2014-11-17T12:27:46-06:00 2013-12-31 930418710 DELAP LLP 5885 MEADOWS ROAD NO 200 LAKE OSWEGO OR 97035 990 2013-01-01 930583856 COLUMBIA LUTHERAN CHARITIES COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 971033329 STEPHANIE D BRENDEN CFO 5033254321 2014-11-17 1 MARK E EKLUND CPA P00156145 5036974118 2013 2015-11-30 17:44:51Z COLUMBIA MEMORIAL HOSPITAL STEPHANIE D BRENDEN 2111 EXCHANGE STREET ASTORIA OR 971033329 73215117 0 X WWW.COLUMBIAMEMORIAL.ORG X 1958 OR PROVIDE EXCELLENCE, LEADERSHIP & COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 14 14 576 105 0 0 241709 857064 64446382 67712027 427803 429765 2502188 2383349 67618082 71382205 76471 65100 0 0 37735475 39941801 11250 0 246353 25155620 27626143 62978816 67633044 4639266 3749161 83916777 90849713 52551952 47251547 31364825 43598166 THE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. 0 0 58398366 65100 69827866 SEE SCHEDULE O 58398366 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 1 131 0 1 576 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 14 0 0 1 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 ERIK THORSEN CEO 40.00 X 333548 0 22365 WILLIAM G RIVERS CIO 40.00 X 190819 0 24011 STEPHANIE D BRENDEN CFO 40.00 X 161393 0 36254 KENNETH M BOUCHER COO 40.00 X 150756 0 15761 TERESA L GURRAD CCO 40.00 X 115689 0 14275 DOUGLAS ABBOTT MD PHYSICIAN 40.00 X 599538 0 32889 RICHARD CRASS MD PHYSICIAN 40.00 X 370848 0 38419 EDOUARD DURET MD PHYSICIAN 40.00 X 407237 0 45472 ROBERT HOLLAND MD PHYSICIAN 40.00 X 304355 0 27453 DAVID LEIBEL DO PHYSICIAN 40.00 X 313897 0 43042 2948080 0 299941 51 0 1 0 RICKENBACK CONSTRUCTION INC 37734 EAGLE LANE ASTORIA OR 97103 GENERAL CONTRACTOR 2091472 NORTH COAST EMERGENCY 2111 EXCHANGE STREET ASTORIA OR 97103 EMERGENCY ROOM PHYSICIANS 1946254 BIG RIVER CONSTRUCTION INC 1050 OLNEY AVENUE ASTORIA OR 97103 GENERAL CONTRACTOR 680277 P&C CONTRUCTION 2133 NW YORK STREET PORTLAND OR 97210 GENERAL CONTRACTOR 497586 APOGEE MEDICAL MANAGEMENT 2525 E CAMELBACK ROAD PHOENIX AZ 85016 HOSPITALIST PHYSICIANS 383320 23 38543 95222 723299 857064 OUTPATIENT REVENUE 621990 74860422 74860422 EMERGENCY ROOM REVENUE 621990 28231866 28231866 INPATIENT REVENUE 621990 24278181 24278181 PROVISION FOR CHARITY CARE 621990 -3142648 -3142648 CONTRACTUAL ALLOWANCE 621990 -51519613 -51519613 -4996181 -4996181 67712027 330085 330085 329818 50704 279114 279114 279114 1881888 1782208 99680 99680 99680 JOINT VENTURE 621500 827404 827404 CAFETERIA AND VENDING 722210 267510 267510 PHARMACY SERVICES 446110 165788 165788 843533 843533 2104235 71382205 69827866 0 697275 65100 65100 1064872 1064872 29339542 26233824 2942782 162936 3252563 2934642 300403 17518 3917389 3373914 517250 26225 2367435 2046963 299642 20830 327674 100 327574 163919 147569 16350 5084420 4676653 407767 315839 1415 314424 295103 180491 114511 101 1144192 445269 698923 1642049 1374941 267108 238441 66833 171608 357982 293583 64185 214 831444 831444 3254600 2774574 480026 580911 580911 MEDICAL SUPPLIES & PHAR 7823961 7823961 REPAIRS & MAINTENANCE 1204951 1112140 92811 OTHER PURCHASED SERVICE 839107 653167 185940 OUTSIDE MEDICAL SERVICE 645846 644614 1232 2875704 2283827 589698 2179 67633044 58398366 8988325 246353 8797050 5676971 10579570 12030548 41667 28889 136219 179810 1217037 1380522 1539612 1000508 64010786 31009013 27271794 33001773 28600464 31257760 900818 777767 4832546 5515165 83916777 90849713 6912200 11105782 31919646 30917985 13720106 5227780 52551952 47251547 X 31260907 43528835 103918 69331 31364825 43598166 83916777 90849713 X 3749161 1129807 7354373 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 920043 920043 22629997 11563663 11066334 1257051 282390 974661 35125476 19162960 15962516 4078219 4078219 33001773 OTHER ASSETS 202421 INSURANCE ANNUITIES - DEFERRED COMP PLAN 179878 ESTIMATED THIRD-PARTY PAYOR RECEIVABLES 2134922 RENTAL AND OTHER PROPERTY HELD FOR FUTURE DEVELOPMENT 2997944 5515165 MEDICAL MALPRACTICE CLAIMS 476616 ACCRUED RETIREMENT PLAN LIABILITY 4751164 5227780 72121208 1129807 50704 1180511 70940697 441508 441508 71382205 67252883 61347 61347 67191536 441508 441508 67633044 PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 50,704. PART XI, LINE 4B - OTHER ADJUSTMENTS: INCOME REPORTED AS EXPENSES ON FORM 990 441,508. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSE 50,704. CONTRIBUTION FROM FOUNDATION 10,643. PART XII, LINE 4B - OTHER ADJUSTMENTS: INCOME REPORTED AS EXPENSES ON FORM 990 441,508. 1 1 1 X 1 X 1 1 0 1 1 1720364 399760 1320604 0.01950 9706350 7651003 2055347 0.03040 11426714 8050763 3375951 0.04990 96452 150 96302 0.00140 14800 4500 10300 0.00020 208759 208759 0.00310 320011 4650 315361 0.00470 11746725 8055413 3691312 0.05460 68819 15925 52894 0.00080 68819 15925 52894 0.00080 1 2812892 18041769 31477680 -13435911 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.LOWERCOLUBIAHOSPICE.ORG 161047 HOSPICE SERVICES COLUMBIA MEMORIAL HOSPITAL 1 1 X X X X X X X X X X 13 1 0 1 X WWW.COLUMBIAMEMORIAL.ORG X X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X 1 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 3: 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: CMH CONTINUES TO TAKE AN ACTIVE ROLL IN ASSURING THAT ADEQUATE FOOD IS AVAILABLE TO THE RESIDENTS OF CLATSOP COUNTY, RAISING OVER $10,000 AND DONATING OVER 50 TONS OF FOOD IN 2013. OPERATION BUNNY SUITE IS A CMH 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. CMH CREATED DOC WALK WHICH SUPPORTS HEART HEALTH EDUCATION WITH A WEEKLY SUMMERTIME WALK WITH CARDIOLOGIST DR. DIANA RINKEVICH. CMH PARTICIPATES IN RELAY FOR LIFE AND THE MARCH FOR BABIES, SUPPORTS PROGRAMS FOR FOSTER CHILDREN IN NEED OF SCHOOL CLOTHES, AND CHAMPIONS THE WARRENTON SCHOOL DISTRICTS WALK FOR HEALTH AND OTHER WALK/RUNS THROUGHOUT THE COUNTY. 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 5100 SCHOLARSHIPS CITY OF ASTORIA 1095 DUANE ST ASTORIA OR 97103 25000 GARDEN OF SURGING WAVES, CITY OF ASTORIA BICENTENNIAL LEGACY GIFT CLATSOP COMMUNITY COLLEGE 1651 LEXINGTON AVE ASTORIA OR 97103 930505508 35000 NURSING PROGRAM 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 ERIK THORSEN CEO 304513 0 27895 0 1140 0 20400 0 1965 0 355913 0 0 0 WILLIAM G RIVERS CIO 178078 0 12051 0 690 0 9469 0 14542 0 214830 0 0 0 STEPHANIE D BRENDEN CFO 151131 0 10000 0 262 0 12846 0 23408 0 197647 0 0 0 KENNETH M BOUCHER COO 145163 0 5000 0 593 0 3498 0 12263 0 166517 0 0 0 DOUGLAS ABBOTT MD PHYSICIAN 574538 0 0 0 25000 0 6375 0 26514 0 632427 0 0 0 RICHARD CRASS MD PHYSICIAN 355446 0 15402 0 0 0 16330 0 22089 0 409267 0 0 0 EDOUARD DURET MD PHYSICIAN 352997 0 54240 0 0 0 19125 0 26347 0 452709 0 0 0 ROBERT HOLLAND MD PHYSICIAN 298306 0 6049 0 0 0 0 0 27453 0 331808 0 0 0 DAVID LEIBEL DO PHYSICIAN 310860 0 3037 0 0 0 20400 0 22642 0 356939 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 1001661 31993533 2128275 541030 889525 2310003 13186481 1 0 0 1 A 0 0 0 1 0 0 0 1 A 0 0 0 0 0 0 0 0 0 DOUGLAS ABBOTT EMPLOYEE SIGN ON BONUS X 75000 16667 0 1 1 ANALIZA JUSTO EMPLOYEE SIGN ON BONUS X 20000 12222 0 1 1 28889 HEATHER SEPPA CMH BOARD MEMBER 10946 PRESIDENT OF BANK OF ASTORIA, WHERE COLUMBIA MEMORIAL HOSPITAL HAS SEVERAL BANK ACCOUNTS AND PAYS ROUTINE BANKING TRANSACTION FEES 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 FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE REVISED IN NOVEMBER 2013. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE 990 IS MAILED 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 7,316,873. 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 2013: INPATIENT ADMISSION, INCLUDING NEWBORNS: 1,855 INPATIENT DAYS, INCLUDING NEWBORNS: 4,818 SURGERY PATIENTS: 2,454 ANCILLARY VISITS: 41,545 LABORATORY TESTS: 135,647 IMAGING TOTALS: 33,576 CLINIC VISITS: 44,044 EMERGENCY & TRAUMA VISITS: 13,149 HOME HEALTH VISITS: 3,394 HOSPICE PATIENT DAYS: 5,790 COLUMBIA MEMORIAL HOSPITAL'S (CMH) MISSION IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE. THE CMH 2011 TO 2013 THREE-YEAR STRATEGIC PLAN WAS DEVELOPED IN 2010 AND INCLUDED SEVERAL GOALS LISTED UNDER THE FOLLOWING PILLARS; QUALITY AND CUSTOMER SERVICE, STAFF DEVELOPMENT, PROVIDER RELATIONS, GROWTH, AND FINANCIAL PERFORMANCE. AS OF THE YEAR ENDED DECEMBER 31ST, 2013 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 ACHIEVED ACCREDITATION IN THE FALL OF 2011 FOR THREE YEARS THROUGH THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP). SURVEYORS ARE ANTICIPATED TO ARRIVE UNANNOUNCED IN 2014 TO VERIFY COMPLIANCE WITH INTERNAL POLICIES AS WELL AS WITH EXTERNAL REGULATIONS. -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. THE 2011 2013 STRATEGIC PLAN INCLUDED A GOAL TO ACHIEVE PLANETREE "DESIGNATION", WHICH IS A PROCESS INVOLVING RIGOROUS CRITERIA AND MEASUREMENTS TO RECOGNIZE HOSPITALS THAT SUSTAIN EXCELLENCE IN THE DELIVERY OF PATIENT-CENTERED CARE. IN 2011, A NEW PLANETREE COUNCIL AND TEN ACTION TEAMS WERE ESTABLISHED AND SET TO WORK ON THIS LOFTY GOAL. IN 2012, THE OFFICIAL APPLICATION FOR DESIGNATION WAS SUBMITTED TO PLANETREE AND WAS ACCEPTED CONTINGENT ON A SITE VISIT AND THE FULFILLMENT OF CERTAIN PATIENT SATISFACTION AND QUALITY MEASUREMENT REQUIREMENTS. THE RESULTS OF THESE INCREASED EFFORTS WERE REALIZED THROUGH A SHARP INCREASE IN BOTH PATIENT SATISFACTION AND QUALITY MEASURES, IN PARTICULAR BETWEEN THE MONTHS OF AUGUST AND DECEMBER 2012. THE DECEMBER SITE VISIT LEFT CMH WITH 5 OPPORTUNITIES OR "GAPS" FOR IMPROVEMENT. LEADERSHIP FORMED ACTION TEAMS DURING THE FINAL PUSH TO TACKLE THESE OPPORTUNITIES AND BECAME AN OFFICIALLY DESIGNATED PLANETREE HOSPITAL IN JULY OF 2013! CMH IS NOW ONE OF 20 HOSPITALS IN THE UNITED STATES TO RECEIVE THIS HONOR AND THE 40TH HOSPITAL WORLD-WIDE. CMH ACCEPTED THE PLANETREE PATIENT-CENTERED DESIGNATION AWARD IN MONTREAL, QUEBEC ON OCTOBER 10TH, 2013, WHERE HOSPITAL REPRESENTATIVES ATTENDED THE ANNUAL PLANETREE CONFERENCE AND BROUGHT BACK MANY NEW IDEAS FOR THE PLANETREE COUNCIL TO PRIORITIZE AND IMPLEMENT IN THE COMING YEAR. -THE CMH LABORATORY MET 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 SERVICES TO ITS PATIENTS. -ACHIEVED THE AMERICAN HOSPITAL ASSOCIATION'S (AHA) MOST-WIRED HOSPITAL AWARD IN 2011,2012 AND 2013 AND ATTESTED TO THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS) MEANINGFUL USE CRITERIA. THESE ACHIEVEMENTS HAVE SUCCESSFULLY POSITIONED CMH TO FULFILL THE GOAL OF "ONE PATIENT, ONE RECORD" AND WILL ASSIST IN ESTABLISHING A FULLY ELECTRONIC PATIENT MEDICAL RECORD IN 2013/2014. -THE CMH MEDICAL RECORDS DEPARTMENT WORKED TO PREPARE FOR THE ICD-10-CM IMPLEMENTATION SCHEDULED FOR OCTOBER 2014. 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 ACHIEVED ACCREDITATION IN ECHOCARDIOGRAPY FOR A THREE-YEAR TERM 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. -LOWER COLUMBIA HOSPICE INVITED THE OREGON HOSPICE ASSOCIATION TO DO AN AGENCY SURVEY JULY 31 TO AUG 2 TO GAIN ACCREDITATION FOR OUR HOSPICE SERVICE. IN NOVEMBER 2013 HOSPICE WAS NOTIFIED THAT FULL ACCREDITATION HAD BEEN GRANTED. THE INTENT OF THIS ACCREDITATION IS TO ENSURE HOSPICE PROVIDERS IMPROVE STANDARDS OF CARE AND MEET REGULATORY REQUIREMENTS ON A CONTINUING BASIS. -CMH HAS RECEIVED THE IBCLC CARE AWARD IN RECOGNITION FOR THE COMMITMENT TO PROVIDING LACTATION SUPPORT TO BREASTFEEDING MOTHERS IN THE LOWER COLUMBIA REGION. STAFF DEVELOPMENT: -87% OF ALL EMPLOYEES PARTICIPATED IN PATIENT-CENTERED CARE RETREATS DURING 2013 WITH EMPHASIS ON THE CMH SERVICE EXCELLENCE STANDARDS, AIDET, AND CARE FOR THE CAREGIVER. ADDITIONALLY OVER 136 EMPLOYEES ATTENDED THE SKILLS FAIR IN OCTOBER FOR ANNUAL COMPETENCIES WITH EMPHASIS IN HOURLY ROUNDING AND BED-SIDE REPORT INVOLVING THE PATIENT AND THEIR CARE PARTNER(S) IN THEIR CARE PLAN. -CMH EMPLOYEES TEAMED UP WITH A NEIGHBORING HOSPITAL AND RAISED DONATIONS FOR THE REGIONAL FOOD BANK DURING THE MONTH OF NOVEMBER. THROUGH INCREDIBLE GENEROSITY, THE TWO GROUPS DONATED 60,538 POINTS WORTH OF FOOD AND $7,659 TO THE REGIONAL FOOD BANK. GROWTH: -THE NEW EAR, NOSE & THROAT, (ENT) CLINIC OPENED WITH A NEW ADDITION TO THE CMH MEDICAL GROUP, DR. NYTE, IN FEBRUARY 2013. -DR MICHAEL LEWIS, PULMONOLIGIST, BEGAN PRACTICING TWO WEEKS A MONTH IN THE CMH CARDIOLOGY CLINIC IN MAY 2013. -CMH OPENED A NEW WARRENTON URGENT CARE AND PRIMARY CARE CLINIC DURING THE SUMMER OF 2013. DR BRIAN COX, THE LOCUMS TENENS INTERNAL MEDICINE PHYSICIAN PROVIDING SERVICES IN WARRENTON SIGNED A PERMANENT EMPLOYMENT CONTRACT WITH CMH AND JOINED THE CMH MEDICAL GROUP IN NOVEMBER 2013. -CMH OPENED A NEW ENDOCRINOLOGY CLINIC IN JUNE 2013. ANA MARINA, ENDOCRINOLOGIST, IS ORIGINALLY FROM THE UKRAINE AND COMPLETED HER FELLOWSHIP IN SEATTLE AT THE UNIVERSITY OF WASHINGTON. -THE REMODEL OF THE MATERNITY DEPARTMENT IS NEARLY COMPLETE AND PLANNING AN OPEN HOUSE IN JANUARY 2014. THIS REMODEL INCLUDED 2 LDRPS, A NURSES LOUNGE, DOCTOR SLEEPING ROOOM 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 2013 TO APPROXIMATELY TWICE THE SIZE TO ACCOMMODATE THE GROWING CARDIAC AND PULOMONARY REHABILITATION PROGRAM OVERSEEN BY THE CMH AND OHSU CARDIOLOGY CLINIC. -THE ASTORIA SCHOOL DISTRICT, CITY OF ASTORIA AND CMH HAVE FINALIZED AND APPROVED THE FINAL ARCHITECT DRAWINGS FOR A SPORTS COMPLEX, BEING BUILT BY CMH AND THEN EXCHANGED ONCE COMPLETED FOR THE SCHOOL DISTRICT'S CURRENT FOOTBALL FIELD, SITTING ON AN ADJACENT PLOT TO THE CMH CAMPUS. WORK WILL RESUME ON THE SPORTS COMPLEX IN JANUARY 2014 AND IS SCHEDULED FOR THE COMPLETION BY THE FALL OF 2014. -THE CCU AND EMERGENCY REMODEL DESIGN PROCESS IS CURRENTLY UNDERWAY WITH PLANS FOR CONSTRUCTION IN 2014/2015. PROVIDER RELATIONS: -INVITED INDEPENDENT PROVIDERS TO PARTICIPATE ON "DOC TALK", A LOCAL RADIO SHOW WHERE PROVIDERS AND HEALTHCARE PROFESSIONALS CAN DISCUSS THEIR SPECIALTIES, CURRENT HEALTHCARE TOPICS AND UPCOMING EVENTS IN THE HEALTHCARE INDUSTRY -EXPANDED CMH WEBSITE TO INCLUDE A NEW MOBILE DEVICE THAT HELPS CONSUMERS FIND A LOCAL PROVIDER MORE EASILY. -CMH MARKETING COMPLETED A PROVIDER GUIDE IN MAY 2013. 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. FORM 990, PART III, LINE 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS FINANCIAL PERFORMANCE: -WOMEN'S HEART HEALTH EDUCATION RECIEVED A BOOST FROM THE CMH FOUNDATION'S COMMUNITY RELATIONS COMMITTEE FIFTH ANNUAL CHAMPAGNE TEA, "ART FOR THE HEART", HELD SATURDAY FEBRUARY 9TH AT THE ELKS' BALLROOM. THE ART AUCTION AND TEA EVENT NETTED $17,000, WHICH INCLUDED A MATCH FOR THE AMOUNTS RASIED DURING A SPECIAL APPEAL BY OHSU, THE TITLE SPONSOR. -CMH FOUNDATION AND MARKETING DEPARTMENTS TEAMED UP TO PUT ON A PHIL VASSAR CONCERT AND FUNDRAISING EVENT WITH PROCEEDS OF APPROXIMATELY $17,000 WERE ALLOCATED TO THE CANCER CARE PHASE II PROJECT. -CMH FOUNDATION ALSO HELD THEIR ANNUAL DENIM & DIAMONDS FUNDRAISING GALA AND AUCTION IN JUNE 2013. THIS EVENT RAISED OVER $100,000 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. 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 0 ASTORIA IMAGING LLC 2111 EXCHANGE STREET ASTORIA OR 97103 800240381 MRI JOINT VENTURE OR RELATED 683992 1957803 0 0 0.51000 COASTAL HEALTH ASSURANCE INC 2111 EXCHANGE STREET ASTORIA OR 97103 911818894 PHYSICAN ASSOCIATION, MEDICAL CONTRACT MANAGEMENT OR C -181 20739 0.50000 0 0 1 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 0 1 CMH FOUNDATION (IN-KIND CONTRIBUTIONS) B 34967 ACTUAL CMH FOUNDATION (IN-KIND CONTRIBUTIONS SALARY EXPENSES) O 249386 ACTUAL ASTORIA IMAGING LLC (SALARY EXPENSES FOR MRI MGMT TECHS & REGISTRATION) O 274129 ACTUAL CMH FOUNDATION (TOTAL GRANTS & ALLOCATIONS) C 2724 ACTUAL CMH FOUNDATION (TOTAL QUARTERLY TRANSFERS) Q 100378 ACTUAL CMH FOUNDATION (TRANSFER OF RESTRICTED FUNDS TO CMH DIABETIC ED) S 385 ACTUAL