2022-08-10T18:39:28-05:00 2021-12-31 930900579 MCDONALD JACOBS PC 520 SW YAMHILL ST STE 500 PORTLAND OR 97204 990 2021-01-01 930878074 FAMILYCARE INC FAMI 5034712103 2121 SW BROADWAY ST 115 PORTLAND OR 97201 JEFFREY HEATHERINGTON PRESIDENT/CEO 5034712103 2022-07-31 1 JEFFREY HEATHERINGTON XXX-XX-XXXX SANG AHN P00540880 5032270581 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z JEFFREY HEATHERINGTON 2121 SW BROADWAY ST 115 PORTLAND OR 97201 64823111 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE 4 4 5 4 0 0 0 0 12783521 21181873 2103897 6659500 338528 166127 15225946 28007500 2228000 89589 0 0 1401951 1532548 0 0 0 1863510 26252728 5493461 27874865 9732485 132635 100087421 129470681 3640605 24591056 96446816 104879625 X TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 22589589 22589589 21348000 PRIOR TO 2019, FAMILYCARE INC. PROVIDED COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID (THE CONTRACT). THE CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID ENDED JANUARY 31, 2018. APPROXIMATELY 106,000 MEMBERS WERE UNDER THE CONTRACT. SINCE THE END OF THE CONTRACT, FAMILYCARE INC. HAS BEEN WINDING DOWN OPERATIONS AS IT SATISFIES REMAINING OBLIGATIONS UNDER THE CONTRACT. . THESE OBLIGATIONS INCLUDE, AMONG OTHER THINGS, CLAIMS RUNOUT, MAINTENANCE OF INSURANCE, SYSTEM MAINTENANCE, RECORDKEEPING AND REPORTING, FOR TIME PERIODS SPECIFIED IN THE CONTRACT WHICH EXTEND UP TO 10 YEARS AFTER THE CONTRACT END DATE. FAMILYCARE, INC. RECEIVES NO ADDITIONAL COMPENSATION UNDER THE CONTRACT FOR THESE OBLIGATIONS AFTER THE CONTRACT END DATE. FAMILYCARE INC. ANTICIPATES THE ORDERLY WIND DOWN OF OPERATIONS TO CONTINUE THROUGH AT LEAST 2022. 22589589 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 3 0 5 1 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X JEFFREY HEATHERINGTON 5034712103 2121 SW BROADWAY ST 115 PORTLAND OR 97201 ROBIN RICHARDSON DO CHAIR & BOARD MEMBER 1.00 1.00 X X 0 0 0 ROBERT CARUS SECRETARY & BOARD MEMBER 1.00 1.00 X X 0 0 0 JOE HROMCO BOARD MEMBER 1.00 1.00 X 0 0 0 CARL ERICKSON BOARD MEMBER 1.00 1.00 X 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 35.00 5.00 X 504000 0 49989 WILLIAM MURRAY COO 39.00 1.00 X 485383 0 55506 ARTUR SUCHORZEWSKI DIRECTOR, GOVERNMENT AFFAI 39.00 1.00 X 160000 0 26402 1149383 0 131897 3 0 1 0 PERKINS COIE LLP 1201 THIRD AVENUE SUITE SEATTLE WA 98101 LEGAL AND PROFESSIONAL 2376840 PRICEWATERHOUSECOOPERS LLP PO BOX 514038 LOS ANGELES CA 90051 LEGAL AND PROFESSIONAL 130186 2 CONTRACT REVENUE 624100 21181873 21181873 21181873 1840688 1840688 41634423 36815611 4818812 4818812 4818812 CLAIM REFUNDS 624100 166127 166127 166127 28007500 21348000 0 6659500 89589 89589 1094878 1094878 291923 291923 41270 41270 37604 37604 66873 66873 2545591 2545591 34682 34682 553231 553231 228918 228918 101936 101936 100526 100526 FUTURE GRANTS PER SETTL 22500000 22500000 DATA AND HOSTING SERVIC 187844 187844 27874865 22589589 5285276 0 31480415 9147 18185650 21181873 49807547 108031176 613809 248485 100087421 129470681 3640605 2091056 22500000 3640605 24591056 X 96446816 104879625 96446816 104879625 100087421 129470681 X 132635 8297921 2253 X X 0 1 X 1 0 0 X PART X, LINE 2: THE ORGANIZATION FOLLOWS THE PROVISION OF FASB ASC TOPIC 740 OF ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. MANAGEMENT HAS EVALUATED THE ORGANIZATION'S TAX POSITIONS AND CONCLUDED THAT THERE ARE NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENT TO THE FINANCIAL STATEMENTS TO COMPLY WITH PROVISIONS OF THIS TOPIC. 1 OREGON HISTORICAL SOCIETY 1200 SW PARK AVE PORTLAND OR 97205 930391599 501(C)(3) 25000 0 CREATE AND PROMOTE EXHIBITIONS, LECTURES, EVENTS AND PROGRAMS OF THE OREGON HISTORICAL SOCIETY LIFEWORKS NORTHWEST 5415 SW WESTGATE DR PORTLAND OR 97221 930502822 501(C)(3) 60000 0 $10,000 AWARDED FOR PORTLAND'S ORIGINAL IRON CHEF SPONSORSHIP FUNDRAISER AND $50,000 FOR GENERAL SUPPORT OF ORGANZIATIONS PROGRAMS AND SERVICES TO THE HEALTH OF OUR COMMUNITY 2 0 PART I, LINE 2: GRANT RECIPIENTS SUBMIT PERIODIC REPORTS AS DEFINED BY THEIR AGREEMENTS. X 0 1 X X X X X 0 0 0 0 0 0 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 504000 0 0 0 0 0 0 37944 0 12045 504000 49989 0 0 WILLIAM MURRAY COO 389606 0 95777 0 0 0 0 31420 0 24086 485383 55506 0 0 ARTUR SUCHORZEWSKI DIRECTOR, GOVERNMENT AFFAI 160000 0 0 0 0 0 0 14357 0 12045 160000 26402 0 0 PART I, LINE 1A FIRST CLASS AIRLINE TRAVEL PAID FOR EXECUTIVES ON LONG DURATION FLIGHTS (I.E. TO EAST COAST) OR FOR OCCASIONAL LAST-MINUTE TRAVEL PLANS WHEN COACH SEATS ARE NOT AVAILABLE. NOT INCLUDED IN TAXABLE COMPENSATION. PART I, LINE 1B THE POLICY IS DETERMINED BY THE CEO AND IS NOT IN WRITING. FORM 990, PART VI, SECTION A, LINE 6 SEE THE DESCRIPTION PROVIDED FOR PART VI, SECTION A, LINE 7B, BELOW. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION HAS 4 CORPORATE MEMBERS. THE CORPORATE MEMBERS ELECT THE ORGANIZATION'S BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE POWERS RESERVED TO THE MEMBERS ARE THE FOLLOWING: (A) AMENDING THE ARTICLES OF INCORPORATION; (B) AMENDING THE BYLAWS (C) APPOINTING MEMBERS; (D) ELECTING THE BOARD OF DIRECTORS; (E) APPROVING EXPENDITURES OF MORE THAN 5% OF THE RESERVES OF THE ORGANIZATION; AND (F) APPROVING THE SALE, TRANSFER, MERGER, OR DISSOLUTION OF THE ORGANIZATION. 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 15 COMPENSATION METHODOLOGY: CEO: THE LEVEL AND ADEQUACY OF 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 AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO REVIEW AND ESTABLISH THE CEO'S TOTAL COMPENSATION. THE TWO MOST RECENT REVIEWS COMPLETED BY THE CONSULTANT WERE IN MAY 2015 AND APRIL 2017. KEY EMPLOYEES: THE LEVEL AND ADEQUACY OF KEY EMPLOYEES TOTAL COMPENSATION IS DETERMINED BY THE CEO, WITH INPUT FROM THE VICE PRESIDENT OF HUMAN RESOURCES. THE CEO AND VICE PRESIDENT OF HUMAN RESOURCES USE AN INDEPENDENT EXECUTIVE COMPENSATION CONSULTANT TO REVIEW AND ESTABLISH KEY EMPLOYEES TOTAL COMPENSATION. THE TWO MOST RECENT REVIEWS COMPLETED BY THE CONSULTANT WERE IN MAY 2015 AND APRIL 2017, INCLUDING SEVERANCE PACKAGES. 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 XI, LINE 9: INCOME FROM SUBSIDIARY 2,253. PART XII LINE 2C THE PROCESS FOR FINANCIAL OVERSIGHT HAS NOT CHANGED FROM THE PRIOR YEAR. FAMILYCARE HEALTH PLANS INC 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 911829317 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) FAMILYCARE INC 1 HEATHERINGTON FOUND FOR INNOVATION AND EDUCATION IN HEALTH CARE 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 930988354 TO SUPPORT INNOVATION AND FUND HEALTHCARE EDUCATION OR 501(C)(3) PF 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0