FIRSTCARE HEALTH FOUNDATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- FIRSTCARE HEALTH FOUNDATION (EIN 93-0900124)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-11
- IRS object ID
- 201123159349303547
- Schema version
- 2010v3.2
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-11T16:50:48-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | 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 | 2011-11-09 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID TRIEBES | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1046 SIXTH AVE SW | AddressLine1 |
| City | ALBANY | City |
| State | OR | State |
| ZIP Code | 97321 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 512708 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | N/A | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | YearFormation |
| State Legal Domicile | OR | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT AND BENEFIT ALBANY GENERAL HOSPITAL AND OTHER ENTITIES AFFILIATED WITH SAMARITAN HEALTH SERVICES TO ACHIEVE THEIR CHARITABLE PURPOSES, AND TO PROMOTE HEALTHCARE IN THE COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 10 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 160355 | OtherRevenuePriorYear |
| Other Revenue Current Year | 194892 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 160355 | TotalRevenuePriorYear |
| Total Revenue Current Year | 194892 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9007 | OtherExpensePriorYear |
| Other Expenses Current Year | 8504 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9007 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8504 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 151348 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 186388 | RevenuesLessExpensesCY |
| Total Assets BOY | 4469703 | TotalAssetsBOY |
| Total Assets EOY | 3337020 | TotalAssetsEOY |
| Total Liabilities BOY | 1978012 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 113 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2491691 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3336907 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO SUPPORT AND BENEFIT ALBANY GENERAL HOSPITAL AND OTHER ENTITIES AFFILIATED WITH SAMARITAN HEALTH SERVICES TO ACHIEVE THEIR CHARITABLE PURPOSES, AND TO PROMOTE HEALTHCARE IN THE COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8429 | Expense |
| Description | ALL PROGRAM SERVICE EXPENSES WERE INCURRED TO FURTHER THE EXEMPT PURPOSES OF THIS ENTITY. THIS ENTITY PROVIDES FACILITIES USED BY SUPPORTED AFFILIATES TO ACCOMPLISH THEIR EXEMPT PURPOSES. | Description |
| Total Program Service Expense | 8429 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OR | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5417684773 | TelephoneNumber |
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) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (12 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| DAVID TRIEBES | ||||||
| BOARD SECRETARY & TREASURER/CEO AGH | 1.00 | X | X | 0 | 308998 | 60436 |
| MARIA DELAPOER | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| BRUCE MADSEN MD | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| PAUL DASKALOS DO | ||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | X | 0 | 379584 | 47087 | |
| JIM DENHAM | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| PATRICK HAGERTY DMD | ||||||
| BOARD CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| GREGG MILLER MD | ||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | X | 0 | 275475 | 42462 | |
| SENATOR FRANK MORSE | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| PAT RICHARDS | ||||||
| BOARD VICE-CHAIR | 1.00 | X | X | 0 | 0 | 0 |
| PAUL GREAVES MD | ||||||
| BOARD MEMBER | 1.00 | X | 0 | 0 | 0 | |
| STEPHEN NEWMAN MD | ||||||
| BOARD MEMBER/PHYSICIAN | 1.00 | X | 0 | 523123 | 30674 | |
| DANIEL B SMITH | ||||||
| VP FINANCE/CFO | 1.00 | X | 0 | 287449 | 47700 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1774629 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 228359 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 512708 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 317816 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 194892 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 194892 | TotalRevenueColumn |
| Exclusion | $194,892 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 194892 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $194,892 | ExclusionAmount |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4625 | Total |
| Program Services | 4625 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3804 | Total |
| Program Services | 3804 | ProgramServices |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | LICENSES & TAXES | Description |
| Total | 75 | Total |
| Management And General | 75 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8504 | Total |
| Program Services | 8429 | ProgramServices |
| Management And General | 75 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6413 | BOY |
| EOY | 6614 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 5561651 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 2231245 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3482547 | BOY |
| EOY | 3330406 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 980743 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4469703 | BOY |
| EOY | 3337020 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10964 | BOY |
| EOY | 113 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1967048 | BOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1978012 | BOY |
| EOY | 113 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2491691 | BOY |
| EOY | 3336907 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2491691 | BOY |
| EOY | 3336907 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4469703 | BOY |
| EOY | 3337020 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 186388 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 658828 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
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 (3 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | Supported Organization NotifiedSupportedOrganizationNotified | Organized In USOrganizedInUS | AmountAmount |
|---|---|---|---|---|---|
| ALBANY GEN HOSP | |||||
| 930110095 | 3 | 1 | 1 | 1 | $2,775 |
| ALB GEN HOSP FND | |||||
| 930712890 | 7 | 1 | 1 | 1 | $1,850 |
| FIRSTCARE MED FND | |||||
| 930932697 | 9 | 1 | 1 | 1 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 3 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 4625 | SumOfAmounts |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1065649 | OtherCostOrOtherBasis |
| Book Value | 1065649 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4227053 | OtherCostOrOtherBasis |
| Depreciation | 1969781 | Depreciation |
| Book Value | 2257272 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 189385 | OtherCostOrOtherBasis |
| Depreciation | 181900 | Depreciation |
| Book Value | 7485 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 79564 | OtherCostOrOtherBasis |
| Depreciation | 79564 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3330406 | TotalOfBookValueLandBuildings |
| Total Revenue | 194892 | TotalRevenue |
| Total Expenses | 8504 | TotalExpenses |
| Excess Or Deficit For Year | 186388 | ExcessOrDeficitForYear |
| Other | $658,828 | OtherAmount |
| Total Adjustments | 658828 | TotalAdjustments |
| Excess Or Deficit Per FS | 845216 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 0 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 0 | RevenueSubtotal |
| Other Revenues Not Included | 194892 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 194892 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 194892 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | -186388 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | -194892 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | -194892 | ExpensesNotRptdF990 |
| Expenses Subtotal | 8504 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 8504 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| PART XI, LINE 8 - OTHER ADJUSTMENTS: | INTERCOMPANY TRANSFERS 658,828. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | NET RENTAL INC SHOWN ON 990, PART VIII 194,892. |
| PART XIII, LINE 2D - OTHER ADJUSTMENTS: | NET RENTAL INC SHOWN ON 990, PART VIII -194,892. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 1 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID TRIEBES | |||||||||||||
| 0 | 262713 | 0 | 32689 | 0 | 13596 | 0 | 35144 | 0 | 25292 | 0 | 369434 | 0 | 0 |
| PAUL DASKALOS DO | |||||||||||||
| 0 | 374346 | 0 | 4668 | 0 | 570 | 0 | 22577 | 0 | 24510 | 0 | 426671 | 0 | 0 |
| GREGG MILLER MD | |||||||||||||
| 0 | 250423 | 0 | 24500 | 0 | 552 | 0 | 18332 | 0 | 24130 | 0 | 317937 | 0 | 0 |
| STEPHEN NEWMAN MD | |||||||||||||
| 0 | 502503 | 0 | 19375 | 0 | 1245 | 0 | 20228 | 0 | 10446 | 0 | 553797 | 0 | 0 |
| DANIEL B SMITH | |||||||||||||
| 0 | 255799 | 0 | 25000 | 0 | 6650 | 0 | 18341 | 0 | 29359 | 0 | 335149 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 5 | ReturnReference |
| Explanation | VARIOUS PHYSICIAN COMPENSATION METHODOLOGIES ARE UTILIZED AND, DEPENDING ON SPECIALTY, RELATIVE VALUE UNITS (RVU'S) MAY BE USED IN DETERMINING A PORTION OF OR ALL OF THEIR COMPENSATION. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (13 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | PAUL DASKALOS, DO AND GREGG MILLER, MD HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 6 | FIRSTCARE HEALTH FOUNDATION HAS A SOLE CORPORATE MEMBER, SAMARITAN HEALTH SERVICES, INC., WHICH IS A SECTION 501(C)(3) TAX-EXEMPT ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 7A | FIRSTCARE HEALTH FOUNDATION ELECTS MEMBERS OF ITS BOARD OF DIRECTORS. THOSE ELECTED MEMBERS ARE THEN SUBMITTED TO THE SOLE CORPORATE MEMBER FOR APPROVAL. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE CORPORATE MEMBER HAS SEVERAL RESERVED POWERS OVER THE ORGANIZATION. THESE RESERVED POWERS INCLUDE, BUT ARE NOT LIMITED TO, APPROVAL AT CERTAIN THRESHOLD LEVELS: THE BORROWING OF FUNDS, MERGERS AND ACQUISITIONS, AND SALES OR TRANSFERS OF ASSETS. IN ADDITION, THE SOLE CORPORATE MEMBER MUST APPROVE ANY CHANGE IN THE MISSION OF THE ORGANIZATION, THE ANNUAL BUDGET, AND ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE ORGANIZATION'S FINAL FORM 990 (INCLUDING REQUIRED SCHEDULES), AS ULTIMATELY FILED WITH THE IRS, WAS PROVIDED TO EACH VOTING MEMBER OF THE SAMARITAN HEALTH SERVICES (SHS) AUDIT AND COMPLIANCE COMMITTEE PRIOR TO ITS FILING WITH THE IRS. SHS IS A 501(C)(3) CORPORATION AND IS THE SOLE MEMBER OF THE FILING ORGANIZATION. SHS'S CHIEF FINANCIAL OFFICER CONDUCTED THE FORM 990 REVIEW WITH THE COMMITTEE AND PROVIDED TIME FOR QUESTIONS FROM THE GROUP. A FORMAL REPORT OF THIS COMMITTEE HAS BEEN MADE TO THE FULL BOARD OF DIRECTORS OF SHS. | |
| BOARD MEMBER CONFLICTS OF INTEREST: THE MEMBERS OF THE BOARD MUST ANNUALLY COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE, WHICH REQUIRES DISCLOSURE OF ANY CONFLICTS OR POTENTIAL CONFLICTS OF INTEREST. THE COMPLETED QUESTIONNAIRES ARE REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CORPORATE COMPLIANCE OFFICER. IF A CONFLICT IS DISCLOSED THAT COULD PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THIS IS EVALUATED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES (SHS) BOARD OF DIRECTORS TO DETERMINE WHETHER THE MEMBER SHOULD CONTINUE TO SERVE ON THE BOARD. IF A CONFLICT IS DISCLOSED THAT DOES NOT PROHIBIT A MEMBER FROM SERVING ON THE BOARD, THE CONFLICT IS MANAGED THROUGH A PROCESS SET FORTH IN THE ORGANIZATION'S BYLAWS. THE BYLAWS PROHIBIT ANY BOARD MEMBER FROM VOTING ON AN ACTION WHERE AN INDIVIDUAL MEMBER HAS A CONFLICT OF INTEREST. EMPLOYEE CONFLICTS OF INTEREST: THE SHS CODE OF ETHICS AND CONDUCT POLICY REQUIRES THAT ALL SHS EMPLOYEES COMPLETE AN ANNUAL DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST. THROUGH THE HUMAN RESOURCES SOFTWARE, PERFORMANCE MANAGER, THE DISCLOSURE REQUIREMENT NOTICE IS ASSIGNED TO ALL EMPLOYEES AND BY YEAR END ALL TASKS ARE TO BE COMPLETED. IF THERE IS A PERCEIVED CONFLICT OF INTEREST IT IS REVIEWED BY THE CORPORATE COMPLIANCE OFFICER, LEGAL COUNSEL AND/OR SENIOR MANAGEMENT. ACTUAL CONFLICTS OF INTEREST ARE REVIEWED AND DISCUSSED BY THE AUDIT AND COMPLIANCE COMMITTEE OF THE SAMARITAN HEALTH SERVICES BOARD OF DIRECTORS. | FORM 990, PART VI, SECTION B, LINE 12C | |
| FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. SYSTEM-WIDE SUMMARIZED DATA IS ALSO PROVIDED IN THE ANNUAL REPORT TO THE COMMUNITY. THIS REPORT IS MADE AVAILABLE IN ALL KIOSKS AND HIGH-TRAFFIC AREAS OF ALL HOSPITALS AND PHYSICIAN CLINICS, AS WELL AS COMMUNITY PLACES SUCH AS THE PUBLIC LIBRARY. IT IS ALSO DISTRIBUTED TO THE BOARDS OF DIRECTORS AND DIRECTLY MAILED TO DONORS AND NEW RESIDENTS IN THE COMMUNITY. ADDITIONALLY, THE REPORT IS MADE AVAILABLE AT ALL EVENTS, COMMUNITY OUTREACH PROJECTS, AND SCREENINGS ATTENDED THROUGHOUT THE YEAR. GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| GREGG MILLER, MD | DR. MILLER WORKED 40 HOURS PER WEEK FOR A RELATED ORGANIZATION. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THAT ORGANIZATION. | PART VII - COMPENSATION EXPLANATION |
| PAUL DASKALOS, DO | DR. DASKALOS WORKED 40 HOURS PER WEEK FOR A RELATED ORGANIZATION. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THAT ORGANIZATION. | PART VII - COMPENSATION EXPLANATION |
| STEPHEN NEWMAN, MD | DR. NEWMAN WORKED 40 HOURS PER WEEK FOR A RELATED ORGANIZATION. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THAT ORGANIZATION. | PART VII - COMPENSATION EXPLANATION |
| DAVID TRIEBES | MR. TRIEBES WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | PART VII - COMPENSATION EXPLANATION |
| DANIEL B. SMITH | MR. SMITH WORKED 40 HOURS PER WEEK FOR SEVERAL RELATED ORGANIZATIONS. HIS COMPENSATION WAS PAID BY A RELATED ORGANIZATION FOR WORK DONE FOR THE FILING ORGANIZATION AND SEVERAL RELATED ORGANIZATIONS. | PART VII - COMPENSATION EXPLANATION |
| CHANGES IN NET ASSETS OR FUND BALANCES: | INTERCOMPANY TRANSFERS 658,828. TOTAL TO FORM 990, PART XI, LINE 5: 658,828. | FORM 990, PART XI, LINE 5: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (13 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ALBANY GENERAL HOSPITAL | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930110095 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 0 | |
| ALBANY GENERAL HOSPITAL FOUNDATION | |||||||||||
| 1046 SIXTH AVENUE SW | ALBANY | OR | 97321 | 930712890 | TO SUPPORT ALBANY GENERAL HOSPITAL | OR | 501(C)(3) | 7 | ALBANY GENERAL HOSPITAL | 0 | |
| GOOD SAMARITAN HOSPITAL CORVALLIS | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930391573 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 0 | |
| FIRSTCARE MEDICAL FOUNDATION | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930932697 | PROVIDER OF MEDICAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 9 | SAMARITAN HEALTH SERVICES | 0 | |
| GOOD SAMARITAN HOSPITAL FOUNDATION | |||||||||||
| PO BOX 1068 | CORVALLIS | OR | 97339 | 237252406 | TO SUPPORT GOOD SAMARITAN HOSPITAL | OR | 501(C)(3) | 7 | GOOD SAMARITAN HOSPITAL | 0 | |
| INTERCOMMUNITY HEALTH PLANS INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 931124326 | SERVE OREGON HEALTH PLAN FOR MEDICAID | OR | 501(C)(4) | N/A | SAMARITAN HEALTH SERVICES | 0 | |
| LEBANON COMMUNITY HOSPITAL FOUNDATION | |||||||||||
| PO BOX 739 | LEBANON | OR | 97355 | 931260080 | TO SUPPORT LEBANON COMMUNITY HOSPITAL | OR | 501(C)(3) | 7 | MID-VALLEY HEALTHCARE INC | 0 | |
| MID-VALLEY HEALTHCARE INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930396847 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 0 | |
| PARADIGM INDEMNITY CORPORATION | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 731668317 | PURE NON-PROFIT CAPTIVE INSURANCE COMPANY | HI | 501(C)(3) | 11A, I | SAMARITAN HEALTH SERVICES | 0 | |
| SAMARITAN HEALTH SERVICES INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 930951989 | PROVIDE HEALTHCARE SUPPORT SERVICES | OR | 501(C)(3) | 11C, III-FI | 0 | N/A | |
| SAMARITAN NORTH LINCOLN HOSPITAL | |||||||||||
| 3043 NE 28TH STREET | LINCOLN CITY | OR | 97367 | 931305493 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 0 | |
| SAMARITAN PACIFIC HEALTH SERVICES | |||||||||||
| 930 SW ABBEY STREET | NEWPORT | OR | 97365 | 931329784 | HOSPITAL SERVICES FOR THE COMMUNITY | OR | 501(C)(3) | 3 | SAMARITAN HEALTH SERVICES | 0 | |
| SAMARITAN SENIOR CARE INC | |||||||||||
| PO BOX 3000 | CORVALLIS | OR | 973393000 | 931245534 | PROVIDE HEALTHCARE FOR SENIORS | OR | 501(C)(3) | 9 | SAMARITAN HEALTH SERVICES | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (10 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| SAMARITAN ENDOSCOPY CENTER LLC | |||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 202860067 | MEDICAL SERVICES | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| CORVALLIS MEDICAL BUILDINGS LLC | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OH | 97330 | 931257913 | REAL ESTATE RENTAL | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| EAST LINN MRI LLC | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 320229399 | IMAGING | OR | MID-VALLEY HEALTHCARE INC | N/A | 0 | 0 | |
| HULL IMAGING LLC | |||||||||||
| 3600 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 203255479 | IMAGING | OR | GOOD SAMARITAN HOSPITAL | N/A | 0 | 0 | |
| SAMARITAN OPEN MRI LLC | |||||||||||
| 3600 NW SAMARITAN DR | CORVALLIS | OR | 97330 | 208346225 | IMAGING | OR | ALBANY GENERAL HOSPITAL | N/A | 0 | 0 | |
| CBA-SAM LLC | |||||||||||
| PO BOX 433 | LINCOLN CITY | OR | 97367 | 931314523 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | |
| CORVALLIS MRI A JOINT VENTURE | |||||||||||
| 3615 NW SAMARITAN DRIVE | CORVALLIS | OR | 97330 | 930949704 | IMAGING | OR | N/A | 0 | 0 | N/A | |
| MID-VALLEY MEDICAL PROPERTIES ASSOC LLC | |||||||||||
| 1046 SIXTH AVE SW | ALBANY | OR | 97321 | 300508747 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | |
| MID-VALLEY MEDICAL BUILDINGS LLC | |||||||||||
| PO BOX 557 | LEBANON | OR | 97355 | 931126353 | REAL ESTATE RENTAL | OR | N/A | 0 | 0 | N/A | |
| NORTHWEST MEDICAL ISOTOPES LLC | |||||||||||
| 815 NW 9TH ST STE 256 | CORVALLIS | OR | 97330 | 273007752 | RESEARCH | OR | SAMARITAN HEALTH SERVICES | N/A | 0 | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH PLANS INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3600 NW SAMARITAN DRIVE | AddressLine1 |
| City | CORVALLIS | City |
| State | OR | State |
| ZIP Code | 97330 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 930860860 | EIN |
| Primary Activity | HEALTH INSURANCE CARRIER FOR THE COMMUNITY | PrimaryActivity |
| Legal Domicile State | OR | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SAMARITAN HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |