STRATEGY STUDIO / PUBLIC DATA EXPLORER

FIRSTCARE HEALTH FOUNDATION: Form 990EZ, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
FIRSTCARE HEALTH FOUNDATION (EIN 93-0900124)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-08
IRS object ID
201203139349200435
Schema version
2011v1.2
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

FieldValueIRS element (for citing)
Timestamp2012-11-08T11:36:34-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate
Return Type990EZReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930900124EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FIRSTCARE HEALTH FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlFIRSNameControl
Phone5417684773Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1C/O SHS ACCOUNTING PO BOX 3000AddressLine1
CityCORVALLISCity
StateORState
ZIP Code973393000ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDANIEL B SMITHName
TitleVP FINANCE/CFOTitle
Phone5417684773Phone
Date Signed2012-11-05DateSigned
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990-EZ IRS990EZ

FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Web SiteN/AWebSite
Organization501c3XOrganization501c3
Gross Receipts117840GrossReceipts
Info In Schedule O Part IXInfoInScheduleOPartI
Contributions Gifts Grants Etc117840ContributionsGiftsGrantsEtc
Total Revenue117840TotalRevenue
Salaries Other Comp Empl Benefits88596SalariesOtherCompEmplBenefits
Other Expenses Total407899OtherExpensesTotal
Total Expenses496495TotalExpenses
Excess Or Deficit For Year-378655ExcessOrDeficitForYear
Net Assets Or Fund Balances BOY3336907NetAssetsOrFundBalancesBOY
Other Changes In Net Assets-3336907OtherChangesInNetAssets
Net Assets Or Fund Balances EOY-378655NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIXInfoInScheduleOPartII

Land And Buildings LandAndBuildings

FieldValueIRS element (for citing)
BOY3322921BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY14099BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY3337020BOY
EOY0EOY

Sum Of Total Liabilities SumOfTotalLiabilities

FieldValueIRS element (for citing)
BOY113BOY
EOY378655EOY

Net Assets Or Fund Balances NetAssetsOrFundBalances

FieldValueIRS element (for citing)
BOY3336907BOY
EOY-378655EOY
FieldValueIRS element (for citing)
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Primary Exempt PurposeTO IMPROVE ACCESS TO HEALTHCARE FOR UNINSURED AND UNDERINSURED LOW-INCOME COMMUNITY MEMBERS THROUGH FIRSTCARE'S MEDICAL AND DENTAL CLINIC.PrimaryExemptPurpose

Program Service Accomplishment ProgramServiceAccomplishment

FieldValueIRS element (for citing)
Description Program Service AccomFIRSTCARE 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 Allocations0GrantsAndAllocations
Program Service Expenses496495ProgramServiceExpenses
FieldValueIRS element (for citing)
Total Program Service Expenses496495TotalProgramServiceExpenses

Officer Director Trustee Key Empl OfficerDirectorTrusteeKeyEmpl (12 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeTitleTitleAvg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPositionCompensationCompensationContri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtcExpense Account Other AllowancesExpenseAccountOtherAllowances
DAVID TRIEBES
1046 SIXTH AVE SWALBANYOR97321BOARD SECRETARY & TREASURER/CEO AGH1.00000
MARIA DELAPOER
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER1.00000
BRUCE MADSEN MD
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER1.00000
PAUL DASKALOS DO
1046 SIXTH AVE SWALBANYOR97321BOARD VICE-CHAIR/PHYSICIAN1.00000
JIM DENHAM
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER1.00000
PATRICK HAGERTY DMD
1046 SIXTH AVE SWALBANYOR97321BOARD CHAIR1.00000
GREGG MILLER MD
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER/PHYSICIAN1.00000
SENATOR FRANK MORSE
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER1.00000
GEORGENE MCALHANY
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER1.00000
PAUL GREAVES MD
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER1.00000
STEPHEN NEWMAN MD
1046 SIXTH AVE SWALBANYOR97321BOARD MEMBER/PHYSICIAN1.00000
DANIEL B SMITH
1046 SIXTH AVE SWALBANYOR97321VP FINANCE/CFO1.00000
FieldValueIRS element (for citing)
Info In Schedule O Part VXInfoInScheduleOPartV
Activities Not Previously Rpt1ActivitiesNotPreviouslyRpt
Made Changes To Orgnzng Etc Doc0MadeChangesToOrgnzngEtcDoc
Organization Had UBI0OrganizationHadUBI
Subject To Proxy Tax0SubjectToProxyTax
Organization Dissolved Etc1OrganizationDissolvedEtc
Direct Indirect Political Expend0DirectIndirectPoliticalExpend
Made Loans To From Officers0MadeLoansToFromOfficers
Tax Imposed Under IRC49110TaxImposedUnderIRC4911
Tax Imposed Under IRC49120TaxImposedUnderIRC4912
Tax Imposed Under IRC49550TaxImposedUnderIRC4955
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTrans
Amount Of Tax Imposed On Org Mgr0AmountOfTaxImposedOnOrgMgr
Amount Of Tax Reimbursed By Org0AmountOfTaxReimbursedByOrg
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SAMARITAN HEALTH SERVICESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 3000AddressLine1
CityCORVALLISCity
StateORState
ZIP Code973393000ZIPCode
FieldValueIRS element (for citing)
Telephone Number5417684773TelephoneNumber
FieldValueIRS element (for citing)
Foreign Financial Account0ForeignFinancialAccount
Foreign Office0ForeignOffice
Maintain Any Donor Advised Funds0MaintainAnyDonorAdvisedFunds
Does Org Have Hospital0DoesOrgHaveHospital
Tanning Services Provided0TanningServicesProvided
Related Org Controlled Entity0RelatedOrgControlledEntity
Engage Political Cmpgn Activities0EngagePoliticalCmpgnActivities
Engage In Lobbying Activities0EngageInLobbyingActivities
Operating School0OperatingSchool
Trnsfrs Exempt Non Char Related Org0TrnsfrsExemptNonCharRelatedOrg
Part VI Of Comp Of Highest Paid EmplNONEPartVIOfCompOfHighestPaidEmpl
Part VIA Hghst Paid Cntrct Prof SerNONEPartVIAHghstPaidCntrctProfSer
Filed Schedule A1FiledScheduleA

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type2XSupportingOrg509a3Type2
Certification CheckboxXCertificationCheckbox
Contrib By Controlling Individual0ContribByControllingIndividual
Contribution By Related Party0ContributionByRelatedParty
Contrib By35 Controlled Entity0ContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation (4 entries)

EINEINType Of OrganizationTypeOfOrganizationListed In Governing DocListedInGoverningDocSupported Organization NotifiedSupportedOrganizationNotifiedOrganized In USOrganizedInUSAmountAmount
ALBANY GEN HOSP
9301100953111$236,864
FIRSTCARE MED FND
9309326979111$172,369
MID-VALLEY HC
9303968473011$5,217
GOOD SAM HOSP
9303915733011$13,843
FieldValueIRS element (for citing)
Total Number Of Supported Orgs4TotalNumberOfSupportedOrgs
Sum Of Amounts428293SumOfAmounts
Facts And Circumstances TestTHE EXEMPT ACTIVITIES OF FIRSTCARE HEALTH FOUNDATION CHANGED AS OF 1/1/2011. PREVIOUSLY FIRSTCARE HEALTH FOUNDATION SERVED TO SUPPORT ALBANY GENERAL HOSPITAL, A RELATED 501(C)(3) ORGANIZATION, AND OTHER RELATED 501(C)(3) ORGANIZATIONS. THESE ACTIVITIES AND THE ASSOCIATED ASSETS AND LIABILITIES WERE TRANSFERRED TO ALBANY GENERAL HOSPITAL AS OF 1/1/2011.AS OF 1/1/2011, FIRSTCARE HEALTH FOUNDATION IS THE EXEMPT ORGANIZATION WITHIN THE CONTROLLED GROUP, SAMARITAN HEALTH SERVICES, THAT REPORTS THE ACTIVITIES OF THE INREACH CLINIC. THE INREACH CLINIC PROVIDES MEDICAL AND DENTAL SERVICES TO UNINSURED COMMUNITY MEMBERS AT LITTLE OR NO COST.FOR 2011, THE CHARITABLE ACTIVITIES OF INREACH CLINIC COMPRISE ALL OF THE ACTIVITIES REPORTED ON FIRSTCARE HEALTH FOUNDATION'S 990. THE INREACH CLINIC IS FUNDED EXCLUSIVELY THROUGH GOVERNMENTAL AND PUBLIC SUPPORT. FOR 2011, THERE ARE NO REVENUES GENERATED FROM FIRSTCARE HEALTH FOUNDATION CARRYING OUT ITS EXEMPT FUNCTIONS.THE RENTAL REVENUES THAT ARE REPORTED ON THE PUBLIC SUPPORT SCHEDULE FROM 2007 TO 2010 ARE FROM WHEN FIRSTCARE HEALTH FOUNDATION WAS A SUPPORTING ORGANIZATION FOR ALBANY GENERAL HOSPITAL AND OTHER RELATED 501(C)(3) ORGANIZATIONS.FactsAndCircumstancesTest

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule N IRS990ScheduleN

Disposition Table DispositionTable (4 entries)

Description Of AssetDescriptionOfAssetDate Of DistributionDateOfDistributionFMV Of AssetFMVOfAssetMethod Of FMV DeterminationMethodOfFMVDeterminationEINEINAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeIRC SectionIRCSection
ALBANY GENERAL HOSPITAL
BUILDINGS2011-01-012257272BOOK VALUE9301100951046 SIXTH AVE SWALBANYOR97321501(C)(3)
ALBANY GENERAL HOSPITAL
LAND2011-01-011065649BOOK VALUE9301100951046 SIXTH AVE SWALBANYOR97321501(C)(3)
ALBANY GENERAL HOSPITAL
LAND IMPROVEMENTS2011-01-017485BOOK VALUE9301100951046 SIXTH AVE SWALBANYOR97321501(C)(3)
ALBANY GENERAL HOSPITAL
EQUIPMENT2011-01-010BOOK VALUE9301100951046 SIXTH AVE SWALBANYOR97321501(C)(3)
FieldValueIRS element (for citing)
Director Of Successor20DirectorOfSuccessor2
Employee Of Successor20EmployeeOfSuccessor2
Owner Of Successor20OwnerOfSuccessor2
Receive Compensation20ReceiveCompensation2

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
OTHER EXPENSESFORM 990-EZ, PART I, LINE 16DESCRIPTION: OFFICE EXPENSES. AMOUNT: 949. DESCRIPTION: CONFERENCES, CONVENTIONS, AND MEETINGS. AMOUNT: 265. DESCRIPTION: INSURANCE. AMOUNT: 3,036. DESCRIPTION: PURCHASED SERVICES. AMOUNT: 403,574. DESCRIPTION: LICENSES & TAXES. AMOUNT: 75. TOTAL TO FORM 990-EZ, LINE 16: 407,899.
OTHER CHANGES IN NET ASSETSFORM 990-EZ, PART I, LINE 20DESCRIPTION: INTERCOMPANY TRANSFERS. AMOUNT: -3,336,907.
OTHER ASSETSFORM 990-EZ, PART II, LINE 24DESCRIPTION: PREPAID EXPENSES. BEG. OF YEAR AMOUNT: 6,614. END OF YEAR AMOUNT: 0. DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 7,485. END OF YEAR AMOUNT: 0.
OTHER LIABILITIESFORM 990-EZ, PART II, LINE 26DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 113. END OF YEAR AMOUNT: 4,437. DESCRIPTION: ACCOUNTS PAYABLE - AFFILIATES. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 374,218.
FORM 990-EZ, PART V, LINE 33, ACTIVITIES NOT PREVIOUSLY REPORTED:FIRSTCARE HEALTH FOUNDATION ("FIRSTCARE") WAS ORIGINALLY FORMED TO PROVIDE SUPPORT TO, AND FUNCTION FOR THE BENEFIT OF, ALBANY GENERAL HOSPITAL AND ALBANY GENERAL HOSPITAL FOUNDATION, AND SUBSEQUENTLY OTHER ENTITIES NOW AFFILIATED WITH SAMARITAN HEALTH SERVICES, ALL OF WHICH ARE TAX-EXEMPT CHARITABLE ORGANIZATIONS PURSUANT TO INTERNAL REVENUE CODE SECTION 501(C)(3). FOR MANY YEARS PRIOR TO 2011, FIRSTCARE'S PRIMARY ACTIVITY WAS CENTERED AROUND THE OWNERSHIP OF REAL ESTATE AND THE LEASING OF SUCH REAL ESTATE TO ITS SUPPORTED ORGANIZATIONS IN FURTHERANCE OF THE OPERATIONS OF THOSE CHARITABLE ORGANIZATIONS AND THE PROVISION OF THEIR RESPECTIVE HEALTHCARE ACTIVITIES. IN 2011, FIRSTCARE TRANSFERRED OWNERSHIP OF THESE PROPERTIES TO ITS TAX-EXEMPT AFFILIATE, ALBANY GENERAL HOSPITAL (SEE SCHEDULE N). ALSO DURING THE 2011 TAX REPORTING YEAR, FIRSTCARE SIGNIFICANTLY EXPANDED ITS CHARITABLE SERVICES AND TAX-EXEMPT ACTIVITIES. IN 2011, FIRSTCARE BEGAN MANAGING THE OPERATIONS OF A MEDICAL CLINIC WHICH PROVIDES LIMITED HEALTH CARE SERVICES TO ADULTS AND CHILDREN WHO ARE UNINSURED OR UNDER-INSURED AND ARE EXPERIENCING FINANCIAL, SOCIAL OR CULTURAL OBSTACLES TO OBTAINING HEALTH CARE SERVICES. FIRSTCARE OPERATES THIS MEDICAL CLINIC UNDER THE ASSUMED NAME OF "ALBANY INREACH CLINIC." FIRSTCARE CURRENTLY PROVIDES MEDICAL CARE TO SUCH INDIVIDUALS ON A LIMITED NUMBER OF DAYS EACH WEEK, THOUGH FIRSTCARE ANTICIPATES INCREASING THE NUMBER OF DAYS IN THE FUTURE. INDIVIDUALS ARE SEEN AND TREATED AT ALBANY INREACH CLINIC FOR A LIMITED NUMBER OF HEALTH CARE ISSUES INCLUDING COUGHS, SINUS INFECTIONS, ASTHMA, BRONCHITIS, COPD, HIGH BLOOD PRESSURE, DIABETES, STRAINS AND SPRAINS, NON-URGENT INJURIES, NON-URGENT BLEEDING AND DENTAL CONDITIONS. PATIENTS WITH HEALTH CARE ISSUES BEYOND WHAT ALBANY INREACH CLINIC IS CAPABLE OF DEALING WITH ARE REFERRED TO OTHER HEALTH CARE PROVIDERS IN THE COMMUNITY, INCLUDING AFFILIATED HOSPITALS AND CLINICS. FIRSTCARE, THROUGH ITS ALBANY INREACH CLINIC, PROVIDES EDUCATION TO INDIVIDUALS REGARDING HOW TO USE PRESCRIPTION MEDICATIONS, IMPORTANT ILLNESS PREVENTATIVE MEASURES AS WELL AS OTHER BASIC HEALTH CARE MATTERS. FIRSTCARE OPERATES A DENTAL PROGRAM THROUGH WHICH CHILDREN AND ADULTS WITHOUT EITHER DENTAL INSURANCE OR ADEQUATE FINANCIAL MEANS CAN OBTAIN NECESSARY DENTAL CARE. FIRSTCARE WORKS IN COOPERATION WITH COMMUNITY SCHOOLS, ORGANIZATIONS AND BUSINESSES TO IDENTIFY CHILDREN AND ADULTS IN NEED OF DENTAL CARE. THESE INDIVIDUALS ARE REFERRED TO FIRSTCARE'S SERVICES AND CAN OBTAIN DENTAL CARE AT SPECIAL CLINICS, OFFICE LOCATIONS, OR AT A MOBILE DENTAL OFFICE WHICH COOPERATES WITH FIRSTCARE IN CONDUCTING ITS DENTAL SERVICES PROGRAM. FIRSTCARE STAFFS THE ALBANY INREACH CLINIC AND ITS HEALTH CARE OPERATIONS WITH QUALIFIED VOLUNTEER MEDICAL PROFESSIONALS, STUDENTS AND INDIVIDUALS ALL OF WHOM ARE DEDICATED TO FIRSTCARE'S MISSION OF PROVIDING COORDINATED AND PROACTIVE HEALTH CARE FOR THE MEDICALLY UNDERSERVED RESIDENTS OF ALBANY, MILLERSBURG, AND TANGENT, OREGON AND THE SURROUNDING COMMUNITIES. FIRSTCARE GENERATES A PORTION OF ITS FINANCIAL SUPPORT FOR ITS HEALTH CARE OPERATIONS FROM CONTRIBUTIONS DONATED BY INDIVIDUALS, COMMUNITY BUSINESSES AND LOCAL ORGANIZATIONS. MONETARY OR OTHER FORMS OF SUPPORT ARE ALSO PROVIDED TO FIRSTCARE BY SAMARITAN HEALTH SERVICES OR ITS AFFILIATED ENTITIES. FIRSTCARE, IN TURN, SUPPORTS THE MEDICAL COMMUNITY, INCLUDING AFFILIATED HEALTHCARE ENTITIES, BY TREATING THE INDIGENT POPULATION THAT MAY OTHERWISE NEED EMERGENT OR URGENT CARE IN A MORE EXPENSIVE SETTING, SUCH AS THE HOSPITAL EMERGENCY ROOM.

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

FieldValueIRS element (for citing)
DeclarationTHE 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