2024-09-30T18:01:46-05:00 2023-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1400 PORTLAND OR 97205 990 2023-01-01 930583856 COLUMBIA LUTHERAN CHARITIES COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 971033329 BRANDON PARKER CFO 5033254321 2024-09-30 1 1 WENDY CAMPOS P00448102 5032421447 2024-09-30 2023 2024-10-15 13:58:12Z COLUMBIA MEMORIAL HOSPITAL ERIK THORSEN 2111 EXCHANGE STREET ASTORIA OR 971033329 222449351 0 X WWW.COLUMBIAMEMORIAL.ORG X 1958 OR PROVIDE EXCELLENCE, LEADERSHIP & COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 14 14 851 66 996404 0 3305921 3527466 180779561 202892588 3641695 5769700 951758 852658 188678935 213042412 166525 60451 0 0 63265710 73789847 0 0 553291 108170129 118595393 171602364 192445691 17076571 20596721 249655078 283041281 77771621 79364061 171883457 203677220 THE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 0 0 146143479 60451 201896184 SEE SCHEDULE O 146143479 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 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 109 0 1 851 1 1 1 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 1 0 OR X BRANDON PARKER 5033254321 2111 EXCHANGE STREET ASTORIA OR 97103 ROBBERT HOLLAND MD PRESIDENT 3.00 X X 0 0 0 MIKE AUTIO VICE PRESIDENT 3.00 X X 0 0 0 DAVE NYGAARD SECRETARY 3.00 X X 0 0 0 JAMES HEILMAN MD QUALITY OVERSIGHT COMMITTE CHAIR 3.00 X 0 0 0 BILL LANDWEHR TREASURER 3.00 X X 0 0 0 DOUG KAUP TRUSTEE 3.00 X 0 0 0 HEATHER SEPPA TRUSTEE 3.00 X 0 0 0 JEAN DANFORTH TRUSTEE 3.00 X 0 0 0 MARK SMITH TRUSTEE 3.00 X 0 0 0 MATT PHILLIPS TRUSTEE 3.00 X 0 0 0 NANCY MCALLISTER TRUSTEE 3.00 X 0 0 0 PAUL HAINES TRUSTEE 3.00 X 0 0 0 QURATULAIN DURRANI MD TRUSTEE 3.00 X 0 0 0 ERIK THORSEN CEO 40.00 1.00 X 804969 0 49551 NICOLE WILLIAMS COO 40.00 X 380815 0 55407 JARROD KARNOFSKI VP - ANCILLARY SERVICES 40.00 X 291895 0 49629 CHRISTOPHER LAMAN VP - STRATEGY 40.00 X 286382 0 45428 JUDY GEIGER VP - PATIENT CARE 40.00 X 264225 0 28818 NICOLE PEREZ VP - HEALTH INFORMATION SERVICES 40.00 X 237465 0 43519 BRANDON PARKER CFO 40.00 1.00 X 234662 0 23551 DAVID LEIBEL PHYSICIAN 40.00 X 293605 0 33438 JEFFREY CHOW MANAGER - OP PHARMACY 40.00 X 207399 0 41780 AMY MCKELVEY MANAGER - PHARMACY 40.00 X 218382 0 26564 JEANETTE SCHACHER DIRECTOR - MEDICAL GROUP 40.00 X 203442 0 41049 BENJAMIN KIEFER PHARMACIST 40.00 X 198240 0 41692 3621481 0 480426 104 0 1 0 OHSU (CONSOLIDATED) 3181 SAM JACKSON PARK RD MAIL CODE PORTLAND OR 97239 PHYSICIAN FEES 23838707 MAXIM HEALTHCARE SERVICES 12558 COLLECTONS CENTER DR CHICAGO IL 60693 HEALTHCARE STAFFING 5843400 ZIMMER GUNSUL FRASCA ARCHITECTS LLP 1223 SW WASHINGTON ST STE 200 PORTLAND OR 97205 ARCHITECTS 5117216 ANESTHESIA ASSOCIATES NORTHWEST LLC 6400 SE LAKE RD STE 300 PORTLAND OR 97222 ANESTHESIOLOGY PHYSICIANS 2527849 LEASE CRUTCHER LEWIS LLC 550 SW 12TH AVE PORTLAND OR 97205 GENERAL CONTRACTOR 1587258 49 3527466 3527466 OUTPATIENT REVENUE 621990 262787736 262787736 EMERGENCY ROOM REVENUE 621990 68039484 68039484 INPATIENT REVENUE 621990 41104176 41104176 OBSERVATION REVENUE 621990 8448574 8448574 CONTRACTUAL ALLOWANCE 621990 -179700444 -179700444 2213062 1216658 996404 202892588 5839482 5839482 205002 186870 18132 18132 18132 9150287 9214245 5824 -63958 -5824 -69782 -69782 CAFETERIA 900099 432699 432699 REBATES & REFUNDS 900099 325075 325075 DEFERRED REVENUE 900099 -54368 -54368 131120 131120 834526 213042412 201896184 996404 6622358 X 60451 60451 2796317 2796317 51842881 37445923 14168958 228000 2829437 1875643 942022 11772 12352882 8991176 3307814 53892 3968330 2805468 1145607 17255 13936 13936 470663 470663 157767 157767 150287 150287 47315377 39373426 7867240 74711 439161 687 413723 24751 3292587 1759931 1461624 71032 3564553 743782 2820771 2316738 1317917 998821 104138 82461 21677 444193 149072 294004 1117 1199140 1199140 5947781 1871911 4075870 2010220 654307 1355913 MEDICAL SUPPLIES & PHAR 24335137 24069370 264342 1425 PHARMACEUTICALS 18991294 18991294 BAD DEBT 2924022 2924022 CHARITY CARE 2362634 2362634 2555765 664004 1822425 69336 192445691 146143479 45748921 553291 110180 52033 4615946 3201774 17032315 24437192 4298050 4040426 2333057 2751561 144492156 83946841 53582793 60545315 140667741 156886484 2475000 2475000 24539996 28651496 249655078 283041281 19606089 24557368 39009478 37914094 19156054 16892599 77771621 79364061 X 171883457 203677220 171883457 203677220 249655078 283041281 X 20596721 8207707 2989335 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7480255 11781085 19261340 8014667 40374151 28913862 19474956 5511686 2702139 2809547 69200798 52330840 16869958 2129514 2129514 60545315 OTHER RECEIVABLES 5795384 INSURANCE ANNUITIES - DEFERRED COMP PLAN 1120148 MEDICAL MALPRACTICE RECEIVABLE 5020000 ASC 842 RIGHT OF USE ASSETS 8556989 ACCR RETIREMNT PLAN ACCRD PENSION 8158975 28651496 ESTIMATED 3RD PARTY PAYOR 2120831 DEFERRED COMPENSATION 1051724 MEDICAL MALPRACTICE CLAIMS 5221000 ACCRUED RETIREMENT PLAN LIABILITY 591244 ASC 842 LEASE LIABILITIES 7907800 16892599 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. 1 1 X 1 X 300.000000000000 1 X 1 1 0 1 1 1095118 1139024 0 0.00000 31734451 26454841 5279610 0.02740 32829569 27593865 5279610 0.02740 257088 257088 0.00130 13560 13560 0.00010 168664 168664 0.00090 439312 439312 0.00230 33268881 27593865 5718922 0.02970 1 2924022 0 79767856 64693936 15073920 X 1 1 3 1 COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 WWW.COLUMBIAMEMORIAL.ORG 14-1146 X X X X 2 CMH PRIMARY CARE CLINICCMH URGENT CARE 1639 SE ENSIGN LANE STE B103 WARRENTON OR 97146 WWW.COLUMBIAMEMORIAL.ORG 14-1146-1 X X HOSPITAL SATELLITE A 3 SEASIDE PRIMARY CARE CLINICCMH IMAGING & LAB 1111 N ROOSEVELT DRIVE SUITE 210 SEASIDE OR 97138 WWW.COLUMBIAMEMORIAL.ORG 14-1146-2 X X HOSPITAL SATELLITE A COLUMBIA MEMORIAL HOSPITAL 0 0 1 X X X X X X X X 22 1 1 1 1 X SEE PART V, PAGE 8 X 1 22 1 SEE PART V, PAGE 8 0 1 X 300.000000000000 400.000000000000 X X X X X X 0 1 X X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X 1 X X 0 X X X 1 0 0 PART V, SECTION B, LINE 5 COMMUNITY REPRESENTATION FOR PRIMARY DATA:COMMUNITY REPRESENTATION WAS A KEY COMPONENT OF THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). CMH AND THE TEAM CONDUCTING THE ASSESSMENT (COLLABORATIVE PARTNERS) ACCESSED DATA FROM SEVERAL STATE AND FEDERAL SOURCES TO DEVELOP A CLEAR UNDERSTANDING OF OUR COMMUNITY'S DEMOGRAPHICS, SOCIAL, ECONOMIC, AND CLINICAL CHARACTERISTICS. THE COLLABORATIVE PARTNERS WORKING ON THE CHNA ALSO SHARED DATA BETWEEN ORGANIZATIONS TO ESTABLISH AN ACCURATE PICTURE OF NEEDS IN THE REGION. THE COLLABORATIVE PARTNERS WORKED WITH LOCAL COMMUNITY-BASED ORGANIZATIONS (CBOS) TO DISTRIBUTE AND COLLECT ONLINE AND PAPER SURVEYS IN ENGLISH AND SPANISH, CONDUCT VIRTUAL LISTENING SESSIONS IN ENGLISH AND SPANISH, AND CONDUCT COMMUNITY LEADER INTERVIEWS. MORE THAN SIX HUNDRED SURVEYS WERE COMPLETED, SIX COMMUNITY LISTENING SESSIONS, AND TEN COMMUNITY LEADER INTERVIEWS TOOK PLACE. IN TOTAL, MORE THAN TWENTY LOCAL ORGANIZATIONS TOOK PART IN THIS CHNA INCLUDING SCHOOL DISTRICTS, THE COAST GUARD, THE HEALTH DEPARTMENT AND OUR LOCAL AND CBO DEDICATED TO THE LATINO IMMIGRANT COMMUNITY. PART V, SECTION B, LINE 6A PROVIDENCE SEASIDE HOSPITAL PART V, SECTION B, LINE 6B CLATSOP COUNTY HEALTH DEPARTMENT, COLUMBIA COUNTY HEALTH DEPARTMENT, COLUMBIA PACIFIC COORDINATED CARE ORGANIZATION PART V, SECTION B, LINE 7A WWW.COLUMBIAMEMORIAL.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART V, SECTION B, LINE 10A RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/COLUMBIA-MEMORIAL-SITE-387/MEDIA/00BE1A3CA9C14B859E2DD157360D2343/20232025-COLUMBIA-MEMORIAL-HOSPITAL-COMMUNITY-HEALTH-IMPROVEMENT-PLAN-ASTORIA-OR.PDF PART V, SECTION B, LINE 11 THE MOST SIGNIFICANT NEEDS IDENTIFIED IN THE 2022 CHNA WERE ACCESS TO HEALTHCARE SERVICES (CARE FOR CHRONIC CONDITIONS, BEHAVIORAL HEALTH, DENTAL CARE, AND CANCER SCREENING), HOUSELESSNESS AND HOUSING INSTABILITY, ECONOMIC INSECURITY, AND AFFORDABLE CHILDCARE AND PRESCHOOLS. NONE OF THESE PROBLEMS CAN BE SOLVED BY THE HOSPITAL ALONE. AS PART OF THE CMH COMMUNITY HEALTH IMPROVEMENT PLAN, OUR HOSPITAL IS PARTNERING WITH OTHER LOCAL ORGANIZATIONS TO PROVIDE FREE DENTAL CARE IN THE COMMUNITY. CMH HAS ADDED SOCIAL WORKERS AND BEHAVIORAL HEALTH SPECIALISTS TO OUR CLINICS AND EXPANDED THE NUMBER OR PRIMARY CARE PROVIDERS IN THE COMMUNITY TO HELP CARE FOR PATIENTS WITH CHRONIC CONDITIONS. CMH PARTNERS WITH THE KNIGHT CANCER INSTITUTE TO DEVELOP AND PROMOTE CANCER SCREENING PROGRAMS AND ALSO PLAYS A SIGNIFICANT ROLE IN THE CLATSOP COUNTY CHILDCARE AND HOUSING COALITIONS. THIS HAS INCLUDED SUBSTANTIAL MONETARY SUPPORT FOR THE EXPANSION OF LOCAL CHILDCARE BUSINESSES. PART V, SECTION B, LINE 13H A PATIENT'S ELIGIBILITY IS DETERMINED BY THE FINANCIAL COUNSELOR DURING THE SCREENING PROCESS BASED UPON THE FEDERAL POVERTY LEVEL GUIDELINES, HOUSEHOLD SIZE, LIVING EXPENSES, AND OTHER ASSETS WHICH ARE AVAILABLE FOR PAYMENT. A PATIENT/GUARANTOR'S PRIMARY RESIDENCE AND AUTOMOBILES WILL NOT BE CONSIDERED IN ASSET EVALUATION. THE PATIENT'S INCOME HISTORY AND FINANCIAL SITUATION WILL BE REVIEWED, AND IF THERE ARE INSUFFICIENT ASSETS AVAILABLE FOR PAYMENT, ASSISTANCE WILL BE PROVIDED BASED UPON THE SCHEDULE BELOW.INCOME % OF THE FEDERAL POVERTY LEVEL: 0% - 300%DISCOUNT %: 100%INCOME % OF THE FEDERAL POVERTY LEVEL: 301% - 400%DISCOUNT %: 65%*INCOME % OF THE FEDERAL POVERTY LEVEL: >400% UNINSUREDDISCOUNT %: 20% SELF-PAY DISCOUNT*MINIMUM CHARITY DISCOUNT IS BASED ON AGB AS DESCRIBED BELOW AND WILL BE REVIEWED ANNUALLY AND REVISED IF NECESSARY TO COMPLY WITH IRS 501(R). PART V, SECTION B, LINE 16A, 16B, AND 16C WWW.COLUMBIAMEMORIAL.ORG/PATIENT-AND-VISITORS/BILLING-INFORMATION/FINANCIAL-ASSISTANCE/ 19 1 - INFUSION CENTER 1905 EXCHANGE ST ASTORIA OR 97103 INFUSION SERVICES 2 - CARDIOLOGY CLINIC 2095 EXCHANGE ST SUITE 301 ASTORIA OR 97103 CARDIOLOGY SERVICES 3 - ORTHOPEDIC CLINIC 2265 EXCHANGE ST 3RD FLOOR ASTORIA OR 97103 ORTHOPEDIC SERVICES 4 - WOMEN'S CENTER CLINIC 2265 EXCHANGE ST 2ND FLOOR ASTORIA OR 97103 WOMEN'S SERVICES 5 - SEASIDE CLINIC 111 N ROSEVELT DRIVE 210 SEASIDE OR 97138 PRIMARY CARE SERVICES 6 - WARRENTON PRIMARY CARE (RHC) 1639 SE ENSIGN LANE SUITE B103 WARRENTON OR 97146 PRIMARY CARE SERVICES 7 - GENERAL SURGERY CLINIC 2055 EXCHANGE ST SUITE 270 ASTORIA OR 97103 GENERAL SURGERY SERVICES 8 - ASTORIA PRIMARY CARE CLINIC 2158 EXCHANGE ST SUITE 107 ASTORIA OR 97103 PRIMARY CARE SERVICES 9 - PEDIATRIC CLINIC 2265 EXCHANGE ST 3RD FLOOR ASTORIA OR 97103 PEDIATRIC SERVICES 10 - FOOT & ANKLE CLINIC 2265 EXCHANGE ST 3RD FLOOR ASTORIA OR 97103 PODIATRY SERVICES 11 - UROLOGY CLINIC 2265 EXCHANGE ST 3RD FLOOR ASTORIA OR 97103 UROLOGY SERVICES 12 - LOWER COLUMBIA HOSPICE 2158 EXCHANGE ST SUITE 206 ASTORIA OR 97103 HOSPICE SERVICES 13 - MEDICAL ONCOLOGY CLINIC 1905 EXCHANGE ST ASTORIA OR 97103 MEDICAL ONCOLOGY SERVICES 14 - URGENT CARE CLINIC 2265 EXCHANGE ST 1ST FLOOR ASTORIA OR 97103 URGENT CARE SERVICES 15 - PULMONOLOGY CLINIC 2055 EXCHANGE ST SUITE 210 ASTORIA OR 97103 PULMONOLOGY SERVICES 16 - ENDOCRINOLOGY CLINIC 2158 EXCHANGE ST SUITE 205 ASTORIA OR 97103 ENDOCRINOLOGY SERVICES 17 - RADIATION ONCOLOGY CLINIC 1905 EXCHANGE ST ASTORIA OR 97103 RADIATION THERAPY SERVICES 18 - WOUND CARE CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 WOUND CARE SERVICES 19 - INTERV RADIOLOGY CLINIC 2111 EXCHANGE ST ASTORIA OR 97103 INTERVENTIONAL RADIOLOGY SERVICES PART I, LINE 3C: THE HOSPITAL'S CRITERIA FOR THE DETERMINATION OF CHARITY CARE INCLUDE PATIENT'S - OR THE OTHER RESPONSIBLE PARTY'S - ANNUAL HOUSEHOLD INCOME, HOUSEHOLD SIZE, ASSETS, CREDIT HISTORY, EXISTING DEBT OBLIGATIONS, AND OTHER INDICATORS OF THE PATIENT'S ABILITY TO PAY. PART I, LINE 7: A COST-TO-CHARGE RATIO IS USED, BASED ON WORKSHEET 2. PART III, LINE 2: THE METHODOLOGY USED TO ESTIMATE BAD DEBT EXPENSE IS THE TOTAL OF ACTUAL BAD DEBT WRITE-OFFS, OFFSET WITH BAD DEBT RECOVERIES PLUS A RESERVE FOR SELF PAY ACCOUNTS EXPECTED TO BE UNCOLLECTABLE BASED ON THE AGING OF THE ACCOUNT. PART III, LINE 3: THE HOSPITAL'S BAD DEBT EXPENSE INCLUDES IMPLICIT PRICE CONCESSIONS FOR PATIENTS WHO DO NOT QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBT EXPENSE DOES NOT INCLUDE CHARITY CARE. PART III, LINE 4: SEE PAGE 13 OF ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: AS A MISSION-DRIVEN HOSPITAL, HEALTHCARE SERVICES ARE OFFERED TO THE COMMUNITY EVEN WHEN THE COST OF THAT CARE IS KNOWN TO BE MORE THAN THE REVENUE THAT WILL BE RECEIVED. AS THE HOSPITAL ABSORBS THESE LOSSES FROM MEDICARE (DETERMINED BY THE RATIOS USED IN THE MEDICARE COST REPORT), THE ENTIRE COMMUNITY BENEFITS BECAUSE MANY OF THESE PROGRAMS/SERVICES WOULD NOT EXIST WITHOUT HOSPITAL SUPPORT. PART III, LINE 9B: PERSONAL PAY ACCOUNTS AND THE BALANCE AFTER INSURANCE ARE SUBJECT TO A MINIMUM PAYMENT SCHEDULE. IF THE PATIENT OR GUARANTOR IS UNABLE TO MEET THIS PAYMENT SCHEDULE, APPLICATION MAY BE MADE THROUGH PATIENT FINANCIAL SERVICES CREDIT AND COLLECTION CLERK'(S) AND OR THE PATIENT FINANCIAL SERVICES MANAGER FOR CHARITY, FINANCIAL ASSISTANCE, OR REDUCED PAYMENTS. PART VI, LINE 2: THE ORGANIZATION CONTRACTS WITH A THIRD PARTY VENDOR TO PERFORM THE COMMUNITY HEALTH NEEDS ASSESSMENT. THIS IS PERFORMED EVERY THREE YEARS. PART VI, LINE 3: THE ORGANIZATION EMPLOYS FINANCIAL COUNSELORS WHO ARE AVAILABLE TO ASSIST PATIENTS WITH ELIGIBILITY FOR ASSISTANCE WITH ALL FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS. PART VI, LINE 4: THE ORGANIZATION IS LOCATED IN ASTORIA,OREGON AT THE ESTUARY WHERE THE COLUMBIA RIVER AND THE PACIFIC OCEAN MEET ALONG THE NORTH COAST OF OREGON. OUR SERVICE AREA INCLUDES NORTHWEST OREGON AND SOUTHWEST WASHINGTON STATE. PART VI, LINE 5: THE ORGANIZATION IS A MEMBER AND ACTIVE PARTICIPANT IN THE COLUMBIA PACIFIC COMMUNITY CARE ORGANIZATION'S REGIONAL HEALTH ASSESSMENT AND REGIONAL HEALTH IMPROVEMENT PLAN PROGRAMS. PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 COLUMBIA PACIFIC ECONOMIC DISTRICT PO BOX 1535 ST HELENS OR 97051 931178553 501(C)(3) 20000 0 CHILDCARE GRANT LEWIS & CLARK FIRE DEPARTMENT 34571 HWY 101 BUSINESS ASTORIA OR 97103 931001875 LOCAL GOVERNMENT 18941 0 CPR MACHINES CLATSOP COMMUNITY COLLEGE 1651 LEXINGTON AVE ASTORIA OR 97103 237100856 501(C)(3) 13060 0 SCHOLARSHIPS - NURSING AND CAN BUMBLE PRESCHOOL 1555 W MARINE DR ASTORIA OR 97103 371857623 8450 0 CHILDCARE GRANT 3 1 PART I, LINE 2: THE CEO REVIEWS AND APPROVES WHEN THE ENTITY MAKES A CONTRIBUTION TO AN ORGANIZATION. X X 1 1 X X X X 0 1 0 0 0 1 0 0 0 ERIK THORSEN CEO 517293 0 111426 0 176250 0 23452 0 26099 0 854520 0 68424 0 NICOLE WILLIAMS COO 293752 0 31743 0 55320 0 26084 0 29323 0 436222 0 0 0 JARROD KARNOFSKI VP - ANCILLARY SERVICES 216664 0 20423 0 54808 0 23460 0 26169 0 341524 0 0 0 CHRISTOPHER LAMAN VP - STRATEGY 224290 0 20910 0 41182 0 19260 0 26168 0 331810 0 0 0 DAVID LEIBEL PHYSICIAN 249767 0 3560 0 40278 0 23498 0 9940 0 327043 0 0 0 JUDY GEIGER VP - PATIENT CARE 209988 0 22657 0 31580 0 18088 0 10730 0 293043 0 0 0 NICOLE PEREZ VP - HEALTH INFORMATION SERVICES 209280 0 14988 0 13197 0 17407 0 26112 0 280984 0 0 0 BRANDON PARKER CFO 191927 0 36234 0 6501 0 0 0 23551 0 258213 0 0 0 JEFFREY CHOW MANAGER - OP PHARMACY 177921 0 16579 0 12899 0 15953 0 25827 0 249179 0 0 0 AMY MCKELVEY MANAGER - PHARMACY 181684 0 12760 0 23938 0 15273 0 11291 0 244946 0 0 0 JEANETTE SCHACHER DIRECTOR - MEDICAL GROUP 152319 0 20531 0 30592 0 14741 0 26308 0 244491 0 0 0 BENJAMIN KIEFER PHARMACIST 181420 0 525 0 16295 0 16374 0 25318 0 239932 0 0 0 PART I, 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 $609.78 PER MONTH TO COVER THE CEO CAR, ($609.78/MONTH - $7,317.36 ANNUALLY). THE CAR IS ONLY USED FOR BUSINESS PURPOSE AND NOT INCLUDED IN TAXABLE INCOME. AMOUNTS FOR THE DISCRETIONARY SPENDING ACCOUNT ARE 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 ($365/MONTH FROM JANURARY TO JUNE AND $375/MONTH FROM JULY TO DECEMBER - $4,440 ANNUALLY) AND ROTARY CLUB DUES FOR ERIK THORSEN, CEO, OF $200 QUARTERLY ($800 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. 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 I, LINE 4B ERIK THORSEN, CEO IS PARTICIPATING IN A 457(F) PLAN WHICH STARTED IN 2015. COLUMBIA MEMORIAL HOSPITAL CONTRIBUTED $70,356 TO THIS 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 6 MANAGEMENT BONUSES ARE CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION. A THE HOSPITAL FACILITIES AUTHORITY OF THE CITY OF ASTORIA 270034718 2022-06-23 20910000 REFUNDING OF 2012 BOND ISSUES 0 0 0 B THE HOSPITAL FACILITIES AUTHORITY OF THE CITY OF ASTORIA 270034718 046279CAI 2016-07-07 20451436 BUILDING OF THE CMH-OHSU KNIGHT CANCER COLLABORATIVE AND ER REMODEL 0 0 0 A 20910000 418200 20491800 2022 1 0 1 1 B 20447424 1667755 870640 409029 17500000 2017 0 0 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 0 B 0 0 0 1 0 0 0 0 0 A 0 B 0 PART 1 SECTION (C) CUSIP # 2016 BOND 046279CAI 046279B27 046279C89 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS MADE AVAILABLE, ELECTRONICALLY, TO THE BOARD OF TRUSTEES, PRIOR TO THE BOARD MEETING. THE 990 IS REVIEWED AND DISCUSSED AT THE BOARD FINANCE COMMITTEE MEETING 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 TRUSTEES, OFFICERS, AND KEY EMPLOYEES ANNUALLY. ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES MUST SIGN AND DATE THE CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT, QUESTIONNAIRE, AND DISCLOSURE STATEMENT. ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AT THE BOARD OR OFFICER LEVEL ARE DISCUSSED AT THE BOARD MEETING. ACTUAL CONFLICTS OF INTEREST ARE ADDRESSED, DOCUMENTED, AND FILED IN THE 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. THIS REVIEW IS DONE ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL INFORMATION REPORTED IN THE 990 ARE AVAILABLE UPON REQUEST AT THE HOSPITAL. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 32,582,458. MANAGEMENT AND GENERAL EXPENSES 2,525,738. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 35,108,196. CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 184,747. FUNDRAISING EXPENSES 9,759. TOTAL EXPENSES 194,506. RECRUITING FEES: PROGRAM SERVICE EXPENSES 45,585. MANAGEMENT AND GENERAL EXPENSES 533,758. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 579,343. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 6,745,383. MANAGEMENT AND GENERAL EXPENSES 4,622,997. FUNDRAISING EXPENSES 64,952. TOTAL EXPENSES 11,433,332. FORM 990, PART XI, LINE 9: DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT 2,989,335. FROM 990, PART XI, 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. FORM 990, PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS MISSION STATEMENT: THE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. UTILIZATION STATISTICES: YEAR ENDING 2023 AVAILABLE BEDS: 25 ADMISSIONS: 1,476 PATIENT DAYS: 4,175 OBSERVATIONS: 725 AVERAGE LENGTH OF STAY (IN DAYS): 3.05 OCCUPANCY RATE: 45.8% DELIVERIES: 226 EMERGENCY ROOM VISITS: 15,780 URGENT CARE VISITS: 19,341 OUTPATIENT VISITS (NET OF ER): 276,884 SURGICAL CASES: 3,615 PLANETREE DESIGNATION THE HOSPITAL HAS ADOPTED A PHILOSOPHY OF PROVIDING PATIENT-CENTERED CARE THROUGHOUT ITS FACILITIES. IN 2000, THE HOSPITAL JOINED AN ORGANIZATION CALLED PLANETREE, INC ("PLANETREE") AS AN AFFILIATE MEMBER. PLANETREE PARTNERS WITH HEALTHCARE ORGANIZATIONS AROUND THE WORLD TO DEVELOP AND ADVANCE PATIENT CENTERED APPROACHES TO CARE. IN 2013, THE HOSPITAL BECAME ONLY THE SECOND HOSPITAL IN OREGON TO ACHIEVE THE PRESTIGIOUS PLANETREE DESIGNATION STATUS. PLANETREE-DESIGNATION REPRESENTS THE HIGHEST LEVEL OF ACHIEVEMENT IN PATIENT/PERSON-CENTERED CARE BASED ON EVIDENCE AND STANDARDS, ACCORDING TO PLANETREE. PLANETREE-DESIGNATED HOSPITALS MUST DEMONSTRATE THEIR COMMITMENT AND SUCCESSFUL ADOPTION OF THE PATIENT CENTERED CARE PRINCIPLES BY PASSING A RIGOROUS SURVEY PROCESS, PERFORMED BY PLANETREE EVERY THREE YEARS. COLUMBIA MEMORIAL HOSPITAL WAS AWARDED RE-DESIGNATION FOR ANOTHER THREE YEARS IN NOVEMBER 2016 AT THE ANNUAL PLANTREE CONFERENCE. THE HOSPITAL HAS MAINTAINED PLANETREE DESIGNATION BY CREATING AN ORGANIZATIONAL CULTURE COMMITTED TO PROVIDING THE LATEST IN MEDICAL TECHNOLOGY IN A HEALING, NURTURING ENVIRONMENT THAT ENCOURAGES A PATIENT'S INVOLVEMENT IN THE CARE THAT THEY RECEIVE. THE HOSPITAL CONTINUALLY STRIVES TO OFFER PEACEFUL, COMFORTABLE SURROUNDINGS, WARM AND SUPPORTIVE CAREGIVERS, ACCESS TO HEALTH INFORMATION ALTERNATIVE THERAPIES, AND EDUCATION TO HELP PATIENTS GET WELL FASTER AND STAY WELL LONGER. COLUMBIA MEMORIAL HOSPITAL RECENT ACCREDITATIONS: 1. HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP) - NATIONALLY RECOGNIZED ACCREDITATION - ORGANIZATION WITH DEEMING AUTHORITY FROM THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) 2. COMMISSION OF OFFICE LABORATORY ACCREDITATION (COLA) - LABORATORY ACCREDITATION 3. AMERICAN COLLEGE OF RADIOLOGY MAMMOGRAPHY QUALITY STANDARDS ACT (ACR/MSQA) - IMAGING SERVICES/MAMO ACCRED. 4. INTER-SOCIETAL ACCREDITATION COMMISSION (IAC) - ECHOCARDIOGRAPHY ACCREDITATION 5. AMERICAN ASSOCIATION OF CARDIOVASULAR REHABILITATION (AACVP) - CARDIAC REHABILITATION ACCREDITATION 6. AMERICAN ASSOC. FOR RESPIRATORY CARE QUALITY RESPIRATORY CARE RECOGNITION (AARC'S QRCR) RESPIRATORY THERAPY ACCREDITATION INFORMATION TECHNOLOGY: THE HOSPITAL'S INVESTMENT IN THE HEALTHCARE INFORMATION TECHNOLOGY ALONG WITH THE NESESSARY HUMAN RESOURCES AND ASSOCIATED PROCESS CHANGE HAVE RESULTED IN IMPROVED CLINICAL OPERATIONS, QUALITY, PATIENT SAFETY, AND OVERALL EFFICIENCY. THE HOSPITAL RECEIVED THE MOST WIRED AWARD FROM THE AMERICAN HOSPITAL ASSOCIATION IN NINE CONSECUTIVE YEARS OF 2011-2019 AND IN 2021. THE HOSPITAL HAS ALSO ACHIEVED COMPLIANCE WITH THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 MEANINGFUL USE OF HEALTHCARE IT CRITERIA BOTH STAGE 1 AND STAGE 2. SINCE 2012, THE HOSPITAL HAS REALIZED MEANINGFUL USE INCENTIVE REVENUES OF APPROXIMATELY $3,164,000. THE HOSPITAL INVESTED IN AN INDUSTRY LEADING BUSINESS INTELLIGENCE PLATFORM WHICH IS UTILIZED IN OPTIMIZING OPERATIONS AND FINANCIAL PERFORMANCE. CMH MEDICAL GROUP: THE HOSPITAL OWNS AND OPERATES A NUMBER OF PROVIDER-BASED PRIMARY, URGENT CARE, AND SPECIALTY CARE CLINICS ORGANIZED AND COLLECTIVELY KNOWN AS THE CMH MEDICAL GROUP. THE CLINICS OPERATE IN 3 SEPERATE ASTORIA LOCATIONS AND 1 WARRENTON AND 1 IN SEASIDE OREGON. THE WARRENTON AND SEASIDE LOCATIONS OPERATES AS A PROVIDER-BASED LOCASTIONS AND EXPANDING THE CAPACITY TO PROVIDE PRIMARY CARE SERVICES FOR THE COMMUNITY. THERE ARE SEVENTY-THREE (73) PHYSICIANS AND MID-LEVEL PROVIDERS EMPLOYED WITHIN THE CMH MEDICAL GROUP IN ELEVEN (11) DIFFERENT MEDICAL SPECIALTIES. THESE SPECIALTIES INCLUDE: GENERAL SURGERY, PEDIATRICS, PRIMARY CARE, URGENT CARE, UROLOGY, ENDOCRINOLOGY, ORTHOPEDICS, PODIATRY, AND WOMEN'S HEALTHCARE, ONCOLOGY, AND CARDIOLOGY IN COLLABORATION WITH OHSU. CLINICAL COLLABORATIONS: IN ORDER TO ENHANCE THE SERVICES THAT THE HOSPITAL PROVIDES TO THE COMMUNITY, THE HOSPITAL ESTABLISHED A CLINICAL ALLIANCE WITH OHSU IN 2010. THROUGH THIS ALLIANCE, THE HOSPITAL AND OHSU INITIALLY CREATED THE CMH/OHSU CANCER CARE CENTER WHICH WAS DEDICATED TO PROVIDING COMPREHENSIVE, INTER-DISCIPLINARY, CONSULTATIVE, AND ONGOING ONCOLOGY AND HEMATOLOGY CARE. IN 2011, THE HOSPITAL AND OHSU ESTABLISHED THE CMH/OHSU CARDIOLOGY CLINIC, WHICH PROVIDES COMPREHENSIVE CARE FOR A RANGE OF HEART HEALTH AND HEART DIISEASE PREVENTION NEEDS IN THE COMMUNITY. SINCE 2011, THE ALLIANCE HAS BROADENED SUBSTANTIALLY AND NOW INCLUDES CLINICAL OVERSIGHT AND STAFFING OF THE HOSPITAL'S EMERGENCY DEPARTMENT, GENERAL SURGERY AND RESIDENCY PROGRAMS, TELEMEDICINE, A WOMEN'S HEART HEALTH PROJECT AND CONTINUING MEDICAL EDUCATION. IN TOTAL, THERE ARE APPROXIMATELY FORTY-SIX (46) OHSU PHYSICIANS WORKING FULL-TIME IN THE HOSPITAL'S FACILITIES. JOINT OPERATING AGREEMENT: IN THE FIRST QUARTER OF 2015, THE HOSPITAL ENTERED INTO A JOINT OPERATING AGREEMENT (JOA) WITH OHSU THROUGH THE OHSU KNIGHT CANCER INSTITUTE TO BETTER SERVE THE ONCOLOGY CARE NEEDS OF ASTORIA AND SURROUNDING COMMUNITIES IN OREGON AND SOUTHWEST WASHINGTON. A BOND WAS SECURED IN JULY OF 2016 TO PROVIDE FOR THE FINANCING OF A 19,000 SQUARE-FOOT, TWO-STORY COMPREHENSIVE CANCER TREATMENT CENTER AND EQUIPMENT. CONSTRUCTION ON THE CANCER TREATMENT CENTER BEGAN IN AUGUST OF 2016 AND WAS COMPLETED IN THE FALL OF 2017. THE JOA AND ADDITIONAL SPACE AND EQUIPMENT PROVIDED CMH THE OPPORTUNITY TO EXPAND SERVICES TO INCLUDE RADIATION THERAPY IN ADDITION TO MEDICAL ONCOLOGY AND INFUSION THERAPY SERVICES. COLUMBIA MEMORIAL HOSPITAL & OHSU KNIGHT CANCER COLLABORATION IS THE ONLY PROVIDER ON THE NORTH OREGON COAST THAT PROVIDES RADIATION THERAPY SERVICES. CMH FOUNDATION: THE HOSPITAL BENEFITS FORM SUBSTANTIAL COMMUNITY SUPPORT. THE FOUNDATION PROVIDES A DIRECT LINK TO THE REGION'S NEED FOR COMPASSIONATE HEALTH CARE BY SUPPORTING THE ENHANCEMENT OF THE HOSPITAL'S PROGRAMS AND SERVICES. THE FOUNDATION WAS INCORPORATED IN 1991 BY A GROUP OF CITIZENS TO SERVE AS THE BRIDGE BETWEEN THE COMMUNITY AND THE HOSPITAL TO ENCOURAGE FINANCIAL SUPPORT OF HEALTH PROGRAMS AND SERVICES. THE FOUNDATION IS A DEDICATED FUND DEVELOPMENT ENITY THAT HAS SUCCESSFULLY RAISED OVER $5,000,000. IN 2010, THE FOUNDATION CONTRIBUTED $500,000 TO THE HOSPITAL TO ASSIST WITH THE SURGERY CENTER RENOVATION. THIS SUPPORT CONTINUED WITH A $185,000 DONATION IN 2012 FOR THE CONTINUED EXPANSION OF THE CANCER CENTER AND HAS RAISED AN ADDITION OF $2,000,000 TO BENEFIT THAT PROGRAM. THE FOUNDATION FOCUSES ON WORKING WITH DONORS WHO WISH TO MAKE MAJOR AND PLANNED GIFTS IN SUPPORT OF THE HOSPITAL. IN SOME CASES, THE FOUNDATION WILL RAISE FUNDS TO SUPPORT A VARIETY OF PRIORITIES AS IDENTIFIED BY THE HOSPITAL AND IN PARTNERSHIP WITH DONORS. THE FOUNDATION PROVIDES OPPORTUNITIES FOR DONORS TO SUPPORT A MISSION THAT MATCHES THEIR OWN INTERESTS SUCH AS PROVIDING EQUIPMENT, CREATING PROGRAMS TO SERVE THE COMMUNITY OR FUNDING THE FUTURE ENDOWMENT. COLUMBIA MEMORIAL HOSPITAL FOUNDATION 2111 EXCHANGE STREET ASTORIA OR 97103 931091701 FUNDRAISING-CMH OR 501(C)3 LINE 12A, I COLUMBIA LUTHERAN CHARITIES 1 COLUMBIA MEMORIAL HOSPITAL AUXILIARY 2111 EXCHANGE STREET ASTORIA OR 97103 931306211 PROVIDE VOLUNTEERS OR 501(C)3 LINE 12A, I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 COLUMBIA MEMORIAL HOSPITAL FOUNDATION N 242702 ACTUAL COLUMBIA MEMORIAL HOSPITAL FOUNDATION O 310919 ACTUAL