2024-05-13T18:14:24-05:00 2023-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 100 BELLEVUE WA 98004 990 2022-07-01 931070304 UMPQUA COMMUNITY HEALTH CENTER UMPQ 5416729596 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 LEAH WOODS CFO 5416729596 2024-05-08 1 LEAH WOODS 999009999 1 KURT BENNION CPA P01469618 4252506100 2024-05-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z AVIVA HEALTH RUTH GALSTER 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 39503483 0 X AVIVA.HEALTH X 1992 OR PROVIDE QUALITY, COMPASSIONATE, ACCESSIBLE & AFFORDABLE HEALTHCARE TO THE PEOPLE OF DOUGLAS COUNTY 12 12 368 15 0 0 10288244 8253489 19354723 27290584 124869 141275 1610571 2062148 31378407 37747496 330444 15313 0 0 19902453 23875200 0 0 0 7056160 9461134 27289057 33351647 4089350 4395849 27410085 60585879 10987364 33554756 16422721 27031123 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 27862614 15313 29044847 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. 27862614 1 1 0 0 0 0 0 0 0 0 1 0 1 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 57 0 368 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 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 40.00 0.00 X 333547 0 41983 KANANI DILCHER PHYSICIAN 40.00 0.00 X 308941 0 40794 KC BOLTON CEO 50.00 0.00 X 306323 0 32030 HEATHER STEARMAN PHYSICIAN 40.00 0.00 X 269514 0 41319 HEIDI BEERY PHYSICIAN 40.00 0.00 X 264681 0 40892 GLEN MONTEIRO PHYSICIAN 40.00 0.00 X 255225 0 28045 ALIM KARIM PHYSICIAN 40.00 0.00 X 247807 0 33888 JOE POSPOSIL CCO (THROUGH APRIL 2023) 40.00 0.00 X 159001 0 28348 LEAH WOODS CFO 49.00 1.00 X 157471 0 22854 ROBERT BRISENO DDS CDO (THROUGH JULY 2022) 20.00 0.00 X 102473 0 0 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 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 CHRISTINE GOODWIN MEMBER 1.00 0.00 X 0 0 0 HAROLD HALL DDS MEMBER (THROUGH JUNE 2023) 1.00 0.00 X 0 0 0 ERIN HELGREN MEMBER (THROUGH OCTOBER 2022) 1.00 0.00 X 0 0 0 CHARLES IRELAND MEMBER (THROUGH JULY 2022) 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 RON SMICKER MEMBER 1.00 0.00 X 0 0 0 KERI WINN MEMBER 1.00 0.00 X 0 0 0 2404983 0 310153 29 0 1 0 ATHENAHEALTH INC 311 ARSENAL ST WATERTOWN MA 02472 BILLING SERVICES 949088 NW QUALITY CLEANING CO LLC 392 DAIRY LOOP ROSEBURG OR 97471 JANITORIAL SERVICES 401797 ELWOOD STAFFING 2368 CRATER LAKE AVE 103 MEDFORD OR 97504 CONTRACT LABOR 192511 ROBERT BRISENO DMD 505 NW WOODSON DR GRANTS PASS OR 97526 DENTAL SERVICES 118607 RAELYN SUTTON DMD 462 STONERIDGE DR GRANTS PASS OR 97527 CONTRACT LABOR 117810 20 7929341 324148 8253489 NET PATIENT SERVICE REVENUE 621300 22617848 22617848 HEALTHCARE CONTRACT REVENUE 621300 2780029 2780029 INCENTIVE REVENUE 621300 1892707 1892707 27290584 141275 141275 115095 0 115095 115095 115095 3510250 1755987 1754263 1754263 OTHER INCOME 900099 192790 192790 192790 37747496 29044847 0 449160 15313 15313 1045925 194852 851073 18007958 15678511 2329447 488141 430498 57643 2972734 2583161 389573 1360442 1158520 201922 48614 48614 104960 104960 2920011 2890561 29450 113851 113849 2 990934 717008 273926 1799014 1686790 112224 74885 72663 2222 751835 656508 95327 387717 3 387714 213815 172209 41606 401959 29781 372178 MEDICAL SUPPLIES 913484 913156 328 REPAIRS & MAINTENANCE 206376 167860 38516 DUES & SUBSCRIPTIONS 199914 118186 81728 EQUIPMENT RENT 101048 100966 82 232717 162219 70498 33351647 27862614 5489033 0 2851666 5201595 5474557 6251808 691543 268495 5113693 5954004 11894900 11894900 30287 30277 139256 517675 4947524 2521141 1169524 2426383 6212553 44659 21828189 27410085 60585879 1839873 2096511 9147491 9120231 0 22338014 10987364 33554756 X 16422721 27031123 16422721 27031123 27410085 60585879 X 4395849 6212553 X 0 1 X 1 1 1 X 4094212 6639038 8467940 10288244 8253489 37742923 4094212 6639038 8467940 10288244 8253489 37742923 37742923 13566 13776 70880 124869 256370 479461 33448 62171 204901 104443 192790 597753 38820137 100862508 0.97230 0.98060 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 36720 36720 131176 35223 95953 757216 434674 322542 2915195 2051244 863951 1107217 1107217 2426383 INVESTMENT IN AFFILIATE 6212553 C 6212553 DEPOSITS HELD BY OTHERS 65256 RIGHT-OF-USE LEASE ASSETS 21762933 21828189 RIGHT-OF-USE LEASE LIABILITIES 22338014 22338014 X 39181335 1755987 1755987 37425348 322148 322148 37747496 35107634 1755987 1755987 33351647 0 33351647 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 1,755,987. PART XI, LINE 4B - OTHER ADJUSTMENTS: CAPITAL CONTRIBUTIONS 322,148. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 1,755,987. 1 MUSIC ON THE HALF SHELL PO BOX 2010 ROSEBURG OR 97470 931128460 501(C)(3) 10000 0 FUNDRAISING EVENT SPONSORSHIPS 1 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 X 0 0 0 1 0 0 0 1 0 JAY RICHARDS DO CMO 333457 0 0 0 90 0 8829 0 33154 0 375530 0 0 0 KANANI DILCHER PHYSICIAN 308881 0 0 0 60 0 7640 0 33154 0 349735 0 0 0 KC BOLTON CEO 306065 0 0 0 258 0 7883 0 24147 0 338353 0 0 0 HEATHER STEARMAN PHYSICIAN 269454 0 0 0 60 0 8069 0 33250 0 310833 0 0 0 HEIDI BEERY PHYSICIAN 264621 0 0 0 60 0 7738 0 33154 0 305573 0 0 0 GLEN MONTEIRO PHYSICIAN 255165 0 0 0 60 0 7640 0 20405 0 283270 0 0 0 ALIM KARIM PHYSICIAN 247753 0 0 0 54 0 7418 0 26470 0 281695 0 0 0 JOE POSPOSIL CCO (THROUGH APRIL 2023) 158239 0 0 0 762 0 4810 0 23538 0 187349 0 0 0 LEAH WOODS CFO 157423 0 0 0 48 0 4708 0 18146 0 180325 0 0 0 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 2022, 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. FORM 990, PART XI, LINE 9: CHANGE IN INVESTMENT IN AFFILIATE 6,212,553. 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 1 0 0 1 0 0 0 0 0 1 1 0 1 1 0 1 0 0 AVIVA QALICB E 11000000 CASH