2024-09-13T11:22:23-05:00 2023-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1400 PORTLAND OR 97205 990 2023-01-01 931091701 COLUMBIA MEMORIAL HOSPITAL FOUNDATION COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 97103 BRANDON PARKER CFO 5033254321 2024-09-11 1 1 WENDY CAMPOS P00448102 5032421447 2024-09-11 2023 2024-08-08 14:25:15Z ERIK THORSEN 2111 EXCHANGE STREET ASTORIA OR 97103 3418311 0 X WWW.COLUMBIAMEMORIAL.ORG/GIVING/CMH-FOUNDATION/ X 1991 OR COLUMBIA MEMORIAL HOSPITAL FOUNDATION (CMHF), WAS CREATED TO SUPPORT COLUMBIAN LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL (CMH) (EIN #93-0583856). FUNDRAISING REVENUES ARE RELEASED TO CMH TO COVER THE COSTS OF CERTAIN PROGRAMS AND EQUIPMENT. SALARIES, PAYROLL TAXES, BENEFITS AND OTHER ADMINISTRATIVE EXPENSES ARE PAID BY CMH AS AN IN KIND CONTRIBUTION TO CMHF. CMHF IS ULTIMATELY GOVERNED BY CMH AND THEREFORE CMHF MUST FOLLOW POLICIES OF CMH. 18 15 0 40 0 0 566582 3130210 0 0 -40314 72463 0 58987 526268 3261660 25590 43063 0 0 0 0 0 0 0 12147 6564 37737 49627 488531 3212033 2162690 5626341 13058 13212 2149632 5613129 COLUMBIA MEMORIAL HOSPITAL FOUNDATION ESTABLISHES AND MAINTAINS RELATIONSHIPS THAT GENERATE PHILANTHROPIC SUPPORT TO ENHANCE COLUMBIA MEMORIAL HOSPITAL'S ABILITY TO PROVIDE EXCELLENCE IN HEALTHCARE. 0 0 43063 43063 IN SUPPORT OF COLUMBIA MEMORIAL HOSPITAL (ID: 93:0583856), COLUMBIA MEMORIAL HOSPITAL FOUNDATION (CMHF) RAISED FUNDS WITH THE HELP OF COMMUNITY MEMBERS AND EMPLOYEES. FUNDS THAT WERE RAISED IN 2023 WERE PUT TOWARDS A FUND WHICH WILL ASSIST IN BUILDING THE EXPANSION OF THE HOSPITAL. THIS COLUMBIA MEMORIAL HOSPITAL PROJECT WILL WORK TO EXPAND OUR FACILITIES AND INCREASE OUR SERVICES. 3913 IN SUPPORT OF COLUMBIA MEMORIAL HOSPITAL (ID: 93-0583856), LOWER COLUMBIA HOSPICE (LCH) COLLECTS VARIOUS MEMORIAL DONATIONS FROM THE FAMILIES AND FRIENDS OF DEPARTED PATIENTS PREVIOUSLY IN HOSPICE CARE OR VIA LCH SPONSORED EVENTS LIKE THE ANNUAL RACE TO THE BAR. THESE FUNDS ARE USED TO ASSIST PATIENTS IN HOSPICE CARE. 46976 1 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X BRANDON PARKER CFO 5033254321 2111 EXCHANGE STREET ASTORIA OR 97103 AMBER HILL BOARD MEMBER 4.00 X 0 0 0 AVERY RAWSON BOARD MEMBER 4.00 X 0 0 0 BETSY JOHNSON EMERITUS BOARD MEMBER 1.00 X 0 0 0 BILL GARVIN BOARD CHAIR-BOARD OF DIRECTORS 4.00 X X 0 0 0 BREE PHILLIPS BOARD MEMBER 4.00 X 0 0 0 CHRISTOPHER JONES BOARD MEMBER 4.00 X 0 0 0 JOHN CRAWFORD BOARD MEMBER 4.00 X 0 0 0 KURTIS BIRDENO BOARD MEMBER 4.00 X 0 0 0 LINDA MORELAND TREASURER 4.00 X X 0 0 0 MICHELLE MURRAY BOARD MEMBER 4.00 X 0 0 0 MIKE AUTIO BOARD MEMBER 1.00 X 0 0 0 MIKE BROSIUS BOARD MEMBER 4.00 X 0 0 0 MIKE MURDOCK MD BOARD MEMBER 4.00 X 0 0 0 REGINA MYSLIWIEC MD BOARD MEMBER 4.00 X 0 0 0 ROBERT HOLLAND MD EX-OFFICIO 4.00 X 0 0 0 JOHN NYGAARD BOARD MEMBER THRU 03/23 4.00 X 0 0 0 JOHN SHEPHERD BOARD MEMBER THRU 01/23 4.00 X 0 0 0 ERIK THORSEN CEO 1.00 40.00 X 0 804970 49551 MARK KUJALA EXECUTIVE DIRECTOR OF THE FOUNDATION 4.00 40.00 X 0 163910 38264 BRANDON PARKER CFO 1.00 40.00 X 0 234662 23551 0 1203542 111366 0 0 0 0 0 365000 2765210 3130210 73041 73041 2160 2738 -578 -578 -578 212900 365000 153913 58987 58987 3261660 0 0 131450 43063 43063 2651 2651 OTHER PROGRAM EXPENSES 3913 3913 49627 46976 2651 0 125255 112600 3791 2324547 2024644 3180194 9000 9000 2162690 5626341 13058 13212 13058 13212 X 1434904 1758618 714728 3854511 2149632 5613129 2162690 5626341 X 3212033 292659 -41195 X X 0 1 X 1 0 X X 1 COLUMBIA LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL 930583856 3 1 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART IV, SECTION A, LINE 6 THE FILING ORGANIZATION MADE GRANTS TO INDIVIDUALS THAT ARE PART OF THE CHARITABLE CLASS BENEFITED BY ITS SUPPORTED ORGANIZATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14 9100 3230634 6818 36245 122889 3757655 1 1 2226 2226 2226 2226 1758 468 2226 1290 468 1758 0.00000 1.00000 0.00000 0 0 0 LONG-TERM ANNUITIES PAYABLE 13212 13212 X PART X, LINE 2: INCOME TAX POSITIONS THAT MEET A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN CHARITIES' CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN CHARITIES' CONSOLIDATED STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2023 AND 2022. DIAMOND DERBY 577900 365000 212900 75949 22456 55508 577900 365000 212900 75949 22456 55508 153913 58987 0 FRIENDSHIP FUND GRANTS 40 36245 EMERGENCY FINANCIAL ASSISTANCE PROVIDED TO EMPLOYEES WHO ARE EXPERIENCING PERSONAL FINANCIAL CRISIS. ARM IN ARM AGAINST CANCER GRANTS 20 6818 TO PROVIDE ASSISTANCE TO CANCER PATIENTS FOR SUPPORT AND FOLLOW UP TREATMENTS. X X 0 1 0 0 0 0 0 0 0 ERIK THORSEN CEO 0 517293 0 111427 0 176250 0 23452 0 26099 0 854521 0 0 BRANDON PARKER CFO 0 191927 0 36234 0 6501 0 0 0 23551 0 258213 0 0 MARK KUJALA EXECUTIVE DIRECTOR OF THE FOUNDATION 0 149536 0 13174 0 1200 0 12204 0 26060 0 202174 0 0 PART I, LINE 4B ERIK THORSEN, CEO, IS PARTICIPATING IN A 457(F) PLAN OF A RELATED ORGNIZATION WHICH STARTED IN 2015. COLUMBIA MEMORIAL HOSPITAL CONTRIBUTED $70,356 TO THE PLAN IN 2023. CONTRIBUTIONS ARE MADE THROUGHOUT THE YEAR AND DISTRIBUTED AT THE BEGINNING OF THE FOLLOWING YEAR. THE DISTRIBUTION IS INCLUDED IN TAXABLE INCOME. PART I, LINE 3 COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE: COMPENSATION OF ALL OFFICERS IS REVIEWED WITH COMPARABILITY DATA BY A THIRD PARTY CONSULTANT. THE RESULTS OF THE STUDY ARE REVIEWED AND DISCUSSED AT THE BOARD OF TRUSTEES MEETING. PART 1, LINE 1A DISCRETIONARY SPENDING ACCOUNT: BASED ON SIGNED EMPLOYMENT CONTRACTS, COLUMBIA MEMORIAL HOSPITAL PAID ONE LUMP SUM PAYMENT ON THE FIRST PAY-PERIOD OF EACH YEAR TO COVER DISCRETIONARY EXPENSE OF ERIK THORSEN, CEO, ($2,500), IN ADDITION, COLUMBIA MEMORIAL HOSPITAL PAID $714.92 PER MONTH TO COVER THE CEO CAR, ($714.92/MONTH - $8,579.04 ANNUALLY). THE CAR IS ONLY USED FOR BUSINESS PURPOSE AND NOT INCLUDED IN TAXABLE INCOME. THE DISCRETIONARY EXPENSE ACCOUNT IS INCLUDED IN TAXABLE INCOME. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: BASED ON SIGNED EMPLOYMENT CONTRACTS, COLUMBIA MEMORIAL HOSPITAL REIMBURSED MONTHLY COUNTRY CLUB MEMBERSHIP DUES FOR ERIK THORSEN, CEO ($405/MONTH- $4,860 ANNUALLY) AND ROTARY CLUB DUES FOR NICOLE WILLIAMS, COO, OF $285 QUARTERLY ($1,140 ANNUALLY). THESE EXPENSES WERE SUBMITTED ON MONTHLY EXPENSE REPORTS OR DIRECT INVOICES FROM THE CLUB AND WERE REVIEWED AND APPROVED IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL AUTHORITY POLICY AND BUSINESS EXPENSE POLICY. FORM 990, PART V, LINE 1A,B AND 2A SINCE ALL ACCOUNTS PAYABLE, PAYROLL AND PAYROLL TAXES ARE INITIALLY PAID BY CMH. W-2 AND W-3 FORMS ARE FILED BY CMH. SOME EXPENSES ARE LATER REIMBURSED BY CMHF. FORM 990, PART VI, SECTION A, LINE 6 COLUMBIA MEMORIAL HOSPITAL IS THE SOLE MEMBER OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A COLUMBIA MEMORIAL HOSPITAL HAS THE POWER TO APPOINT AND REMOVE MAJORITY OF BOARD MEMBERS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS ARE SUBJECT TO APPROVAL BY THE COLUMBIA MEMORIAL HOSPITAL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS PROVIDED TO ALL BOARD OF TRUSTEE MEMBERS FOR REVIEW AND DISCUSSION PRIOR TO FINALIZING AND FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD OF DIRECTORS. ALL BOARD MEMBERS MUST SIGN AND DATE THE CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT, QUESTIONNAIRE AND DISCLOSURE STATEMENT. ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AT THE BOARD LEVEL ARE DISCUSSED AT THE BOARD MEETING. ACTUAL CONFLICT OF INTERESTS ARE ADDRESSED, DOCUMENTED AND FILED IN A CONFIDENTIAL PERSONNEL FILE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF ALL OFFICERS WAS REVIEWED WITH COMPARABILITY DATA BY A THIRD-PARTY CONSULTANT. THE RESULTS OF THE STUDY WERE REVIEWED AND DISCUSSED AT A BOARD OF TRUSTEES' MEETING OF A RELATED ORGANIZATION, CMH. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION ARE AVAILABLE UPON REQUEST AT COLUMBIA MEMORIAL HOSPITAL. FORM 990, PART XI, LINE 9: DONOR RESTRICTIONS -43,063. DONNOR RESTRICTIONS GAIN 1,868. FORM 990, PART XII, LINE 2C THE BOARD OF TRUSTEE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT, REVIEW, AND SELECTION OF AN INDEPENDENT AUDIT FIRM. TRADITIONALLY, A THREE YEAR CONTRACT WITH A SELECTED AUDIT FIRM IS APPROVED. ANNUALLY, A SPECIAL BOARD MEETING IS HELD AND THE AUDIT FIRM PRESENTS THE AUDITED FINANCIAL STATEMENTS TO THE BOARD OF TRUSTEES. DURING THE MEETING, THE BOARD MEMBERS ARE GIVEN THE OPPORTUNITY TO ASK QUESTIONS WITHOUT MANAGEMENT PRESENT. FOLLOW-UP INFORMATION ON THE MANAGEMENT LETTER RECOMMENDATIONS IS ALSO PRESENTED SEMI-ANNUALLY TO THE BOARD FINANCE COMMITTEE. COLUMBIA LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 930583856 HEALTHCARE PROVIDER OR 501(C)(3) LINE 3 0 CMH AUXILIARY 2111 EXCHANGE STREET ASTORIA OR 97103 931306211 HOSPITAL GIFT SHOP OR 501(C)(3) LINE 12A, I COLUMBIA LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL 0 COASTAL HEALTH ASSURANCE INC 2111 EXCHANGE STREET ASTORIA OR 97103 911818894 PHYSICIAN ASSOCIATION, MEDICAL CONTRACT MANAGEMENT OR N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0