2015-10-06T11:57:26-05:00 2014-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2014-01-01 911829317 FAMILYCARE HEALTH PLANS INC FAMI 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFF HEATHERINGTON PRESIDENT 5032223205 2015-09-22 1 ROY ABRAMOWITZ P01329049 5032210336 2014 2016-02-25 16:41:14Z JEFF HEATHERINGTON 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 42995943 0 X N/A X 1997 OR TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 12 9 15 0 0 0 0 0 31142604 32110116 81831 194016 0 0 31224435 32304132 0 0 0 0 631724 958778 0 0 0 30740896 36334501 31372620 37293279 -148185 -4989147 12073782 27853743 6655921 7052194 5417861 20801549 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 32100621 32110116 PROVIDING COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH CENTERS OF MEDICARE AND MEDICAID SERVICES (CMS). SERVED APPROXIMATELY 2,614 MEMBERS MONTHLY. 32100621 0 0 0 0 0 0 0 0 0 0 1 0 1 1 1 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 1 607 0 1 15 1 0 0 0 0 0 0 X 12 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X THE ORGANIZATION 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFF HEATHERINGTON PRESIDENT 1.00 X X 0 429438 14171 JEFFREY PAWLOWSKI TREASURER 1.00 X X 0 0 0 KAREN CARNAHAN DIRECTOR 1.00 X 0 11000 0 ROBIN RICHARDSON CHAIR 1.00 X X 0 0 0 JANET TESCH VICE CHAIR 1.00 X X 0 11500 0 ROBERT CARUS DIRECTOR 1.00 X 0 0 0 JOE HROMCO DIRECTOR 1.00 X 0 0 0 PATRICIA PARKER SECRETARY 1.00 X X 0 0 0 MIKE RILEY DIRECTOR 1.00 X 0 0 0 RICHARD BARSOTTI DIRECTOR 1.00 X 0 0 0 CARL ERICKSON DIRECTOR 1.00 X 0 0 0 MATT DASKALOS DIRECTOR 1.00 X 0 0 0 ROBIN TOLLE DIRECTOR SALES & ENROLLMENT 40.00 X 168578 0 8268 RESA BRADEEN MEDICAL DIRECTOR 1.00 X 0 341881 21996 168578 793819 44435 1 0 1 0 PACWEST COMMUNICATIONS 8600 SW ST HELENS DR STE 100 WILSONVILLE OR 97070 MARKETING 412533 MILLIMAN INC 1301 FIFTH AVE STE 3800 SEATTLE WA 981012605 CONSULTING 410483 LAMAR OBIE CORPORATIONS PO BOX 96030 BATON ROUGE LA 70896 MARKETING 408718 PERFORMANCE HEALTH TECHNOLOGY 3993 FAIRVIEW INDUSTRIAL DR SOUTH SALEM OR 97302 CLAIMS PROCESSING 350713 MEDAGATE CORPORATION 1001 BAYHILL DR SUITE 185 B SAN CARLOS CA 94066 TPA-RX 266960 13 32110116 32110116 32110116 148964 148964 10736863 10691811 45052 45052 45052 32304132 32110116 0 194016 X 880549 880549 7390 7390 70839 70839 936770 936770 144859 144859 16051 16051 50098 50098 OTHER PROFESSIONAL SERV 13869322 13869322 INPATIENT HOSPITAL 9286342 9286342 EMERGENCY ROOM AND OUT- 3188392 3188392 PHYSICIAN SERVICES 3180024 3180024 5662643 2576541 3086102 37293279 32100621 5192658 0 278598 13565732 407092 654034 2946653 2122730 5005831 7956021 2267073 1626906 1168535 1928320 12073782 27853743 587707 427571 6068214 6624623 6655921 7052194 X 5417861 20801549 5417861 20801549 12073782 27853743 X -4989147 372834 20000000 X X 0 1 X 1 0 0 US TREASURY NOTES 1626906 F 1626906 OTHER CURRENT ASSETS, NET 1376325 OTHER ASSETS 274829 RESTRICTED LONG-TERM INVESTMENTS 277166 1928320 OTHER POLICY LIABILITIES 392487 DUE TO AFFILIATES 106557 CLAIMS PAYABLE AND UNPAID CLAIMS ADJUDICATION 6125579 6624623 X PART X, LINE 2: FINANCIAL STATEMENT FOOTNOTE REGARDING FIN 48: FAMILYCARE AND HEALTH PLANS ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4). ONLY THE COMPANY'S UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. IT IS MANAGEMENT'S BELIEF THAT NONE OF THE COMPANY'S ACTIVITIES HAVE GENERATED MATERIAL UNRELATED BUSINESS INCOME; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. GENERALLY, THE COMPANY IS SUBJECT TO EXAMINATION BY FEDERAL, STATE AND LOCAL INCOME TAX AUTHORITIES FOR THREE YEARS FROM THE FILING OF A TAX RETURN. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO SUCH EXAMINATIONS FOR YEARS ENDED BEFORE DECEMBER 31, 2011. 0 0 0 0 0 0 0 0 0 JEFF HEATHERINGTON PRESIDENT 0 376250 0 39509 0 13679 0 7500 0 6671 0 443609 0 0 ROBIN TOLLE DIRECTOR SALES & ENROLLMENT 107692 0 55706 0 5180 0 0 0 8268 0 176846 0 0 0 RESA BRADEEN MEDICAL DIRECTOR 0 225115 0 111268 0 5498 0 7500 0 14496 0 363877 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 AS FOLLOWS. 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. 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 A RELATED ORGANIZATION TO FAMILYCARE HEALTH PLANS, 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 C, LINE 19 FAMILYCARE HEALTH PLANS, 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 2,576,541. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,576,541. OTHER PROFESSIONAL SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,840,479. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,840,479. ADMIN FEE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 571,135. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 571,135. AGENTS COMMISSION : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 427,299. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 427,299. BAD DEBT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 74,137. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,137. REPAIRS AND MAINTENANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 67,482. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 67,482. POSTAGE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 45,158. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 45,158. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 17,505. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,505. OTHER ADMINISTRATIVE EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 10,306. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,306. DUES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 9,721. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,721. TRAINING : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 8,884. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,884. MEALS AND ENTERTAINMENT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,296. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,296. OTHER INSURANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,655. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,655. MISCELLANEOUS : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,031. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,031. BANK FEES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 2,272. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,272. TAX EXPENSE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 742. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 742. FORM 990, PART XI, LINE 9: INVESTMENT FROM FAMILYCARE, INC. 20,000,000. 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 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 930878074 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) 0 HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 930988354 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(3) NON-PRIVATE FDN 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FAMILYCARE INC S 106557 FMV FAMILYCARE INC C 15383689 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. PART V THE ORGANIZATIONS OTHER TRANSFER OF CASH FROM FAMILYCARE,INC. WAS FOR OPERATIONAL EXPENSES.