2017-11-08T14:19:15-06:00 2016-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2016-01-01 930878074 FAMILYCARE INC FAMI 5032223205 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 JEFFREY HEATHERINGTON PRESIDENT, CEO 5032223205 2017-11-05 1 CYNTHIA P BARTHOLOMEW P01313965 5032210336 2017-11-03 70.102.39.100 2017-11-05 00:00:37 PD P FF88915644AD7F74D27F791CF0BD36FB54136F65 A5A6F1C0E07EDBEBF6E43D6E874CE1FF0144AD5F 2016 2021-01-29 14:40:06Z JEFFREY HEATHERINGTON 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 735649234 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 13 10 386 0 0 0 0 23000 543777686 495159924 3032761 2421455 24800000 26891 571610447 497631270 4014947 978110 0 0 16013386 22991240 0 0 0 477255749 494567816 497284082 518537166 74326365 -20905896 319177877 272139883 151138753 136098585 168039124 136041298 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 472651148 978110 495186815 PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID. APPROXIMATELY 119,184 SERVED MONTHLY. 472651148 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 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 1470 0 1 386 1 0 0 0 0 1 1 0 X 13 10 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X ANTHONY JACKSON 5032223205 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 JEFFREY HEATHERINGTON PRESIDENT, CEO AND DIRECTOR 39.00 1.00 X X 627702 0 26740 ROBIN RICHARDSON DO CHAIR AND DIRECTOR 1.00 X X 8250 0 0 JANET TESCH VICE CHAIR (PART YEAR) AND DIRECTOR 1.00 X X 3500 0 0 MATT DASKALOS VICE CHAIR (PART YEAR) AND DIRECTOR 1.00 X X 2250 0 0 PATRICIA PARKER SECRETARY & DIRECTOR 1.00 X X 3250 0 0 JEFFREY PAWLOWSKI TREASURER AND DIRECTOR 1.00 X X 6750 0 0 KAREN CARNAHAN DIRECTOR 1.00 X 1750 0 0 RICHARD BARSOTTI DIRECTOR 1.00 X 4339 0 0 ROBERT CARUS DIRECTOR 1.00 X 4750 0 0 JOE HROMCO DIRECTOR 1.00 X 3750 0 0 MICHAEL RILEY DIRECTOR 1.00 X 4589 0 0 CARL ERICKSON DIRECTOR 1.00 X 3500 0 0 EVERETT NEWCOMB DIRECTOR 1.00 X 1000 0 0 ROYAL E HARRIS DIRECTOR 1.00 X 4089 0 0 PAIGE JACKSON VP 40.00 X 200340 0 11544 WILLIAM MURRAY COO 40.00 X 398291 0 28189 KEVIN CLANCY VP FINANCE 40.00 X 290891 0 29125 OSCAR CLARK VP COMMUNITY & HEALTH SERV 40.00 X 236628 0 14833 CHRISTOPHER DIAZ VP INFORMATION TECHNOLOGY 40.00 X 257045 0 24402 CHERI PFANNES VP CORPORATE COMPLIANCE 40.00 X 152786 0 5361 CHONG LEE MEDICAL DIRECTOR 40.00 X 246258 0 7388 JOSEPH BADOLATO DIRECTOR 40.00 X 268480 0 28434 BENNETT GARNER DIRECTOR 40.00 X 293789 0 25156 ANNA JIMENEZ DIRECTOR 40.00 X 254046 0 20497 ALEXANDER BULOCHNIK MANAGER 40.00 X 183451 0 18529 3461474 0 240198 36 0 1 0 PERFORMANCE HEALTH TECHNOLOGY LTD 3993 FAIRVIEW INDUSTRIAL DR SE SALEM OR 97302 CLAIMS PROCESSING 4014450 TRIZETTO CORPORATION 9655 MAROON CIR ENGLEWOOD CO 80112 CLAIMS PROCESSING 3669684 LINGUAVA INTERPRETERS 7931 NE HALSEY SUITE 305 PORTLAND OR 97213 LANGUAGE SUPPORT 992196 MCKESSON CORPORATION 22423 NETWORK PLACE CHICAGO IL 60673 CONSULTING 761475 STOEL RIVES LLP 760 SW NINTH AVE SUITE 3000 PORTLAND OR 97205 LEGAL SERVICES 745064 24 23000 23000 MEDICAID PREMIUMS 624100 494768060 494768060 391864 391864 495159924 3526297 3526297 236913122 238017964 -1104842 -1104842 -1104842 SETTLEMENT CREDIT 624100 26891 26891 26891 497631270 495186815 0 2421455 X 978110 978110 2355642 575969 1779673 14745789 12091547 2654242 553001 453461 99540 3131589 2567903 563686 2205219 1808280 396939 880200 880200 168483 168483 14670 14670 8749509 8749509 60129 60129 1139105 1139105 1754935 1754935 278498 278498 40071 40071 1085487 1085487 274129 274129 PHYSICIAN SERVICES 107309726 107309726 INPATIENT HOSPITAL 90857482 90857482 OTHER MEDICAL AND HOSPI 86906222 86906222 OTHER PROFESSIONAL SERV 86379338 86379338 108669832 82723110 25946722 518537166 472651148 45886018 0 74433042 68751728 64471558 59644788 18233538 16225384 11078690 4170219 3598917 6908471 125027416 103162090 33413406 17447422 319177877 272139883 150704329 135611400 434424 487185 151138753 136098585 X 168039124 136033298 0 8000 168039124 136041298 319177877 272139883 X -20905896 2160324 -13252254 X X 0 1 X 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 95250 0 0 0 PART I-A, LINE 1: MONETARY DONATIONS TO SUPPORT CANDIDATES FOR ELECTIVE PUBLIC OFFICE 967195 235044 732151 5523728 3894365 1629363 4587767 40810 4546957 6908471 OTHER CURRENT ASSETS, NET 4807726 OTHER ASSETS, NET 228384 DUE FROM AFFILIATES 376520 INVESTMENT IN FAMILYCARE HEALTH PLANS 12034792 17447422 CAPITAL LEASE OBLIGATION 487185 487185 1 AMERICAN OSTEOPATHIC 142 EAST ONTARIO ST 1450 CHICAGO IL 60611 362170786 501(C)(3) 65000 GENERAL SUPPORT AND SPONSORSHIP ASIAN HEALTH & SERVICE CENTER 3430 SE POWELL BLVD PORTLAND OR 97202 931192100 501(C)(3) 18000 SPONSORSHIP CASCADE AIDS PROJECT 208 SW 5TH AVE SUITE 800 PORTLAND OR 97204 930903383 501(C)(3) 10500 SPONSORSHIP CITY CLUB OF PORTLAND 901 SW WASHINGTON ST PORTLAND OR 97205 930140220 501(C)(3) 6000 SPONSORSHIP COMPASSION AND CHOICES 4155 E JEWELL AVE 200 DENVER CO 80222 841328829 501(C)(3) 10000 GENERAL SUPPORT LUND REPORT PO BOX 82841 PORTLAND OR 97282 263019179 501(C)(3) 11575 SPONSORSHIP NORTHWEST OSTEOPATHIC MEDICAL FOUNDATION 1327 SE TACOMA 326 PORTLAND OR 97202 930882138 501(C)(3) 10000 EDUCATION GRANT OREGON SYMPHONY ASSOCIATION 921 SW WASHINGTON ST 200 PORTLAND OR 97205 930446527 501(C)(3) 110000 GENERAL SUPPORT OSTEOPATHIC PHYSICIANS & SURGEONS 4380 SW MACADAM AVE SUITE 185 PORTLAND OR 972396426 936025596 501(C)(6) 104000 OSTEOPATHIC SUPPORT, EDUCATION GRANT PLANNED PARENTHOOD ADVOCATES OF OREGON PO BOX 12267 PORTLAND OR 97212 931040482 501(C)(4) 6000 SPONSORSHIP FOR 2016 COURAGEOUS VOICE BREAKFAST PORTLAND BUSINESS JOURNAL PO BOX 36919 CHARLOTTE NC 28236 N/A 10000 SPONSORSHIP FOR THE BUSINESS JOURNAL'S HEALTH CARE OF THE FUTURE EVENT. SKANNER FOUNDATION PO BOX 5455 PORTLAND OR 97228 931109980 501(C)(3) 30000 SPONSORSHIP UNITED WAY OF THE COLUMBIA-WILLAMETTE 619 SW 11TH AVE 300 PORTLAND OR 97205 930582124 501(C)(3) 255000 GENERAL SUPPORT UPSTREAM PUBLIC HEALTH 240 N BROADWAY 214 PORTLAND OR 97227 421579435 501(C)(3) 25000 GENERAL SUPPORT VIRGINIA GARCIA MEMORIAL FOUNDATION PO BOX 486 CORNELIUS OR 97113 930717997 501(C)(3) 10000 GENERAL SUPPORT WESTERN UNIVERSITY OF HEALTH SERVICES 200 MULLINS DR LEBANON OR 97355 953127273 501(C)(3) 150000 EDUCATION GRANT WILSON STRATEGIC COMMUNICATIONS 3500 188TH ST SW STE 590 LYNNWOOD WA 98037 201502691 N/A 10000 SPONSORSHIP FOR THE 2016 OREGON STATE OF REFORM HEALTH POLICY CONFERENCE WOMEN OF VISIONWORLD VISION 316 NW 187TH AVE HILLSBORO OR 97006 951922279 501(C)(3) 27500 GENERAL SUPPORT 14 4 PART I, LINE 2: GRANT RECIPIENTS SUBMIT PERIODIC REPORTS AS DEFINED BY THEIR AGREEMENTS. REPORTS INCLUDE INVOICES CONTAINING SERVICES RENDERED AND PERIOD COVERED. X X 0 0 0 0 0 0 0 0 0 JEFFREY HEATHERINGTON PRESIDENT, CEO AND DIRECTOR 505013 0 122401 0 288 0 18831 0 7909 0 654442 0 0 0 PAIGE JACKSON VP 190000 0 4787 0 5553 0 3872 0 7672 0 211884 0 0 0 WILLIAM MURRAY COO 351106 0 40450 0 6735 0 11949 0 16240 0 426480 0 0 0 KEVIN CLANCY VP FINANCE 262019 0 28693 0 179 0 8727 0 20398 0 320016 0 0 0 OSCAR CLARK VP COMMUNITY & HEALTH SERV 212760 0 23865 0 3 0 7099 0 7734 0 251461 0 0 0 CHRISTOPHER DIAZ VP INFORMATION TECHNOLOGY 229689 0 22511 0 4845 0 7711 0 16691 0 281447 0 0 0 CHERI PFANNES VP CORPORATE COMPLIANCE 138346 0 14369 0 71 0 4583 0 778 0 158147 0 0 0 CHONG LEE MEDICAL DIRECTOR 220213 0 25992 0 53 0 7388 0 0 0 253646 0 0 0 JOSEPH BADOLATO DIRECTOR 244352 0 19913 0 4215 0 8055 0 20379 0 296914 0 0 0 BENNETT GARNER DIRECTOR 284255 0 4995 0 4539 0 8814 0 16342 0 318945 0 0 0 ANNA JIMENEZ DIRECTOR 247651 0 2387 0 4008 0 4220 0 16277 0 274543 0 0 0 ALEXANDER BULOCHNIK MANAGER 157570 0 25860 0 21 0 5504 0 13025 0 201980 0 0 0 CARNAHAN SMITH AND GUNTER ENTITY MORE THAN 35% OWNED BY KAREN CARNAHAN, BOARD MEMBER 218405 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM FOR LEADERSHIP TRAINING. 0 RILEY RESEARCH ASSOCIATES ENTITY MORE THAN 35% OWNED BY MICHAEL RILEY, BOARD MEMBER 66155 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM. 0 WESTERN PSYCHOLOGICAL & COUNSELING SERVICES INC BOARD MEMBER JOSEPH HROMCO IS THE VICE PRESIDENT OF OPERATIONS 3694315 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES. 0 FORM 990, PART VI, SECTION A, LINE 2 JEFFREY PAWLOWSKI, BOARD MEMBER, AND MICHAEL RILEY, BOARD MEMBER, HAVE A BUSINESS RELATIONSHIP. ROBERT CARUS, BOARD MEMBER, AND KAREN CARNAHAN, BOARD MEMBER, ALSO HAVE A BUSINESS RELATIONSHIP. BOARD MEMBERS MICHAEL RILEY, JOE HROMCO, AND KAREN CARNAHAN OWN OR CONTROL ENTITIES THAT DO BUSINESS WITH FAMILYCARE, INC. 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 THE 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 COMPARABILITY DATA IN DETERMINING THE SALARY, AND ALL DELIBERATIONS AND DECISIONS ARE DOCUMENTED. COO: THE LEVEL AND ADEQUACY OF THE COO TOTAL COMPENSATION IS DETERMINED BY THE CEO, WITH INPUT AND ANALYSIS SUPPLIED BY THE VICE PRESIDENT 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 VICE PRESIDENT OF HUMAN RESOURCES 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 VICE PRESIDENT 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. FORM 990, PART IX, LINE 24E MEDICAL AND HOSPITAL EXPENSES : PROGRAM SERVICE EXPENSES 57,305,184. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 57,305,184. EMERGENCY ROOM AND OUT-OF-AREA SERVICES : PROGRAM SERVICE EXPENSES 25,300,676. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 25,300,676. BAD DEBT : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 21,050,557. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,050,557. EQUIPMENT RENTAL & MAINTENANCE : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 4,390,361. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,390,361. BOOKS/SUBSCRIPTIONS/DUES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 197,182. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 197,182. OTHER EMPLOYEE EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 157,473. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 157,473. MEALS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 131,553. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,553. CANDIDATE SUPPORT: PROGRAM SERVICE EXPENSES 95,250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,250. SUPPORT FOR PROPOSED LEGISLATION: PROGRAM SERVICE EXPENSES 22,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,000. OTHER EXPENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,596. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,596. FORM 990, PART XI, LINE 9: LOSS OF SUBSIDIARY -13,252,254. 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 1400 PORTLAND OR 97232 911829317 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) 0 HEATHERINGTON FOUNDATION FOR INNOVATION & EDUCATION IN HEALTHCARE FKA FCMC 825 NE MULTNOMAH SUITE 1400 PORTLAND OR 97232 930988354 TO SUPPORT INNOVATION AND FUND HEALTHCARE EDUCATION OR 501(C)(3) PF 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FAMILYCARE HEALTH PLANS INC D 613485 CASH - U.S. CURRENCY FAMILYCARE HEALTH PLANS INC B 15000000 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. ALL MEMBERS OF THE RELATED ORGANIZATIONS' BOARDS ALSO SERVE ON FAMILYCARE, INC.'S BOARD OF DIRECTORS.