2015-08-17T12:54:36-05:00 2014-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2014-01-01 930583856 COLUMBIA LUTHERAN CHARITIES COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 971033329 STEPHANIE D BRENDEN CFO 5033254321 2015-08-18 1 MARK E EKLUND CPA P00156145 5036974118 2015-08-18 2014 2016-04-25 22:37:26Z COLUMBIA MEMORIAL HOSPITAL STEPHANIE D BRENDEN 2111 EXCHANGE STREET ASTORIA OR 971033329 80254326 0 X WWW.COLUMBIAMEMORIAL.ORG X 1958 OR PROVIDE EXCELLENCE, LEADERSHIP & COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 12 12 610 103 0 0 857064 733743 67712027 76151726 429765 698482 2383349 2590754 71382205 80174705 65100 38065 0 0 39941801 41698697 0 0 241576 27626143 33427207 67633044 75163969 3749161 5010736 90849713 93169432 47251547 50819948 43598166 42349484 THE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 0 0 64462154 38065 78423371 SEE SCHEDULE O 64462154 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 0 1 1 1 0 0 1 116 0 1 610 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 1 0 OR X STEPHANIE D BRENDEN CFO 5033387505 2111 EXCHANGE STREET ASTORIA OR 97103 DAVID PHILLIPS BOARD MEMBER 3.00 X 0 0 0 BILL LIND BOARD MEMBER 3.00 X 0 0 0 HEATHER SEPPA BOARD MEMBER 3.00 X 0 0 0 KEVIN BAXTER 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 KATHERINE HELLBERG BOARD MEMBER 3.00 X 0 0 0 ED NELSON JR BOARD MEMBER 3.00 X 0 0 0 NORMAN SHATTO BOARD MEMBER 3.00 X 0 0 0 MALCOLM SMITH 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 HOUMAN SABAHI BOARD MEMBER 3.00 X 0 0 0 ROBERT HOLLAND BOARD MEMBER 40.00 X 301878 0 32160 ERIK THORSEN CEO 40.00 X 339845 0 21465 STEPHANIE D BRENDEN CFO 40.00 X 201642 0 29483 TERESA L GURRAD CCO 40.00 X 179163 0 28049 JARROD P KARNOFSKI VP - ANCILLIARY SERVICES 40.00 X 155004 0 43742 KATRINA M MCPHERSON VP - MEDICAL GROUP OPERATIONS 40.00 X 222962 0 44428 DOUGLAS ABBOTT MD PHYSICIAN 40.00 X 583342 0 51354 RICHARD CRASS MD PHYSICIAN 40.00 X 370448 0 42762 EDOUARD DURET MD PHYSICIAN 40.00 X 363287 0 51493 CHRISTOPHER NYTE MD PHYSICIAN 40.00 X 384300 0 37532 DAVID LEIBEL DO PHYSICIAN 40.00 X 318001 0 46636 WILLIAM G RIVERS FORMER CIO 40.00 X 179578 0 9525 KENNETH M BOUCHER FORMER COO 40.00 X 235884 0 20616 3835334 0 459245 59 1 1 0 P&C CONTRUCTION 2133 NW YORK STREET PORTLAND OR 97210 GENERAL CONTRACTOR 7178794 CERNER CORPORATION 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 HOSPITAL SOFTWARE 2872131 NORTH COAST EMERGENCY 2111 EXCHANGE STREET ASTORIA OR 97103 EMERGENCY ROOM PHYSICIANS 1833465 ANESTHESIA ASSOC NW LLC 6400 SE LAKE RD STE 130 PORTLAND OR 97222 ANESTHESIOLOGY PHYSICIANS 1422844 RICKENBACK CONSTRUCTION INC 37734 EAGLE LANE ASTORIA OR 97103 GENERAL CONTRACTOR 1246538 22 7047 36769 689927 733743 OUTPATIENT REVENUE 621990 83693608 83693608 EMERGENCY ROOM REVENUE 621990 33220776 33220776 INPATIENT REVENUE 621990 29276504 29276504 PROVISION FOR CHARITY CARE 621990 -1445114 -1445114 CONTRACTUAL ALLOWANCE 621990 -66811842 -66811842 -1782206 -1782206 76151726 59213 59213 382075 382075 309590 50704 258886 258886 258886 286111 28917 257194 257194 257194 JOINT VENTURE 621500 1078476 1078476 CAFETERIA AND VENDING 722210 319109 319109 PHARMACY SERVICES 446110 174629 174629 759654 759654 2331868 80174705 78423371 0 1017591 38065 38065 1711387 1711387 31317648 28065318 3079316 173014 1855014 1598206 243235 13573 4341006 3802000 514060 24946 2473642 2148276 312843 12523 229264 229264 127460 109940 17520 6541735 5902280 639455 255525 3675 251850 274401 169030 105371 1397613 1223104 174509 1635641 1365124 270517 60173 51888 8285 435768 240590 195178 940615 940615 4089496 3156209 933287 931647 931647 MEDICAL SUPPLIES & PHAR 9640856 9640856 OTHER PURCHASED SERVICE 1667320 675776 991544 REPAIRS & MAINTENANCE 1294219 1265347 28872 OUTSIDE MEDICAL SERVICE 691899 688362 3537 3213575 2555786 657789 75163969 64462154 10460239 241576 5676971 2422186 12030548 19245687 28889 22222 179810 151735 1380522 1794224 1000508 971257 79304172 37402963 33001773 41901209 29322648 22664385 1935112 1881411 777767 722194 5515165 1392922 90849713 93169432 11105782 9379141 30917985 30513084 5227780 10927723 47251547 50819948 X 43528835 42286216 69331 63268 43598166 42349484 90849713 93169432 X 5010736 309509 -6568927 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7480255 1125135 8605390 6905421 23807239 15040522 15672138 1257051 473468 783583 38631961 21888973 16742988 97110 97110 41901209 MEDICAL MALPRACTICE CLAIMS 576616 ACCRUED RETIREMENT PLAN LIABILITY 9963107 ESTIMATED 3RD PARTY PAYOR 388000 10927723 80199609 309508 50704 360212 79839397 335308 335308 80174705 74880348 50704 50704 74829644 334325 334325 75163969 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 50,704. PART XI, LINE 4B - OTHER ADJUSTMENTS: INCOME REPORTED AS EXPENSES ON FORM 990 335,308. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 50,704. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCOME REPORTED AS EXPENSES ON FORM 990 334,325. 1 1 1 X 1 X 1 1 0 1 1 1184505 58542 1125963 0.01500 17099588 14378970 2720618 0.03620 18284093 14437512 3846581 0.05120 141100 1150 139950 0.00190 14930 3000 11930 0.00020 246644 246644 0.00330 402674 4150 398524 0.00540 18686767 14441662 4245105 0.05660 72464 9046 63418 0.00080 72464 9046 63418 0.00080 1 3485540 2732910 17099588 32682530 -15582942 X 1 1 1 COASTAL HEALTH ASSURANCE PHYSICIAN ASSC. MEDICAL CONTRACTS 0.50000 0.50000 2 ASTORIA IMAGING LLC MRI JOINT VENTURE 0.51000 0.51000 4 1 COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 WWW.COLUMBIAMEMORIAL.ORG 141146 X X X X OTHER 2 ASTORIA IMAGING LLC 2111 EXCHANGE STREET ASTORIA OR 97103 WWW.COLUMBIAMEMORIAL.ORG 141146 MRI JOINT VENTURE 3 CMH HOME HEALTH 2158 EXCHANGE STREET SUITE 206 ASTORIA OR 97103 WWW.COLUMBIAMEMORIAL.ORG 13141146 HOME SERVICES 4 LOWER COLUMBIA HOSPICE 2158 EXCHANGE STREET SUITE 206 ASTORIA OR 97103 WWW.LOWERCOLUMBIAHOSPICE.ORG 161047 HOSPICE SERVICES COLUMBIA MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X X 13 1 0 0 1 X HTTP://COLUMBIAMEMORIAL.NETRETURNS.BIZ/CLIENT_FILES/COLUMBIAMEMORIAL/CM/SYS 1 13 1 WWW.COLUMBIAMEMORIAL.ORG 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X X X X 1 X X 1 X X X X 1 X 0 0 COLUMBIA MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THERE ARE SEVERAL SOURCES OF PRIMARY AND SECONDARY DATA FOR THE CHNA ON WHICH THE GOALS AND OUTCOMES OF THIS REPORT ARE BASED: PRIMARY DATA:ENVIRONMENT ASSESSMENT - CONDUCTED IN JUNE 2013 BY AN INDEPENDENT CONSULTANT,STROUDWATER ASSOCIATES, THIS ASSESSMENT UPDATED THE ENVIRONMENT AND PROVIDER NEEDASSESSMENT DATA GATHERED IN 2011 IN SUPPORT OF THE DEVELOPMENT OF COLUMBIAMEMORIAL HOSPITAL'S 2014 TO 2016 STRATEGIC PLAN. COMMUNITY OPINION SURVEY AND PROVIDER NEED ASSESSMENT - CONDUCTED IN JULY2011 BY AN INDEPENDENT CONSULTANT, HEALTH FACILITIES PLANNING & DEVELOPMENT, THISSURVEY AND ASSESSMENT DATA PROVIDES INSIGHT INTO COMMUNITY AWARENESS, PERCEPTIONSAND PRIORITIES FOR THE LOCAL HEALTH SYSTEM.KEY INFORMANT INTERVIEWS - FACE-TO-FACE INTERVIEWS WITH BOTH INDEPENDENT ANDEMPLOYED PROVIDERS WERE CONDUCTED IN 2011, 2012, AND 2013 TO ASSESS THE NEEDS OFTHE COMMUNITY FROM THE PROVIDER PERSPECTIVE. IN ADDITION, A COMMUNITY LEADERSHIPROUND TABLE WAS HELD IN 2011 AND INCLUDED REPRESENTATIVES FROM THE CITY OF ASTORIA,U.S. COAST GUARD, CLATSOP COUNTY HEALTH DEPARTMENT, COASTAL FAMILY HEALTH CLINIC,CLATSOP CARE CENTER AND OTHERS.FOCUS GROUPS, PATIENT & FAMILY ADVISORY COUNCIL, AND COMMUNITY LEADERSHIPCOUNCIL -O PATIENT FOCUS GROUPS CONSISTING OF PREVIOUS INPATIENT, EMERGENCY, OUTPATIENT,AND CLINIC PATIENTS WERE CONDUCTED IN BOTH SEPTEMBER OF 2011 AND DECEMBEROF 2012 TO GATHER INFORMATION ABOUT AWARENESS, PATIENT-CENTERED PRACTICES,AND OPINIONS ABOUT OPPORTUNITIES FOR IMPROVEMENT FOR LOCAL HEALTHCARE.O A PATIENT & FAMILY ADVISORY COUNCIL (PFAC) WAS ESTABLISHED IN 2012 TO FORM ACONTINUOUS FEEDBACK LOOP TO IDENTIFY OPPORTUNITIES.O A COMMUNITY LEADERSHIP COUNCIL REPRESENTING LOCAL GOVERNMENT, SCHOOLDISTRICTS, AND LOCAL BUSINESSES WAS RECENTLY ESTABLISHED IN LATE 2013 TO SUPPORTTHE NEXT STEPS IN CREATING A HEALTHIER COMMUNITY. SECONDARY DATA:CLATSOP COUNTY COMMUNITY ASSESSMENT JULY 2013, THIS ASSESSMENT CREATES AFOUNDATION OF SHARED KNOWLEDGE ABOUT THE COMMUNITY HEALTH AND WELL-BEING INCLATSOP COUNTY. AT LEAST 75% OF CMH PATIENTS RESIDE IN CLATSOP COUNTY, WITH THEREMAINDER LARGELY RESIDING IN PACIFIC COUNTY, WASHINGTON. 1 CMH PROFESSIONAL OFFICE BUILDING I 2055 EXCHANGE STREET ASTORIA OR 97103 OFFICE SPACE LEASED TO PRIVATE HEALTHCARE PROVIDERS PART II, COMMUNITY BUILDING ACTIVITIES: PART II: COMMUNITY BUILDING ACTIVITIES: CMH CONTINUES TO TAKE AN ACTIVE ROLE IN ASSURING THAT ADEQUATE FOOD IS AVAILABLE TO THE RESIDENCE OF CLATSOP COUNTY, RAISING $7,775 AND DONATING OVER 50 TONS OF FOOD IN 2014. CMH HOSTED OPERATION BUNNY SUITE, OUTREACH PROGRAM IN WHICH FIFTH GRADE AREA ELEMENTARY SCHOOL CHILDREN SPEND THE DAY AT CMH LEARNING ABOUT THE SURGERY PROGRAM, AS WELL AS PROGRAMS IN NON SMOKING, NUTRITION, AND PHYSICAL THERAPY. CMH'S COMMUNITY BASED SPORTS TRAINING PROGRAM INCLUDES PRE AND POST CONCUSSION ASSESSMENTS AS WELL AS LOCAL COACHES RECEIVING EDUCATION ON ASSESSING PLAYERS ON THE FIELD. NEW IN 2014, CMH HOSTED A HEART HEALTH FAIR FOR THE LOCAL COMMUNITY. THIS INCLUDED FREE BOOTH SPACES AND EDUCATIONAL PRESENTATIONS FROM STAFF AND PHYSICIANS SUCH AS CARDIOLOGIST DIANA RINKEVICH. CMH PARTICIPATES IN RELAY FOR LIFE, MARCH FOR BABIES, AND UNITED WAY. WE SUPPORT PROGRAMS FOR FOSTER CHILDREN IN NEED OF SCHOOL CLOTHES AND WE CHAMPION THE WARRENTON SCHOOL DISTRICTS WALK FOR HEALTH AS WELL AS OTHER WALK RUNS THROUGHOUT OUT THE COUNTY. IN ORDER TO DELIVER PRESCRIPTIONS TO HOME BOUND PATIENTS, CMH COVERS THE COST OF TRANSPORTATION FROM A PHARMACY TO THE PATIENTS' HOME. THE HOSPITAL'S EDUCATION DEPARTMENT PUT ON MULTIPLE COMMUNITY EDUCATION CLASSES THROUGHOUT THE YEAR. IN 2014 WE HOSTED: STRONG WOMEN STRONG BONES, LIVING WELL WITH CHRONIC CONDITIONS, HEALTH EATING, A MATTER OF BALANCE, AS WELL DONATING CONFERENCE SPACE TO LOCAL COMMUNITY NEEDS. THE STAFF OF CMH CONTINUES TO DONATE THEIR TIME AND SERVICES TO VARIOUS COMMUNITY EVENTS AND NEEDS YEAR ROUND. PART III, LINE 4: THE COLLECTION OF RECEIVABLES FROM THIRD PARTY PAYERS AND PATIENTS IS THE HOSPITAL'S PRIMARY SOURCE OF CASH AND IS CRITICAL TO ITS OPERATING PERFORMANCE. WHEN THE HOSPITAL PROVIDES CARE TO PATIENTS, IT DOES NOT REQUIRE COLLATERAL; HOWEVER, IT MAINTAINS AN ESTIMATED ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE PRIMARY COLLECTION RISKS RELATE TO UNINSURED PATIENT ACCOUNTS AND PATIENT ACCOUNTS FOR WHICH THE PRIMARY INSURANCE PAYOR HAS PAID, BUT PATIENT RESPONSIBILITY AMOUNTS (GENERALLY DEDUCTIBLES AND CO PAYMENTS) REMAIN OUTSTANDING. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IS ESTIMATED BASED PRIMARILY UPON THE HOSPITAL'S HISTORICAL COLLECTION EXPERIENCE, THE AGE OF THE PATIENT'S ACCOUNT, MANAGEMENT'S ESTIMATE OF THE PATIENT'S ECONOMIC ABILITY TO PAY AND THE EFFECTIVENESS OF COLLECTION EFFORTS. PATIENT ACCOUNTS RECEIVABLE BALANCES ARE ROUTINELY REVIEWED IN CONJUNCTION WITH HISTORICAL COLLECTION RATES AND OTHER ECONOMIC CONDITIONS WHICH MIGHT ULTIMATELY AFFECT THE COLLECTIBILITY OF PATIENT ACCOUNTS WHEN CONSIDERING THE ADEQUACY OF THE AMOUNTS RECORDED IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.ACTUAL WRITE-OFFS HAVE HISTORICALLY BEEN WITHIN MANAGEMENT'S EXPECTATIONS. SIGNIFICANT CHANGES IN PAYOR MIX, BUSINESS OFFICE OPERATIONS, ECONOMIC CONDITIONS, OR TRENDS IN FEDERAL AND STATE GOVERNMENTAL HEALTHCARE COVERAGE COULD AFFECT THE HOSPITAL'S COLLECTION OF PATIENT ACCOUNTS RECEIVABLE, CASH FLOWS, AND RESULTS OF OPERATIONS. 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 CLATSOP COMMUNITY COLLEGE 1651 LEXINGTON AVE ASTORIA OR 97103 930505508 501(C)3 5310 0 SCHOLARSHIPS ASTORIA-WARRENTON CHAMBER OF COMMERCE PO BOX 176 ASTORIA OR 97103 930115760 501(C)6 10000 0 GREAT COLUMBIA CROSSING RUN/WALK EVENT 1 1 SCHEDULE I, PART I, LINE 2: A CMH EMPLOYEE IS ASSIGNED TO MANAGE THE GRANT REVENUE PROGRAM PER THE TERMS OF EACH GRANT AGREEMENT. THE ACCOUNTING DEPARTMENT KEEPS COPIES OF ALL GRANT AGREEMENTS, MAINTAINS DETAILED REVENUE AND EXPENDITURE RECORDS FOR EACH GRANT, AND ASSISTS IN THE PREPARATION OF ANY REQUIRED FINANCIAL REPORTING. X 1 1 X X X X 1 0 0 0 0 1 0 0 0 ROBERT HOLLAND BOARD MEMBER 296878 0 0 0 5000 0 0 0 32160 0 334038 0 0 0 ERIK THORSEN CEO 309238 0 29419 0 1188 0 19500 0 1965 0 361310 0 0 0 STEPHANIE D BRENDEN CFO 186680 0 14500 0 462 0 16094 0 13389 0 231125 0 0 0 TERESA L GURRAD CCO 166922 0 10875 0 1366 0 2739 0 25310 0 207212 0 0 0 JARROD P KARNOFSKI VP - ANCILLIARY SERVICES 142731 0 12199 0 74 0 12400 0 31342 0 198746 0 0 0 KATRINA M MCPHERSON VP - MEDICAL GROUP OPERATIONS 207416 0 15546 0 0 0 12268 0 32160 0 267390 0 0 0 DOUGLAS ABBOTT MD PHYSICIAN 566676 0 0 0 16666 0 19194 0 32160 0 634696 0 0 0 RICHARD CRASS MD PHYSICIAN 354746 0 15702 0 0 0 16926 0 25836 0 413210 0 0 0 EDOUARD DURET MD PHYSICIAN 352645 0 10642 0 0 0 19500 0 31993 0 414780 0 0 0 CHRISTOPHER NYTE MD PHYSICIAN 374171 0 10129 0 0 0 6500 0 31032 0 421832 0 0 0 DAVID LEIBEL DO PHYSICIAN 318001 0 0 0 0 0 20800 0 25836 0 364637 0 0 0 WILLIAM G RIVERS FORMER CIO 162517 0 16500 0 561 0 0 0 9525 0 189103 0 0 0 KENNETH M BOUCHER FORMER COO 221195 0 13455 0 1234 0 11171 0 9445 0 256500 0 0 0 PART I, LINE 1A ASTORIA GOLF AND COUNTRY CLUB DUES FOR CEO ERIK THORSEN WERE PAID BY THE ORGANIZATION. 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 046279BS3 2012-09-27 31993533 FINANCE EHR SYSTEM, ASSET ACQUISTION, REFUNDING OF 2002 & 2007 BOND ISSUES 1 0 0 A 31993533 2463279 268129 889525 7708816 1785404 2014 1 0 0 1 A 0 0 0 1 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 ANALIZA JUSTO EMPLOYEE SIGN ON BONUS X 20000 5555 0 1 1 PETER BALES EMPLOYEE SIGN ON BONUS X 20000 16667 0 1 1 22222 DAVID PHILLIPS CMH BOARD MEMBER 3219 REIMBURSEMENT FOR TRAVEL AND CONFERENCE EXPENSES 0 KEVIN BAXTER DO CMH BOARD MEMBER 72000 HOSPICE MEDICAL DIRECTOR AT BAXTER FAMILY MEDICINE AND MEDICAL DIRECTOR FOR LOWER COLUMBIA HOSPICE, PART OF COLUMBIA MEMORIAL HOSPITAL 0 SCOTT SEPPA SPOUSE OF CMH BOARD MEMBER PARTNER AT KNUTSEN INSURANCE, WHICH PROVIDES INSURANCE FOR COLUMBIA MEMORIAL HOSPITAL 0 HEATHER SEPPA CMH BOARD MEMBER OFFICER AT COLUMBIA STATE BANK, ONE OF THE PRIMARY BANKS USED BY CMH. 0 FORM 990, PART VI, SECTION B, LINE 11 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 XI, LINE 9: DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -6,606,427. NET ASSETS RELEASED FROM RESTRICTION - CITY OF ASTORIA GRANT 37,500. 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 KEY STATISTICS FOR 2014: INPATIENT ADMISSION, INCLUDING NEWBORNS: 1,899 INPATIENT DAYS, INCLUDING NEWBORNS: 4,937 SURGERY PATIENTS: 2,265 (INCLUDES OP 1,890 AND IP 375) ANCILLARY VISITS: 60,441 (THIS INCLUDES CARDIAC REHAB VISITS OF 10,695 AND INFUSION OF 2,867) LABORATORY TESTS: 133,867 IMAGING TOTALS: 35,263 CLINIC VISITS: 52,891 EMERGENCY & TRAUMA VISITS: 13,046 HOME HEALTH VISITS: 2,963 HOSPICE PATIENT DAYS: 5,246 COLUMBIA MEMORIAL HOSPITAL'S (CMH) MISSION IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. THE CMH 2013-2015 THREE-YEAR STRATEGIC PLAN INCLUDED SEVERAL GOALS LISTED UNDER THE FOLLOWING PILLARS; QUALITY AND CUSTOMER SERVICE, EMPLOYEE DEVELOPMENT, GROWTH, PROVIDER RELATIONS, AND FINANCIAL PERFORMANCE. AS OF THE YEAR ENDED DECEMBER 31ST, 2014 MANY GOALS HAVE BEEN ACHIEVED ALLOWING CMH TO CONTINUE TO FULFILL THE MISSION OF THE ORGANIZATION AND TO RAISE BOTH THE QUALITY AND RANGE OF SERVICES PROVIDED TO THE LOCAL COMMUNITY. QUALITY AND CUSTOMER SERVICE: -CMH HAS BEEN A PLANETREE AFFILIATED HOSPITAL SINCE 2001 EMBRACING THE PHILOSOPHY OF PATIENT-CENTERED CARE TO PERSONALIZE, HUMANIZE, AND DEMYSTIFY HEALTHCARE FOR THE PATIENTS OF OUR COMMUNITY. IN 2013 THE HOSPITAL OFFICIALLY BECAME A DESIGNATED HOSPITAL. CMH IS NOW ONE OF 20 HOSPITALS IN THE UNITED STATES TO RECEIVE THIS HONOR AND THE 40TH HOSPITAL WORLD-WIDE. RECERTIFICATION WILL TAKE PLACE IN 2016. CMH WON 2014 PLANETREE COMMUNITY OUTREACH PROGRAM AWARD IN SPORTS MEDICINE. THERE WAS A SPORTS MEDICINE PROGRAM IMPLEMENTED. -THE CMH LABORATORY HAS MAINTAINED ALL CRITERIA FOR LABORATORY ACCREDITATION BY COLA, A NATIONAL HEALTHCARE ACCREDITATION ORGANIZATION. ACCREDITATION IS GIVEN ONLY TO LABORATORIES THAT APPLY RIGID STANDARDS OF QUALITY IN DAY-TO-DAY OPERATIONS, DEMONSTRATE CONTINUED ACCURACY IN THE PERFORMANCE OF PROFICIENCY TESTING, AND PASS A RIGOROUS ON-SITE LABORATORY SURVEY. CMH HAS EARNED COLA ACCREDITATION AS A RESULT OF A LONG-TERM COMMITMENT TO PROVIDE QUALITY SERVICE TO ITS PATIENTS. -ACHIEVED THE AMERICAN HOSPITAL ASSOCIATION'S (AHA) MOST-WIRED HOSPITAL AWARD IN 2011 THROUGH 2014. -CMH WENT LIVE WITH CERNER EMR SYSTEM IN MARCH OF 2014. THIS WILL ENSURE INCREASED PATIENT EXPERIENCES AND SATISFACTION ALONG WITH THE COMMITMENT TO "ONE PATIENT, ONE RECORD" GOAL. THIS PROJECT TOOK FIFTEEN MONTHS OF PREPARATION AND A TREMENDOUS SHOWING OF TEAMWORK AND TENACITY. THIS RECORD CAN NOW BE ACCESSED BY PROVIDERS IN ANY CMH CLINIC OR SERVICE AREA. -THE LOWER COLUMBIA HOSPICE PROGRAM WAS NAMED A 2014 HOSPICE HONORS RECIPIENT. HOSPICE HONORS IS A PRESTIGIOUS ANNUAL HONOR RECOGNIZING THE HOSPICES THAT CONTINUOUSLY PROVIDE THE HIGHEST LEVEL OF SATISFACTION THROUGH THEIR CARE AS MEASURED FROM THE CAREGIVERS POINT OF VIEW. -CMH IMAGING DEPARTMENT SUCCESSFULLY ACHIEVED CERTIFICATION ACR/MSQA FOR THEIR MAMMOGRAPHY PROGRAM IN 2014. -THE CMH MEDICAL RECORDS DEPARTMENT WORKED TO PREPARE FOR THE ICD-10-CM IMPLEMENTATION SCHEDULED FOR OCTOBER 2015. ICD-10-CM IS A CODING SYSTEM THAT ASSIGNS ALPHA-NUMERIC CODES TO DISEASES AND IS USED TO SUBMIT INFORMATION TO INSURANCE COMPANIES FOR PAYMENT, RESEARCH, QUALITY IMPROVEMENT AND VARIOUS OTHER REPORTING REQUIREMENTS. -THE CARDIOLOGY CLINIC MAINTAINED ACCREDITATION IN ECHOCARDIOGRAPHY FOR A THREE-YEAR TERM BEGINNING IN 2013 FROM THE INTERSOCIETAL ACCREDITATION COMMISSION (IAC). ONLY TWO OTHER FACILITIES HAVE BEEN ACCREDITED IN ALL THREE MODALITIES: OHSU AND OREGON HEART AND VASCULAR INSTITUTE IN SPRINGFIELD. ADDITIONALLY. THE CMH CARDIAC REHAB PROGRAM WAS GRANTED 2013 AACVPR PROGRAM CERTIFICATION. CERTIFICATION IS GIVEN AFTER STRINGENT STANDARDS ARE MET WITH THE AMERICAN ASSOCIATION OF CARDIOVASCULAR AND PULMONARY REHABILITATION. STAFF DEVELOPMENT: -91.9% OF ALL EMPLOYEES COMPLETED THEIR COMPLIANCE MODULES IN 2014. ADDITIONALLY OVER 83 EMPLOYEES ATTENDED THE CLINICAL SKILLS FAIR. BOOTHS RANGED FROM INFORMATION STATIONS TO DEMONSTRATIONS AND VIDEOS. FOCUS FOR SPECIALIZED DEPARTMENTS WILL BE IN THOSE AREAS IN THE FUTURE AND THE SKILLS FAIR PROVIDED MORE HOUSE WIDE INFORMATION. THE MAIN FOCUS FOR THE FAIR EVOLVED PATIENT CENTERED CARE AND DIRECTION FROM MANAGER. -CMH EMPLOYEES TEAMED UP WITH A NEIGHBORING HOSPITAL AND RAISED DONATION FOR THE REGIONAL FOOD BANK. THROUGH INCREDIBLE GENEROSITY, THE TWO GROUPS DONATED 101,141 POINTS, WHICH EQUAL 50 TONS OF FOOD, AND $7,774 TO THE REGIONAL FOOD BANK. -THE WELLNESS A-TEAM HOSTED AN EMPLOYEE HEALTH & WELLNESS FAIR IN JANUARY 2014. MORE THAN 150 EMPLOYEES ATTENDED. -CMH LEADERS INCLUDING ADMINISTRATION AND ALL DEPARTMENT MANAGERS ARE PARTICIPATING IN ONGOING LEADERSHIP DEVELOPMENT. TOGETHER WE ARE ALL WORKING TO IMPROVE OUR CULTURE AND COMMUNICATION. IN 2015 THE ENTIRE CMH TEAM WILL BEGIN PARTICIPATING IN STAFF DEVELOPMENT SESSIONS. GROWTH: -CMH EXPANDED THE WARRENTON URGENT CARE AND PRIMARY CARE CLINIC DURING 2014AND IS SCHEDULE TO REOPENED IN 2015. THE CLINIC APPROXIMATELY HAS DOUBLED ITS ORIGINAL SIZE TO ACCOMMODATE THE GROWING DEMAND FOR SERVICES. -THE REMODEL OF THE MATERNITY DEPARTMENT WAS COMPLETED IN JANUARY 2014. THIS REMODEL INCLUDED 2 LDRPS, NURSES LOUNGE, DOCTOR SLEEPING ROOM AND A NEW NURSERY. -CMH ACQUIRED ADJACENT REAL ESTATE TO BE CLEARED AND TURNED INTO ADDITIONAL PARKING IN 2014-2015 TO ENHANCE EMPLOYEE AND PATIENT CONVENIENCE/EXPERIENCE WHILE AT CMH. -THE CARDIAC REHABILITATION SPACE WAS EXPANDED IN 2014 TO APPROXIMATELY TWICE THE SIZE TO ACCOMMODATE THE GROWING CARDIAC AND PULMONARY REHABILITATION PROGRAM OVERSEEN BY THE CMH AND OHSU CARDIOLOGY CLINIC. -THE ASTORIA SPORTS COMPLEX WAS COMPLETED IN OCT 2014. CMH TOOK OWNERSHIP OF THE JOHN WARREN FIELD WHEN THE SPORTS COMPLEX WAS COMPLETED. CMH'S FUTURE ON THE EXISTING CAMPUS IS NOW SECURED FOR DECADES TO COME. THE FIRST PROJECT ON THE JOHN WARREN FIELD WILL BE A PARKING LOT EXPANSION EXPECTED TO BEGIN THE SPRING OF 2015. -THE CCU REMODEL DESIGN PROCESS WAS APPROVED AND IS CURRENTLY UNDERWAY EXPECTED TO BE COMPLETED EARLY 2015. -CMH PURCHASED THE ELLIS PROPERTY IN 2014 FOR FURTHER EXPANSION. -CMH OPENED THE CMH FOOT AND ANKLE CLINIC IN THE WELLNESS PAVILION AND NEW CMH LAB SERVICES LOCATED IN THE PARK MEDICAL BUILDING. PROVIDER RELATIONS: -CMH MARKETING COMPLETED A PROVIDER GUIDE IN 2014. THIS 24 PAGE GUIDE IS A HELPFUL TOOL TO INFORM OUR COMMUNITY ON THE AVAILABLE PROVIDER SERVICES AT CMH, PROVIDES INSIGHT INTO MANY OF OUR ANCILLARY SERVICES AS WELL AS OUR COMMITMENT TO PATIENT CENTERED CARE. -CMH ADDED SIX NEW PROVIDERS DURING 2014. THERE ARE IN THE FOLLOWING DEPARTMENTS: ORTHOPEDICS, GENERAL SURGERY, AND PODIATRY, PEDIATRICS, URGENT CARE (NURSE PRACTITIONER) AND ONCOLOGY (NURSE PRACTITIONER). -CMH ADDED A NEW ALLIANCE WITH ANESTHESIA ASSOCIATES NORTHWEST IN 2014. FINANCIAL PERFORMANCE: -CMH FOUNDATION HELD THEIR ANNUAL DENIM & DIAMONDS FUNDRAISING GALA, AUCTION, AND GOLF TOURNAMENT IN JUNE 2014. THIS EVENT RAISED $90,000 TOWARD BRINGING EXPANDED CANCER TREATMENT SERVICES TO THE COMMUNITY AND MAKING SIGNIFICANT PROGRESS TOWARD PROVIDING MOST CANCER TREATMENTS LOCALLY WITHOUT THE NEED FOR LONG DISTANCE TRAVEL. -CMH FOUNDATION INCREASED THEIR DONATION TOWARDS LOCAL CANCER CARE SERVICES BY "PUTTIN' ON THE GLITZ" AT THEIR ANNUAL FASHION SHOW. THE FASHION SHOW RAISED $10,848 TOWARDS BUILDING A NEW CANCER CARE CENTER IN ASTORIA, OREGON. COLUMBIA MEMORIAL HOSPITAL FOUNDATION 2111 EXCHANGE STREET ASTORIA OR 97103 931091701 FUNDRAISING FOR THE HOSPITAL OR 501(C)3 LINE 11A, I 1 COLUMBIA MEMORIAL HOSPITAL AUXILIARY 2111 EXCHANGE STREET ASTORIA OR 97103 931306211 PROVIDE VOLUNTEERS OR 501(C)3 LINE 11A, I 0 ASTORIA IMAGING LLC 2111 EXCHANGE STREET ASTORIA OR 97103 800240381 MRI JOINT VENTURE OR RELATED 848422 1860766 0 1 0.51000 COASTAL HEALTH ASSURANCE INC 2111 EXCHANGE STREET ASTORIA OR 97103 911818894 PHYSICAN ASSOCIATION, MEDICAL CONTRACT MANAGEMENT OR C -102 20637 0.50000 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 0 1 CMH FOUNDATION (IN-KIND CONTRIBUTIONS) B 18848 ACTUAL CMH FOUNDATION (IN-KIND CONTRIBUTIONS SALARY EXPENSES) O 233384 ACTUAL ASTORIA IMAGING LLC (SALARY EXPENSES FOR MRI MGMT TECHS & REGISTRATION) O 293531 ACTUAL CMH FOUNDATION (TOTAL QUARTERLY TRANSFERS) Q 90300 ACTUAL CMH FOUNDATION (TRANSFER OF RESTRICTED FUNDS TO CMH DIABETIC ED) S 400 ACTUAL