2023-05-01T09:44:47-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 100 BELLEVUE WA 98004 990 2021-07-01 931070304 UMPQUA COMMUNITY HEALTH CENTER UMPQ 5416729596 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 LEAH HAMILTON CFO 5416729596 2023-04-27 1 LEAH HAMILTON 999009999 KURT BENNION CPA P01469618 4252506100 2023-04-27 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z AVIVA HEALTH RUTH GALSTER 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 33052261 0 X AVIVA.HEALTH X 1992 OR PROVIDE QUALITY, COMPASSIONATE, ACCESSIBLE & AFFORDABLE HEALTHCARE TO THE PEOPLE OF DOUGLAS COUNTY 15 15 315 15 0 0 8467940 10288244 16436457 19354723 70880 124869 1738279 1610571 26713556 31378407 3197322 330444 0 0 17529339 19902453 0 0 0 6005530 7056160 26732191 27289057 -18635 4089350 24495606 27410085 12162235 10987364 12333371 16422721 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 22387330 330444 20860851 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. 22387330 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 48 0 315 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 OR X X LEAH HAMILTON 5416729596 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 JAY RICHARDS DO CMO 40.00 X 317739 0 40582 KC BOLTON CEO 50.00 X 289708 0 31514 HEATHER STEARMAN PHYSICIAN 40.00 X 266675 0 33764 GLEN MONTEIRO PHYSICIAN 40.00 X 272794 0 27407 KANANI DILCHER PHYSICIAN 40.00 X 263608 0 33764 HEIDI BEERY PHYSICIAN & RESIDENCY DIRECTOR 40.00 X 252944 0 38616 ALIM KARIM PHYSICIAN 40.00 X 247616 0 20350 JOE POSPOSIL CCO 40.00 X 145330 0 26803 LEAH HAMILTON CFO (AS OF AUGUST 2021) 40.00 X 118873 0 9542 HEIDI HILL COO (THROUGH FEBRUARY 2022) 40.00 X 109719 0 7259 GARY HUNT CFO (THROUGH AUGUST 2021) 40.00 X 19888 0 17811 ROBERT BRISENO DDS CDO 20.00 X 0 0 0 RUTH GALSTER PRESIDENT 1.00 X X 0 0 0 ANDREA MINER VICE PRESIDENT 1.00 X X 0 0 0 GWEN GRAHAM SECRETARY 1.00 X X 0 0 0 ANGELA MURPHY TREASURER & MEMBER 1.00 X X 0 0 0 JODEE JACKSON MEMBER & TREASURER 1.00 X X 0 0 0 TAMARA DANVILLE MEMBER 1.00 X 0 0 0 MIKE FIELDMAN MEMBER 1.00 X 0 0 0 HAROLD HALL DDS MEMBER 1.00 X 0 0 0 ERIN HELGREN MEMBER 1.00 X 0 0 0 CHARLES IRELAND MEMBER 1.00 X 0 0 0 NICK JONES MEMBER 1.00 X 0 0 0 STEVE LOOSLEY MEMBER 1.00 X 0 0 0 NICHOLE LOUDER MEMBER 1.00 X 0 0 0 MINDY MCFERRIN MEMBER 1.00 X 0 0 0 KERI WINN MEMBER 1.00 X 0 0 0 2304894 0 287412 32 0 1 0 ATHENAHEALTH INC 311 ARSENAL STREET WATERTOWN MA 02472 BILLING SERVICES 710553 BASCO LOGGING 1039 PARK HILL LANE SUTHERLIN OR 97479 LOGGING SERVICES 485898 NW QUALITY CLEANING CO LLC 392 DAIRY LOOP ROSEBURG OR 97471 JANITORIAL SERVICES 259255 ELWOOD STAFFING 2368 CRATER LAKE AVENUE 103 MEDFORD OR 97504 CONTRACT LABOR 189543 ROBERT BRISENO DMD 505 NW WOODSON DRIVE GRANTS PASS OR 97526 DENTAL SERVICES 174938 10 9256330 1031914 10288244 NET PATIENT SERVICE REVENUE 621300 16275498 16275498 HEALTHCARE CONTRACT REVENUE 621300 2126297 2126297 INCENTIVE REVENUE 621300 952928 952928 19354723 124869 124869 3179982 1673854 1506128 1506128 OTHER INCOME 900099 104443 104443 104443 31378407 20860851 0 229312 330444 330444 1084470 172706 911764 14947492 13067959 1879533 418585 373986 44599 2321471 2042152 279319 1130435 959099 171336 -8727 -8727 79993 79993 2504200 2248147 256053 114672 114672 931110 694131 236979 253787 224352 29435 38824 34932 3892 190460 163589 26871 575491 575491 196310 145422 50888 85719 15505 70214 MEDICAL SUPPLIES 813169 813169 LICENSES & PERMITS 437292 378022 59270 EQUIPMENT RENT 380911 291031 89880 REPAIRS & MAINTENANCE 130914 121088 9826 332035 196924 135111 27289057 22387330 4901727 0 2403147 2851666 5464230 5474557 140562 691543 3078242 5113693 11894900 11894900 30758 30287 258795 139256 3495186 2325662 1192868 1169524 32104 44659 24495606 27410085 1688195 1839873 14883 0 10459157 9147491 12162235 10987364 X 12108133 16422721 225238 0 12333371 16422721 24495606 27410085 4089350 0 X 0 1 X 1 1 1 X 3415653 4094212 6639038 8467940 10288244 32905087 3415653 4094212 6639038 8467940 10288244 32905087 32905087 2584 13566 13776 70880 124869 225675 19567 33448 62171 204901 104443 424530 33555292 82080929 0.98060 0.98410 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 36720 36720 83280 31776 51504 593746 397750 195996 2668400 1896136 772264 113040 113040 1169524 X 32952944 1673854 1673854 31279090 99317 99317 31378407 28646768 1673854 1673854 26972914 316143 316143 27289057 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. 1 UMPQUA COMMUNITY COLLEGE 1140 UMPQUA COLLEGE ROAD ROSEBURG OR 97470 237287018 UMPQUA COMM. COLLEGE 10000 0 FUNDRAISING EVENT SPONSORSHIPS AVIVA QALICB 150 NE KENNETH FORD DRIVE ROSEBURG OR 97470 853172690 501(C)(3) 316143 0 GENERAL OPERATING SUPPORT 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 X 0 0 0 1 0 0 0 1 0 JAY RICHARDS DO CMO 317739 0 0 0 0 0 9612 0 30970 0 358321 0 0 0 KC BOLTON CEO 289708 0 0 0 0 0 8678 0 22836 0 321222 0 0 0 HEATHER STEARMAN PHYSICIAN 266675 0 0 0 0 0 5325 0 28439 0 300439 0 0 0 GLEN MONTEIRO PHYSICIAN 272794 0 0 0 0 0 8176 0 19231 0 300201 0 0 0 KANANI DILCHER PHYSICIAN 263608 0 0 0 0 0 5325 0 28439 0 297372 0 0 0 HEIDI BEERY PHYSICIAN & RESIDENCY DIRECTOR 252944 0 0 0 0 0 7586 0 31030 0 291560 0 0 0 ALIM KARIM PHYSICIAN 247616 0 0 0 0 0 4279 0 16071 0 267966 0 0 0 JOE POSPOSIL CCO 145330 0 0 0 0 0 4415 0 22388 0 172133 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 2021, 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 1 0 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 0 AVIVA QALICB B 316143 CASH AVIVA QALICB E 11000000 CASH