2012-08-23T19:43:41-05:00 2011-12-31 930928924 PERKINS & COMPANY PC 1211 SW FIFTH AVE SUITE 1000 PORTLAND OR 972043710 990 2011-01-01 930878074 FAMILYCARE INC FAMI 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JESSE GAMEZ 5032223205 2012-08-17 1 ROY ABRAMOWITZ P01329049 5032210336 2011 2016-02-24 21:20:13Z JESSE GAMEZ 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 149198184 0 X WWW.FAMILYCAREINC.ORG X 1984 OR TO PROVIDE COMMUNITY HEALTH CARE. 7 6 179 0 0 0 0 0 107150185 145060257 191253 245004 0 0 107341438 145305261 149279 341207 0 0 5943072 8167768 0 0 0 99310978 127778763 105403329 136287738 1938109 9017523 32675412 42848263 24950182 26176775 7725230 16671488 TO PROVIDE PROGRAMS OF COOPERATIVE AND COMPREHENSIVE HEALTHCARE TO THE COMMUNITY. 0 0 127695681 341207 145060257 PROVIDE COMPREHENSIVE AND COOPERATIVE HEALTH CARE TO MEMBERS ACCORDING TO THE TERMS OF A CONTRACT WITH THE OREGON HEALTH PLAN/MEDICAID. APPROXIMATELY 50,584 SERVED MONTHLY. 127695681 0 0 1 1 0 0 0 0 0 1 0 0 1 1 1 1 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 0 1 1009 0 1 179 1 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X JEFF HEATHERINGTON 5032223205 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 JEFFREY PAWLOWSKI 1.00 X X 8000 0 0 KAREN CARNAHAN 1.00 X X 12000 0 0 ROBIN RICHARDSON DO 1.00 X X 3850 0 0 JANET TESCH 1.00 X X 3350 0 0 ROBERT CARUS 1.00 X 4000 0 0 ROSS RONISH 1.00 X 3562 0 0 JILL RISSI 1.00 X 3000 0 0 JEFF HEATHERINGTON 40.00 X 380323 0 29951 GREG MARTENSON 40.00 X 15504 0 0 KATHERINE ELLIS 40.00 X 135810 0 11871 DOUGLAS LUTHER 40.00 X 261249 0 7571 JESSE GAMEZ 40.00 X 157037 0 8605 RONALD PRESTON 40.00 X 158750 0 10555 AMY SZCZUKOWSHI 40.00 X 127750 0 17952 NANCY BOYD 40.00 X 115046 0 4000 DERRICK DALE 40.00 X 107318 0 14221 1496549 0 104726 9 0 1 0 PHYSICIANS INSURANCE A MUTAL CO 1301 SECOND AVENUE SUITE 2700 SEATTLE WA 98101 INSURANCE SERVICES 4067156 HEALTH NET OF OREGON 11918 SE DIVISION 144 PORTLAND OR 97266 INSURANCE SERVICES 1119803 AXIAN INC 9600 SW NUMBUS AVE SUITE 200 BEAVERTON OR 97008 IT SERVICES & REPORTING 930077 VISION SERVICE PLAN 121 SW MORRISON ST SUITE 1050 PORTLAND OR 97204 INSURANCE SERVICES 625336 STOEL RIVES LLP 900 SW FIFTH AVE SUITE 2600 PORTLAND OR 97204 LEGAL SERVICES 610477 21 145060257 145060257 145060257 159383 159383 3978544 3892923 85621 85621 85621 145305261 145060257 0 245004 341207 341207 880040 514753 365287 6570152 5321823 1248329 136253 110365 25888 557 557 580766 580766 352537 352537 109987 109987 94761 94761 25465 25465 471491 471491 613232 613232 72567 72567 10600 10600 26356 26356 948392 948392 865885 865885 INPATIENT HOSPITAL 43343852 43343852 OTHER PROFESSIONAL SERV 28907708 27198747 1708961 PHYSICIAN SERVICES 28356275 28356275 EMERGENCY ROOM AND OUT- 12440085 12440085 11139570 10068574 1070996 136287738 127695681 8592057 0 10966698 18218115 920925 1251074 4001864 3006286 5430993 2396858 3053527 3034135 3845571 3333565 9886827 14005088 32675412 42848263 24742858 25712291 207324 464484 24950182 26176775 X 7725230 16671488 7725230 16671488 32675412 42848263 X 9017523 -71265 X X 0 1 1 X 0 10000 1 0 1 84761 179231 263992 0 PART IV, SUPPLEMENTAL INFORMATION: PART I-A, LINE 1 $10,000 WAS CONTRIBUTED TO THE EILEEN FOR MAYOR CAMPAIGN. PART III-B PER REV. PROC. 98-19, FAMILYCARE, INC. IS EXEMPTED FROM THE PROXY TAX AND THE NOTIFICATION REQUIREMENT OF IRC SEC. 6033(E)(1) BECAUSE MORE THAN 90% OF THE ORGANIZATION'S ANNUAL DUES (OR SIMILAR AMOUNTS) ARE RECEIVED FROM ORGANIZATIONS DESCRIBED IN SECTION 501(C)(3), STATE GOVERNMENTS, LOCAL GOVERNMENTS, ENTITIES WHOSE INCOME IS EXEMPT FROM TAX UNDER SECTION 115, OR ORGANIZATIONS EXCEPTED UNDER SECTION 4.01 OF REV. PROC. 98-19. 68312 17753 50559 4725336 2324574 2400762 637345 54531 582814 3034135 OTHER CURRENT ASSETS, NET 2802720 OTHER ASSETS, NET 167654 RESTRICTED CASH AND CASH EQUIVALENTS 334656 INVESTMENTS IN FAMILYCARE HEALTH PLANS 4739938 RESTRICTED SHORT-TERM INVESTMENTS 634087 RESTRICTED LONG-TERM INVESTMENTS 5326033 14005088 CAPITAL LEASE OBLIGATION, LESS CURRENT PORTION 464484 464484 145305261 136287738 9017523 -107835 36570 -71265 8946258 176999120 -107835 31801694 31693859 145305261 0 145305261 168052862 31765124 31765124 136287738 0 136287738 PART XI, LINE 8 - OTHER ADJUSTMENTS: INCOME FROM SUBSIDIARY 36,570. PART XII, LINE 2D - OTHER ADJUSTMENTS: OTHER ENTITY REVENUE 31,801,694. PART XIII, LINE 2D - OTHER ADJUSTMENTS: OTHER ENTITY EXPENSE 31,765,124. SCHEDULE D, PART X, LINE 1 FINANCIAL STATEMENT FOOTNOTE REGARDING ASC 740: FAMILYCARE, AND HEALTH PLANS ARE TAX-EXEMPT ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE (IRC) SECTION 501(C)(4). ONLY THE COMPANY'S UNRELATED BUSINESS INCOME IS SUBJECT TO FEDERAL OR STATE INCOME TAXES. IT IS MANAGEMENT'S BELIEF THAT NONE OF THE COMPANY'S ACTIVITIES HAVE GENERATED MATERIAL UNRELATED BUSINESS INCOME; THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN MADE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. GENERALLY, THE COMPANY IS SUBJECT TO EXAMINATION BY FEDERAL, STATE AND LOCAL INCOME TAX AUTHORITIES FOR THREE YEARS FROM THE FILING OF A TAX RETURN. WITH FEW EXCEPTIONS, THE COMPANY IS NO LONGER SUBJECT TO SUCH EXAMINATIONS FOR YEARS ENDED BEFORE DECEMBER 31, 2008. 1 CHILDREN'S RELIEF NURSERY 8425 N LOMBARD PORTLAND OR 97203 931260988 501(C)(3) 10000 SPONSORSHIP - IRON CHEF NW OSTEOPATHIC MEDICAL FOUNDATION 1410 SW MORRISON ST SUITE 700 PORTLAND OR 97205 930882138 501(C)(3) 18000 EDUCATION; SPONSORSHIP OSTEOPATHIC PHYSICIANS & SURGEONS OF OREGON INC 4380 SW MACADAM AVE SUITE 125 PORTLAND OR 97239 936025596 501(C)(6) 100000 OSTEOPATHIC SUPPORT; EDUCATION GRANT. BASIC RIGHTS EDUCATION FUND PO BOX 40625 PORTLAND OR 97240 931266613 501(C)(3) 17500 DONATION & SPONSORSHIP CASCADE AIDS PROJECT 208 SW 5TH AVE STE 800 PORTLAND OR 97204 930903383 501(C)(3) 15000 SPONSORSHIP WESTERN UNIVERSITY OF HEALTH SCIENCES 200 MULLINS DR LEBANON OR 97355 953127273 501(C)(3) 20000 DONATION - NEW SCHOOL HILLSBORO SCHOOL DISTRICT - EASTWOOD ELEMENTARY SCHOOL 2100 NE LINCOLN ST HILLSBORO OR 97124 936001037 501(C)(3) 20000 SPONSORSHIP - HSHO 2011 AWARD GLADSTONE EDUCATION FOUNDATION - JOHN WETTEN ELEMENTARY SCHOOL 250 E EXETER ST GLADSTONE OR 97027 931284265 501(C)(3) 20000 SPONSORSHIP - HSHO 2011 AWARD NAMI 4701 SE 24TH AVE STE E PORTLAND OR 97202 930875209 501(C)(3) 9045 SPONSORSHIP NORTHWEST MOTHERS MILK BANK 3439 NE SANDY BLVD 130 PORTLAND OR 97232 263458029 501(C)(3) 10000 DONATION OREGON SCHOOL-BASED HEALTH CARE NETWORK PO BOX 12191 PORTLAND OR 97212 364588657 501(C)(3) 21000 SPONSORSHIP REYNOLDS SCHOOL DISTRICT #7 1204 NE 201ST AVE FAIRVIEW OR 97024 931220481 501(C)(3) 20000 SPONSORSHIP - HSHO 2011 AWARD GRESHAM-BARLOW EDUCATION FOUNDATION 1331 NW EASTMAN PKY GRESHAM OR 97030 931148994 501(C)(3) 20000 SPONSORSHIP - HSHO 2011 AWARD 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: FAMILYCARE DOES NOT AWARD GRANTS, BUT SPONSORS A LIMITED NUMBER OF CHARITABLE FUNDRAISING EVENTS. 0 0 0 0 0 0 0 0 0 JEFF HEATHERINGTON 350000 0 11227 0 19096 0 23708 0 6243 0 410274 0 0 0 DOUGLAS LUTHER 242204 0 7283 0 11762 0 7036 0 535 0 268820 0 0 0 JESSE GAMEZ 152596 0 1001 0 3440 0 2650 0 5955 0 165642 0 0 0 RONALD PRESTON 153846 0 601 0 4303 0 1244 0 9311 0 169305 0 0 0 ROBIN RICHARDSON DO SECRETARY AND BOARD MEMBER 11475 EXPENSES PAID FOR HEALTHCARE-RELATED SERVICES 0 KAREN CARNAHAN CHAIR AND BOARD MEMBER 135038 EXPENSES PAID TO PROFESSIONAL SERVICES FIRM 0 ROSS RONISH BOARD MEMBER 2082432 EXPENSES PAID TO A PROVIDER CLINIC FOR HEALTHCARE-RELATED SERVICES 0 FORM 990, PART VI, SECTION B, LINE 11 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 C, LINE 19 FAMILYCARE, INC. MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -107,835. INCOME FROM SUBSIDIARY 36,570. TOTAL TO FORM 990, PART XI, LINE 5: -71,265. 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 300 PORTLAND OR 97232 911829317 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(4) 0 FAMILYCARE MEDICAL CLINICS INC 825 NE MULTNOMAH SUITE 300 PORTLAND OR 97232 930988354 TO PROVIDE COMMUNITY HEALTH CARE OR 501(C)(3) NON-PRIVATE FDN 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 FAMILYCARE HEALTH PLANS INC R 397751 PART II FAMILYCARE, INC., FAMILYCARE HEALTH PLANS, INC. AND FAMILYCARE MEDICAL CLINICS, INC. ARE RELATED TAX-EXEMPT ORGANIZATIONS BY VIRTUE OF COMMON BOARD MEMBERS.