Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HEALTH SHARE OF OREGON
Employer identification number
45-5093195
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
19,192,123
298,016
19,490,139
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
218,703,601
662,883,214
881,586,815
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
237,895,724
663,181,230
901,076,954
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
18,154,259
298,016
18,452,275
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
18,154,259
298,016
18,452,275
8
Public support (Subtract line 7c from line 6.)
882,624,679
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
237,895,724
663,181,230
901,076,954
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9,985
37,993
47,978
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
9,985
37,993
47,978
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
237,905,709
663,219,223
901,124,932
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
HEALTH SHARE OF OREGON
Employer identification number
45-5093195
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 1
THE BOARD IS COMPRISED OF AN 11 PERSON MEMBER DIRECTOR BOARD AND 9 COMMUNITY OR ELECTED MEMBERS. THE MEMBER DIRECTOR BOARD IS THE FINAL APPROVAL FOR SPECIFIC ITEMS AS LISTED IN THE ORGANIZATION'S BYLAWS (ARTICLE III, SECTION 8), AS THEY REPRESENT THOSE WHO INVESTED CAPITAL IN THE INITIAL DAYS TO START HEALTH SHARE. THERE ARE ALSO TWO SUBCOMMITTEES - QUALITY & GOVERNANCE AND FINANCE & AUDIT COMMITTEES. THESE EACH HAVE BOARD MEMBERS DELEGATED TO THEM, WITH VOTING RIGHTS REPRESENTING THE BOARD. ONCE APPROVED BY A SUBCOMMITTEE, AN ITEM WOULD GO BEFORE THE FULL BOARD, THEN TO THE MEMBER BOARD.
FORM 990, PART VI, SECTION A, LINE 3
HEALTH SHARE CONTRACTS WITH CAREOREGON INC TO PROVIDE CERTAIN MANAGEMENT SERVICES, INCLUDING HUMAN RESOURCES, FINANCIAL SERVICES, INFORMATION TECHNOLOGY SERVICES, CUSTOMER SERVICE, SPACE, FURNISHINGS AND SUPPLIES. HEALTH SHARE ALSO LEASES CERTAIN MANAGEMENT EMPLOYEES FROM CAREOREGON, INCLUDING THE FOLLOWING OFFICERS LISTED IN PART VII - CHIEF EXECUTIVE OFFICER, CHIEF INFORMATION OFFICER, CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER AND CHIEF MEDICAL OFFICER. HEALTH SHARE PAID CAREOREGON $1,097,844 FOR THEIR SERVICES IN 2013.
FORM 990, PART VI, SECTION A, LINE 4
THE ORGANIZATION'S BYLAWS WERE AMENDED TO FURTHER DEFINE THE ORGANIZATION'S PURPOSE, MEMBERSHIP, MEETINGS, BOARD OF DIRECTORS (INCLUDING VOTING RIGHTS), BOARD MEETINGS, COMMITTEES, OFFICERS AND OTHER PROVISIONS AND TO CONFORM TO THE MANDATORY REQUIREMENTS OF THE OREGON NONPROFIT CORPORATIONS ACT.
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS TWO CLASSES OF MEMBERS: MEMBER DIRECTORS AND COMMUNITY OR ELECTED MEMBERS. ALL MEMBERS HAVE THE SAME RIGHTS AND OBLIGATIONS WITH RESPECT TO VOTING, DISSOLUTION, REDEMPTION AND TRANSFER.
FORM 990, PART VI, SECTION A, LINE 7A
ALL CLASSES OF MEMBERS MAY VOTE IN ELECTIONS FOR MEMBERS OF THE GOVERNING BODY. THE MEMBER BOARD HAS FINAL APPROVAL FOR ALL ELECTIONS.
FORM 990, PART VI, SECTION A, LINE 7B
ALL MEMBERS ARE ENTITLED TO VOTE ON VARIOUS GOVERNANCE MATTERS, INCLUDING ADOPTION OF STRATEGIC PLAN AND ANNUAL CAPITAL AND OPERATING BUDGETS; APPROVAL OF NON-BUDGETED EXPENDITURES OVER SET LIMITS AND CORPORATE INDEBTEDNESS NOT INCLUDED IN THE OPERATING BUDGET; DECISIONS AFFECTING COMPENSATION; DISTRIBUTIONS, IF ANY, FROM THE CORPORATION TO THE MEMBERS; SIGNIFICANT RESTRUCTURING OF THE CORPORATION OR FILING OF VOLUNTARY BANKRUPTCY; CHANGE TO GEOGRAPHIC AREA SERVED; REMOVAL OF ELECTED DIRECTOR; AMENDMENTS TO ARTICLES AND BYLAWS; ADMISSION, EXPULSION, SUSPENSION OR TERMINATION OF MEMBERS; AND THE SETTING OF MEMBERSHIP ASSESSMENTS.
FORM 990, PART VI, SECTION B, LINE 11
CAREOREGON AND MOSS ADAMS, THE ORGANIZATION'S INDEPEDENT ACCOUNTING FIRM, ASSIST IN THE PREPARATION OF FORM 990. THE ORGANIZATION'S CONTROLLER AND CHIEF EXECUTIVE OFFICER REVIEW AND APPROVE THE FORM, WHICH IS PRESENTED TO AND REVIEWED BY THE AUDIT & FINANCE COMMITTEE CHAIR PRIOR TO FILING AND THE FULL BOARD AFTER FILING.
FORM 990, PART VI, SECTION B, LINE 12C
THE CONFLICT OF INTEREST POLICY APPLIES TO "COVERED PERSONS", DEFINED AS (I) ANY DIRECTOR OR OFFICER OF THE CORPORATION, (II) MEMBERS OF ANY CORPORATION COMMITTEE, COUNCIL, WORKGROUP, OR TASK FORCE DESIGNATED BY THE CORPORATION'S CHAIR, AND (III) THOSE EMPLOYEES AND INDEPENDENT CONTRACTORS OF THE CORPORATION WHO ARE DESIGNATED BY THE CORPORATION'S CHAIR. EVERY COVERED PERSON SHALL COMPLETE AN ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. DUTIES OF COVERED PERSONS: EVERY COVERED PERSON (A) SHALL PERFORM HIS OR HER DUTIES FOR THE CORPORATION IN GOOD FAITH AND WITH THE DEGREE OF CARE THAT AN ORDINARILY PRUDENT PERSON WOULD EXERCISE UNDER SIMILAR CIRCUMSTANCES; (B) MUST ACT WITH LOYALTY TO THE CORPORATION; AND (C) MAY NOT ENGAGE IN ANY TRANSACTION OR ARRANGEMENT OR UNDERTAKE POSITIONS WITH OTHER ORGANIZATIONS THAT INVOLVE A CONFLICT OF INTEREST. EVERY COVERED PERSON SHALL (I) DISCLOSE ALL ACTUAL AND POTENTIAL CONFLICTS; AND (II) RECUSE HIMSELF/HERSELF FROM VOTING ON ANY TRANSACTION OR ARRANGEMENT IN WHICH HE/SHE HAS A POTENTIAL OR ACTUAL CONFLICT OF INTEREST, AND, IF SO REQUESTED BY THE CORPORATION'S CHAIR, NOT BE PRESENT WHEN ANY SUCH VOTE IS TAKEN. DISCLOSURE: EACH COVERED PERSON SHALL PROMPTLY AND FULLY DISCLOSE ALL MATERIAL FACTS OF EVERY ACTUAL OR POTENTIAL CONFLICT OF INTEREST: (A) EXISTING AT THE TIME WHEN HE/SHE BECOMES A COVERED PERSON; (B) THAT ARISES WHILE HE/SHE IS A COVERED PERSON, AT THE TIME SUCH ACTUAL OR POTENTIAL CONFLICT ARISES; AND (C) ANNUALLY THROUGH THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE. ALL DISCLOSURES INVOLVING A TRANSACTION OR ARRANGEMENT BEING CONSIDERED AT A MEETING OF THE BOARD OR A COMMITTEE THEREOF SHALL BE MADE TO ALL MEMBERS PRESENT AT SUCH MEETING. ALL OTHER DISCLOSURES SHALL BE MADE TO THE CHAIR (WHO SHALL DISCLOSE HIS OR HER CONFLICTS TO THE BOARD OF DIRECTORS OR A BOARD COMMITTEE). EVALUATION: ON A QUARTERLY BASIS (OR MORE FREQUENTLY IF NECESSARY UNDER THE CIRCUMSTANCES), THE CHAIR SHALL DISCLOSE TO THE BOARD OF DIRECTORS, OR A BOARD COMMITTEE, ALL CONFLICTS OF INTEREST REPORTED TO HIM OR HER UNDER POLICY. THE BOARD OF DIRECTORS, OR A BOARD COMMITTEE, WILL EVALUATE THE DISCLOSURES TO DETERMINE WHETHER THEY INVOLVE ACTUAL CONFLICTS OF INTEREST AND MAY ATTEMPT TO DEVELOP ALTERNATIVES TO REMOVE THE CONFLICT FROM THE SITUATION. ENFORCEMENT: EACH COVERED PERSON SHALL SIGN A STATEMENT ACKNOWLEDGING THAT HE OR SHE HAS RECEIVED A COPY OF THE POLICY, HAS READ AND UNDERSTANDS IT, AND AGREES TO COMPLY WITH IT. IF THE BOARD OF DIRECTORS HAS REASONABLE CAUSE TO BELIEVE THAT A COVERED PERSON HAS FAILED TO COMPLY WITH THE POLICY, THE BOARD MAY COUNSEL THE COVERED PERSON REGARDING SUCH FAILURE AND, IF THE ISSUE IS NOT RESOLVED TO THE BOARD'S SATISFACTION, MAY CONSIDER ADDITIONAL CORRECTIVE ACTION AS APPROPRIATE.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT AND KEY EMPLOYEES IS REVIEWED AND APPROVED BY AN INDEPENDENT THIRD PARTY. THE EXECUTIVES ARE LEASED FROM ANOTHER COMPANY BUT THEIR COMPENSATION IS DETERMINED BY HEALTH SHARE'S BOARD, WHICH OBTAINS SERVICES FROM THE THIRD PARTY TO OBTAIN, ANALYZE AND VERIFY RELEVANT MARKET DATA. THIS PROCESS IS COMPLETED AT LEAST EVERY OTHER YEAR FOR ALL EXECUTIVE POSITIONS.
FORM 990, PART VI, SECTION C, LINE 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S PLACE OF BUSINESS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.