2018-11-06T11:42:06-06:00 2017-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2017-01-01 930878074 FAMILYCARE INC FAMI 5032223205 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 JEFFREY HEATHERINGTON PRESIDENT, CEO 5032223205 2018-10-29 1 CYNTHIA P BARTHOLOMEW P01313965 5032210336 2018-10-29 70.102.39.100 2018-10-29 14:52:03 PD P B01359FE453E4800DAEA04FA9F75AD3820A6EE36 8C1C78DD8FC880D0435241EC6ED772A926349A0D 2017 2019-02-21 02:37:17Z JEFFREY HEATHERINGTON 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 660143772 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 10 8 411 0 0 0 23000 60928 495159924 512666738 2421455 8360380 26891 34902 497631270 521122948 978110 1114640 0 0 22991240 35111102 0 0 0 494567816 523149001 518537166 559374743 -20905896 -38251795 272139883 176652870 136098585 88546638 136041298 88106232 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 512051494 1114640 512701640 DURING 2017, FAMILYCARE, INC. CONTINUED TO PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID. APPROXIMATELY 119,184 SERVED MONTHLY. 512051494 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 1 1483 0 1 411 1 0 0 0 0 1 1 0 X 10 8 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X ANTHONY JACKSON 5032223205 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 ROBIN RICHARDSON DO CHAIR & DIRECTOR 1.00 1.00 X X 11250 0 0 JANET TESCH VICE CHAIR (PART YEAR) & BOARD MEMBER 1.00 X X 1000 0 0 MATT DASKALOS VICE CHAIR (PART YEAR) & BOARD MEMBER 1.00 X X 2500 0 0 PATRICIA PARKER SECRETARY & BOARD MEMBER 1.00 X X 3750 0 0 JEFFREY PAWLOWSKI TREASURER & BOARD MEMBER 1.00 1.00 X X 9390 0 0 KAREN CARNAHAN BOARD MEMBER 1.00 X 1000 0 0 RICHARD BARSOTTI BOARD MEMBER 1.00 X 4250 0 0 ROBERT CARUS BOARD MEMBER 1.00 X 6000 0 0 JOE HROMCO BOARD MEMBER 1.00 X 5250 0 0 MICHAEL RILEY BOARD MEMBER 1.00 1.00 X 4762 0 0 CARL ERICKSON BOARD MEMBER 1.00 X 4250 0 0 ROYAL E HARRIS BOARD MEMBER 1.00 X 5500 0 0 JEFFREY HEATHERINGTON PRESIDENT, CEO 39.00 1.00 X 504000 0 16821 PAIGE JACKSON VP 30.00 10.00 X 206183 0 14658 WILLIAM MURRAY COO 30.00 10.00 X 378798 0 25919 KEVIN CLANCY VP FINANCE 30.00 10.00 X 277428 0 30487 OSCAR CLARK VP COMMUNITY & HEALTH SERV 30.00 10.00 X 227640 0 15586 CHRISTOPHER DIAZ VP INFORMATION TECHNOLOGY 30.00 10.00 X 195752 0 5188 CHERI PFANNES VP CORPORATE COMPLIANCE 30.00 10.00 X 179613 0 7214 BENNETT GARNER DIRECTOR 30.00 10.00 X 305278 0 26010 ANNA JIMENEZ DIRECTOR 30.00 10.00 X 267342 0 25817 ALEXANDER BULOCHNIK MANAGER 30.00 10.00 X 195140 0 20280 WILLIAM GUEST III VP PROVIDER NETWORK 30.00 10.00 X 219321 0 25027 RONALD LANGERGREN DIRECTOR 30.00 10.00 X 181904 0 4740 3197301 0 217747 51 0 1 0 TRIZETTO CORPORATION 9655 MAROON CIR ENGLEWOOD CO 80112 CLAIMS PROCESSING 5417803 PERFORMANCE HEALTH TECHNOLOGY LTD 3993 FAIRVIEW INDUSTRIAL DR SE SALEM OR 97302 CLAIMS PROCESSING 4668289 PERKINS COIE 1201 THIRD AVE STE 4900 SEATTLE WA 98101 LEGAL SERVICES 1622890 LINGUAVA INTERPRETERS 12106 NE MARX ST PORTLAND OR 97220 LANGUAGE SUPPORT 1204766 TECH HEADS INC 7060 SE BEVELAND PORTLAND OR 97223 CONSULTING 992671 32 60928 60928 MEDICAID PREMIUMS 624100 465108918 465108918 BAD DEBT RECOVERY 424000 47557820 47557820 512666738 4799870 4799870 142581334 139020824 3560510 3560510 3560510 SETTLEMENT CREDIT 624100 34902 34902 34902 521122948 512701640 0 8360380 X 1114640 1114640 2144190 579309 1564881 26563610 13484179 13079431 556997 442805 114192 3580965 2846816 734149 2265340 1691241 574099 2626211 2626211 200274 200274 5960 5960 238381835 225878246 12503589 252011 252011 942194 942194 3721651 3721651 267273 267273 24984 24984 994776 994776 259133 259133 OTHER MEDICAL AND HOSPI 96381175 96381175 INPATIENT HOSPITAL 89770820 89770820 MEDICAL AND HOSPITAL EX 52588125 52588125 EMERGENCY ROOM AND OUT- 27256388 27256388 9476191 17750 9458441 559374743 512051494 47323249 0 68751728 18526539 59644788 26949145 16225384 3581591 1180877 1558279 6133670 3970271 6908471 2163399 103162090 104667100 16266545 19206817 272139883 176652870 135611400 88215573 487185 331065 136098585 88546638 X 136033298 88106232 8000 0 136041298 88106232 272139883 176652870 X -38251795 442291 -10125562 X X 0 1 X 1 0 17750 0 0 0 PART I-A, LINE 1: MONETARY DONATIONS TO SUPPORT CANDIDATES FOR ELECTIVE PUBLIC OFFICE 183358 40760 142598 5043409 3723425 1319984 906903 206086 700817 2163399 PRESCRIPTION REBATES RECEIVABLE 572783 INVESTMENT IN FAMILYCARE HEALTH PLANS 16909230 DUE FROM AFFILIATES 166568 OTHER ASSETS, NET 444497 ACCRUED INTEREST AND DIVIDENDS 1113739 19206817 CAPITAL LEASE OBLIGATION 331065 331065 1 ASIAN HEALTH & SERVICE CENTER 3430 SE POWELL BLVD PORTLAND OR 97202 931192100 501(C)(3) 90101 SPONSORSHIP CASCADE AIDS PROJECT 208 SW 5TH AVE SUITE 800 PORTLAND OR 97204 930903383 501(C)(3) 80000 SPONSORSHIP GLADSTONE SCHOOL DISTRICT #115 17789 WEBSTER RD GLADSTONE OR 97027 936000287 STATE OF ORE/GLAD SD 215000 GENERAL OPERATING SUPPORT NORTHWEST FAMILY SERVICES 6200 SE KING RD PORTLAND OR 97222 930841022 501(C)(3) 115025 GENERAL OPERATING SUPPORT PROJECT ACCESS NOW PO BOX 10953 PORTLAND OR 97296 208928388 501(C)(3) 80000 GENERAL OPERATING SUPPORT YAKIMA VALLEY FARM WORKERS CLINIC PO BOX 190 TOPPENISH WA 98948 911019392 501(C)(3) 67303 GENERAL OPERATING SUPPORT MULTNOMAH COUNTY OREGON 501 SE HAWTHORNE BLVD PORTLAND OR 97214 936002309 MULTNOMAH COUNTY 58649 GENERAL OPERATING SUPPORT LIFEWORKS NORTHWEST 14600 NW CORNELL RD PORTLAND OR 97229 930502822 501(C)(3) 53500 GENERAL OPERATING SUPPORT RANDALL CHILDREN'S HOSPITAL FOUNDATION PO BOX 4484 PORTLAND OR 97208 931314469 501(C)(3) 50000 GENERAL OPERATING SUPPORT PHAME ACADEMY 1631 NE BROADWAY 134 PORTLAND OR 97232 930991167 501(C)(3) 50000 GENERAL OPERATING SUPPORT SCHOOL DISTRICT 1J MULTNOMAH COUNTY 501 N DIXON ST PORTLAND OR 97227 936000830 MULTNOMAH COUNTY 48222 GENERAL OPERATING SUPPORT LATINO NETWORK 410 NE 18TH AVE PORTLAND OR 97232 731675402 501(C)(3) 45830 GENERAL OPERATING SUPPORT CENTRAL CITY CONCERN 232 NW SIXTH AVE PORTLAND OR 97209 930728816 501(C)(3) 34210 GENERAL OPERATING SUPPORT THE INTERTWINE ALLIANCE FOUNDATION 2100 SW RIVERPARKWAY STE 450 PORTLAND OR 97201 452629474 501(C)(3) 20000 GENERAL OPERATING SUPPORT HELPING MEN HEAL LLC 16703 SE MCGILLIVRAY BLVD STE 185 VANCOUVER WA 98683 460808649 501(C)(3) 15000 GENERAL OPERATING SUPPORT NORTH BY NORTHEAST COMMUNITY CENTER 714 NE ALBERTA STREET PORTLAND OR 97211 721618287 501(C)(3) 15000 GENERAL OPERATING SUPPORT ADELANTE MUJERES 2036 MAIN STREET STE A FOREST GROVE OR 97116 304731810 501(C)(3) 12137 GENERAL OPERATING SUPPORT OREGON FOOD BANK 7900 NE 33RD DR PORTLAND OR 97211 930785786 501(C)(3) 7000 GENERAL OPERATING SUPPORT PART I, LINE 2: GRANT RECIPIENTS SUBMIT PERIODIC REPORTS AS DEFINED BY THEIR AGREEMENTS. REPORTS INCLUDE INVOICES CONTAINING SERVICES RENDERED AND PERIOD COVERED. X X X X X 0 0 0 0 0 0 0 0 0 JEFFREY HEATHERINGTON PRESIDENT, CEO 504000 0 0 0 0 0 8100 0 8721 0 520821 0 0 0 PAIGE JACKSON VP 195024 0 5664 0 5495 0 6186 0 8472 0 220841 0 0 0 WILLIAM MURRAY COO 361051 0 11250 0 6497 0 8100 0 17819 0 404717 0 0 0 KEVIN CLANCY VP FINANCE 269441 0 7987 0 0 0 8323 0 22164 0 307915 0 0 0 OSCAR CLARK VP COMMUNITY & HEALTH SERV 220836 0 6804 0 0 0 6829 0 8757 0 243226 0 0 0 CHRISTOPHER DIAZ VP INFORMATION TECHNOLOGY 163995 0 6661 0 25096 0 5188 0 0 0 200940 0 0 0 CHERI PFANNES VP CORPORATE COMPLIANCE 173600 0 5055 0 958 0 5388 0 1826 0 186827 0 0 0 BENNETT GARNER DIRECTOR 292151 0 8999 0 4128 0 8100 0 17910 0 331288 0 0 0 ANNA JIMENEZ DIRECTOR 255102 0 8566 0 3674 0 8020 0 17797 0 293159 0 0 0 ALEXANDER BULOCHNIK MANAGER 170810 0 4991 0 19339 0 5854 0 14426 0 215420 0 0 0 WILLIAM GUEST III VP PROVIDER NETWORK 203907 0 10000 0 5414 0 2921 0 22106 0 244348 0 0 0 RONALD LANGERGREN DIRECTOR 153758 0 4245 0 23901 0 4740 0 0 0 186644 0 0 0 CARNAHAN SMITH AND GUNTER ENTITY MORE THAN 35% OWNED BY KAREN CARNAHAN, BOARD MEMBER 217755 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM FOR LEADERSHIP TRAINING. 0 RILEY RESEARCH ASSOCIATES ENTITY MORE THAN 35% OWNED BY MICHAEL RILEY, BOARD MEMBER 10190 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM. 0 WESTERN PSYCHOLOGICAL & COUNSELING SERVICES INC BOARD MEMBER JOSEPH HROMCO IS THE VICE PRESIDENT OF OPERATIONS 3479188 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 2 JEFFREY PAWLOWSKI, BOARD MEMBER, AND MICHAEL RILEY, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. ROBERT CARUS, BOARD MEMBER, AND KAREN CARNAHAN, BOARD MEMBER, ALSO HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS MICHAEL RILEY, JOE HROMCO, AND KAREN CARNAHAN OWN OR CONTROL ENTITIES THAT DO BUSINESS WITH FAMILYCARE, INC. 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 15A COMPENSATION METHODOLOGY: CEO: THE LEVEL AND ADEQUACY OF THE 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 COMPARABILITY DATA IN DETERMINING THE SALARY, AND ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED. COO: THE LEVEL AND ADEQUACY OF THE COO TOTAL COMPENSATION IS DETERMINED BY THE CEO, WITH INPUT AND ANALYSIS SUPPLIED BY THE VICE PRESIDENT OF HUMAN RESOURCES. HIGHLY COMPENSATED EXECUTIVES SUCH AS VICE PRESIDENT OF FINANCE, VICE PRESIDENT COMMUNITY AND BUSINESS DEVELOPMENT, DIRECTOR OF GOVERNMENT PROGRAMS, VICE PRESIDENT OF INTEGRATED SERVICES, DIRECTOR OF INFORMATION SERVICES, AND OTHER EXECUTIVES ALL HAVE COMPENSATION DETERMINED AS DESCRIBED BELOW. GENERAL APPROACH TO COMPENSATION DETERMINATIONS: IN THE FIRST QUARTER OF 2013, ALL COMPENSATION RANGES EXCLUDING THE CEO WERE REVIEWED AND TESTED BY AN EXTERNAL COMPENSATION PROFESSIONAL. HE EXAMINED CURRENT SALARIES, COMPARABILITY, EXEMPTION STATUS, RANGES, AND EQUITY IN ALL JOBS IN FAMILYCARE. HIS FINDINGS WERE POSITIVE, WITH ONLY RECOMMENDATIONS TO CORRECT THE NON-EXEMPT STATUS OF SEVERAL EMPLOYEES. IN DETERMINING WAGE PLACEMENT OR SALARY, THE VICE PRESIDENT OF HUMAN RESOURCES IS ACCOUNTABLE TO USE PUBLISHED, REPUTABLE DATA FOR COMPARISONS OF JOB ACCOUNTABILITIES AND COMPENSATION RANGES. FAMILYCARE ENGAGED AN ORGANIZATION IN THE FIRST QUARTER OF 2013; THIS ORGANIZATION HAS A PUBLISHED INVENTORY OF DETAILED INFORMATION ABOUT NATIONAL JOBS THAT INCLUDE JOB CONTENT, ACCOUNTABILITIES, USUAL REQUIREMENTS, NATIONAL, REGIONAL AND SPECIFIC PORTLAND AREA RANGES. THE VICE PRESIDENT OF HR SETS ALL SALARIES AND RESPONDS TO ANY INQUIRIES RELATED TO FAIRNESS, EQUITY, AND PROCESS. 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 IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 120,642,627. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,642,627. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,480,185. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,480,185. MEDICAL PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 47,262,986. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,262,986. CONSULTING & CLAIMS PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 11,023,404. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,023,404. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 57,972,633. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,972,633. FORM 990, PART XI, LINE 9: LOSS FROM SUBSIDIARY -10,125,562. 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 HEALTH PLANS INC 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 911829317 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) 1 HEATHERINGTON FOUNDATION FOR INNOVATION & EDUCATION IN HEALTHCARE FKA FCMC 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 930988354 TO SUPPORT INNOVATION AND FUND HEALTHCARE EDUCATION OR 501(C)(3) PF 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 FAMILYCARE HEALTH PLANS INC B 15000000 CASH - U.S. CURRENCY FAMILYCARE HEALTH PLANS INC N 209952 CASH - U.S. CURRENCY FAMILYCARE HEALTH PLANS INC O 664147 CASH - U.S. CURRENCY 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 HAVING BOARD MEMBERS IN COMMON. MORE THAN 50% OF MEMBERS OF THE RELATED ORGANIZATIONS' BOARDS ALSO SERVE ON FAMILYCARE, INC.'S BOARD OF DIRECTORS.