2011-11-15T14:20:17-06:00 2010-12-31 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2010-01-01 930878074 FAMILYCARE INC FAMI 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFF HEATHERINGTON 5032223205 2011-11-14 1 ROY ABRAMOWITZ 5032210336 2010 2016-03-07 17:11:31Z JEFF HEATHERINGTON 825 NE MULTNOMAH 300 PORTLAND OR 97232 111114321 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 6 4 90 0 0 0 0 0 75581088 107150185 -718133 191253 0 0 74862955 107341438 151700 149279 0 0 4451479 5943072 0 0 0 69422888 99310978 74026067 105403329 836888 1938109 26326073 32675412 18013074 24950182 8312999 7725230 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 98677770 149279 107150185 PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID. APPROXIMATELY 36,017 SERVED MONTHLY. 98677770 0 0 0 1 0 0 0 0 0 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 1 0 1 0 0 1 90 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 6 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X JEFF HEATHERINGTON 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFF HEATHERINGTON 40.00 X X 366544 0 16258 JEFFREY PAWLOWSKI 1.00 X X 3800 0 0 KAREN CARNAHAN 1.00 X X 4750 0 0 ROBIN RICHARDSON DO 1.00 X X 2100 0 0 JANET TESCH 1.00 X X 2800 0 0 ROBERT CARUS 1.00 X 2800 0 0 ROSS RONISH 1.00 X 2166 0 0 JILL LAM 40.00 X 36490 0 3070 KATHERINE ELLIS 40.00 X 71467 0 2316 DOUGLAS LUTHER 40.00 X 229067 0 7379 KATHLEEN QUANDEE 40.00 X 108278 0 17952 AMY SZCZUKOWSHI 40.00 X 141879 0 19028 972141 0 66003 4 0 1 0 AXIAN INC 9600 SW NUMBUS AVE SUITE 200 BEAVERTON OR 97008 IT SERVICES & REPORTING 257396 RAM TECHNOLOGIES INC 275 COMMERCE DRIVE SUITE 100 FORT WASHINGTON PA 19034 IT SOFTWARE SUPPORT 203103 ASSIST GROUP 300 UNION BOULEVARD SUITE 515 LAKEWOOD CO 80228 FORENSIC REVIEW CLAIMS 166625 3 107150185 107150185 107150185 119214 119214 3844922 3772883 72039 72039 72039 107341438 107150185 0 191253 149279 149279 751007 456183 294824 4643393 3914863 728530 78951 67753 11198 11306 11306 458415 458415 196773 196773 72497 72497 179231 179231 16163 16163 69403 69403 585963 585963 76770 76770 8000 8000 847888 847888 708549 708549 INPATIENT HOSPITAL 35898585 35898585 OTHER PROFESSIONAL SERV 24349678 23694553 655125 PHYSICIAN SERVICES 19062095 19062095 EMERGENCY ROOM AND OUT- 9345923 9345923 OTHER MEDICAL AND HOSPI 5857812 5857812 2035648 230724 1804924 105403329 98677770 6725559 0 5682801 10966698 1019450 920925 3364986 4001864 4556204 1502677 2772209 3053527 3292472 3845571 10194155 9886827 26326073 32675412 18013074 24742858 0 207324 18013074 24950182 X 8312999 7725230 8312999 7725230 26326073 32675412 X 1938109 -2525878 X X 0 1 1 X 0 1 0 1 179231 179231 PART IV, SUPPLEMENTAL INFORMATION: 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 10922 57390 4359217 1491755 2867462 128675 128675 3053527 OTHER CURRENT ASSETS, NET 1483541 OTHER ASSETS, NET 151150 DUE FROM AFFILIATES 305485 RESTRICTED CASH AND CASH EQUIVALENTS 365806 INVESTMENTS IN FAMILYCARE HEALTH PLANS 3703367 RESTRICTED SHORT-TERM INVESTMENTS 1546949 RESTRICTED LONG-TERM INVESTMENTS 2330529 9886827 CAPITAL LEASE OBLIGATION, LESS CURRENT PORTION 207324 207324 107341438 105403329 1938109 313476 -2839354 -2525878 -587769 138090618 313476 30435704 30749180 107341438 0 107341438 138678387 33275058 33275058 105403329 0 105403329 PART XI, LINE 8 - OTHER ADJUSTMENTS: INCOME FROM SUBSIDIARIES -2,839,354. PART XII, LINE 2D OTHER ENTITIES REVENUES $30,435,704 PART XIII, LINE 2D OTHER ENTITIES EXPENSES $33,275,058 1 CHILDREN'S RELIEF NURSERY 8425 N LOMBARD PORTLAND OR 97203 931260988 501(C)(3) 10000 SUPPORT CHILDREN AT RISK; SPONSORSHIP IRON CHEF 2010. NW OSTEOPATHIC MEDICAL FOUNDATION 1410 SW MORRISON ST SUITE 700 PORTLAND OR 97205 930882138 501(C)(3) 10000 EDUCATION; SPONSORSHIP - FOUNDERS WEEKEND OSTEOPATHIC PHYSICIANS & SURGEONS OF OREGON INC 4380 SW MACADAM AVE SUITE 125 PORTLAND OR 97239 936025596 501(C)(6) 100000 OSTEOPATHIC SUPPORT; EDUCATION GRANT. OREGON OSTEOPATHIC FOUNDATION 4380 SW MACADAM AVE SUITE 125 PORTLAND OR 97239 203174637 501(C)(3) 13500 GRANT WESTERN UNIVERSITY OF HEALTH SCIENCES 100 MULLINS DR SUITE 42 LEBANON OR 97355 953127727 501(C)(3) 10000 DONATION - NEW CAMPUS 4 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. 0 0 0 0 0 0 0 0 0 JEFF HEATHERINGTON 350000 0 0 0 16544 0 0 0 16258 0 382802 0 0 0 DOUGLAS LUTHER 211150 0 0 0 17917 0 0 0 7379 0 236446 0 0 0 AMY SZCZUKOWSHI 137200 0 0 0 4679 0 0 0 19028 0 160907 0 0 0 ROBIN RICHARDSON DO SECRETARY AND BOARD MEMBER 20187 EXPENSES PAID FOR HEALTHCARE-RELATED SERVICES 0 KAREN CARNAHAN CHAIR AND BOARD MEMBER 50903 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM 0 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, 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 5: NET UNREALIZED GAINS ON INVESTMENTS: 313,476. INCOME FROM SUBSIDIARIES -2,839,354. TOTAL TO FORM 990, PART XI, LINE 5: -2,525,878. FORM 990, PART XI, 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) 1 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 1 OSTEOPATHIC PHYSICIANS AND SURGEONS OF OREGON INC 4380 SW MACADAM AVE SUITE 125 PORTLAND OR 97239 936025596 TO ADVANCE OSTEOPATHIC MEDICINE OR 501(C)(6) 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 OSTEOPATHIC PHYSICIANS AND SURGEONS OF OREGON INC B 100000 FAMILYCARE HEALTH PLANS INC Q 305485