2024-10-14T20:45:17-05:00 2023-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1400 PORTLAND OR 97205 990 2023-01-01 810905254 PACIFIC HEALTH ASSOCIATES PACI 5416861242 555 INTERNATIONAL WAY SPRINGFIELD OR 97477 PATRICIA J SCHMITT PRESIDENT & CHAIR 5416861242 2024-09-18 1 1 MAGGIE ELLIOTT P01790721 5032421447 2024-09-18 2023 2024-10-15 13:58:12Z PATRICIA J SCHMITT 555 INTERNATIONAL WAY SPRINGFIELD OR 97477 9243109 0 X N/A X 2015 OR PROVIDING GRANTS TO ACCOMPLISH CHARITABLE PURPOSES; INCLUDING GRANTS WITH A FOCUS ON HEALTH AND WELFARE OF THE POOR AND NEEDY; TO LESSEN THE BURDENS OF GOVERNMENT; TO IMPROVE PATIENTS' EXPERIENCE WITH HEALTH CARE; TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE COMMUNITY; AND TO REDUCE THE PER CAPITA COST OF HEALTH CARE. 12 12 0 0 -2993 0 0 0 0 0 194185 199287 1441461 1436617 1635646 1635904 1900000 1300000 0 0 53750 73625 0 0 0 373127 462085 2326877 1835710 -691231 -199806 295734085 314006745 0 0 295734085 314006745 X PROVIDING GRANTS TO ACCOMPLISH CHARITABLE PURPOSES; INCLUDING GRANTS WITH A FOCUS ON HEALTH AND WELFARE OF THE POOR AND NEEDY; TO LESSEN THE BURDENS OF GOVERNMENT; TO IMPROVE PATIENTS' EXPERIENCE WITH HEALTH CARE; TO IMPROVE THE HEALTH OF INDIVIDUALS IN THE COMMUNITY; AND TO REDUCE THE PER CAPITA COST OF HEALTH CARE. 0 0 1300000 1300000 ISSUING RESTRICTED GRANTS FOR UTILIZATION IN FURTHERANCE OF HEALTH CARE ACCESS INITIATIVES THAT ADDRESS THE HEALTHCARE NEEDS OF CHILDREN AND YOUTH, AS WELL AS ADULTS WHO HAVE BARRIERS TO CARE, AND/OR ADVANCE AND PROMOTE STRATEGIES THAT IMPROVE ACCESS TO HIGH QUALITY HEALTHCARE, TEST AND IMPLEMENT INNOVATIVE CARE MODELS, IMPROVE COMMUNITY HEALTH, AND/OR LOWER COSTS ACROSS THE SYSTEM. 1300000 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 17 0 1 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 1 0 0 0 OR X KARI PATTERSON 5416861242 555 INTERNATIONAL WAY SPRINGFIELD OR 97477 MARTIN J GABICA VICE CHAIR 1.00 1.00 X X 7500 3500 0 PATRICIA J SCHMITT PRESIDENT & CHAIR 1.00 X X 10250 0 0 EDWIN E DAHLBERG DIRECTOR 1.00 1.00 X 5500 3500 0 THOMAS B SLICK DIRECTOR 1.00 1.00 X 5500 3500 0 JOHN C DEWENTER DIRECTOR 1.00 1.00 X 5500 3500 0 PRISCILLA J GOULD PRESIDENT & CHAIR THRU SEPT 2023 1.00 1.00 X X 5875 2625 0 ROGER M SAYDACK SECRETARY & TREASURER 1.00 X X 7500 0 0 STEVEN DON MARKS DIRECTOR 1.00 1.00 X 3500 3500 0 KARL WATTS DIRECTOR 1.00 1.00 X 3500 3500 0 RICHARD L WRIGHT DIRECTOR 1.00 X 6500 0 0 CHARLES ZACHEM DIRECTOR 1.00 X 5500 0 0 DIVYA SHARMA DIRECTOR 1.00 X 3500 0 0 CLAUDIA VALDERRAMA DIRECTOR 1.00 X 3500 0 0 73625 23625 0 0 0 0 0 0 445548 -2993 448541 1848244 411627 1436617 1436617 1436617 6949317 7195578 -246261 -246261 -246261 1635904 0 -2993 1638897 1300000 1300000 73625 73625 157215 157215 62501 62501 7500 7500 70496 70496 600 600 4322 4322 1000 1000 7322 7322 122502 122502 TAXES, LICENSES, FEES 28627 28627 1835710 1300000 535710 0 1150343 1240119 1779 12667 76926 97837 16147275 2657339 13860728 13489936 14452204 15940858 265171530 282231129 1020575 994199 295734085 314006745 0 0 X 295734085 314006745 295734085 314006745 295734085 314006745 X -199806 7383067 11089399 X 1 X 0 1 0 1686362 1686362 14460913 2657339 11803574 13489936 INVESTMENT IN PACIFICSOURCE 278519251 F LIMITED PARTNERSHIPS 3711878 F 282231129 1 PACIFICSOURCE FOUNDATION FOR HEALTH IMPROVEMENT PO BOX 7068 SPRINGFIELD OR 974750068 931100080 501(C)(3) 1300000 0 SUPPORTING COMMUNITY HEALTH INITIATIVES TO INCREASE ACCESS TO CARE 1 0 PART I, LINE 2: PHA ISSUES GRANTS TO ORGANIZATIONS UNDER THE CONDITION THAT ALL GRANT FUNDS MUST BE USED EXCLUSIVELY FOR SOCIAL WELFARE PURPOSES AS SPECIFICALLY APPROVED WITH THE ORIGINAL GRANT APPLICATION. WITHIN 12 MONTHS OF THE DATE THAT PAYMENTS ARE MADE, GRANTEES MUST AGREE TO PROVIDE A NARRATIVE AND FINANCIAL REPORT TO PHA REGARDING THE USE OF GRANT FUNDS. PHA MAY TERMINATE THE GRANT AGREEMENT OR CANCEL UNPAID DISBURSEMENTS IF PHA DETERMINES THAT GRANTEES' USE OF GRANT FUNDS FAIL TO MEET ALL REQUIREMENTS PREVIOUSLY SET FORTH BY PHA. ANY FUNDS NOT USED FOR THE PURPOSES DESCRIBED IN THE GRANT AGREEMENT MUST BE RETURNED TO PHA WITHIN A PRESCRIBED PERIOD OF TIME. FORM 990, PART V, LINE 13A OR FORM 990, PART VI, SECTION A, LINE 8B ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A PROFESSIONAL TAX PREPARER IS ENGAGED TO PREPARE THE FORM 990. THE CONTRACTED ORGANIZATION'S TAX DIRECTOR CONDUCTS AN INITIAL REVIEW OF THE FORM 990. A FINAL COPY OF THE FORM 990 IS PROVIDED TO THE MEMBERS OF THE BOARD FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. THE INDEPENDENT CPA FIRM PREPARING THE RETURN IS AVAILABLE FOR THE BOARD MEMBERS TO ASK QUESTIONS. FORM 990, PART VI, SECTION B, LINE 12C IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD. ANY DIRECTOR MAY RECUSE HIMSELF OR HERSELF AT ANY TIME FROM INVOLVEMENT IN ANY DECISION OR DISCUSSION IN WHICH THE DIRECTOR BELIEVES HE OR SHE HAS OR MAY HAVE A CONFLICT OF INTEREST, WITHOUT GOING THROUGH THE PROCESS FOR DETERMINING WHETHER A CONFLICT OF INTEREST EXISTS. AFTER DISCLOSING OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE BOARD MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE BOARD SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD SHALL DETERMINE WHETHER PHA CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN PHA'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE BOARD DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS THAT ARE REQUIRED TO BE OPEN FOR PUBLIC INSPECTION UPON REQUEST FORM 990, PART XI, LINE 9: ADJUSTMENT TO EQUITY INTEREST IN CORPORATE JOINT VENTURE 11,089,399. PACIFICSOURCE FOUNDATION FOR HEALTH IMPROVEMENT PO BOX 7068 SPRINGFIELD OR 97475 931100080 GRANTMAKING OR 501(C)(3) PF N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0