2019-11-15T11:54:09-06:00 2018-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2018-01-01 930583856 COLUMBIA LUTHERAN CHARITIES COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 971033329 ZACHARY SCHMITT CFO 5033254321 2019-11-08 1 MARK E EKLUND CPA P00156145 5036974118 2019-11-08 76.14.192.226 2019-11-08 14:11:12 PS P DE3CBF9142AB1A9C45D327EC0B3FC07BFC578F99 C9C56614DEA4E3F8F2BAE576B1AB9F35B16A97BE 2018 2020-04-17 16:48:07Z COLUMBIA MEMORIAL HOSPITAL ZACHARY SCHMITT 2111 EXCHANGE STREET ASTORIA OR 971033329 146280832 0 X WWW.COLUMBIAMEMORIAL.ORG X 1958 OR PROVIDE EXCELLENCE, LEADERSHIP & COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 12 10 766 82 1147649 110668 603087 1987500 109436077 135765950 1665474 2592400 2681927 2414678 114386565 142760528 179319 57475 0 0 54299381 57261256 0 0 606546 47662989 66079516 102141689 123398247 12244876 19362281 138380163 155406915 69872722 72238124 68507441 83168791 X THE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 1 0 79510025 57475 142737316 SEE SCHEDULE O 79510025 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 1 0 0 0 0 1 1 1 0 0 0 1 106 0 1 766 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X X ZACHARY SCHMITT 5033384613 2111 EXCHANGE STREET ASTORIA OR 97103 MIKE AUTIO BOARD MEMBER 3.00 X 0 0 0 JEAN DANFORTH BOARD MEMBER 3.00 X 0 0 0 DOUG KAUP BOARD MEMBER 3.00 X 0 0 0 BILL LANDWEHR BOARD MEMBER 3.00 X 0 0 0 NANCY MCALLISTER BOARD MEMBER 3.00 X 0 0 0 DAVE NYGAARD BOARD MEMBER 3.00 X 0 0 0 DAVID PHILLIPS BOARD MEMBER 3.00 X 0 0 0 HEATHER SEPPA BOARD MEMBER 3.00 X 0 0 0 MARK SMITH BOARD MEMBER 3.00 X 0 0 0 CONSTANCE WAISANEN BOARD MEMBER 3.00 X 0 0 0 KEVIN BAXTER BOARD MEMBER/PHYSICIAN 40.00 X 312099 0 51898 ROBERT HOLLAND BOARD MEMBER/PHYSICIAN 40.00 X 305622 0 35122 ERIK THORSEN CEO 40.00 X 563883 0 101826 ZACHARY SCHMITT CFO 40.00 X 233803 0 29555 NICOLE WILLIAMS COO 40.00 X 251693 0 19037 GALINA GANDY VP - INFORMATION SERVICES 40.00 X 222745 0 43741 JARROD KARNOFSKI VP - ANCILLARY SERVICES 40.00 X 220064 0 39708 DOUGLAS ABBOTT PHYSICIAN 40.00 X 617350 0 42852 PETER BALES PHYSICIAN 40.00 X 597733 0 47453 DAVID LEIBEL PHYSICIAN 40.00 X 372579 0 42691 MICHAEL MURDOCK PHYSICIAN 40.00 X 312611 0 43648 NATHAN AMRINE PHYSICIAN 40.00 X 283563 0 31292 TERESA GURRAD VP - PATIENT CARE 40.00 X 314858 0 29717 KATRINA MCPHERSON VP - MEDICAL GROUP 40.00 X 355750 0 17755 4964353 0 576295 58 1 1 0 OHSU (EMERGENCY) 3181 SAM JACKSON PARK RD MAIL CODE PORTLAND OR 972393098 EMERGENCY PHYSICIANS 2546248 OHSU (CARDIOSURGERY) 3181 SAM JACKSON PARK RD MAIL CODE PORTLAND OR 972393098 CARDIO/SURGERY PHYSICIANS 1906413 ANESTHESIA ASSOCIATES NORTHWEST LLC 6400 SE LAKE RD STE 130 PORTLAND OR 97222 ANESTHESIOLOGY PHYSICIANS 1798282 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 SOFTWARE SERVICES 1272696 HEALTHCARE RESOURCE GROUP INC 12610 MIRABEAU PARKWAY SPOKANE VALLEY WA 99216 CODING/BILLING SERVICE 1062423 45 1900000 37500 50000 1987500 OUTPATIENT REVENUE 621990 161025092 159788910 1236182 EMERGENCY ROOM REVENUE 621990 48232739 48232739 INPATIENT REVENUE 621990 46871652 46871652 PROVISION FOR CHARITY CARE 621990 -2520306 -2491752 -28554 CONTRACTUAL ALLOWANCE 621990 -116998311 -116891461 -106850 -844916 -844916 135765950 1348556 1348556 222077 287009 -64932 -64932 -64932 4475139 2000 3233295 0 1241844 2000 1243844 1243844 JOINT VENTURE 621500 1049752 1049752 HOSPITALIST 621110 494868 494868 CAFETERIA AND VENDING 722210 424492 424492 510498 463627 46871 2479610 142760528 136608487 1147649 3016892 X 57475 57475 2418015 2418015 42024165 30061517 11681233 281415 2981064 2007683 937533 35848 6362391 3991709 2333687 36995 3475621 2371806 1080523 23292 189751 189751 195425 192450 2975 13854370 12190478 1643834 20058 171361 171361 9224500 928119 8206994 89387 2031897 372558 1659339 3946450 882200 3059715 4535 82259 63279 17929 1051 564120 186292 367005 10823 6537329 1771216 4766113 936692 168891 767801 MEDICAL SUPPLIES & PHAR 20614515 20479311 135204 OTHER PURCHASED SERVICE 5402746 2707451 2622352 72943 REPAIRS & MAINTENANCE 1764064 1039787 709959 14318 RECRUITMENT FEES 382991 83214 299777 181046 147039 21101 12906 123398247 79510025 43281676 606546 27511 24033 16521615 31910696 13681757 17480158 2609348 2977056 1277670 1878363 105432547 51057884 56840661 54374663 43692713 41538397 1956390 2008873 75000 237502 1697498 2977174 138380163 155406915 11557202 15372713 46821111 45921231 11494409 10944180 69872722 72238124 X 68507441 83168791 68507441 83168791 138380163 155406915 X 19362281 -3315482 -1197325 -188124 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7480255 2136984 9617239 7248011 34071630 20499232 20820409 2019070 1216447 802623 51228381 29342205 21886176 1248216 1248216 54374663 229599 ESTIMATED 3RD PARTY PAYOR 239000 DEFERRED COMPENSATION 955494 MEDICAL MALPRACTICE CLAIMS 997617 ACCRUED RETIREMENT PLAN LIABILITY 8522470 10944180 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, 2018 AND 2017. 1 1 1 X 300.000000000000 1 X 301.000000000000 1 1 0 1 1 2782334 259533 2522801 0.02070 2782334 259533 2522801 0.02070 387231 31374 355857 0.00290 24785 24785 0.00020 99422 99422 0.00080 511438 31374 480064 0.00390 3293772 290907 3002865 0.02460 34230 34230 0.01040 34230 34230 0.01040 1 3635324 2520306 49726626 50800943 -1074317 X 1 1 1 COASTAL HEALTH ASSURANCE CE/PHYSICIAN ASSC. MEDICAL CONTRACTS 0.50000 0.50000 2 ASTORIA IMAGING LLC MRI JOINT VENTURE 0.51000 0.49000 2 1 COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 WWW.COLUMBIAMEMORIAL.ORG 14-1146 X X X X 2 CMH PRIMARY CARE CLINIC CMH URGENT CARE 1639 SE ENSIGN LANE STE B103 WARRENTON OR 97146 WWW.COLUMBIAMEMORIAL.ORG 14-1146-1 X X HOSPITAL SATELLITE COLUMBIA MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 16 1 1 0 1 X WWW.COLUMBIAMEMORIAL.ORG X 1 16 1 WWW.COLUMBIAMEMORIAL.ORG 0 1 X 300.000000000000 301.000000000000 0 1 X X X X 1 X WWW.COLUMBIAMEMORIAL.ORG X WWW.COLUMBIAMEMORIAL.ORG X WWW.COLUMBIAMEMORIAL.ORG X X X 1 X X X 0 X X X 1 0 0 COLUMBIA MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: COMMUNITY REPRESENTATION FOR PRIMARY DATA:PRIMARY DATA IS THE INFORMATION THAT HAS BEEN COLLECTED BY PARTNERS SPECIFICALLY FOR USE IN THIS ASSESSMENT. THEY INCLUDE HOSPITAL UTILIZATION DATA, A COMMUNITY HEALTH SURVEY, KEY STAKEHOLDER INTERVIEWS AND COMMUNITY LISTENING SESSIONS. SECONDARY DATA IS INFORMATION THAT HAS BEEN COLLECTED BY OTHERS FOR PURPOSES OTHER THAN THIS ASSESSMENT, BUT PROVIDE IMPORTANT CONTEXT OR OTHER DATA POINTS. THESE INCLUDE CLATSOP COUNTY PUBLIC HEALTH, COLUMBIA PACIFIC CCO, COUNTY HEALTH RANKINGS, ANNIE E CASEY KIDS COUNT REPORT AND OTHERS. COLUMBIA MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: CHNA - CONDUCTED WITH PROVIDENCE SEASIDE HOSPITAL COLUMBIA MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: BASED UPON THE VARIOUS SOURCES OF INFORMATION IN THE CHNA ASSESSMENT, ITEMS THAT WERE CORROBORATED BY TWO OR MORE SOURCES WERE IDENTIFIED AS KEY UNMET HEALTH NEEDS. THESE NEEDS WERE THEN GROUPED INTO FOUR ACTIONABLE CATAGORIES, WHICH WILL GUIDE EFFORTS IN DEVELOPING THE "COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP)". DUE TO THE INITIAL IDENTIFICATION OF NEEDS, THIS PRIORITIZATION INCLUDED WORSENING TRENDS, VALUES WORSE THAN STATE AVERAGES, AND A DISPROPORTIONATE IMPACT ON COMMUNITIES OF COLOR, LOW-INCOME, OR OTHERWISE MARGINALIZED GROUPS. ADDITIONAL PRIORITIZATION REGARDING FEASIBILITY, EFFECTIVENESS OF INTERVENTIONS, AND ABILITY TO PARTNER WITH COMMUNITY ORGANIZATIONS WILL BE APPLIED DURING CHIP DEVELOPMENT. 18 1 - INFUSION CLINIC 1905 EXCHANGE ST ASTORIA OR 97103 INFUSION SERVICES 2 - ASTORIA IMAGING LLC 2111 EXCHANGE ST ASTORIA OR 97103 MAGNETIC RESONANCE IMAGING SERVICES 3 - ASTORIA PRIMARY CARE CLINIC 2158 EXCHANGE ST SUITE 107 ASTORIA OR 97103 PRIMARY CARE SERVICES 4 - CARDIOLOGY CLINIC 2095 EXCHANGE ST SUITE 301 ASTORIA OR 97103 CARDIOLOGY SERVICES 5 - WARRENTON PRIMARY CARE (RHC) 1639 SE ENSIGN LANE SUITE B103 WARRENTON OR 97146 PRIMARY CARE SERVICES 6 - WOMEN'S CENTER CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 WOMEN'S SERVICES 7 - ORTHOPEDIC CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 ORTHOPEDIC SERVICES 8 - GENERAL SURGERY CLINIC 2055 EXCHANGE ST SUITE 270 ASTORIA OR 97103 GENERAL SURGERY SERVICES 9 - PEDIATRIC CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 PEDIATRIC SERVICES 10 - LOWER COLUMBIA HOSPICE 2158 EXCHANGE ST SUITE 206 ASTORIA OR 97103 HOSPICE SERVICES 11 - URGENT CARE CLINIC 2265 EXCHANGE ST 1ST FLOOR ASTORIA OR 97103 URGENT CARE SERVICES 12 - FOOT & ANKLE CLINIC 2265 EXCHANGE ST 3RD FLOOR ASTORIA OR 97103 PODIATRY SERVICES 13 - RADIATION ONCOLOGY CLINIC 1905 EXCHANGE ST ASTORIA OR 97103 RADIATION THERAPY SERVICES 14 - MEDICAL ONCOLOGY CLINIC 1905 EXCHANGE ST ASTORIA OR 97103 MEDICAL ONCOLOGY SERVICES 15 - UROLOGY CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 UROLOGY SERVICES 16 - ENDOCRINOLOGY CLINIC 2158 EXCHANGE ST SUITE 205 ASTORIA OR 97103 ENDOCRINOLOGY SERVICES 17 - PULMONOLOGY CLINIC 2055 EXCHANGE ST SUITE 210 ASTORIA OR 97103 PULMONOLOGY SERVICES 18 - WOUND CARE CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 WOUND CARE SERVICES PART II, COMMUNITY BUILDING ACTIVITIES: COLUMBIA HOSPITAL HOSTED A HEALTH FAIR AT A COMMUNITY FESTIVAL THAT DREW SEVERAL HUNDRED PEOPLE. THIS INCLUDED FREE BOOTH SPACES FOR COMMUNITY ORGANIZATIONS AND EDUCATIONAL PRESENTATIONS FROM STAFF AND PHYSICIANS. IN 2018, CMH ALSO PARTICIPATED IN SEVERAL OTHER COMMUNITY HEALTH FAIRS. 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 PORTION OF BAD DEBT EXPENSE THAT WAS TREATED AS COMMUNITY BENEFIT EXPENSE IS THE NET COST OF CHARITY CARE PROVIDED IN 2018 ESTIMATED USING THE HOSPITAL'S COST OF CHARGE RATIO. THE MAJORITY OF THIS CHARITY CARE WAS PROVIDED FOR EMERGENCY, TRAUMA AND CANCER CARE TREATMENTS. PART III, LINE 4: SEE PAGE 8 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 7, REPORTS FILED WITH STATES OR 0 ASTORIA-WARRENTON CHAMBER OF COMMERCE PO BOX 176 ASTORIA OR 97103 930115760 501(C)6 10000 GENERAL ASSISTANCE CLATSOP COMMUNITY COLLEGE FOUNDATION 1651 LEXINGTON AVENUE ASTORIA OR 97103 930505508 501(C)3 5000 GENERAL ASSISTANCE RELAY FOR LIFE OF CLATSOP COUNTY - THE AMERICAN CANCER SOCIETY 250 WILLIAMS STREET NW SUITE 400 ATLANTA GA 30303 131788491 501(C)3 5000 GENERAL ASSISTANCE X X 1 1 X X X X 0 1 0 0 0 1 0 0 0 KEVIN BAXTER BOARD MEMBER/PHYSICIAN 296769 0 14530 0 800 0 19105 0 32793 0 363997 0 0 0 ROBERT HOLLAND BOARD MEMBER/PHYSICIAN 303000 0 1822 0 800 0 250 0 34872 0 340744 0 0 0 ERIK THORSEN CEO 471875 0 83505 0 8503 0 77359 0 24467 0 665709 0 0 0 ZACHARY SCHMITT CFO 218462 0 7679 0 7662 0 0 0 29555 0 263358 0 0 0 NICOLE WILLIAMS COO 240451 0 7042 0 4200 0 4005 0 15032 0 270730 0 0 0 GALINA GANDY VP - INFORMATION SERVICES 199136 0 22409 0 1200 0 16582 0 27159 0 266486 0 0 0 JARROD KARNOFSKI VP - ANCILLARY SERVICES 197314 0 20073 0 2677 0 17022 0 22686 0 259772 0 0 0 DOUGLAS ABBOTT PHYSICIAN 592500 0 24050 0 800 0 22000 0 20852 0 660202 0 0 0 PETER BALES PHYSICIAN 570000 0 26933 0 800 0 13750 0 33703 0 645186 0 0 0 DAVID LEIBEL PHYSICIAN 359271 0 4441 0 8867 0 17493 0 25198 0 415270 0 0 0 MICHAEL MURDOCK PHYSICIAN 270618 0 41193 0 800 0 20625 0 23023 0 356259 0 0 0 NATHAN AMRINE PHYSICIAN 275001 0 3796 0 4766 0 11635 0 19657 0 314855 0 0 0 TERESA GURRAD VP - PATIENT CARE 145015 0 168266 0 1577 0 15830 0 13887 0 344575 0 0 0 KATRINA MCPHERSON VP - MEDICAL GROUP 81241 0 274209 0 300 0 9645 0 8110 0 373505 0 0 0 PART I, LINE 4B ERIK THORSEN, CEO IS PARTICIPATING IN A 457(F) PLAN WHICH STARTED IN 2015. COLUMBIA MEMORIAL HOSPITAL CONTRIBUTION $58,388 TO THIS PLAN IN 2018. PART I, LINE 6 MANAGEMENT BONUSES ARE CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION. 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, ($1,000), IN ADDITION, COLUMBIA MEMORIAL HOSPITAL PAID $500, PER MONTH TO COVER THE CEO CAR, ($500/MONTH - $6,000 ANNUALLY) 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 ($250/MONTH - $3,000 ANNUALLY) AND ROTARY CLUB DUES FOR ERIK THORSEN, CEO, ($155/MONTH - $1,860 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. A THE HOSPITAL FACILITIES AUTHORITY OF THE CITY OF ASTORIA 270034718 046279BS3 2012-09-27 31993533 FINANCE EHR SYSTEM, ASSET ACQUISTION, REFUNDING OF 2002 & 2007 BOND ISSUES 1 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 31993533 1015284 893237 12531869 18080686 2015 1 0 1 1 B 20451436 795556 758562 14471039 3141748 2017 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 PART 1 SECTION (C) CUSIP # 2016 BOND 046279CAI 046279B27 046279C89 FORM 990, PART III, LINE 4A: STATMENT OF PROGRAM SERVICE ACCOMPLISHMENTS HEATHER SEPPA BOARD MEMBER IS OFFICER AT BANK USED BY HOSPITAL 0 FORM 990, PART III, LINE 2 IN 2017, THE CMH & OHSU KNIGHT CANCER COLLABORATION OPENED A 19,000 SQUARE FOOT, COMPREHENSIVE CANCER TREATMENT CENTER. THE JOINT OPERATING AGREEMENT BETWEEN CMH & OHSU KNIGHT CANCER PROVIDED CMH WITH THE OPPORTUNITY TO EXPAND SERVICES TO INCLUDE RADIATION THERAPY IN ADDITION TO EXPANDING CURRENT MEDICAL ONCOLOGY AND INFUSION THERAPY SERVICES. THROUGH THIS JOINT OPERATING AGREEMENT, CMH SHARES A PORTION OF PROFIT FROM ONCOLOGY SERVICES WITH OHSU. 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. 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 12,190,478. MANAGEMENT AND GENERAL EXPENSES 1,643,834. FUNDRAISING EXPENSES 20,058. TOTAL EXPENSES 13,854,370. FORM 990, PART XI, LINE 9: DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -1,348,358. NET ASSETS RELEASED FROM RESTRICTION - CITY OF ASTORIA GRANT 1,907,450. HOSPICE EQUITY TRANSFER TO FOUNDATION -724,007. INCOME FROM PROVIDER TRUST K-1 -23,209. 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 2015 2016 2017 AVAILABLE BEDS 25 25 25 ADMISSIONS 1,597 1,587 1,653 PATIENT DAYS 4,595 4,613 4,836 OBSERVATIONS 536 516 318 AVERAGE LENGTH OF STAY (IN DAYS) 2.88 2.91 2.93 OCCUPANCY RATE 50.4% 50.4% 53.0% DELIVERIES 317 344 302 EMERGENCY ROOM VISITS 13,255 13,786 13,133 URGENT CARE VISITS 12,854 13,984 14,781 OUTPATIENT VISITS (NET OF ER) 160,544 177,896 186,694 SURGICAL CASES: 2,448 2,554 3,000 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 EIGHT CONSECUTIVE YEARS OF 2011- 2018. 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 KNOW AS THE CMH MEDICAL GROUP. THE CLINICS OPERATE IN 3 SEPERATE ASTORIA LOCATIONS AND 1 WARRENTON, OREGON LOCATION. THE WARRENTON LOCATION OPERATES AS A PROVIDER-BASED RURAL HEALTH CLINIC, WHICH EXPANDED AND DOUBLED THE CAPACITY TO PROVIDE PRIMARY CARE SERVICES FOR THE COMMUNITY IN 2015. THERE ARE FORTY-TWO (42) PHYSICIANS AND MID-LEVEL PROVIDERS EMPLOYED WITHIN THE CMH MEDICAL GROUP IN TWELVE DIFFERENT MEDICAL SPECIALTIES. THESE SPECIALTIES INCLUDE: GENERAL SURGERY, PEDIATRICS, PRIMARY CARE, URGENT CARE, UROLOGY, ENDOCRINOLOGY, ORTHOPEDICS, PODIATRY, AND WOMEN'S HEALTHCARE, ONCOLOGY IN COLLABORATION WITH OHSU, CARIOLLOGY AND GENERAL SURGERY ALSO 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 15 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. 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