Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 1,149,778 | 0 | 0 | 1,149,778 |
| 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 | 1,734,870 | 4,865,952 | 5,353,598 | 11,954,420 | ||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 343,056 | 652,844 | 995,900 | |||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 0 | 0 | 2,884,648 | 5,209,008 | 6,006,442 | 14,100,098 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 14,100,098 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 0 | 0 | 2,884,648 | 5,209,008 | 6,006,442 | 14,100,098 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | |||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 0 | 0 | 2,884,648 | 5,209,008 | 6,006,442 | 14,100,098 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| PART III, LINE 1 | ORGANIZATION'S MISSION ---------------------- HOUSECALL PROVIDERS IS DEDICATED TO PROVIDING QUALITY HOME-CENTERED MEDICAL CARE, INTEGRATING PRIMARY, PALLIATIVE AND HOSPICE SERVICES FOR HOMEBOUND MEMBERS OF OUR COMMUNITY. WE OFFER COMPASSIONATE PHYSICAL, EMOTIONAL AND SPIRITUAL SUPPORT THROUGH LIFE'S JOURNEY. |
| PART III, LINE 4A | STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS -------------------------------------------- SINCE 1995, HOUSECALL PROVIDERS, PC HAS BEEN THE SOLUTION FOR OVER 8,000 COMMUNITY MEMBERS WHOSE MEDICAL NEEDS COULD NOT BE MET IN A TRADITIONAL CLINICAL SETTING. THESE CHRONICALLY ILL PEOPLE, MANY OF WHOM ARE HOMEBOUND, ARE OFTEN FORCED TO RELY ON EMERGENCY ROOM VISITS AND HOSPITALIZATIONS TO MANAGE THEIR MULTIPLE CHRONIC ILLNESSES. THESE TRIPS TAKE THEIR TOLL ON AN ALREADY OVER-BURDENED BODY AND ARE INCREDIBLEY COSTLY TO OUR HEALTH CARE SYSTEM. HOUSECALL PROVIDERS, PC HAS BEEN A TRUSTED SOURCE FOR DELIVERING HOME-BASED PRIMARY CARE THROUGHOUT THE PORTLAND METRO AREA. SINCE OUR MODEST BEGINNINGS, WE HAVE GROWN TO SERVE MORE THAN 2,000 PATIENTS AND FAMILIES A YEAR AND EXPANDED OUR SERVICES TO INCLUDE TRANSITION AND PALLIATIVE CARE SERVICES. BY TRAINING OUR DOCTORS, NURSE PRACTITIONERS, AND PHYSICIAN ASSISTANTS TO IMPLEMENT TEAM-BASED, PROACTIVE PRIMARY MEDICAL CARE WHERE OUR PATIENTS LIVE, WE HELP PREVENT THOSE EXPENSIVE TRIPS TO THE HOSPITAL AND UNNECESSARY SKILLED NURSING FACILITY STAYS. NOT ONLY DOES THIS SET A NEW STANDARD FOR THE QUALITY OF CARE PATIENTS CAN EXPECT AT HOME, IT IMPROVES PATIENT HEALTH OUTCOMES AND LOWERS HEALTH CARE COSTS. THROUGH OUR SIX-YEAR INVOLVEMENT IN THE MEDICARE DEMONSTRATION PROJECT, INDEPENDENCE AT HOME, HOUSECALL PROVIDERS, PC ALONG WITH 14 OTHER PROGRAM SITES ACROSS THE U.S., IS HELPING TO PROVE TO THE CENTERS FOR MEDICARE AND MEDICAID SERVICES ("CMS") THAT VALUE-BASED REIMBURSEMENT, NOT FEE-FOR-SERVICE, IS THE APPROPRIATE PAYMENT MODEL TO PROVIDE HOME-BASED MEDICAL CARE FOR THE VULNERABLE POPULATION WE SERVE. WHEN HOUSECALL PROVIDERS, PC JOINED THE CAREOREGON FAMILY IN MAY OF 2017, WE WELCOMED THE ADVANCED ILLNESS CARE TEAM INTO OUR CONTINUUM OF HOME-BASED MEDICAL CARE. UNIFYING THESE SERVICES HAS MADE CARE TRANSITIONS SMOOTHER, CUT DOWN ON PATIENT WAIT TIMES AND MADE COMMUNICATION MORE EFFICIENT. THE TEAM INCLUDES NURSES, SOCIAL WORKERS, OUTREACH SPECIALISTS, A CHAPLAIN, AND A PHARMACIST WHO ALL HAVE THE FLEXIBILITY TO MAKE HOME, CLINIC AND HOSPITAL VISITS. THE ADVANCED ILLNESS CARE TEAM WORKS CLOSELY WITH PROVIDERS AND HEALTH CARE TEAMS TO FOCUS ON THE PATIENT'S GOALS OF CARE, SYMPTOM MANAGEMENT AND CARE COORDINATION. HOUSECALL PROVIDERS, PC EMPLOYEES ALSO PROVIDE HEALTHCARE SUPPORT TO OTHER CAREOREGON ENTITIES. |
| PART VI, LINE 6 | ORGANIZATION MEMBERS OR STOCKHOLDERS ------------------------------------ HOUSECALL PROVIDERS, PC IS 51% OWNED BY AMIT SHAH, MD AND 49% OWNED BY CAREOREGON. |
| PART VI, LINE 11B | FORM 990 TO GOVERNING BODY -------------------------- HOUSECALL PROVIDERS, PC'S FORM 990 GOES THROUGH MULTIPLE LAYERS OF REVIEWS BEFORE IT IS REVIEWED BY THE BOARD TREASURER OF HOUSECALL PROVIDERS, PC (WHO IS ALSO THE CFO OF CAREOREGON) AND THE BOARD OF DIRECTORS. ALL REVIEWERS ARE GIVEN TIME TO RESPOND WITH ANY REVISIONS. AFTER INCORPORATION OF ALL REVISIONS, THE FORM 990 IS REDISTRIBUTED TO THE REVIEWERS FOR FINAL REVIEW PRIOR TO FILING. |
| PART VI, LINE 12C | EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS ------------------------------------------------------ FOR FINANCIAL REPORTING AND ACCOUNTING PRACTICES, THE FINANCIAL STATEMENTS OF HOUSECALL PROVIDERS, PC ARE CONSOLIDATED INTO THE CONSOLIDATED FINANCIAL STATEMENTS OF CAREOREGON. AS SUCH, HOUSECALL PROVIDERS, PC IS GOVERNED BY THE POLICIES OF CAREOREGON AS APPLICABLE INCLUDING THE CONFLICT OF INTEREST POLICY OF CAREOREGON, WHICH IS APPLICABLE TO ALL OF CAREOREGON'S SUBSIDIARIES WHICH HAVE NOT ADOPTED A SEPARATE CONFLICT OF INTEREST POLICY. THIS CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO THE BOARD MEMBERS ANNUALLY. IT APPLIES TO DIRECTORS, OFFICERS AND KEY EMPLOYEES (ON THE BASIS OF TESTS SET FORTH IN IRS FORM 990), AND ANY OTHER INDIVIDUAL IN A POSITION TO EXERCISE SIGNIFICANT INFLUENCE OVER A DECISION HAVING MATERIAL ECONOMIC IMPACT FOR HOUSECALL PROVIDERS, PC, COLLECTIVELY DEFINED AS "COVERED PERSONS". THE CONFLICT OF INTEREST POLICY IS REVIEWED AND APPROVED ANNUALLY BY THE CAREOREGON BOARD. AN ANNUAL CONFLICT OF INTEREST DECLARATION AND INDEPENDENCE QUESTIONNAIRE IS DISTRIBUTED TO ALL COVERED PERSONS. THROUGH THE DISTRIBUTED DOCUMENT, EACH COVERED PERSON SIGNS AND ACKNOWLEDGES THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY AND REPORTS FAMILY AND BUSINESS RELATIONSHIPS THAT ARE USED TO DETERMINE THE INDEPENDENCE OF A DIRECTOR PURSUANT TO THE DEFINITION AND TESTS SET FORTH IN IRS FORM 990. THE BOARD OF DIRECTORS REVIEWS THE RESPONSES TO THE ANNUAL QUESTIONNAIRE FOR HOUSECALL PROVIDERS, PC COVERED PERSONS AND MAKES RESOLUTIONS OR ACTIONS REQUIRED TO MITIGATE ANY CONFLICT OF INTEREST. FOR 2019, THERE WERE NO CONFLICTS OF INTEREST REQUIRING RESOLUTIONS OR ACTIONS. IF FOR A SPECIFIC MATTER REQUIRING BOARD ACTION, A CONFLICT OF INTEREST EXISTS, AS DETERMINED BY THE BOARD, AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE MEETING, DISCLOSING THE EXISTENCE OF HIS OR HER INTEREST AND SHALL DISCLOSE ALL MATERIAL FACTS. FOLLOWING THE PERSON'S DISCLOSURE AND AFTER A DISCUSSION WITH THE BOARD, THE INDIVIDUAL LEAVES THE MEETING WHILE THE BOARD INDEPENDENTLY DISCUSSES THE MATTER BEFORE IT VOTES ON THE PROPOSED TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST. IF THERE IS A REASONABLE QUESTION ABOUT THE APPROPRIATENESS OF THE PROPOSED TRANSACTION OR ARRANGEMENT, THE CHAIR SHALL APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD SHALL EVALUATE THE RESULTING ALTERNATIVES PRESENTED BY THE APPOINTED PERSON OR COMMITTEE. IF AN APPROPRIATE CONFLICT-FREE ALTERNATIVE IS NOT REASONABLY ATTAINABLE, THE BOARD SHALL DETERMINE BY MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE ORIGINAL TRANSACTION OR ARRANGEMENT IS IN HOUSECALL PROVIDERS, PC'S AND CAREOREGON'S BEST INTERESTS, FOR HOUSECALL PROVIDERS, PC'S AND CAREOREGON'S OWN BENEFIT, WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO HOUSECALL PROVIDERS, PC AND CAREOREGON, AND WHETHER THE TRANSACTION IS IN COMPLIANCE WITH ALL APPLICABLE LAWS AND REGULATIONS. THE BOARD SHALL THEN VOTE WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH THE EVALUATION OF THE FOREGOING. |
| PART VI, LINE 15A AND 15B | COMPENSATION REVIEW & APPROVAL PROCESS - CEO & TOP MANAGEMENT ------------------------------------------------------------- MARKET DATA ON THE TOTAL COMPENSATION PACKAGE FOR EXECUTIVE POSITIONS (CEO, COO, CFO, CLO AND CMO), IS PROVIDED ANNUALLY BY AN OUTSIDE INDEPENDENT COMPENSATION CONSULTANT USING COMPARABLE ORGANIZATIONS BY INDUSTRY, PROFIT/NON-PROFIT STATUS AND REVENUE SIZE. THE COMPENSATION COMMITTEE, CONSISTING OF A MAJORITY OF INDEPENDENT BOARD MEMBERS, REVIEWS MARKET DATA, EVALUATES CEO PERFORMANCE AND REVIEWS CEO RECOMMENDATIONS FOR COMPENSATION FOR OTHER EXECUTIVE OFFICERS. THE COMMITTEE PRESENTS ITS RECOMMENDATIONS FOR CEO TO THE BOARD. DECISIONS ARE MADE IN A BOARD MEETING. THE BOARD REVIEWS THE RECOMMENDATION FOR THE COMPENSATION OF ALL OTHER EMPLOYEES AS PART OF THE BUDGET APPROVAL PROCESS. THE PROCESS OF DETERMINING THE COMPENSATION OF TOP MANAGEMENT OFFICIALS AND KEY OFFICERS INCLUDES A REVIEW OF AN INDEPENDENT CONSULTANT'S REPORT OF COMPARABLE SALARIES OF SIMILAR ORGANIZATIONS AND IS GUIDED BY WRITTEN COMPENSATION PRACTICES. WITH THE CEO AND ALL OTHER OFFICERS ABSENT FROM THE MEETINGS, THE BOARD APPROVES THE SALARY OF THE CEO. THIS PROCESS WAS LAST UNDERTAKEN ON MARCH 13, 2020 FOR THE CEO, AND THE CEO'S RECOMMENDATIONS FOR OTHER OFFICERS. THERE IS CONTEMPORANEOUS DOCUMENTATION OF THIS PROCESS AND THE RESULTS. |
| PART VI, LINE 18 AND LINE 19 | PUBLIC INSPECTION ----------------- THE TAX RETURN INFORMATION IS AVAILABLE UPON REQUEST. WHILE NO REQUIREMENT TO MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC EXISTS, HOUSECALL PROVIDERS, PC WILL CONSIDER ALL REQUESTS FOR THESE DOCUMENTS ON A CASE-BY-CASE BASIS. |
| PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS OR FUND BALANCES -------------------------------------------- EQUITY TRANSFER FROM CAREOREGON $ 5,500,000 ------------------ TOTAL PART XI, LINE 9 $ 5,500,000 |
| Software ID: | |
| Software Version: |