FIRSTCARE HEALTH FOUNDATION: Form 990EZ, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FIRSTCARE HEALTH FOUNDATION (EIN 93-0900124)
- Tax period
- 2016-01-01 to 2016-12-31
- Filed
- 2017-11-14
- IRS object ID
- 201723189349203017
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-11-14T13:29:48-06:00 | ReturnTs |
| Tax Period End | 2016-12-31 | TaxPeriodEndDt |
| Return Type | 990EZ | ReturnTypeCd |
| Tax Period Begin | 2016-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930900124 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIRSTCARE HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FIRS | BusinessNameControlTxt |
| Phone | 5417684773 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O SHS ACCOUNTING PO BOX 3000 | AddressLine1Txt |
| City | CORVALLIS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 973393000 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DANIEL B SMITH | PersonNm |
| Person Title | VP FINANCE/CFO | PersonTitleTxt |
| Phone | 5417684773 | PhoneNum |
| Signature | 2017-11-10 | SignatureDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 209.237.75.250 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2017-11-10 | IPDt |
| IP Tm | 15:14:14 | IPTm |
| IP Timezone | PS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 59652E4EB5EE42D6A476341002D5FB1D21634885 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B66EAA5503DC61BC9FDA127200D93CF6872DA565 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Website Address | N/A | WebsiteAddressTxt |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Gross Receipts | $92,500 | GrossReceiptsAmt |
| Info In Schedule O Part I | Yes (X) | InfoInScheduleOPartIInd |
| Contributions Gifts Grants Etc | $92,500 | ContributionsGiftsGrantsEtcAmt |
| Total Revenue | $92,500 | TotalRevenueAmt |
| Salaries Other Comp Empl Bnft | $83,984 | SalariesOtherCompEmplBnftAmt |
| Occupancy Rent Utlts And Maint | $23,755 | OccupancyRentUtltsAndMaintAmt |
| Other Expenses Total | $45,552 | OtherExpensesTotalAmt |
| Total Expenses | $153,291 | TotalExpensesAmt |
| Excess Or Deficit For Year | -$60,791 | ExcessOrDeficitForYearAmt |
| Net Assets Or Fund Balances BOY | -$157,826 | NetAssetsOrFundBalancesBOYAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Net Assets Or Fund Balances EOY | -$218,617 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part II | Yes (X) | InfoInScheduleOPartIIInd |
Cash Savings And Investments CashSavingsAndInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total Detail OtherAssetsTotalDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,865 | BOYAmt |
| EOY | $1,214 | EOYAmt |
Form990 Total Assets Form990TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,865 | BOYAmt |
| EOY | $1,214 | EOYAmt |
Sum Of Total Liabilities SumOfTotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $171,691 | BOYAmt |
| EOY | $219,831 | EOYAmt |
Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$157,826 | BOYAmt |
| EOY | -$218,617 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Primary Exempt Purpose | TO IMPROVE ACCESS TO HEALTHCARE FOR UNINSURED AND UNDERINSURED LOW-INCOME COMMUNITY MEMBERS THROUGH FIRSTCARE'S MEDICAL AND DENTAL CLINIC. | PrimaryExemptPurposeTxt |
Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Srvc Accom | FIRSTCARE PARTNERS WITH LOCAL AGENCIES & COMMUNITY ORGANIZATIONS TO PROVIDE A WEEKLY MEDICAL CLINIC CALLED THE INREACH CLINIC. THE INREACH CLINIC'S OBJECTIVE IS TO PROVIDE BASIC MEDICAL CARE AND REFERRALS FOR LOW INCOME UNINSURED AND UNDERINSURED COMMUNITY MEMBERS AT LITTLE OR NO COST. THE INREACH CLINIC ALSO PROVIDES ACCESS TO FREE MEDICATIONS & FREE DIAGNOSTIC SERVICES AT LOCAL HEALTH CARE FACILITIES. | DescriptionProgramSrvcAccomTxt |
| Grants And Allocations | $0 | GrantsAndAllocationsAmt |
| Program Service Expenses | $153,291 | ProgramServiceExpensesAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $153,291 | TotalProgramServiceExpensesAmt |
Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (12 entries)
| TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|
| PAUL DASKALOS DO | ||||
| BOARD CHAIR / PHYSICIAN | 1.00 | $0 | $0 | $0 |
| BRUCE MADSEN MD | ||||
| BOARD VICE CHAIR | 1.00 | $0 | $0 | $0 |
| DAVID TRIEBES | ||||
| BOARD SECRETARY / CEO SAGH | 1.00 | $0 | $0 | $0 |
| STEPHEN NEWMAN MD | ||||
| BOARD MEMBER / PHYSICIAN | 1.00 | $0 | $0 | $0 |
| GREGG MILLER MD | ||||
| BOARD MEMBER / PHYSICIAN | 1.00 | $0 | $0 | $0 |
| JIM DENHAM | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| SENATOR FRANK MORSE | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| PAUL GREAVES MD | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| BRIAN CARROL | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| RICK KENYON | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| STACY KOOS | ||||
| BOARD MEMBER | 1.00 | $0 | $0 | $0 |
| DANIEL SMITH | ||||
| VP FINANCE / CFO | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | Yes (X) | InfoInScheduleOPartVInd |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Chg Made To Orgnzng Doc Not Rpt | 0 | ChgMadeToOrgnzngDocNotRptInd |
| Organization Had UBI | 0 | OrganizationHadUBIInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Direct Indirect Pltcl Expend | $0 | DirectIndirectPltclExpendAmt |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficersInd |
| Tax Imposed Under IRC4911 | $0 | TaxImposedUnderIRC4911Amt |
| Tax Imposed Under IRC4912 | $0 | TaxImposedUnderIRC4912Amt |
| Tax Imposed Under IRC4955 | $0 | TaxImposedUnderIRC4955Amt |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| Tax Imposed On Organization Mgr | $0 | TaxImposedOnOrganizationMgrAmt |
| Tax Reimbursed By Organization | $0 | TaxReimbursedByOrganizationAmt |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3000 | AddressLine1Txt |
| City | CORVALLIS | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 973393000 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5417684773 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Donor Advised Fnds | 0 | DonorAdvisedFndsInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Tanning Services Provided | 0 | TanningServicesProvidedInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| School Operating | 0 | SchoolOperatingInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Part VI Of Comp Of Hghst Pd Empl | NONE | PartVIOfCompOfHghstPdEmplTxt |
| Part VI Hghst Pd Cntrct Prof Srvc | NONE | PartVIHghstPdCntrctProfSrvcTxt |
| Filed Schedule A | Yes (1) | FiledScheduleAInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $70,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $92,500 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $92,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $105,152 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $92,500 | CurrentTaxYearAmt |
| Total | $452,652 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $70,000 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $92,500 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $92,500 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $105,152 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $92,500 | CurrentTaxYearAmt |
| Total | $452,652 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $452,652 | PublicSupportTotal170Amt |
| Total Support | $452,652 | TotalSupportAmt |
| Public Support CY170 | 1.00000 | PublicSupportCY170Pct |
| Public Support PY170 | 1.00000 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: OFFICE EXPENSES. AMOUNT: 436. DESCRIPTION: DUES, TAXES & LICENSING. AMOUNT: 85. DESCRIPTION: INSURANCE. AMOUNT: 4,011. DESCRIPTION: SUPPLIES. AMOUNT: 17,068. DESCRIPTION: PURCHASED SERVICES. AMOUNT: 23,952. TOTAL TO FORM 990-EZ, LINE 16: 45,552. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: PREPAIDS. BEG. OF YEAR AMOUNT: 1,214. END OF YEAR AMOUNT: 1,214. DESCRIPTION: OTHER A/R. BEG. OF YEAR AMOUNT: 12,651. END OF YEAR AMOUNT: 0. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 171,691. END OF YEAR AMOUNT: 205,883. DESCRIPTION: OTHER A/P. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 13,948. |
Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl
| Field | Value | IRS element (for citing) |
|---|---|---|
| Declaration | THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. | DeclarationDesc |