2013-08-14T16:59:52-05:00 2012-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2012-01-01 930878074 FAMILYCARE INC FAMI 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFF HEATHERINGTON 5032223205 2013-08-06 1 ROY ABRAMOWITZ P01329049 5032210336 2012 2016-02-24 21:20:13Z JEFF HEATHERINGTON 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 141807725 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 11 6 167 0 0 0 0 0 145060257 138374851 245004 357683 0 0 145305261 138732534 341207 2109924 0 0 8167768 7554574 0 0 0 127778763 120711790 136287738 130376288 9017523 8356246 42848263 51943890 26176775 27000566 16671488 24943324 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 120593590 2109924 138374851 PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID. APPROXIMATELY 52,653 SERVED MONTHLY. 120593590 0 0 1 1 0 0 0 0 0 1 0 0 1 1 1 1 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 1046 0 1 167 1 0 0 0 0 0 0 X 11 6 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X JEFF HEATHERINGTON 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFFREY PAWLOWSKI 1.00 X X 15100 0 0 KAREN CARNAHAN 1.00 X X 20549 0 0 ROBIN RICHARDSON DO 1.00 X X 5300 0 0 JANET TESCH 1.00 X X 8320 0 0 ROBERT CARUS 1.00 X 6400 0 0 ROSS RONISH 1.00 X 3937 0 0 RICHARD BARSOTTI 1.00 X 2200 0 0 JOE HROMCO 1.00 X 3900 0 0 RICHARD OLSON 1.00 X 2500 0 0 PATRICIA PARKER 1.00 X 2400 0 0 MIKE RILEY 1.00 X 3227 0 0 JEFF HEATHERINGTON 40.00 X 416848 0 14143 GREG MARTENSON 40.00 X 164900 0 20763 JESSE GAMEZ 40.00 X 233790 0 7563 DOUGLAS LUTHER 40.00 X 267283 0 8167 DAYNA STERINGER 40.00 X 152932 0 15933 BILL BUTCHER 40.00 X 146676 0 3727 DANIEL ROTH 40.00 X 265914 0 23397 BILL HURST 40.00 X 128791 0 2781 AMY BRUCE 40.00 X 109451 0 20717 1960418 0 117191 12 0 1 0 PHYSICIANS INSURANCE A MUTAL CO 1301 SECOND AVENUE SUITE 2700 SEATTLE WA 98101 INSURANCE SERVICES 2425839 HEALTH NET OF OREGON 11918 SE DIVISION 144 PORTLAND OR 97266 INSURANCE SERVICES 1295173 VISION SERVICE PLAN 9600 SW NUMBUS AVE SUITE 200 BEAVERTON OR 97008 INSURANCE SERVICES 628832 MCKESSON HEALTH SOLUTIONS LLC 22423 NETWORK PLACE CHICAGO IL 606731224 CONSULTING 460744 PERFORMANCE HEALTH TECHNOLOGY LTD 3993 FAIRVIEW INDUSTRIAL DR SE SALEM OR 97302 CLAIMS PROCESSING 344393 19 138374851 138374851 138374851 339124 339124 3093750 3075191 18559 18559 18559 138732534 138374851 0 357683 2109924 2109924 1207288 597699 609589 5236917 4608487 628430 228370 200966 27404 881999 881999 273034 273034 89409 89409 32050 32050 14283 14283 406000 406000 997406 997406 135896 135896 11148 11148 28459 28459 1039159 1039159 1433373 1433373 INPATIENT HOSPITAL 31554605 31554605 PHYSICIAN SERVICES 28740700 28740700 OTHER PROFESSIONAL SERV 26504824 24839815 1665009 OTHER MEDICAL AND HOSPI 16691004 16691004 12760440 11250390 1510050 130376288 120593590 9782698 0 18218115 11375340 1251074 0 3006286 4597946 5095002 3291905 3034135 1803097 3333565 21418421 14005088 12749086 42848263 51943890 25712291 26647319 464484 353247 26176775 27000566 X 16671488 24943324 16671488 24943324 42848263 51943890 X 8356246 168842 -253252 X X 0 1 X 1 0 5050 1 0 1 32000 263992 295992 0 PART IV, SUPPLEMENTAL INFORMATION: PART I-A, LINE 1 $50 WAS CONTRIBUTED TO THE JUDGE KEMP CAMPAIGN $5,000 WAS CONTRIBUTED TO THE KITZHABER FOR GOVERNOR CAMPAIGN 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. 68312 24707 43605 4391145 3083536 1307609 635545 183662 451883 1803097 OTHER CURRENT ASSETS, NET 1399466 OTHER ASSETS, NET 167643 DUE FROM AFFILIATES 353235 RESTRICTED CASH AND CASH EQUIVALENTS 388070 INVESTMENTS IN FAMILYCARE HEALTH PLANS 4486685 RESTRICTED SHORT-TERM INVESTMENTS 3383232 RESTRICTED LONG-TERM INVESTMENTS 2570755 12749086 CAPITAL LEASE OBLIGATION, LESS CURRENT PORTION 353247 353247 167616470 168842 28715094 28883936 138732534 0 138732534 159344634 28968346 28968346 130376288 0 130376288 PART XI, LINE 2D - OTHER ADJUSTMENTS: OTHER ENTITY REVENUE 28,715,094. PART XII, LINE 2D - OTHER ADJUSTMENTS: OTHER ENTITY EXPENSE 28,968,346. SCHEDULE D, PART X, LINE 1 FINANCIAL STATEMENT FOOTNOTE REGARDING ASC 740: 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, 2009. 1 OSTEOPATHIC PHYSICIANS & SURGEONS OF OREGON INC 4380 SW MACADAM AVE SUITE 125 PORTLAND OR 97239 936025596 501(C)(6) 115000 OSTEOPATHIC SUPPORT; EDUCATION GRANT. BASIC RIGHTS EDUCATION FUND PO BOX 40625 PORTLAND OR 97240 931266613 501(C)(3) 7500 SPONSORSHIP - EQUALITY LUNCH & JUST CIRCLE CASCADE AIDS PROJECT 208 SW 5TH AVE STE 800 PORTLAND OR 97204 930903383 501(C)(3) 10010 SPONSORSHIP - AIDS WALK WESTERN UNIVERSITY OF HEALTH SCIENCES 200 MULLINS DR LEBANON OR 97355 953127273 501(C)(3) 1882993 SPONSORSHIP & DONATION - NEW SCHOOL GLADSTONE EDUCATION FOUNDATION - JOHN WETTEN ELEMENTARY SCHOOL 250 E EXETER ST GLADSTONE OR 97027 931284265 501(C)(3) 8000 SPONSORSHIP & DONATION NAMI - OREGON 4701 SE 24TH AVE STE E PORTLAND OR 97202 930875209 501(C)(3) 5371 SPONSORSHIP - WALK KICKOFF LUNCH & FUNDRAISING MATCH LUND REPORT PO BOX 82841 PORTLAND OR 97282 263019179 501(C)(3) 7500 DONATION OREGON PUBLIC HEALTH INSTITUTE 315 SW FIFTH AVE SUITE 202 PORTLAND OR 97204 931259522 501(C)(3) 15000 SPONSORSHIP DE PAUL TREATMENT CENTERS INC PO BOX 3007 PORTLAND OR 97208 930706892 501(C)(3) 10000 DONATION 8 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FAMILYCARE DOES NOT AWARD GRANTS, BUT SPONSORS A LIMITED NUMBER OF CHARITABLE FUNDRAISING EVENTS. X X 0 0 0 0 0 0 0 0 0 JEFF HEATHERINGTON 350000 0 43802 0 23046 0 7500 0 6643 0 430991 0 0 0 GREG MARTENSON 160000 0 1015 0 3885 0 3002 0 17761 0 185663 0 0 0 JESSE GAMEZ 229231 0 1077 0 3482 0 6896 0 667 0 241353 0 0 0 DOUGLAS LUTHER 248586 0 2675 0 16022 0 7500 0 667 0 275450 0 0 0 DAYNA STERINGER 121357 0 26127 0 5448 0 4438 0 11495 0 168865 0 0 0 BILL BUTCHER 139048 0 1271 0 6357 0 3273 0 454 0 150403 0 0 0 DANIEL ROTH 244354 0 1207 0 20353 0 5598 0 17799 0 289311 0 0 0 ROBIN RICHARDSON DO SECRETARY AND BOARD MEMBER 57311 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. DR. ROBIN RICHARDSON IS THE PRESIDENT OF THE CLINIC. 0 KAREN CARNAHAN CHAIR AND BOARD MEMBER 191882 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM. MS. KAREN CARNAHAN IS AN OWNER OF THE FIRM. 0 ROSS RONISH BOARD MEMBER 2478016 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. MR. ROSS RONISH IS THE CHIEF MEDICAL OFFICER OF THE CLINIC. 0 RICHARD BARSOTTI BOARD MEMBER 1312961 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. MR. RICHARD BARSOTTI IS A PARTNER OF THE CLINIC. 0 JOSEPH HROMCO BOARD MEMBER 1116961 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. DR. JOE HROMCO IS A PARTNER 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. 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INCOME FROM SUBSIDIARY -253,252. 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 FAMILYCARE MEDICAL CLINICS INC 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 930988354 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(3) NON-PRIVATE FDN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 FAMILYCARE HEALTH PLANS INC R 353235 PART II FAMILYCARE, INC., FAMILYCARE HEALTH PLANS, INC. AND FAMILYCARE MEDICAL CLINICS, INC. ARE RELATED TAX-EXEMPT ORGANIZATIONS BY VIRTUE OF INTERLOCKING BOARD MEMBERS.