2025-04-24T16:28:04-05:00 2024-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 100 BELLEVUE WA 98004 990 2023-07-01 931070304 UMPQUA COMMUNITY HEALTH CENTER UMPQ 5416729596 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 RACHAEL SMITH CONTROLLER 5416729596 2025-04-23 1 1 KURT BENNION CPA P01469618 4252506100 2025-04-17 2023 2025-03-06 01:10:19Z AVIVA HEALTH RUTH GALSTER 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 45546379 0 X AVIVA.HEALTH X 1992 OR PROVIDE QUALITY, COMPASSIONATE, ACCESSIBLE & AFFORDABLE HEALTHCARE TO THE PEOPLE OF DOUGLAS COUNTY. 14 14 381 16 0 0 8253489 8243442 27290584 33699818 141275 491887 2062148 754102 37747496 43189249 15313 20231 0 0 23875200 27475846 0 0 0 9461134 10468245 33351647 37964322 4395849 5224927 60585879 59478211 33554756 32772551 27031123 26705660 AVIVA HEALTH IS AN INDEPENDENT, NOT-FOR-PROFIT ORGANIZATION THAT CARES FOR THE PEOPLE OF DOUGLAS COUNTY BY PROVIDING QUALITY, COMPASSIONATE, ACCESSIBLE AND AFFORDABLE HEALTHCARE. 0 0 32047413 20231 34033878 THE ORGANIZATION WAS FOUNDED IN 1992 TO PROVIDE MEDICAL AND DENTAL SERVICES TO ALL CITIZENS IN DOUGLAS COUNTY. THE ORGANIZATION CURRENTLY PROVIDES MEDICAL AND BEHAVIORAL HEALTH SERVICES AT FIVE LOCATIONS: ROSEBURG, GLIDE, SUTHERLIN, MYRTLE CREEK AND DRAIN. THE ORGANIZATION OPERATES A SCHOOL-BASED HEALTH CENTER WITHIN ROSEBURG HIGH SCHOOL DURING THE SCHOOL YEAR. ROSEBURG SERVES AS THE CENTRAL PRACTICE SITE, SUPPORTING ALL LOCATIONS. THE ORGANIZATION ALSO OFFERS DENTAL/ORAL HEALTH SERVICES AT THE ROSEBURG AND MYRTLE CREEK LOCATIONS. THE ORGANIZATION ALSO PARTNERS WITH THE LOCAL HOSPITAL TO OPERATE THE ROSEBURG FAMILY MEDICINE RESIDENCY PROGRAM. 32047413 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 54 0 381 1 0 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X X LEAH WOODS 5416729596 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 JAY RICHARDS DO CMO 50.00 0.00 X 394554 0 67675 KODY SEELEY PHYSICIAN 40.00 0.00 X 326835 0 59099 KC BOLTON CEO 50.00 0.00 X 321802 0 61456 HEATHER STEARMAN PHYSICIAN 50.00 0.00 X 290495 0 58174 KANANI DILCHER PHYSICIAN 40.00 0.00 X 297677 0 47875 BETH BLUMENSTEIN PHYSICIAN 40.00 0.00 X 275134 0 49255 KIRSTIN STOCKS-CARHART PHYSICIAN 40.00 0.00 X 268062 0 39902 LEAH WOODS CFO 49.00 1.00 X 146393 0 40943 RUTH GALSTER PRESIDENT 1.00 0.00 X X 0 0 0 NICK JONES VICE PRESIDENT 1.00 0.00 X X 0 0 0 GWEN GRAHAM SECRETARY & MEMBER (THR. JUNE 2024) 1.00 0.00 X X 0 0 0 RENEE COEN MEMBER & SECRETARY 1.00 0.00 X X 0 0 0 JODEE JACKSON TREASURER 1.00 0.00 X X 0 0 0 TAMARA DANVILLE MEMBER 1.00 0.00 X 0 0 0 RYAN DUNBAR MEMBER 1.00 0.00 X 0 0 0 JOEL GOODWILLIE MEMBER 1.00 0.00 X 0 0 0 CHRISTINE GOODWIN MEMBER 1.00 0.00 X 0 0 0 GREG HENDERSON MEMBER 1.00 0.00 X 0 0 0 STEVE LOOSLEY MEMBER 1.00 0.00 X 0 0 0 NICHOLE LOUDER MEMBER 1.00 0.00 X 0 0 0 MINDY MCFERRIN MEMBER 1.00 0.00 X 0 0 0 RYAN MELTON MEMBER 1.00 0.00 X 0 0 0 JON PETERSEN DMD MEMBER 1.00 0.00 X 0 0 0 KERI WINN MEMBER (THROUGH APRIL 2024) 1.00 0.00 X 0 0 0 2320952 0 424379 35 0 1 0 ATHENAHEALTH INC 311 ARSENAL STREET WATERTOWN MA 02472 BILLING SERVICES 1458525 NORTHWEST QUALITY CLEANING CO LLC 392 DAIRY LOOP ROAD ROSEBURG OR 97471 JANITORIAL SERVICES 534895 ADDCOX HEATING CENTER 831 NW HIGHLAND STREET ROSEBURG OR 97470 HVAC SERVICES 476747 ZERBACH CONSTRUCTION INC 1800 SUTTER STREET SUITE 730 CONCORD CA 94520 CONSTRUCTION LABOR 448916 ELWOOD STAFFING PO BOX 1024 COLUMBUS IN 47202 CONTRACT LABOR 151242 24 1269025 6431914 542503 8243442 NET PATIENT SERVICE REVENUE 621300 28950712 28950712 HEALTHCARE CONTRACT REVENUE 621300 2658727 2658727 INCENTIVE REVENUE 621300 2090379 2090379 33699818 491887 491887 143037 0 143037 143037 143037 2691190 2357130 334060 334060 OTHER INCOME 900099 277005 277005 277005 43189249 34033878 0 911929 20231 20231 1017681 274156 743525 20743983 17914396 2829587 484696 428560 56136 3685057 3219927 465130 1544429 1324115 220314 22087 22087 121265 121265 3530571 3492494 38077 97133 95924 1209 994556 782740 211816 962911 953299 9612 83821 79638 4183 333681 293375 40306 724803 399 724404 261011 247699 13312 144227 48161 96066 MEDICAL SUPPLIES 1105102 1105102 EQUIPMENT RENT 950047 870498 79549 LICENSES & PERMITS 531519 465353 66166 REPAIRS & MAINTENANCE 288073 252722 35351 317438 178624 138814 37964322 32047413 5916909 0 5201595 3989531 6251808 9617964 268495 411200 5954004 7203787 11894900 11894900 30277 30160 517675 792296 6700187 2763820 2426383 3936367 6212553 0 21828189 21602006 60585879 59478211 2096511 3128888 109505 9120231 7405582 22338014 22128576 33554756 32772551 X 27031123 26705660 27031123 26705660 60585879 59478211 5224927 -5550390 0 X 0 1 X 1 1 1 X 6639038 8467940 10288244 8253489 8243442 41892153 6639038 8467940 10288244 8253489 8243442 41892153 41892153 13776 70880 124869 256370 634924 1100819 62171 204901 104443 192790 277005 841310 43834282 124557549 0.95570 0.97230 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 202120 202120 1857166 54139 1803027 814696 469114 345582 3174811 2240567 934244 651394 651394 3936367 DEPOSITS HELD BY OTHERS 44671 RIGHT-OF-USE LEASE ASSETS 21557335 21602006 RIGHT-OF-USE LEASE LIABILITIES 22128576 22128576 X 45539379 2357130 2357130 43182249 7000 7000 43189249 40321452 2357130 2357130 37964322 0 37964322 PART X, LINE 2: AVIVA HEALTH HAS BEEN RECOGNIZED BY THE IRS AS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC) AND IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE IRC AND OREGON INCOME TAXES UNDER OREGON LEGISLATURE NRS 82.021. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS. MANAGEMENT EVALUATED AVIVA HEALTH'S TAX POSITION AND CONCLUDED THAT AVIVA HEALTH HAD TAKEN NO UNCERTAIN TAX POSITIONS THAT REQUIRE ADJUSTMENTS TO THE CONSOLIDATED FINANCIAL STATEMENTS TO COMPLY WITH THE PROVISIONS OF TOPICS 740 OF THE ACCOUNTING STANDARDS CODIFICATION (ASC). AVIVA HEALTH'S FEDERAL EXEMPT ORGANIZATION INCOME TAX RETURNS (FORM 990) ARE SUBJECT TO EXAMINATION BY THE IRS, GENERALLY FOR THREE YEARS AFTER THEY WERE FILED. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 2,357,130. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAPITAL CONTRIBUTIONS 7,000. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 2,357,130. 1 UMPQUA COMMUNITY COLLEGE PO BOX 967 ROSEBURG OR 97470 237287018 501(C)(3) 10000 0 FUNDRAISING EVENT SPONSORSHIPS MERCY FOUNDATION 2700 NW STEWART PARKWAY ROSEBURG OR 97471 936088946 501(C)(3) 10000 0 FUNDRAISING EVENT SPONSORSHIPS 2 0 PART I, LINE 2: PRIOR TO GIVING MONEY TO AN ORGANIZATION, UMPQUA CHC CONFIRMS THAT THE RECIPIENT IS A CHARITY OR THAT THE FUNDS WILL BE USED FOR A CHARITABLE PURPOSE. NO FURTHER FOLLOW-UP IS CONDUCTED. X X X X 0 1 0 1 0 0 0 1 0 JAY RICHARDS DO CMO 333201 0 61263 0 90 0 9654 0 58021 0 462229 0 0 0 KODY SEELEY PHYSICIAN 315099 0 11682 0 54 0 7589 0 51510 0 385934 0 0 0 KC BOLTON CEO 321544 0 0 0 258 0 8288 0 53168 0 383258 0 0 0 HEATHER STEARMAN PHYSICIAN 281605 0 8830 0 60 0 31908 0 26266 0 348669 0 0 0 KANANI DILCHER PHYSICIAN 275030 0 22587 0 60 0 7640 0 40235 0 345552 0 0 0 BETH BLUMENSTEIN PHYSICIAN 255854 0 19022 0 258 0 7640 0 41615 0 324389 0 0 0 KIRSTIN STOCKS-CARHART PHYSICIAN 239518 0 28286 0 258 0 3997 0 35905 0 307964 0 0 0 LEAH WOODS CFO 145693 0 700 0 0 0 4380 0 36563 0 187336 0 0 0 PART I, LINE 4B THE ORGANIZATION HAS A 457(F) DEFERRED COMPENSATION PLAN FOR THE CEO. DURING CALENDAR YEAR 2023, THERE WERE NO CONTRIBUTIONS INTO THE PLAN OR DISTRIBUTIONS OUT OF THE PLAN. PART I, LINE 5 SOME OF OUR MEDICAL PROVIDERS HAVE BONUS COMPENSATION ARRANGEMENTS THAT INCLUDE PRODUCTIVITY, WHICH IS CLOSELY CONNECTED TO THE ORGANIZATION'S REVENUES. PART I, LINE 7 DURING 2023, SMALL HOLIDAY BONUSES WERE GIVEN TO ALL EMPLOYEES. THESE BONUSES WERE REVIEWED BY THE CEO AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 1A THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE OFFICERS OF THE BOARD. THE EXECUTIVE COMMITTEE MAY ACT ON BEHALF OF THE BOARD OF DIRECTORS IN MANAGEMENT OF ALL BUSINESS AFFAIRS BETWEEN MEETINGS OF THE FULL BOARD. THE EXECUTIVE COMMITTEE IS REQUIRED TO BE CONSISTENT WITH THE ESTABLISHED POLICIES AND/OR DIRECTIONS OF THE BOARD AND REPORTS A SUMMARY OF ITS ACTIVITIES TO THE FULL BOARD AT THE BOARD'S NEXT REGULAR MEETING. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 WAS REVIEWED BY THE CFO, BY THE FINANCE COMMITTEE, AND BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C THE WRITTEN CONFLICT OF INTEREST POLICY IS WITHIN THE PERSONNEL POLICIES. THE POLICY IS REVIEWED ANNUALLY AND EMPLOYEES, OFFICERS AND DIRECTORS ARE GIVEN AN OPPORTUNITY AT ANNUAL REVIEW TIME TO DISCLOSE CONFLICTS. THE CONFLICT OF INTEREST POLICY ALSO APPLIES TO BOARD MEMBERS AS PART OF THE BYLAWS. THE BOARD MEMBERS ARE REQUIRED TO SIGN AN ACKNOWLEDGEMENT OF THE POLICY WHEN THEY BECOME MEMBERS. THE POLICY IS ALSO PRESENTED TO BOARD MEMBERS ANNUALLY FOR REVIEW AND CONSIDERATION OF UPDATES. ACTIONS OR RELATIONSHIPS THAT COULD CREATE A CONFLICT OF INTEREST MUST BE DISCLOSED IN ADVANCE AND APPROVED BY THE CEO. EMPLOYEES FOUND TO BE KNOWINGLY VIOLATING THE CONFLICT OF INTEREST POLICY WILL BE SUBJECT TO DISCPLINARY ACTION, UP TO AND INCLUDING TERMINATION OF EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15A THE EXECUTIVE COMMITTEE EVALUATES AND REVIEWS THE CEO'S PERFORMANCE ON AN ANNUAL BASIS. FOR COMPARISON OF WAGES, THE EXECUTIVE COMMITTEE UTILIZES SALARY SURVEYS FROM THE NORTHWEST REGIONAL PRIMARY CARE ASSOCIATION AND NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS. COMPENSATION FOR OTHER OFFICERS AND EMPLOYEES IS REVIEWED BY THE CEO AND HUMAN RESOURCES DEPARTMENT, UTILIZING THE SAME SALARY SURVEYS. FORM 990, PART VI, SECTION C, LINE 19 THE FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. AVIVA QALICB 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 853172690 NEW MARKETS TAX CREDIT OR 501(C)(3) LINE 12C, III-FI UMPQUA COMMUNITY HEALTH CENTER 1 0 0 1 0 1 0 0 0 0 0 1 1 0 1 1 0 1 0 0 AVIVA QALICB C 1269025 CASH AVIVA QALICB E 11000000 CASH AVIVA QALICB K 1162164 CASH