FIRSTCARE HEALTH FOUNDATION: Form 990EZ, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: FIRSTCARE HEALTH FOUNDATION (EIN 93-0900124)
Tax period: 2014-01-01 to 2014-12-31
Filed: 2015-11-13
IRS object ID: 201513179349203566
Schema version: 2014v5.0
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
Form 990-EZ
Schedule A
Schedule B
Schedule O
Transfer Prsnl Bnft Contracts Decl

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2015-11-13T16:24:15-06:00	ReturnTs
Tax Period End	2014-12-31	TaxPeriodEndDt
Return Type	990EZ	ReturnTypeCd
Tax Period Begin	2014-01-01	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	2015-11-13	SignatureDt

Field	Value	IRS element (for citing)
Tax	2014	TaxYr
Build TS	2016-02-25 16:41:14Z	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	$89,119	SalariesOtherCompEmplBnftAmt
Occupancy Rent Utlts And Maint	$10,779	OccupancyRentUtltsAndMaintAmt
Other Expenses Total	$96,096	OtherExpensesTotalAmt
Total Expenses	$195,994	TotalExpensesAmt
Excess Or Deficit For Year	-$103,494	ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY	-$1,051	NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY	-$104,545	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part II	Yes (X)	InfoInScheduleOPartIIInd

Other Assets Total Detail OtherAssetsTotalDetail

Field	Value	IRS element (for citing)
BOY	$1,214	BOYAmt
EOY	$1,214	EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$1,214	BOYAmt
EOY	$1,214	EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$2,265	BOYAmt
EOY	$105,759	EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

Field	Value	IRS element (for citing)
BOY	-$1,051	BOYAmt
EOY	-$104,545	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	$195,994	ProgramServiceExpensesAmt

Field	Value	IRS element (for citing)
Total Program Service Expenses	$195,994	TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (12 entries)

TitleTitleTxt	Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt	CompensationCompensationAmt	Employee Benefit ProgramEmployeeBenefitProgramAmt	Expense Account Other AllwncExpenseAccountOtherAllwncAmt
DAVID TRIEBES
BOARD SECRETARY & TREASURER	1.00	$0	$0	$0
MARIA DELAPOER
BOARD MEMBER	1.00	$0	$0	$0
BRUCE MADSEN MD
BOARD MEMBER	1.00	$0	$0	$0
PAUL DASKALOS DO
BRD CHR(SEP-DEC)/V-CHR(JAN-SEP)PHYS	1.00	$0	$0	$0
JIM DENHAM
INTERIM CHAIR (MAY-AUG)/BRD MBR	1.00	$0	$0	$0
PATRICK HAGERTY DMD
BOARD CHAIR (JAN-APR)	1.00	$0	$0	$0
GREGG MILLER MD
BOARD MEMBER/PHYSICIAN	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
STEPHEN NEWMAN MD
BOARD MEMBER/PHYSICIAN	1.00	$0	$0	$0
BRIAN CARROL
BOARD MEMBER	1.00	$0	$0	$0
DANIEL B 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)
Supporting Organization509a3	Yes (X)	SupportingOrganization509a3Ind
Supporting Org Type2	Yes (X)	SupportingOrgType2Ind
Supported Organizations	3	SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (3 entries)

EINEIN	Organization TypeOrganizationTypeDesc	Governing Document ListedGoverningDocumentListedInd	SupportSupportAmt	Other SupportOtherSupportAmt
ALBANY GEN HOSP
930110095	3	Yes (1)	$133,816	$0
MID-VALLEY HC
930396847	3	0	$26,802	$0
GOOD SAM HOSP
930391573	3	0	$238	$0

Field	Value	IRS element (for citing)
Supported Organizations Total	3	SupportedOrganizationsTotalCnt
Support Sum	$160,856	SupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

Field	Value	IRS element (for citing)
Listed By Name Governing Doc	0	ListedByNameGoverningDocInd
Suprt Org No IRS Determination	0	SuprtOrgNoIRSDeterminationInd
Supported Org Section C456	0	SupportedOrgSectionC456Ind
Supported Org Not Organized US	0	SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org	0	OrganizationChangeSuprtOrgInd
Support Non Supported Org	0	SupportNonSupportedOrgInd
Payment Substantial Contribtr	0	PaymentSubstantialContribtrInd
Loan Disqualified Person	0	LoanDisqualifiedPersonInd
Controlled Disqualified Prsn	0	ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int	0	DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int	0	DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules	0	ExcessBusinessHoldingsRulesInd
Contribution Controller	0	ContributionControllerInd
Contribution Family	0	ContributionFamilyInd
Contribution35 Controlled	0	Contribution35ControlledInd

Field	Value	IRS element (for citing)
Majority Dir Trst Supported Org	0	MajorityDirTrstSupportedOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART IV SEC. A Q. 1	MID-VALLEY HEALTHCARE AND GOOD SAMARITAN HOSPITAL ARE NOT LISTED IN THE ARTICLES OF INCORPORATION OF THE FILING ORGANIZATION. THEIR RELATIONSHIP WITH THE FILING ORGANIZATION IS A HISTORIC AND CONTINUING RELATIONSHIP. ALL OF THE ORGANIZATIONS LISTED IN PART I OF SCHEDULE A ARE TAX-EXEMPT HOSPITALS THAT SHARE THE SAME CORPORATE PARENT, SAMARITAN HEALTH SERVICES, A 501(C)(3) ORGANIZATION, AND ARE PART OF THE SAME GROUP OF CONTROLLED ORGANIZATIONS AS THE FILING ORGANIZATION.
PART IV SEC. C Q. 1	THE FILING ORGANIZATION HAS THE SAME BOARD OF DIRECTORS AS ALBANY GENERAL HOSPITAL. ALBANY GENERAL HOSPITAL IS LISTED AS A SUPPORTED ORGANIZATION IN THE ARTICLES OF INCORPORATION OF THE FILING ORGANIZATION. THE MAJORITY OF THE SUPPORT PROVIDED BY THE FILING ORGANIZATION WAS FOR ALBANY GENERAL HOSPITAL. ALTHOUGH MID-VALLEY HEALTHCARE AND GOOD SAMARITAN HOSPITAL DO NOT SHARE COMMON BOARDS OF DIRECTORS WITH THE FILING ORGANIZATION, THEY ARE PART OF THE SAME GROUP OF CONTROLLED CORPORATIONS WITH THE SAME CORPORATE PARENT, SAMARITAN HEALTH SERVICES, A 501(C)(3) ORGANIZATION.

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART IV SEC. A Q. 1

MID-VALLEY HEALTHCARE AND GOOD SAMARITAN HOSPITAL ARE NOT LISTED IN THE ARTICLES OF INCORPORATION OF THE FILING ORGANIZATION. THEIR RELATIONSHIP WITH THE FILING ORGANIZATION IS A HISTORIC AND CONTINUING RELATIONSHIP. ALL OF THE ORGANIZATIONS LISTED IN PART I OF SCHEDULE A ARE TAX-EXEMPT HOSPITALS THAT SHARE THE SAME CORPORATE PARENT, SAMARITAN HEALTH SERVICES, A 501(C)(3) ORGANIZATION, AND ARE PART OF THE SAME GROUP OF CONTROLLED ORGANIZATIONS AS THE FILING ORGANIZATION.

PART IV SEC. C Q. 1

THE FILING ORGANIZATION HAS THE SAME BOARD OF DIRECTORS AS ALBANY GENERAL HOSPITAL. ALBANY GENERAL HOSPITAL IS LISTED AS A SUPPORTED ORGANIZATION IN THE ARTICLES OF INCORPORATION OF THE FILING ORGANIZATION. THE MAJORITY OF THE SUPPORT PROVIDED BY THE FILING ORGANIZATION WAS FOR ALBANY GENERAL HOSPITAL. ALTHOUGH MID-VALLEY HEALTHCARE AND GOOD SAMARITAN HOSPITAL DO NOT SHARE COMMON BOARDS OF DIRECTORS WITH THE FILING ORGANIZATION, THEY ARE PART OF THE SAME GROUP OF CONTROLLED CORPORATIONS WITH THE SAME CORPORATE PARENT, SAMARITAN HEALTH SERVICES, A 501(C)(3) ORGANIZATION.

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: 1,765. DESCRIPTION: INSURANCE. AMOUNT: 4,004. DESCRIPTION: SUPPLIES. AMOUNT: 2,161. DESCRIPTION: PURCHASED SERVICES. AMOUNT: 88,166. TOTAL TO FORM 990-EZ, LINE 16: 96,096.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS	DESCRIPTION: PREPAIDS. BEG. OF YEAR AMOUNT: 1,214. END OF YEAR AMOUNT: 1,214.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES	DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 2,265. END OF YEAR AMOUNT: 105,759.

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