FIRSTCARE HEALTH FOUNDATION: Form 990EZ, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FIRSTCARE HEALTH FOUNDATION (EIN 93-0900124)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-12
- IRS object ID
- 201323169349202852
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2013-11-12T18:45:24-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
| Return Type | 990EZ | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930900124 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIRSTCARE HEALTH FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FIRS | NameControl |
| Phone | 5417684773 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O SHS ACCOUNTING PO BOX 3000 | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 973393000 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DANIEL B SMITH | Name |
| Title | VP FINANCE/CFO | Title |
| Phone | 5417684773 | Phone |
| Date Signed | 2013-11-05 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990-EZ IRS990EZ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Web Site | N/A | WebSite |
| Organization501c3 | X | Organization501c3 |
| Gross Receipts | 70000 | GrossReceipts |
| Info In Schedule O Part I | X | InfoInScheduleOPartI |
| Contributions Gifts Grants Etc | 70000 | ContributionsGiftsGrantsEtc |
| Total Revenue | 70000 | TotalRevenue |
| Salaries Other Comp Empl Benefits | 98613 | SalariesOtherCompEmplBenefits |
| Occupancy Rent Utilities And Maint | 3310 | OccupancyRentUtilitiesAndMaint |
| Other Expenses Total | 368645 | OtherExpensesTotal |
| Total Expenses | 470568 | TotalExpenses |
| Excess Or Deficit For Year | -400568 | ExcessOrDeficitForYear |
| Net Assets Or Fund Balances BOY | -378655 | NetAssetsOrFundBalancesBOY |
| Other Changes In Net Assets | 778457 | OtherChangesInNetAssets |
| Net Assets Or Fund Balances EOY | -766 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part II | X | InfoInScheduleOPartII |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2378 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2378 | EOY |
Sum Of Total Liabilities SumOfTotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 378655 | BOY |
| EOY | 3144 | EOY |
Net Assets Or Fund Balances NetAssetsOrFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -378655 | BOY |
| EOY | -766 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Primary Exempt Purpose | TO IMPROVE ACCESS TO HEALTHCARE FOR UNINSURED AND UNDERINSURED LOW-INCOME COMMUNITY MEMBERS THROUGH FIRSTCARE'S MEDICAL AND DENTAL CLINIC. | PrimaryExemptPurpose |
Program Service Accomplishment ProgramServiceAccomplishment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Program Service 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. | DescriptionProgramServiceAccom |
| Grants And Allocations | 0 | GrantsAndAllocations |
| Program Service Expenses | 470568 | ProgramServiceExpenses |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | 470568 | TotalProgramServiceExpenses |
| Info In Schedule O Part IV | X | InfoInScheduleOPartIV |
Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (12 entries)
| TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|
| DAVID TRIEBES | ||||
| BOARD SECRETARY & TREASURER/CEO AGH | 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 | ||||
| BOARD VICE-CHAIR/PHYSICIAN | 1.00 | 0 | 0 | 0 |
| JIM DENHAM | ||||
| BOARD MEMBER | 1.00 | 0 | 0 | 0 |
| PATRICK HAGERTY DMD | ||||
| BOARD CHAIR | 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 |
| GEORGENE MCALHANY | ||||
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRpt |
| Made Changes To Orgnzng Etc Doc | 0 | MadeChangesToOrgnzngEtcDoc |
| Organization Had UBI | 0 | OrganizationHadUBI |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtc |
| Direct Indirect Political Expend | 0 | DirectIndirectPoliticalExpend |
| Made Loans To From Officers | 0 | MadeLoansToFromOfficers |
| Tax Imposed Under IRC4911 | 0 | TaxImposedUnderIRC4911 |
| Tax Imposed Under IRC4912 | 0 | TaxImposedUnderIRC4912 |
| Tax Imposed Under IRC4955 | 0 | TaxImposedUnderIRC4955 |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTrans |
| Amount Of Tax Imposed On Org Mgr | 0 | AmountOfTaxImposedOnOrgMgr |
| Amount Of Tax Reimbursed By Org | 0 | AmountOfTaxReimbursedByOrg |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 3000 | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 973393000 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5417684773 | TelephoneNumber |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Foreign Office | 0 | ForeignOffice |
| Maintain Any Donor Advised Funds | 0 | MaintainAnyDonorAdvisedFunds |
| Does Org Have Hospital | 0 | DoesOrgHaveHospital |
| Tanning Services Provided | 0 | TanningServicesProvided |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Engage Political Cmpgn Activities | 0 | EngagePoliticalCmpgnActivities |
| Engage In Lobbying Activities | 0 | EngageInLobbyingActivities |
| Operating School | 0 | OperatingSchool |
| Trnsfrs Exempt Non Char Related Org | 0 | TrnsfrsExemptNonCharRelatedOrg |
| Part VI Of Comp Of Highest Paid Empl | NONE | PartVIOfCompOfHighestPaidEmpl |
| Part VIA Hghst Paid Cntrct Prof Ser | NONE | PartVIAHghstPaidCntrctProfSer |
| Filed Schedule A | 1 | FiledScheduleA |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (4 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| ALBANY GEN HOSP | |||||
| 930110095 | 3 | 1 | 1 | 1 | $266,874 |
| FIRSTCARE MED FND | |||||
| 930932697 | 9 | 1 | 1 | 1 | $116,179 |
| MID-VALLEY HC | |||||
| 930396847 | 3 | 0 | 1 | 1 | $3,155 |
| GOOD SAM HOSP | |||||
| 930391573 | 3 | 0 | 1 | 1 | $10,281 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 4 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 396489 | SumOfAmounts |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| OTHER EXPENSES | FORM 990-EZ, PART I, LINE 16 | DESCRIPTION: OFFICE EXPENSES. AMOUNT: 3,842. DESCRIPTION: TRAVEL. AMOUNT: 615. DESCRIPTION: CONFERENCES, CONVENTIONS, AND MEETINGS. AMOUNT: 694. DESCRIPTION: INSURANCE. AMOUNT: 1,550. DESCRIPTION: SUPPLIES. AMOUNT: 124. DESCRIPTION: PURCHASED SERVICES. AMOUNT: 361,745. DESCRIPTION: LICENSES & TAXES. AMOUNT: 75. TOTAL TO FORM 990-EZ, LINE 16: 368,645. |
| OTHER CHANGES IN NET ASSETS | FORM 990-EZ, PART I, LINE 20 | DESCRIPTION: INTERCOMPANY TRANSFERS. AMOUNT: 778,457. |
| OTHER ASSETS | FORM 990-EZ, PART II, LINE 24 | DESCRIPTION: PREPAIDS. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 2,378. |
| OTHER LIABILITIES | FORM 990-EZ, PART II, LINE 26 | DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 4,437. END OF YEAR AMOUNT: 3,144. DESCRIPTION: ACCOUNTS PAYABLE - AFFILIATES. BEG. OF YEAR AMOUNT: 374,218. END OF YEAR AMOUNT: 0. |
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. | Declaration |