UMPQUA COMMUNITY HEALTH CENTER INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- UMPQUA COMMUNITY HEALTH CENTER INC (EIN 93-1070304)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-05-01
- IRS object ID
- 202301219349300825
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-05-01T09:44:47-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10700 NORTHUP WAY SUITE 100 | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 98004 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 931070304 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UMPQUA COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | UMPQ | BusinessNameControlTxt |
| Phone | 5416729596 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 NE KENNETH FORD DRIVE | AddressLine1Txt |
| City | ROSEBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97470 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LEAH HAMILTON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5416729596 | PhoneNum |
| Signature | 2023-04-27 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LEAH | PersonFirstNm |
| Person Last | HAMILTON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION CPA | PreparerPersonNm |
| PTIN | P01469618 | PTIN |
| Phone | 4252506100 | PhoneNum |
| Preparation | 2023-04-27 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVIVA HEALTH | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RUTH GALSTER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 NE KENNETH FORD DRIVE | AddressLine1Txt |
| City | ROSEBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97470 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $33,052,261 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | AVIVA.HEALTH | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE QUALITY, COMPASSIONATE, ACCESSIBLE & AFFORDABLE HEALTHCARE TO THE PEOPLE OF DOUGLAS COUNTY | ActivityOrMissionDesc |
| Voting Members Governing Body | 15 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 15 | VotingMembersIndependentCnt |
| Total Employee | 315 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $8,467,940 | PYContributionsGrantsAmt |
| CY Contributions Grants | $10,288,244 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,436,457 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,354,723 | CYProgramServiceRevenueAmt |
| PY Investment Income | $70,880 | PYInvestmentIncomeAmt |
| CY Investment Income | $124,869 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,738,279 | PYOtherRevenueAmt |
| CY Other Revenue | $1,610,571 | CYOtherRevenueAmt |
| PY Total Revenue | $26,713,556 | PYTotalRevenueAmt |
| CY Total Revenue | $31,378,407 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,197,322 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $330,444 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $17,529,339 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,902,453 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,005,530 | PYOtherExpensesAmt |
| CY Other Expenses | $7,056,160 | CYOtherExpensesAmt |
| PY Total Expenses | $26,732,191 | PYTotalExpensesAmt |
| CY Total Expenses | $27,289,057 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$18,635 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,089,350 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $24,495,606 | TotalAssetsBOYAmt |
| Total Assets EOY | $27,410,085 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,162,235 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,987,364 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,333,371 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,422,721 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $22,387,330 | ExpenseAmt |
| Grant | $330,444 | GrantAmt |
| Revenue | $20,860,851 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $22,387,330 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 48 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 315 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 15 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 15 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OR | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LEAH HAMILTON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5416729596 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 NE KENNETH FORD DRIVE | AddressLine1Txt |
| City | ROSEBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97470 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (27 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| JAY RICHARDS DO | |||||||
| CMO | 40.00 | Yes (X) | $317,739 | $0 | $40,582 | ||
| KC BOLTON | |||||||
| CEO | 50.00 | Yes (X) | $289,708 | $0 | $31,514 | ||
| HEATHER STEARMAN | |||||||
| PHYSICIAN | 40.00 | $266,675 | $0 | $33,764 | Yes (X) | ||
| GLEN MONTEIRO | |||||||
| PHYSICIAN | 40.00 | $272,794 | $0 | $27,407 | Yes (X) | ||
| KANANI DILCHER | |||||||
| PHYSICIAN | 40.00 | $263,608 | $0 | $33,764 | Yes (X) | ||
| HEIDI BEERY | |||||||
| PHYSICIAN & RESIDENCY DIRECTOR | 40.00 | $252,944 | $0 | $38,616 | Yes (X) | ||
| ALIM KARIM | |||||||
| PHYSICIAN | 40.00 | $247,616 | $0 | $20,350 | Yes (X) | ||
| JOE POSPOSIL | |||||||
| CCO | 40.00 | Yes (X) | $145,330 | $0 | $26,803 | ||
| LEAH HAMILTON | |||||||
| CFO (AS OF AUGUST 2021) | 40.00 | Yes (X) | $118,873 | $0 | $9,542 | ||
| HEIDI HILL | |||||||
| COO (THROUGH FEBRUARY 2022) | 40.00 | Yes (X) | $109,719 | $0 | $7,259 | ||
| GARY HUNT | |||||||
| CFO (THROUGH AUGUST 2021) | 40.00 | Yes (X) | $19,888 | $0 | $17,811 | ||
| ROBERT BRISENO DDS | |||||||
| CDO | 20.00 | Yes (X) | $0 | $0 | $0 | ||
| RUTH GALSTER | |||||||
| PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ANDREA MINER | |||||||
| VICE PRESIDENT | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GWEN GRAHAM | |||||||
| SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| ANGELA MURPHY | |||||||
| TREASURER & MEMBER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| JODEE JACKSON | |||||||
| MEMBER & TREASURER | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| TAMARA DANVILLE | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MIKE FIELDMAN | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| HAROLD HALL DDS | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ERIN HELGREN | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| CHARLES IRELAND | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| NICK JONES | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| STEVE LOOSLEY | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| NICHOLE LOUDER | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| MINDY MCFERRIN | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| KERI WINN | |||||||
| MEMBER | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,304,894 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $287,412 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 32 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ATHENAHEALTH INC | |||||
| 311 ARSENAL STREET | WATERTOWN | MA | 02472 | BILLING SERVICES | $710,553 |
| BASCO LOGGING | |||||
| 1039 PARK HILL LANE | SUTHERLIN | OR | 97479 | LOGGING SERVICES | $485,898 |
| NW QUALITY CLEANING CO LLC | |||||
| 392 DAIRY LOOP | ROSEBURG | OR | 97471 | JANITORIAL SERVICES | $259,255 |
| ELWOOD STAFFING | |||||
| 2368 CRATER LAKE AVENUE 103 | MEDFORD | OR | 97504 | CONTRACT LABOR | $189,543 |
| ROBERT BRISENO DMD | |||||
| 505 NW WOODSON DRIVE | GRANTS PASS | OR | 97526 | DENTAL SERVICES | $174,938 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $9,256,330 | GovernmentGrantsAmt |
| All Other Contributions | $1,031,914 | AllOtherContributionsAmt |
| Total Contributions | $10,288,244 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $16,275,498 | $16,275,498 |
| HEALTHCARE CONTRACT REVENUE | 621300 | $2,126,297 | $2,126,297 |
| INCENTIVE REVENUE | 621300 | $952,928 | $952,928 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,354,723 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $124,869 | TotalRevenueColumnAmt |
| Exclusion | $124,869 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $3,179,982 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $1,673,854 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,506,128 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,506,128 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $104,443 | TotalRevenueColumnAmt |
| Exclusion | $104,443 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $104,443 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,378,407 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,860,851 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $229,312 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $330,444 | TotalAmt |
| Program Services | $330,444 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,084,470 | TotalAmt |
| Program Services | $172,706 | ProgramServicesAmt |
| Management And General | $911,764 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,947,492 | TotalAmt |
| Program Services | $13,067,959 | ProgramServicesAmt |
| Management And General | $1,879,533 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $418,585 | TotalAmt |
| Program Services | $373,986 | ProgramServicesAmt |
| Management And General | $44,599 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,321,471 | TotalAmt |
| Program Services | $2,042,152 | ProgramServicesAmt |
| Management And General | $279,319 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,130,435 | TotalAmt |
| Program Services | $959,099 | ProgramServicesAmt |
| Management And General | $171,336 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$8,727 | TotalAmt |
| Management And General | -$8,727 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,993 | TotalAmt |
| Management And General | $79,993 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,504,200 | TotalAmt |
| Program Services | $2,248,147 | ProgramServicesAmt |
| Management And General | $256,053 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,672 | TotalAmt |
| Program Services | $114,672 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $931,110 | TotalAmt |
| Program Services | $694,131 | ProgramServicesAmt |
| Management And General | $236,979 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $253,787 | TotalAmt |
| Program Services | $224,352 | ProgramServicesAmt |
| Management And General | $29,435 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,824 | TotalAmt |
| Program Services | $34,932 | ProgramServicesAmt |
| Management And General | $3,892 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $190,460 | TotalAmt |
| Program Services | $163,589 | ProgramServicesAmt |
| Management And General | $26,871 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $575,491 | TotalAmt |
| Management And General | $575,491 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,310 | TotalAmt |
| Program Services | $145,422 | ProgramServicesAmt |
| Management And General | $50,888 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $85,719 | TotalAmt |
| Program Services | $15,505 | ProgramServicesAmt |
| Management And General | $70,214 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $813,169 | $813,169 | |
| LICENSES & PERMITS | $437,292 | $378,022 | $59,270 |
| EQUIPMENT RENT | $380,911 | $291,031 | $89,880 |
| REPAIRS & MAINTENANCE | $130,914 | $121,088 | $9,826 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $332,035 | TotalAmt |
| Program Services | $196,924 | ProgramServicesAmt |
| Management And General | $135,111 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,289,057 | TotalAmt |
| Program Services | $22,387,330 | ProgramServicesAmt |
| Management And General | $4,901,727 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,403,147 | BOYAmt |
| EOY | $2,851,666 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,464,230 | BOYAmt |
| EOY | $5,474,557 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $140,562 | BOYAmt |
| EOY | $691,543 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,078,242 | BOYAmt |
| EOY | $5,113,693 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,894,900 | BOYAmt |
| EOY | $11,894,900 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,758 | BOYAmt |
| EOY | $30,287 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $258,795 | BOYAmt |
| EOY | $139,256 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,495,186 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,325,662 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,192,868 | BOYAmt |
| EOY | $1,169,524 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,104 | BOYAmt |
| EOY | $44,659 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,495,606 | BOYAmt |
| EOY | $27,410,085 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,688,195 | BOYAmt |
| EOY | $1,839,873 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,883 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,459,157 | BOYAmt |
| EOY | $9,147,491 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,162,235 | BOYAmt |
| EOY | $10,987,364 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,108,133 | BOYAmt |
| EOY | $16,422,721 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $225,238 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,333,371 | BOYAmt |
| EOY | $16,422,721 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,495,606 | BOYAmt |
| EOY | $27,410,085 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,089,350 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,415,653 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,094,212 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,639,038 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,467,940 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,288,244 | CurrentTaxYearAmt |
| Total | $32,905,087 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $3,415,653 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $4,094,212 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $6,639,038 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $8,467,940 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $10,288,244 | CurrentTaxYearAmt |
| Total | $32,905,087 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | $32,905,087 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,584 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,566 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,776 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $70,880 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $124,869 | CurrentTaxYearAmt |
| Total | $225,675 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $19,567 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $33,448 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $62,171 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $204,901 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $104,443 | CurrentTaxYearAmt |
| Total | $424,530 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $33,555,292 | TotalSupportAmt |
| Gross Receipts Rltd Activities | $82,080,929 | GrossReceiptsRltdActivitiesAmt |
| Public Support CY170 | 0.98060 | PublicSupportCY170Pct |
| Public Support PY170 | 0.98410 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $36,720 | OtherCostOrOtherBasisAmt |
| Book Value | $36,720 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $83,280 | OtherCostOrOtherBasisAmt |
| Depreciation | $31,776 | DepreciationAmt |
| Book Value | $51,504 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $593,746 | OtherCostOrOtherBasisAmt |
| Depreciation | $397,750 | DepreciationAmt |
| Book Value | $195,996 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,668,400 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,896,136 | DepreciationAmt |
| Book Value | $772,264 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $113,040 | OtherCostOrOtherBasisAmt |
| Book Value | $113,040 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,169,524 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $32,952,944 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $1,673,854 | OtherRevenueAmt |
| Revenue Not Reported | $1,673,854 | RevenueNotReportedAmt |
| Revenue Subtotal | $31,279,090 | RevenueSubtotalAmt |
| Other Revenues Not Included | $99,317 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $99,317 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $31,378,407 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $28,646,768 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $1,673,854 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $1,673,854 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,972,914 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $316,143 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $316,143 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,289,057 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 1,673,854. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | CAPITAL CONTRIBUTIONS 99,317. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD 1,673,854. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | TRANSFER TO AFFILIATE 316,143. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|---|
| UMPQUA COMMUNITY COLLEGE | ||||||||
| 1140 UMPQUA COLLEGE ROAD | ROSEBURG | OR | 97470 | 237287018 | UMPQUA COMM. COLLEGE | $10,000 | $0 | FUNDRAISING EVENT SPONSORSHIPS |
| AVIVA QALICB | ||||||||
| 150 NE KENNETH FORD DRIVE | ROSEBURG | OR | 97470 | 853172690 | 501(C)(3) | $316,143 | $0 | GENERAL OPERATING SUPPORT |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 2 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAY RICHARDS DO | ||||||||||||||
| CMO | $317,739 | $0 | $0 | $0 | $0 | $0 | $9,612 | $0 | $30,970 | $0 | $358,321 | $0 | $0 | $0 |
| KC BOLTON | ||||||||||||||
| CEO | $289,708 | $0 | $0 | $0 | $0 | $0 | $8,678 | $0 | $22,836 | $0 | $321,222 | $0 | $0 | $0 |
| HEATHER STEARMAN | ||||||||||||||
| PHYSICIAN | $266,675 | $0 | $0 | $0 | $0 | $0 | $5,325 | $0 | $28,439 | $0 | $300,439 | $0 | $0 | $0 |
| GLEN MONTEIRO | ||||||||||||||
| PHYSICIAN | $272,794 | $0 | $0 | $0 | $0 | $0 | $8,176 | $0 | $19,231 | $0 | $300,201 | $0 | $0 | $0 |
| KANANI DILCHER | ||||||||||||||
| PHYSICIAN | $263,608 | $0 | $0 | $0 | $0 | $0 | $5,325 | $0 | $28,439 | $0 | $297,372 | $0 | $0 | $0 |
| HEIDI BEERY | ||||||||||||||
| PHYSICIAN & RESIDENCY DIRECTOR | $252,944 | $0 | $0 | $0 | $0 | $0 | $7,586 | $0 | $31,030 | $0 | $291,560 | $0 | $0 | $0 |
| ALIM KARIM | ||||||||||||||
| PHYSICIAN | $247,616 | $0 | $0 | $0 | $0 | $0 | $4,279 | $0 | $16,071 | $0 | $267,966 | $0 | $0 | $0 |
| JOE POSPOSIL | ||||||||||||||
| CCO | $145,330 | $0 | $0 | $0 | $0 | $0 | $4,415 | $0 | $22,388 | $0 | $172,133 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 2021, SMALL HOLIDAY BONUSES WERE GIVEN TO ALL EMPLOYEES. THESE BONUSES WERE REVIEWED BY THE CEO AND THE BOARD OF DIRECTORS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | AVIVA QALICB | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 150 NE KENNETH FORD DRIVE | AddressLine1Txt |
| City | ROSEBURG | CityNm |
| State Abbreviation | OR | StateAbbreviationCd |
| ZIP | 97470 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 853172690 | EIN |
| Primary Activities | NEW MARKETS TAX CREDIT | PrimaryActivitiesTxt |
| Legal Domicile State | OR | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12C, III-FI | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UMPQUA COMMUNITY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| AVIVA QALICB | ||
| B | $316,143 | CASH |
| AVIVA QALICB | ||
| E | $11,000,000 | CASH |