2020-11-16T18:07:00-06:00 2019-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2019-01-01 930878074 FAMILYCARE INC FAMI 5034712103 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 JEFFREY HEATHERINGTON PRESIDENT/CEO 5034712103 2020-11-13 1 CYNTHIA P BARTHOLOMEW P01313965 5032210336 2020-11-13 20.36.17.116 2020-11-13 09:30:31 PS P 77695A59B531596819DE8DD35A5213F72518F13B 0AAEAD2123008052C6F6BADB18191F8B3DBF6495 2019 2022-01-07 14:23:13Z JEFFREY HEATHERINGTON 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 60598497 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 4 4 13 7 0 0 118484 0 68128160 1832207 3712972 2182217 0 0 71959616 4014424 20197680 4132940 0 0 8989330 1427248 0 0 0 50791241 2223542 79978251 7783730 -8018635 -3769306 93145656 93794441 17444145 16335782 75701511 77458659 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 3506450 4132940 1832207 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. FAMILYCARE INC. ANTICIPATES THE ORDERLY WIND DOWN OF OPERATIONS TO CONTINUE THROUGH AT LEAST 2020. 3506450 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 1 43 0 1 13 1 0 0 0 0 1 1 0 0 0 X 4 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X WILLIAM MURRAY 5037343147 2121 SW BROADWAY SUITE 115 PORTLAND OR 97201 ROBIN RICHARDSON DO CHAIR & BOARD MEMBER 1.00 1.00 X X 3500 0 0 MATT DASKALOS VICE CHAIR & BOARD MEMBER (PART YEAR) 1.00 0.00 X X 0 0 0 JEFFREY PAWLOWSKI TREASURER & BOARD MEMBER (PART YEAR) 1.00 1.00 X X 2531 0 0 ROBERT CARUS SECRETARY & BOARD MEMBER 1.00 0.00 X X 1500 0 0 RICHARD BARSOTTI BOARD MEMBER (PART YEAR) 1.00 0.00 X 0 0 0 JOE HROMCO BOARD MEMBER 1.00 0.00 X 0 0 0 MICHAEL RILEY BOARD MEMBER (PART YEAR) 1.00 1.00 X 0 0 0 KAREN CARNAHAN BOARD MEMBER (PART YEAR) 1.00 1.00 X 0 0 0 CARL ERICKSON BOARD MEMBER 1.00 1.00 X 0 0 0 ROYAL E HARRIS BOARD MEMBER (PART YEAR) 1.00 1.00 X 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 25.00 15.00 X 511086 0 41562 WILLIAM MURRAY COO 30.00 10.00 X 773138 0 22914 OSCAR CLARK VP COMMUNITY & HEALTH SERVICES 30.00 10.00 X 362359 0 4733 CHERI PFANNES VP CORPORATE COMPLIANCE 30.00 10.00 X 300520 0 4656 ANTHONY JACKSON CONTROLLER 30.00 10.00 X 233685 0 4310 LEE MCDONALD SENIOR NETWORK ADMINISTRATOR 30.00 10.00 X 271337 0 4050 ARTUR SUCHORZEWSKI DIRECTOR, GOVERNMENT AFFAIRS 30.00 10.00 X 210087 0 11942 SAMANTHA LASIN SENIOR DATA ENGINEER 30.00 10.00 X 233684 0 1545 LISA JONES EXECUTIVE MANAGER 30.00 10.00 X 194778 0 12842 3098205 0 108554 9 0 1 0 PERKINS COIE LLP 1201 THIRD AVENUE SUITE 4900 SEATTLE WA 98101 LEGAL AND PROFESSIONAL 2161905 STOEL RIVES LLP 760 SW NINTH AVE STE 3000 PORTLAND OR 97205 LEGAL AND PROFESSIONAL 227002 WILLAMETTE DENTAL GROUP PC 6920 NE CAMPUS WAY HILLSBORO OR 97124 MEDICAL SERVICES 206142 VIBRA SPECIALTY 6730 N WEST AVE STE 109 FRESNO CA 93711 MEDICAL SERVICES 148200 WOODRUFF-SAWYER 50 CALIFORNIA ST FLOOR 12 SAN FRANCISCO CA 94111 INSURANCE 141910 10 MEDICAID CONTRACTS 624100 1832207 1832207 1832207 1873168 1873168 56893122 56584073 309049 309049 309049 4014424 1832207 0 2182217 4132940 4132940 953837 953837 306218 306218 58249 58249 30487 30487 78457 78457 1867400 1867400 176414 176414 408716 408716 76243 76243 27433 27433 9041 9041 164622 164622 UBI TAX 8000 8000 EQUIPMENT RENTAL & MAIN 236653 236653 OTHER PROFESSIONAL SERV 153100 153100 INPATIENT HOSPITAL 68827 68827 -972907 -848417 -124490 7783730 3506450 4277280 0 3214814 1206985 42170629 22339245 19653 0 27212097 49350112 20528463 20898099 93145656 93794441 17444145 16335782 17444145 16335782 X 75701511 77458659 75701511 77458659 93145656 93794441 X -3769306 5209529 316925 X X 0 1 X 0 0 1000 0 0 PART I-A, LINE 1: MONETARY DONATIONS TO SUPPORT CANDIDATES FOR ELECTIVE PUBLIC OFFICE 0 DUE FROM AFFILIATES 26442 OTHER ASSETS, NET 232429 INVESTMENT IN FAMILYCARE HEALTH PLANS 20023739 ACCRUED INTEREST AND DIVIDENDS 615489 20898099 1 AMERICAN OSTEOPATHIC FOUNDATION 142 EAST ONTARIO ST 1450 CHICAGO IL 60611 366056120 501(C)(3) 1025000 GENERAL SUPPORT AND EDUCATION FAMILIAS EN ACCION 2710 NE 14TH AVE PORTLAND OR 97212 931284335 501(C)(3) 10000 GENERAL SUPPORT WILLAMETTE UNIVERSITY 1959 PALOMAR OAKS WAY STE 300 CARLSBAD CA 92011 930386972 501(C)(3) 3000000 PUBLIC HEALTH PROGRAM SPECIAL OLYMPICS OREGON 8313 SW CIRRUS DRIVE PORTLAND OR 97008 930752969 501(C)(3) 70000 GENERAL SUPPORT OSTEOPATHIC PHYSICIANS & SURGEONS 4380 SW MACADAM AVE 185 PORTLAND OR 972396426 936025596 501(C)(6) 25000 GENERAL SUPPORT 4 1 PART I, LINE 2: GRANT RECIPIENTS SUBMIT PERIODIC REPORTS AS DEFINED BY THEIR AGREEMENTS. REPORTS INCLUDE INVOICES CONTAINING SERVICES RENDERED AND PERIOD COVERED. X 0 1 X X X X X 1 0 0 0 0 0 0 0 0 JEFFREY HEATHERINGTON PRESIDENT & CEO 511086 0 0 0 0 0 33820 0 7742 0 552648 0 0 0 WILLIAM MURRAY COO 435232 0 337906 0 0 0 7431 0 15483 0 796052 0 0 0 OSCAR CLARK VP COMMUNITY & HEALTH SERVICES 23591 0 338768 0 0 0 4075 0 658 0 367092 0 0 0 CHERI PFANNES VP CORPORATE COMPLIANCE 60401 0 240119 0 0 0 4656 0 0 0 305176 0 0 0 ANTHONY JACKSON CONTROLLER 35089 0 198596 0 0 0 3652 0 658 0 237995 0 0 0 LEE MCDONALD SENIOR NETWORK ADMINISTRATOR 22564 0 248773 0 0 0 2735 0 1315 0 275387 0 0 0 ARTUR SUCHORZEWSKI DIRECTOR, GOVERNMENT AFFAIRS 137933 0 72154 0 0 0 4200 0 7742 0 222029 0 0 0 SAMANTHA LASIN SENIOR DATA ENGINEER 35352 0 198332 0 0 0 1545 0 0 0 235229 0 0 0 LISA JONES EXECUTIVE MANAGER 125185 0 69593 0 0 0 5100 0 7742 0 207620 0 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. PART I, LINE 4A SEVERANCE PAYMENTS: WILLIAM MURRAY - $157,194 OSCAR CLARK - $226,495 CHERI PFANNES - $128,697 ANTHONY JACKSON - $111,914 LEE MCDONALD - $180,128 SAMANTHA LASIN - $156,136 LISA JONES - $28,744 WESTERN PSYCHOLOGICAL & COUNSELING SERVICES INC BOARD MEMBER JOSEPH HROMCO IS THE VICE PRESIDENT OF OPERATIONS 1200 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 2 BOARD MEMBER JOE HROMCO CONTROLS AN ENTITY THAT DOES BUSINESS WITH FAMILYCARE, INC. JEFFERY PAWLOWSKI, BOARD MEMBER, AND MICHAEL RILEY, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. 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 7 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. OTHER EMPLOYEES: THE VICE PRESIDENT OF HUMAN RESOURCES IS ACCOUNTABLE TO USE PUBLISHED, REPUTABLE DATA FOR COMPARISONS OF JOB ACCOUNTABILITIES AND COMPENSATION RANGES, INCLUDING DATA PROVIDED BY INDEPENDENT COMPENSATION CONSULTANTS. BASED ON THE DATA, THE VICE PRESIDENT OF HUMAN RESOURCES ESTABLISHES AND UPDATES THE COMPENSATION RANGES, AND RESPONDS TO ANY INQUIRIES RELATED TO FAIRNESS, EQUITY AND PROCESS. 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 316,925. FORM 990, PART XII, LINE 2C: THE ORGANIZATION IS WINDING DOWN OPERATIONS AND NO LONGER HAS A STAND-ALONE COMMITTEE THAT ASSUMES OVERSIGHT OF THE AUDIT. 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 N/A 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 FAMILYCARE HEALTH PLANS INC L 81145 CASH - U.S. CURRENCY PART II FAMILYCARE, INC. IS RELATED TO FAMILYCARE HEALTH PLANS, INC. AND TO HEATHERINGTON FOUNDATION FOR INNOVATION AND EDUCATION IN HEALTH CARE, BOTH TAX-EXEMPT ORGANIZATIONS, BY VIRTUE HAVING BOARD MEMBERS IN COMMON. MORE THAN 50% OF MEMBERS OF THE RELATED ORGANIZATIONS' BOARDS ALSO SERVE ON FAMILYCARE, INC.'S BOARD OF DIRECTORS.