2017-11-06T15:28:17-06:00 2016-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2016-01-01 930583856 COLUMBIA LUTHERAN CHARITIES COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 971033329 HILLARY MCELROY INTERIM FINANCE DIRECTOR 5033254321 2017-10-30 1 MARK E EKLUND CPA P00156145 5036974118 2017-10-30 76.14.192.226 2017-10-30 14:09:39 PD P 6EE4B5945FCD93E65398A6249415A829E8D03AFF A037F773A43E5D098BFBF49CACF0A7B31F1836C7 2016 2017-02-10 21:41:12Z COLUMBIA MEMORIAL HOSPITAL HILLARY MCELROY 2111 EXCHANGE STREET ASTORIA OR 971033329 103792885 0 X WWW.COLUMBIAMEMORIAL.ORG X 1958 OR PROVIDE EXCELLENCE, LEADERSHIP & COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 13 10 692 115 0 0 290234 111078 88271302 98803882 738811 888833 3310549 2724310 92610896 102528103 52761 80160 0 0 48043025 52977583 0 0 410941 40420807 42189272 88516593 95247015 4094303 7281088 96537167 126358995 52248520 75290523 44288647 51068472 THE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 0 0 80148937 80160 101147402 SEE SCHEDULE O 80148937 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 1 0 1 0 1 0 0 0 0 1 1 1 0 0 0 1 108 0 1 692 1 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 OR X X HILLARY MCELROY INTERIM FINANCE DIRECTOR 5033384613 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 280243 0 40513 BILL LANDWEHR BOARD MEMBER 3.00 X 0 0 0 NANCY MCALLISTER 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 MARK SMITH BOARD MEMBER 3.00 X 0 0 0 CONSTANCE WAISANEN BOARD MEMBER 3.00 X 0 0 0 ROBERT HOLLAND BOARD MEMBER 3.00 X 331214 0 36390 DOUG KAUP BOARD MEMBER 3.00 X 0 0 0 DAVE NYGAARD BOARD MEMBER 3.00 X 0 0 0 JEAN DANFORTH BOARD MEMBER 3.00 X 0 0 0 ERIK THORSEN CEO 40.00 X 483350 0 104727 THOMAS SAFLEY CFO 40.00 X 62027 0 7190 TERESA L GURRAD CCO 40.00 X 202864 0 35793 JARROD P KARNOFSKI VP - ANCILLIARY SERVICES 40.00 X 182620 0 51792 KATRINA M MCPHERSON VP - MEDICAL GROUP OPERATIONS 40.00 X 269685 0 51745 GALINA GANDY VP-IT 40.00 X 193783 0 31075 DOUGLAS ABBOTT MD PHYSICIAN 40.00 X 598779 0 56799 RICHARD CRASS MD PHYSICIAN 40.00 X 390648 0 46004 MICHAEL MITCHELL MD PHYSICIAN 40.00 X 361239 0 37375 PETER BALES MD PHYSICIAN 40.00 X 551288 0 48033 CAMILO ROSALES MD PHYSICIAN 40.00 X 400438 0 39651 4308178 0 587087 79 0 1 0 P&C CONSTRUCTION 2133 NW YORK STREET PORTLAND OR 97210 CONSTRUCTION COMPANY 2297207 ANESTHESIA ASSOCIATES NORTHWEST LLC 6400 SE LAKE RD STE 130 PORTLAND OR 97222 ANESTHESIOLOGY PHYSICIANS 1744631 HEALTHCARE RESOURCE GROUP INC 12610 EAST MIRABEAU PKWY STE 800 SPOKANE VALLEY WA 99216 BILLING & CODING SERVICES 1635002 BIG RIVER CONSTRUCTION INC 1050 OLNEY AVE ASTORIA OR 97103 CONSTRUCTION COMPANY 651705 MOSS ADAMS LLP PO BOX 748369 LOS ANGELES CA 90074 MANAGEMENT FOR BILLING SERVICES 597870 25 46121 64957 111078 OUTPATIENT REVENUE 621990 111021940 111021940 EMERGENCY ROOM REVENUE 621990 48424611 48424611 INPATIENT REVENUE 621990 40878560 40878560 PROVISION FOR CHARITY CARE 621990 -2418289 -2418289 CONTRACTUAL ALLOWANCE 621990 -99449047 -99449047 346107 346107 98803882 724865 724865 218920 45172 173748 173748 173748 1383578 1202337 17273 181241 -17273 163968 163968 JOINT VENTURE 621500 1297009 1297009 HOSPITALIST 621110 564038 564038 CAFETERIA AND VENDING 722210 380790 380790 308725 308725 2550562 102528103 101147402 0 1269623 80160 80160 1676650 1676650 37912885 32956528 4767782 188575 3312111 2894878 412225 5008 7051576 6133900 882087 35589 3024361 2581967 428173 14221 309018 309018 264998 246958 18040 8332390 7642668 677806 11916 203053 1872 201181 278866 147229 117753 13884 1238577 1074847 161092 2638 1797306 1439183 357078 1045 88715 80025 8587 103 470463 326300 139964 4199 1301879 1301879 4664168 3617498 1046670 736398 736398 MEDICAL SUPPLIES & PHAR 13485510 13484337 1173 OTHER PURCHASED SERVICE 3379143 930438 2402366 46339 REPAIRS & MAINTENANCE 1480755 1421633 58343 779 OUTSIDE MEDICAL SERVICE 725217 719882 5335 3432816 2577315 786896 68605 95247015 80148937 14687137 410941 61386 24593 4889203 4470356 16568058 14300222 9444 2778 92320 424737 2380933 2434432 857847 1244330 93290551 45897279 42458227 47393272 25548785 51818379 1814415 1800570 743067 75000 1113482 2370326 96537167 126358995 10528211 13059311 29285002 47686405 200000 0 12235307 14544807 52248520 75290523 X 44225380 51068472 63267 0 44288647 51068472 96537167 126358995 X 7281088 761903 -1263166 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7480254 1886594 9366848 6985167 26039992 17479445 15545714 1511343 851598 659745 43653710 27566236 16087474 5733491 5733491 47393272 MEDICAL MALPRACTICE CLAIMS 1930582 ACCRUED RETIREMENT PLAN LIABILITY 11930225 ESTIMATED 3RD PARTY PAYOR 684000 14544807 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, 2016 AND 2015. 1 1 1 X 1 X 1 1 0 1 1 1085055 1085055 0.01140 18507208 18584464 0 0.00000 19592263 18584464 1085055 0.01140 289342 74642 214700 0.00230 79315 79315 0.00080 208184 208184 0.00220 576841 74642 502199 0.00530 20169104 18659106 1587254 0.01670 144424 144424 0.00150 144424 144424 0.00150 1 2512430 2418289 36313467 61548250 -25234783 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 0.51000 1 1 COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 WWW.COLUMBIAMEMORIAL.ORG 141146 X X X X COLUMBIA MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X 16 1 1 1 1 X WWW.COLUMBIAMEMORIAL.ORG X 1 16 1 WWW.COLUMBIAMEMORIAL.ORG 0 1 X 200.000000000000 400.000000000000 X 0 1 X X X X 1 X WWW.COLUMBIAMEMORIAL.ORG X WWW.COLUMBIAMEMORIAL.ORG X WWW.COLUMBIAMEMORIAL.ORG X X X X X 1 X X X 0 X X X X 1 X 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. 16 1 - ONCOLOGY & INFUSION CLINIC 2111 EXCHANGE ST ASTORIA OR 97103 ONCOLOGY INFUSION SERVICES 2 - ASTORIA IMAGING LLC 2111 EXCHANGE ST ASTORIA OR 97103 MRI SERVICES 3 - WARRENTON PRIMARY CARE (RHC) 1639 SE ENSIGN LANE SUITE B103 WARRENTON OR 97146 PRIMARY CARE SERVICES 4 - ORTHOPEDIC CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 ORTHOPEDIC SERVICES 5 - WOMENS CENTER CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 WOMEN'S SERVICES 6 - PEDIATRIC CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 PEDIATRIC SERVICES 7 - GENERAL SURGERY CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 GENERAL SURGERY SERVICES 8 - CARDIOLOGY CLINIC 2095 EXCHANGE ST SUITE 301 ASTORIA OR 97103 CARDIOLOGY SERVICES 9 - LOWER COLUMBIA HOSPICE 2158 EXCHANGE STREET SUITE 206 ASTORIA OR 97103 HOSPICE SERVICES 10 - URGENT CARE CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 URGENT CARE SERVICES 11 - UROLOGY CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 UROLOGY CLINIC 12 - CMH HOME HEALTH 2158 EXCHANGE STREET SUITE 206 ASTORIA OR 97103 HOME SERVICES 13 - ENDOCRINOLOGY 2185 EXCHANGE ST SUITE 205 ASTORIA OR 97103 ENDOCRINOLOGY 14 - PULMONOLOGY 2055 EXCHANGE ST SUITE 210 ASTORIA OR 97103 PULMONOLOGY 15 - ENT CLINIC 2055 EXCHANGE ST ASTORIA OR 97103 ENT CLINIC 16 - WOUND CARE CLINIC 2265 EXCHANGE ST ASTORIA OR 97103 WOUND CARE CLINIC 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 ASTORIA-WARRENTON CHAMBER OF COMMERCE 1651 LEXINGTON AVE ASTORIA OR 97103 930115760 501(C)6 10000 GENERAL ASSISTANCE CONECT THE DOTS PO BOX 2426 GEARHART OR 97138 461906387 501(C)3 5000 PLAY PROGRAM SUPPORT CLATSOP BEHAVIORIAL HEALTHCARE 65 N HWY 101 STE 204 WARRENTON OR 97146 930513669 501(C)3 39000 OPERATIONAL ASSISTANCE X 1 1 X X X X 0 1 0 0 0 1 0 0 0 KEVIN BAXTER BOARD MEMBER 279001 0 1242 0 0 0 3138 0 37375 0 320756 0 0 0 ROBERT HOLLAND BOARD MEMBER 301116 0 6629 0 23469 0 0 0 36390 0 367604 0 0 0 ERIK THORSEN CEO 394495 0 28437 0 60418 0 68337 0 36390 0 588077 0 0 0 TERESA L GURRAD CCO 184839 0 16534 0 1491 0 15103 0 20690 0 238657 0 0 0 JARROD P KARNOFSKI VP - ANCILLIARY SERVICES 169682 0 12766 0 172 0 14417 0 37375 0 234412 0 0 0 KATRINA M MCPHERSON VP - MEDICAL GROUP OPERATIONS 248496 0 20225 0 964 0 14370 0 37375 0 321430 0 0 0 GALINA GANDY VP-IT 185203 0 8505 0 75 0 2317 0 28758 0 224858 0 0 0 DOUGLAS ABBOTT MD PHYSICIAN 586439 0 12000 0 340 0 19424 0 37375 0 655578 0 0 0 RICHARD CRASS MD PHYSICIAN 363850 0 14554 0 12244 0 17246 0 28758 0 436652 0 0 0 MICHAEL MITCHELL MD PHYSICIAN 361239 0 0 0 0 0 0 0 37375 0 398614 0 0 0 PETER BALES MD PHYSICIAN 523814 0 20808 0 6666 0 10658 0 37375 0 599321 0 0 0 CAMILO ROSALES MD PHYSICIAN 357108 0 14280 0 29050 0 10893 0 28758 0 440089 0 0 0 PART I, LINE 1A ASTORIA GOLF AND COUNTRY CLUB DUES FOR CEO ERIK THORSEN AND CCO TERESA GURRAD WERE PAID BY THE ORGANIZATION. PART I, LINE 4B ERIK THORSEN, CEO IS PARTICIPATING IN A 457(F) PLAN WHICH STARTED IN 2015. 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 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 31385 893237 2015 1 0 1 1 B 20451436 15013441 292436 23613 356050 2531967 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 PART 1 SECTION (C) CUSIP # 2016 BOND 046279CAI 046279B27 046279C89 PETER BALES EMPLOYEE SIGN ON BONUS X 20000 2778 0 1 1 2778 HEATHER SEPPA CMH PRESIDENT OFFICER AT COLUMBIA STATE BANK, ONE OF THE PRIMARY BANKS USED BY CMH. 0 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 XI, LINE 9: DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -1,299,554. NET ASSETS RELEASED FROM RESTRICTION - CITY OF ASTORIA GRANT 99,655. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS -63,267. 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 2014 2015 2016 AVAILABLE BEDS: 25 25 25 ADMISSIONS: 1,587 1,789 1,587 PATIENT DAYS: 4,289 4,595 4,613 OBSERVATIONS: 663 536 520 AVERAGE LENGTH OF STAY (IN DAYS): 2.70 2.57 2.91 OCCUPANCY RATE: 47.6% 50.4% 50.6% DELIVERIES: 312 317 336 EMERGENCY ROOM VISITS: 13,046 13,255 13,786 URGENT CARE VISITS: 10,820 14,806 13,984 OUTPATIENT VISITS (NET OF ER): 153,793 160,544 177,896 SURGICAL CASES: 2,265 2,448 2,140 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 FIVE CONSECUTIVE YEAR OF 2011- 2015. 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 THIRTY-SIX (36) PHYSICIANS AND MID-LEVEL PROVIDERS EMPLOYED WITHIN THE CMH MEDICAL GROUP IN ELEVEN 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 THIS 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 13 OHSU PHYSICIANS WORKING FULL-TIME IN THE HOSPITAL'S FACILITIES. JOINT OPERATING AGREEMENT: THE HOSPITAL ENTERED INTO A NEW JOINT OPERATING AGREEMENT ("JOA") WITH OHSU THROUGH THE OHSU KNIGHT CANCER INSTITUTE TO BETTER SERVE THE ONCOLOGY CARE NEED OF THE ASTORIA AREA AND SURROUNDING COMMUNITIES IN THE FIRST QUARTER OF 2015. THE JOA WILL ADD RADIATION ONCOLOGY SERVICES TO THE EXISTING CMH/OHSU CANCER CARE CENTER MEDICAL ONCOLOGY PROGRAM AND REBRAND THE CENTER AS THE CMH-OHSU KNIGHT CANCER COLLABORATIVE. IT IS ANTICIPATED THAT THIS NEW COLLABORATION WILL PROVIDE FOR HIGH-QUALITY, COST-EFFICIENT, SAFE, AND EFFECTIVE ONCOLOGY SERVICES FOR THE RESIDENTS OF ASTORIA AND SURROUNDING COMMUNITIES IN LATE 2017. A NEW 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 BEGAN IN AUGUST OF 2016 AND IS EXPECTED TO BE COMPLETED IN THE FALL OF 2017. THE CANCER CENTER WILL INCORPORATE AND ALLOW FOR EXPANSION OF THE CURRENT MEDICAL ONCOLOGY AND INFUSION THERAPY CLINIC. IN ADDITION, THE CANCER CENTER WILL BRING RADIATION ONCOLOGY SERVICES TO THE REGION. THERE ARE CURRENTLY NO RADIATION THERAPY SERVICES AVAILABLE ON THE NORTH OREGON COAST. 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. EXCHANGE STREET LLC 2111 EXCHANGE STREET ASTORIA OR 97103 HOLDS TITLE TO REAL PROPERTY OR 1000 739959 COLUMBIA LUTHERAN CHARITIES COLUMBIA MEMORIAL HOSPITAL FOUNDATION 2111 EXCHANGE STREET ASTORIA OR 97103 931091701 FUNDRAISING-CMH OR 501(C)3 LINE 12C, III-FI 1 COLUMBIA MEMORIAL HOSPITAL AUXILIARY 2111 EXCHANGE STREET ASTORIA OR 97103 931306211 PROVIDE VOLUNTEERS OR 501(C)3 LINE 12A, I 0 ASTORIA IMAGING LLC 2111 EXCHANGE STREET ASTORIA OR 97103 800240381 MRI JOINT VENTURE OR RELATED 1550983 1997801 0 1 0.51000 COASTAL HEALTH ASSURANCE INC 2111 EXCHANGE STREET ASTORIA OR 97103 911818894 PHYSICAN ASSOCIATION, MEDICAL CONTRACT MANAGEMENT OR C 20209 0.50000 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0 0 CMH FOUNDATION (IN-KIND CONTRIBUTIONS) B 169632 ACTUAL CMH FOUNDATION (IN-KIND CONTRIBUTIONS SALARY EXPENSES) O 241309 ACTUAL ASTORIA IMAGING LLC (SALARY EXPENSES FOR MRI MGMT TECHS & REGISTRATION) O 364417 ACTUAL