2016-10-06T14:16:50-05:00 2015-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2015-01-01 930878074 FAMILYCARE INC FAMI 5032223205 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 JEFF HEATHERINGTON PRESIDENT 5032223205 2016-09-29 1 ROY ABRAMOWITZ P01329049 5032210336 2015 2017-02-10 21:41:12Z X JEFF HEATHERINGTON 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 812747214 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 13 3 327 0 0 0 75000 0 408528254 543777686 1879964 3032761 0 24800000 410483218 571610447 15361715 4014947 0 0 11392057 16013386 0 0 0 310450257 477255749 337204029 497284082 73279189 74326365 210164926 319177877 101254186 151138753 108910740 168039124 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 441423005 4014947 568577686 PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID. APPROXIMATELY 121,410 SERVED MONTHLY. 441423005 0 0 0 1 0 0 0 0 0 1 1 0 1 1 1 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 1622 0 1 327 1 0 0 0 0 0 0 X 13 3 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X THE ORGANIZATION 5032223205 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 JEFFREY PAWLOWSKI TREASURER & DIRECTOR 1.00 X X 11297 0 0 KAREN CARNAHAN DIRECTOR 1.00 X 5969 0 0 ROBIN RICHARDSON DO DIRECTOR 1.00 X 14469 0 0 JANET TESCH VICE CHAIR 1.00 X X 10219 0 0 RICHARD BARSOTTI DIRECTOR 1.00 X 4719 0 0 ROBERT CARUS DIRECTOR 1.00 X 5969 0 0 JOE HROMCO DIRECTOR 1.00 X 5969 0 0 PATRICIA PARKER BOARD SECRETARY 1.00 X X 3250 0 0 MIKE RILEY DIRECTOR 1.00 X 5219 0 0 CARL ERICKSON DIRECTOR 1.00 X 4969 0 0 MATT DASKALOS VICE CHAIR 1.00 X X 4719 0 0 JEFF HEATHERINGTON PRESIDENT 40.00 X X 637003 0 20260 EVERETT NEWCOMB DIRECTOR 1.00 X 2219 0 0 WILLIAM MURRAY COO 40.00 X 408430 0 27386 CHONG LEE MEDICAL DIRECTOR 40.00 X 387351 0 12413 KEVIN CLANCY VP FINANCE 40.00 X 254919 0 25692 OSCAR CLARK VP COMMUNITY & HEALTH SERVICE 40.00 X 244679 0 14927 CHRISTOPHER DIAZ VP INFORMATION TECHNOLOGY 40.00 X 239665 0 24254 CHERI PFANNES VP CORPORATE COMPLIANCE 40.00 X 159512 0 5544 JOSEPH BADOLATO DIRECTOR 40.00 X 250265 0 25691 ANTHONY JACKSON MANAGER 40.00 X 182644 0 12933 MARY BRENNER DIRECTOR 40.00 X 181979 0 6838 CINDY BECKER VP COMMUNITY & GOVT RELATIONS 40.00 X 180583 0 13545 3206017 0 189483 28 0 1 0 PERFORMANCE HEALTH TECHNOLOGY LTD 3993 FAIRVIEW INDUSTRIAL DR SE SALEM OR 97302 CLAIMS PROCESSING 4456112 MILLIMAN INC 901 5TH AVE SUITE 2000 SEATTLE WA 98164 CONSULTING 782437 STOEL RIVES LLP 900 SW F IFTH AVE SUITE 2600 PORTLAND OR 97204 LEGAL 707964 PASSPORT TO LANGUAGES 3912 SW 43RD AVE PORTLAND OR 97221 LANGUAGE SUPPORT 664910 LINGUAVA INTERPRETERS 7931 NE HALSEY SUITE 305 PORTLAND OR 97213 LANGUAGE SUPPORT 643087 27 543777686 543777686 543777686 2973188 2973188 241196340 241136767 59573 59573 59573 SETTLEMENT CREDIT 624100 24800000 24800000 24800000 571610447 568577686 0 3032761 X 4014947 4014947 2541013 979705 1561308 11282754 8800548 2482206 466008 363486 102522 1723611 1723611 871656 871656 185113 185113 98182 98182 50526 50526 7556553 7556553 37663 37663 1466770 1466770 1694870 1694870 328321 328321 1173055 1173055 2779682 2779682 PHYSICIAN SERVICES 95078408 95078408 INPATIENT HOSPITAL 89161821 89161821 MEDICAL AND HOSPITAL EX 73752729 73752729 OTHER PROFESSIONAL SERV 72758178 72758178 130262222 96513183 33749039 497284082 441423005 55861077 0 75133676 74433042 216281 64471558 4542339 18233538 6941469 3342552 3810008 3598917 49263532 61694106 40127848 63333310 37071242 33413406 210164926 319177877 100362481 150704329 891705 434424 101254186 151138753 X 108895745 168039124 14995 0 108910740 168039124 210164926 319177877 X 74326365 -4683477 -10514504 X X 0 1 X 1 0 0 0 1 0 1 98182 533670 631852 0 PART III-B PER REV. PROC. 98-19, FAMILYCARE, INC. IS EXEMPTED FROM THE PROXY TAX AND THE NOTIFICATION REQUIREMENT OF IRC SEC. 6033(E)(1) BECAUSE MORE THAN 90% OF THE ORGANIZATION'S ANNUAL DUES (OR SIMILAR AMOUNTS) ARE RECEIVED FROM ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3), STATE GOVERNMENTS, LOCAL GOVERNMENTS, ENTITIES WHOSE INCOME IS EXEMPT FROM TAX UNDER SECTION 115, OR ORGANIZATIONS EXCEPTED UNDER SECTION 4.01 OF REV. PROC. 98-19. 912205 143850 768355 4807387 3051139 1756248 1221877 147563 1074314 3598917 US TREASURY N/B 63333310 F 63333310 OTHER CURRENT ASSETS, NET 4069955 OTHER ASSETS, NET 195537 DUE FROM AFFILIATES 990005 RESTRICTED CASH AND CASH EQUIVALENTS 128046 INVESTMENTS IN FAMILYCARE HEALTH PLANS 10287046 RESTRICTED SHORT-TERM INVESTMENTS 4836172 RESTRICTED LONG-TERM INVESTMENTS 12906645 33413406 CAPITAL LEASE OBLIGATION, LESS CURRENT PORTION 434424 434424 X PART X, LINE 2: FINANCIAL STATEMENT FOOTNOTE REGARDING FIN 48: FAMILYCARE, INC. IS A TAX-EXEMPT ORGANIZATION PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4). ONLY THE ORGANIZATION'S UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. IT IS MANAGEMENT'S BELIEF THAT NONE OF THE ORGANIZATION'S ACTIVITIES HAVE GENERATED MATERIAL UNRELATED BUSINESS INCOME; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 AMERICAN OSTEOPATHIC 142 EAST ONTARIO ST 1450 CHICAGO IL 60611 362170786 501 (C) (3) 256000 DONATION AND SPONSORSHIP ASIAN HEALTH & SERVICE CENTER 3430 SE POWELL BLVD PORTLAND OR 97202 931192100 501 (C) (3) 50034 SPONSORSHIP BASIC RIGHTS EDUCATION FUND PO BOX 40625 PORTLAND OR 97240 931108531 501 (C) (3) 17500 DONATION AND SPONSORSHIP CASCADE AIDS PROJECT 208 SW 5TH AVE SUITE 800 PORTLAND OR 97204 930903383 501 (C) (3) 11500 SPONSORSHIP CASCADIA BEHAVIORAL HEALTHCARE 847 NE 19TH AVE STE 100 PORTLAND OR 97232 930770054 501 (C) (3) 500000 SPONSORSHIP CATHOLIC CHARITIES OREGON 2740 SE POWELL BLVD PORTLAND OR 97202 930386801 501 (C) (3) 6175 SPONSORSHIP CITY CLUB OF PORTLAND 901 SW WASHINGTON ST PORTLAND OR 97205 930140220 501 (C) (3) 5100 SPONSORSHIP CLACKAMAS COUNTY DEPT HEALTH HOUSING & SOCIAL SERVICES 2051 KAEN ROAD 154 OREGON CITY OR 97045 936002286 501 (C) (3) 60000 DONATION ASSOCIATION OF WOMEN'S HEALTH OBSTETRIC AND NEONATAL NURSES 2000 L ST NW SUITE 740 WASHINGTON DC 20036 521788738 501 (C) (3) 10000 DONATION HUMAN SOLUTIONS 12350 SE POWELL PORTLAND OR 97236 930977166 501 (C) (3) 85000 SPONSORSHIP HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION IN HEALTHCARE 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 930988354 501 (C) (3) 2350000 DONATION LIFEWORKS NORTHWEST 14600 NW CORNELL RD PORTLAND OR 97229 930502822 501 (C) (3) 111000 DONATION MOMENTUM ALLIANCE 1631 NE BROADWAY 453 PORTLAND OR 97232 454176224 501 (C) (3) 10000 SPONSORSHIP NORTHWEST FAMILY SERVICES 6200 SE KING ROAD PORTLAND OR 97222 930841022 501 (C) (3) 26250 DONATION OREGON ACADEMY OF FAMILY PHYSICIANS 1717 NE 42ND AVE STE 2103 PORTLAND OR 97213 931150833 501 (C) (3) 6908 SPONSORSHIP OREGON FOOD BANK 7900 NE 33RD DR PORTLAND OR 97211 930785786 501 (C) (3) 40612 DONATION OREGON SYMPHONY ASSOCIATION 921 SW WASHINGTON ST 200 PORTLAND OR 97205 930446527 501 (C) (3) 12905 DONATION OSTEOPATHIC PHYSICIANS & SURGEONS 4380 SW MACADAM AVE SUITE 185 PORTLAND OR 972396426 936025596 501 (C) (6) 100000 OSTEOPATHIC SUPPORT, EDUCATION GRANT OUTSIDE IN 1132 SW 13TH PORTLAND OR 97205 930567549 501 (C) (3) 50000 E.H.R SYSTEM PROVIDENCE CHILD CARE FOUNDATION 830 NE 47TH AVE PORTLAND OR 97213 930800140 501 (C) (3) 20000 DONATION SCHOOLHOUSE SUPPLIES 2735 NE 82ND AVE PORTLAND OR 97220 204223437 501 (C) (3) 132500 DONATION & SPONSORSHIP SKANNER FOUNDATION PO BOX 5455 PORTLAND OR 97228 931109980 501 (C) (3) 7895 SPONSORSHIP WILSON STRATEGIC COMMUNICATIONS 3500 188TH ST SW STE 590 LYNNWOOD WA 98037 201502691 N/A 10000 SPONSORSHIP 21 2 PART I, LINE 2: GRANT RECIPIENTS SUBMIT PERIODIC REPORTS AS DEFINED BY THEIR AGREEMENT. REPORTS INCLUDE INVOICES CONTAINING SERVICES RENDERED AND PERIOD COVERED. X X 0 0 0 0 0 0 0 0 0 JEFF HEATHERINGTON PRESIDENT 518333 0 116795 0 1875 0 12456 0 7804 0 657263 0 0 0 WILLIAM MURRAY COO 332385 0 68516 0 7529 0 11513 0 15873 0 435816 0 0 0 CHONG LEE MEDICAL DIRECTOR 354461 0 27228 0 5662 0 11620 0 793 0 399764 0 0 0 KEVIN CLANCY VP FINANCE 248461 0 5684 0 774 0 5695 0 19997 0 280611 0 0 0 OSCAR CLARK VP COMMUNITY & HEALTH SERVICE 202138 0 42530 0 11 0 7340 0 7587 0 259606 0 0 0 CHRISTOPHER DIAZ VP INFORMATION TECHNOLOGY 219077 0 13241 0 7347 0 7165 0 17089 0 263919 0 0 0 CHERI PFANNES VP CORPORATE COMPLIANCE 131877 0 27313 0 322 0 4796 0 748 0 165056 0 0 0 JOSEPH BADOLATO DIRECTOR 229846 0 5787 0 14632 0 5707 0 19984 0 275956 0 0 0 ANTHONY JACKSON MANAGER 157733 0 24897 0 14 0 5479 0 7454 0 195577 0 0 0 MARY BRENNER DIRECTOR 158731 0 22654 0 594 0 5459 0 1379 0 188817 0 0 0 CINDY BECKER VP COMMUNITY & GOVT RELATIONS 153462 0 20273 0 6848 0 1652 0 11893 0 194128 0 0 0 RICHARD BARSOTTI BOARD MEMBER 1897059 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. DR. RICHARD BARSOTTI IS A PARTNER OF THE CLINIC. 0 KAREN CARNAHAN BOARD MEMBER 246573 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM. MS. KAREN CARNAHAN IS AN OWNER OF THE FIRM. 0 PATRICIA PARKER BOARD MEMBER 3945309 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. DR. PATRICIA PARKER IS THE MANAGER OF HEALTH & SAFETY FOR THE CLINIC. 0 JOSEPH HROMCO BOARD MEMBER 2451501 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. DR. JOE HROMCO IS A PARTNER OF THE CLINIC. 0 MICHAEL RILEY BOARD MEMBER 106414 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM. MR. MICHAEL RILEY IS AN OWNER OF THE FIRM. 0 CARL ERICKSON BOARD MEMBER 37090 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. DR. CARL ERICKSON IS AN OWNER OF THE CLINIC. 0 FORM 990, PART VI, SECTION A, LINE 2 JEFFREY PAWLOWSKI, BOARD MEMBER, AND MICHAEL RILEY, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS CARL ERICKSON, RICHARD BARSOTTI, JOE HROMCO, KAREN CARNAHAN, AND PATRICIA PARKER OWN OR CONTROL ENTITIES THAT DO BUSINESS WITH FAMILYCARE, INC. FORM 990, PART VI, SECTION B, LINE 11 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 THE CEO TOTAL COMPENSATION IS A DOMAIN HELD EXCLUSIVELY BY THE BOARD OF DIRECTORS. THE CEO PERFORMS UNDER AN EXECUTIVE EMPLOYMENT CONTRACT WHICH IS NEGOTIATED AND UPDATED BY THE BOARD. COO: THE LEVEL AND ADEQUACY OF THE COO TOTAL COMPENSATION IS DETERMINED BY THE CEO, WITH INPUT AND ANALYSIS SUPPLIED BY THE DIRECTOR 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 DIRECTOR OF HR 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 DIRECTOR 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. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 24E OTHER MEDICAL AND HOSPITAL EXPENSES: PROGRAM SERVICE EXPENSES 70,906,447. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,906,447. BAD DEBT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 31,568,877. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,568,877. EMERGENCY ROOM AND OUT-OF-AREA SERV : PROGRAM SERVICE EXPENSES 25,606,736. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,606,736. EQUIPMENT RENTAL & MAINTENANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,710,918. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,710,918. OTHER EMPLOYEE EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 233,712. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 233,712. OTHER EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 192,169. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,169. BOOKS/SUBSCRIPTIONS/DUES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 154,768. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,768. MEALS AND ENTERTAINMENT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 124,953. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 124,953. OTHER ADMINISTRATIVE EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES -236,358. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -236,358. FORM 990, PART XI, LINE 9: INCOME FROM SUBSIDIARY -10,514,504. 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 300 PORTLAND OR 97232 911829317 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) 0 HEATHERINGTON FOUNDATION FOR INNOVATION & EDUCATION IN HEALTHCARE FKA FCMC 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 930988354 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(3) NON-PRIVATE FDN 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FAMILYCARE HEALTH PLANS INC D 883448 FMV HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION IN HEALTH CARE B 2350000 FMV PART II FAMILYCARE, INC. AND FAMILYCARE HEALTH PLANS, INC. ARE RELATED TAX-EXEMPT ORGANIZATIONS BY VIRTUE OF HAVING THE SAME BOARD OF DIRECTORS. HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION IN HEALTH CARE IS A RELATED TAX-EXEMPT ORGANIZATION BY VIRTUE OF ITS BOARD MEMBERS SERVING ON THE BOARD OF FAMILYCARE, INC. AND FAMILYCARE HEALTH PLANS, INC.