 KARIN VILLIARIMO DIRECTOR 10.00 30.00 X 0 256546 14052 MICHELLE NARDONE ANALYST 10.00 30.00 X 0 218519 8486 SHANNON NOEL PHARMACIST 10.00 30.00 X 0 198923 13509 CHRISTINE PRICE ANALYST 10.00 30.00 X 0 181240 6849 0 2924881 163138 0 0 1 0 CVS CAREMARK PHARMACY PO BOX 99794 CHICAGO IL 60696 MEDICAL SERVICES 8238496 LEGACY EMANUEL HOSPITAL AND HEALTH 2801 N GANTENBEIN AVE PORTLAND OR 97227 MEDICAL SERVICES 2331918 PROVIDENCE HEALTH SYSTEM OREGON PO BOX 3395 PORTLAND OR 97208 MEDICAL SERVICES 1577712 COLUMBIA LUTHERAN CHARITIES 2111 EXCHANGE ST ASTORIA OR 97103 MEDICAL SERVICES 1495080 PORTLAND ADVENTIST MEDICAL CENTER PO BOX 92900 PORTLAND OR 97292 MEDICAL SERVICES 1421912 5 MEDICARE PREMIUMS, NET 624100 20269404 20269404 BAD DEBT RECOVERY 624100 5448254 5448254 25717658 868964 868964 23199716 23359874 -160158 -160158 -160158 26426464 25717658 0 708806 X 368381 294705 73676 6588 5270 1318 13827 11062 2765 10741267 8918033 1823234 294 294 27804 27804 INPATIENT HOSPITAL 6460189 6460189 OTHER MEDICAL AND HOSPI 2890933 2890933 EMERGENCY ROOM AND OUT- 1765109 1765109 ADMIN FEE 436981 436981 355805 355805 23067178 20345301 2721877 0 4151521 2140076 3805482 14419497 2165611 1200852 286678 0 16055336 1166486 2342236 1173272 28806864 20100183 376925 1767 11520710 391600 11897635 393367 X 16909229 19706816 16909229 19706816 28806864 20100183 3359286 -561699 0 X X 0 1 X 1 0 0 OTHER CURRENT ASSETS, NET 887490 RESTRICTED SHORT-TERM INVESTMENTS 285782 1173272 OTHER POLICY LIABILITIES 145164 DUE TO AFFILIATES 53562 CLAIMS PAYABLE AND UNPAID CLAIMS ADJUDICATION EXPENSES 192874 391600 0 0 0 0 0 0 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 0 504000 0 0 0 6181 0 24750 0 7934 0 542865 0 0 WILLIAM MURRAY COO 0 370494 0 0 0 1980 0 8250 0 16556 0 397280 0 0 KEVIN CLANCY VP FINANCE 0 217498 0 0 0 458 0 4188 0 6754 0 228898 0 0 OSCAR CLARK VP COMMUNITY & HEALTH SERV 0 224029 0 0 0 185 0 6721 0 7209 0 238144 0 0 CHRIS JACOBSEN VP INFORMATION TECHNOLOGY 0 221372 0 0 0 422 0 5204 0 9981 0 236979 0 0 CHERI PFANNES VP CORPORATE COMPLIANCE 0 191535 0 0 0 1126 0 5746 0 0 0 198407 0 0 ANA JIMENEZ DIRECTOR 0 304380 0 0 0 1100 0 7333 0 9616 0 322429 0 0 KARIN VILLIARIMO DIRECTOR 0 256482 0 0 0 64 0 3897 0 10155 0 270598 0 0 MICHELLE NARDONE ANALYST 0 218479 0 0 0 40 0 1732 0 6754 0 227005 0 0 SHANNON NOEL PHARMACIST 0 198813 0 0 0 110 0 3893 0 9616 0 212432 0 0 CHRISTINE PRICE ANALYST 0 181074 0 0 0 166 0 2662 0 4187 0 188089 0 0 PART I, LINE 3 RELATED ORGANIZATION COMPENSATION: FAMILYCARE, INC. AND FAMILYCARE HEALTH PLANS, INC. ARE RELATED TAX-EXEMPT ORGANIZATIONS. THE COMPENSATION METHODOLOGY OF FAMILYCARE, INC. IS NOTED IN SCHEDULE O. FORM 990, PART VI, SECTION A, LINE 2 JEFFREY PAWLOWSKI, BOARD MEMBER, AND MICHAEL RILEY, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. 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 FAMILYCARE, INC. IS THE ORGANIZATION'S SOLE MEMBER. FAMILYCARE, INC. HAS 8 CORPORATE MEMBERS. THE CORPORATE MEMBERS ELECT THE BOARD MEMBERS THAT GOVERN BOTH ORGANIZATIONS. FORM 990, PART VI, SECTION A, LINE 7B THE POWERS RESERVED TO THE MEMBERS OF FAMILYCARE, INC. 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 CORPORATION; AND (F) APPROVING THE SALE, TRANSFER, MERGER, OR DISSOLUTION OF THE CORPORATION. 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 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. OTHER EMPLOYEES: THE VICE PRESIDENT OF HUMAN RESOURCES IS ACCOUNTABLE TO USE PUBLISHED, REPUTABLE DATA FOR COMPARISONS OF JOB ACCOUNTABILITIES AND COMPENSATION RANGES, INCLUDING DATA PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS. BASED ON THE DATA, THE VICE PRESIDENT OF HUMAN RESOURCES ESTABLISHES AND UPDATES THE COMPENSATION RANGES, AND RESPONDS TO ANY INQUIRIES RELATED TO FAIRNESS, EQUITY AND PROCESS. FORM 990, PART VI, SECTION C, LINE 19 FAMILYCARE HEALTH PLANS, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC AT THIS TIME. FORM 990, PART IX, LINE 11G MEDICAL PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 3,769,811. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,769,811. PHYSICIAN SERVICES : PROGRAM SERVICE EXPENSES 4,951,263. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,951,263. OTHER PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 196,959. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 196,959. CONSULTING & CLAIMS PROCESSING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,823,234. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,823,234. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSEEING THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTING AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. FAMILYCARE INC 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 930878074 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) FAMILYCARE HEALTH PLANS 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 N/A 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 FAMILYCARE INC N 113006 CASH - U.S. CURRENCY FAMILYCARE INC O 388796 CASH - U.S. CURRENCY PART II FAMILYCARE HEALTH PLANS, INC. IS RELATED TO FAMILYCARE, INC. AND TO HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION IN HEALTH CARE, BOTH TAX-EXEMPT ORGANIZATIONS, BY VIRTUE OF ITS BOARD MEMBERS SERVING ON THE BOARDS OF BOTH RELATED ORGANIZATIONS.