FURP.ORG / PUBLIC DATA EXPLORER

COLUMBIA LUTHERAN CHARITIES: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COLUMBIA LUTHERAN CHARITIES (EIN 93-0583856)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-12
IRS object ID
201243179349301064
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-12T10:26:21-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN930418710EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELAP LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line15885 MEADOWS ROAD NO 200AddressLine1
CityLAKE OSWEGOCity
StateORState
ZIP Code97035ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN930583856EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA LUTHERAN CHARITIESBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone5033254321Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12111 EXCHANGE STREETAddressLine1
CityASTORIACity
StateORState
ZIP Code971033329ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWILLIAM G RIVERSName
TitleCFOTitle
Phone5033254321Phone
Date Signed2012-10-05DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWESLEY B HANSENName
PTINP00226581PTIN
Phone5036974118Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonWILLIAM G RIVERSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12111 EXCHANGE STREETAddressLine1
CityASTORIACity
StateORState
ZIP Code971033329ZIPCode
FieldValueIRS element (for citing)
Gross Receipts71061682GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.COLUMBIAMEMORIAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1958YearFormation
State Legal DomicileORStateLegalDomicile
Activity Or Mission DescriptionPROVIDE EXCELLENCE, LEADERSHIP & COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees528TotalNbrEmployees
Total Nbr Volunteers60TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year625022ContributionsGrantsPriorYear
Contributions Grants Current Year103601ContributionsGrantsCurrentYear
Program Service Revenue Prior Year58882182ProgramServiceRevenuePriorYear
Program Service Revenue CY66254871ProgramServiceRevenueCY
Investment Income Prior Year762386InvestmentIncomePriorYear
Investment Income Current Year505421InvestmentIncomeCurrentYear
Other Revenue Prior Year640074OtherRevenuePriorYear
Other Revenue Current Year1923423OtherRevenueCurrentYear
Total Revenue Prior Year60909664TotalRevenuePriorYear
Total Revenue Current Year68787316TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year66220GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY120148GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year32926677SalariesEtcPriorYear
Salaries Etc Current Year36566995SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year27000TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY27000TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year278984TotalFundrsngExpCurrentYear
Other Expense Prior Year24171253OtherExpensePriorYear
Other Expenses Current Year27676408OtherExpensesCurrentYear
Total Expenses Prior Year57191150TotalExpensesPriorYear
Total Expenses Current Year64390551TotalExpensesCurrentYear
Revenues Less Expenses Prior Year3718514RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4396765RevenuesLessExpensesCY
Total Assets BOY62073504TotalAssetsBOY
Total Assets EOY64810107TotalAssetsEOY
Total Liabilities BOY35069993TotalLiabilitiesBOY
Total Liabilities EOY36176559TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY27003511NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY28633548NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION OF COLUMBIA MEMORIAL HOSPITAL IS TO PROVIDE EXCELLENCE, LEADERSHIP, AND COMPASSION IN THE ENHANCEMENT OF HEALTH FOR THOSE WE SERVE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense56907729Expense
Grants120148Grants
Revenue68208853Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense56907729TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising1ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization1BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096151NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees528NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Form8899 Filed0Form8899Filed
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members13NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledORStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1WILLIAM G RIVERS CFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number5033387505TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12111 EXCHANGE STREETAddressLine1
CityASTORIACity
StateORState
ZIP Code97103ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
RANDY STEMPER
BOARD MEMBER3.00X000
MALCOLM SMITH
BOARD MEMBER3.00X000
BILL LIND
BOARD MEMBER3.00X000
HEATHER SEPPA
BOARD MEMBER3.00X000
NANCY MCALLISTER
BOARD MEMBER3.00X000
KEVIN BAXTER
BOARD MEMBER3.00X000
KATHERINE HELLBERG
BOARD MEMBER3.00X000
BILL LANDWEHR
BOARD MEMBER3.00X000
ED NELSON JR
BOARD MEMBER3.00X000
DAVID PHILLIPS
BOARD MEMBER3.00X000
PAUL F VOELLER
BOARD MEMBER3.00X000
CONSTANCE WAISANEN
BOARD MEMBER3.00X000
NORMAN SHATTO
BOARD MEMBER3.00X000
ROBERT HOLLAND
CHIEF OF STAFF40.00X285745037580
ERIK THORSEN
COO40.00304520025320X
WILLIAM G RIVERS
CFO40.00169898037644X
RICHARD CRASS
PHYSICIAN40.00343251029162X
EDOUARD DURET
PHYSICIAN40.00333752038464X
RANDALL JOHNSON
CRNA40.00276286017215X
WILLIAM LACOST
PHYSICIAN40.00515926070780X
LESLIE BLASEWITZ
FORMER CCO40.00240466032668X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2469844TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation288833TotalOtherCompensation
Number Individuals GT100 K42NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
RICKENBACH CONSTRUCTION
PO BOX 5837ALOHAOR97006GENERAL CONTRACTOR2663991
NORTH COAST EMERGENCY PHYSICIANS
2111 EXCHANGE STASTORIAOR97103EMERGENCY ROOM PHYSICIANS1840449
CPSI
6600 WALL STMOBILEAL36695SOFTWARE SUPPORT675030
PETER STOLOFF PC
5285 MEADOWS RD SUITE 235LAKE OSWEGOOR97035ATTORNEY143928
DELAP LLP
5885 MEADOWS ROAD NO 200LAKE OSWEGOOR97035ACCOUNTING135991
FieldValueIRS element (for citing)
Number Of Contractors GT100 K12NumberOfContractorsGT100K
Related Organizations15567RelatedOrganizations
Government Grants17513GovernmentGrants
All Other Contributions70521AllOtherContributions
Total Contributions103601TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OUTPATIENT REVENUE6219906171001661710016
INPATIENT REVENUE9000992512785125127851
EMERGENCY ROOM REVENUE9000992494106924941069
PROVISION FOR CHARITY900099-2261310-2261310
CONTRACTUAL ALLOWANCE900099-43262755-43262755
FieldValueIRS element (for citing)
Total Program Service Revenue66254871TotalProgramServiceRevenue

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column432188TotalRevenueColumn
Exclusion$432,188ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real320442Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real525326Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-204884Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-204884TotalRevenueColumn
Exclusion-$204,884ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1820373Securities
Other1900Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1749040Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities71333Securities
Other1900Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column73233TotalRevenueColumn
Exclusion$73,233ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming1047GrossIncomeGaming
Gaming Direct Expenses0GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column1047TotalRevenueColumn
Related Or Exempt Function Income1047RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
JOINT VENTURE621500700976700976
MEANINGFUL USE REVENUE900099627027627027
CAFETERIA AND VENDING722210174325$174,325

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column624932TotalRevenueColumn
Related Or Exempt Function Income624932RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue2127260TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column68787316TotalRevenueColumn
Related Or Exempt Function Income68208853RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$474,862ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total117872Total
Program Services117872ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2276Total
Program Services2276ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total930090Total
Management And General809415ManagementAndGeneral
Fundraising120675Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total25516461Total
Program Services22889464ProgramServices
Management And General2558095ManagementAndGeneral
Fundraising68902Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1726567Total
Program Services1676147ProgramServices
Management And General44033ManagementAndGeneral
Fundraising6387Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6293428Total
Program Services5532015ProgramServices
Management And General735956ManagementAndGeneral
Fundraising25457Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2100449Total
Program Services1887827ProgramServices
Management And General199320ManagementAndGeneral
Fundraising13302Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total109133Total
Program Services54428ProgramServices
Management And General54705ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total157226Total
Management And General141901ManagementAndGeneral
Fundraising15325Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total27000Total
Fundraising27000Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total32189Total
Management And General32189ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6047316Total
Program Services5650041ProgramServices
Management And General397275ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total357308Total
Program Services72987ProgramServices
Management And General284321ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9090201Total
Program Services8664998ProgramServices
Management And General423144ManagementAndGeneral
Fundraising2059Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total798634Total
Program Services525302ProgramServices
Management And General273332ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total689359Total
Program Services635762ProgramServices
Management And General53597ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total292626Total
Program Services97440ProgramServices
Management And General195186ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total219379Total
Program Services217726ProgramServices
Management And General1653ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total176522Total
Program Services135039ProgramServices
Management And General41483ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2676919Total
Program Services2385529ProgramServices
Management And General291390ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total603464Total
Program Services167772ProgramServices
Management And General435692ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE48387944838794
REPAIRS AND MAINTENANCE8950218922922729
RECRUITMENT FEES2034891936069883

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total488828Total
Program Services270412ProgramServices
Management And General218539ManagementAndGeneral
Fundraising-123Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total64390551Total
Program Services56907729ProgramServices
Management And General7203838ManagementAndGeneral
Fundraising278984Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3863253BOY
EOY4219237EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11870113BOY
EOY11558704EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY279430BOY
EOY271616EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1000582BOY
EOY1055965EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1120305BOY
EOY1167278EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis52240968LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec25297149LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27489579BOY
EOY26943819EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY13820037BOY
EOY14048998EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY208315BOY
EOY216193EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2421890BOY
EOY5328297EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY62073504BOY
EOY64810107EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7408383BOY
EOY7083599EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY20342972BOY
EOY19169761EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7318638BOY
EOY9923199EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY35069993BOY
EOY36176559EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY27003511BOY
EOY28633548EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27003511BOY
EOY28633548EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY62073504BOY
EOY64810107EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4396765ReconcilationRevenueExpenses
Reconcilation Other Changes-2766728ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis788734OtherCostOrOtherBasis
Book Value788734BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21337358OtherCostOrOtherBasis
Depreciation9873328Depreciation
Book Value11464030BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis705549OtherCostOrOtherBasis
Depreciation54242Depreciation
Book Value651307BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis28949563OtherCostOrOtherBasis
Depreciation15369579Depreciation
Book Value13579984BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis459764OtherCostOrOtherBasis
Book Value459764BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings26943819TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
BOARD DESIGNATED - FUNDED DEPRECIATION11689051F
HELD BY TRUSTEE UNDER BOND INDENTURE AGR1834731F
BOARD DESIGNATED - HOSPICE521566F
BOARD DESIGNATED - CHAPLIANCY3650F
FieldValueIRS element (for citing)
Total Of Book Value Program Related14048998TotalOfBookValueProgramRelated

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
ESTIMATED THIRD-PARTY PAYOR SETTLEMENT RECEIVABLE543000
RENTAL AND OTHER PROPERTY HELD FOR FUTURE DEVELOPMENT2584179
OTHER ASSETS2201118
FieldValueIRS element (for citing)
Total Book Value Other Assets5328297TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (4 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION$48,180
UNEARNED GRANT REVENUE$300,000
MEDICAL MALPRACTICE CLAIMS$432,607
RETIREMENT PLAN LIABILITY$9,142,412
FieldValueIRS element (for citing)
Total Of Amounts9923199TotalOfAmounts
Total Revenue68787316TotalRevenue
Total Expenses64390551TotalExpenses
Excess Or Deficit For Year4396765ExcessOrDeficitForYear
Net Unrealized GL On Investments-237304NetUnrealizedGLOnInvestments
Other-$2,529,424OtherAmount
Total Adjustments-2766728TotalAdjustments
Excess Or Deficit Per FS1630037ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt68709300TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-229080NetUnrealizedGainsInvestments
Other Revenues525326OtherRevenues
Revenue Not Rptd F990296246RevenueNotRptdF990
Revenue Subtotal68413054RevenueSubtotal
Other Revenues Not Included374262OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt374262RevenueNotRptdOnFinStmt
Total Revenue Per Form99068787316TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt64549839TotExpensesEtcAuditedFinclStmt
Other Expenses Included525326OtherExpensesIncluded
Expenses Not Rptd F990525326ExpensesNotRptdF990
Expenses Subtotal64024513ExpensesSubtotal
Other Expenses Not Included366038OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt366038ExpensesNotRptdOnFinStmt
Total Expenses Per Form99064390551TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -2,537,648. NET ASSETS RELEASED FROM RESTRICTION 8,224. TOTAL TO SCHEDULE D, PART XI, LINE 8: -2,529,424.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE 525,326.
PART XII, LINE 4B - OTHER ADJUSTMENTS:RECLASS OTHER INCOME 366,038. CONTRIBUTION FROM CMH FOUNDATION 8,224.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE 525,326.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:RECLASS FROM OTHER INCOME 366,038.

Schedule G IRS990ScheduleG

FieldValueIRS element (for citing)
Agreement Ref Fundraising1AgreementRefFundraising

Fundraiser Activity Information FundraiserActivityInformation

Name Of Organization NameOfOrganization

FieldValueIRS element (for citing)
Business Name Line1HILLARY LYONS ASSOCIATESBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 99AddressLine1
CityDIMONDALECity
StateMIState
ZIP Code48821ZIPCode
FieldValueIRS element (for citing)
ActivityCONSULTINGActivity
Fundraiser Control Of Funds0FundraiserControlOfFunds
Gross Receipts0GrossReceipts
Amount Retained By Contractor27000AmountRetainedByContractor
Net To Organization0NetToOrganization
FieldValueIRS element (for citing)
Total Retained By Contractors27000TotalRetainedByContractors

Form990 Schedule G Part IV Form990ScheduleGPartIV

FieldValueIRS element (for citing)
ExplanationFUNDRAISING IS DONE THROUGH THE COLUMBIA MEMORIAL HOSPITAL FOUNDATION, EIN #93-1091701. COLUMBIA LUTHERAN CHARITIES PAID $27,000 TO HILLARY LYONS ASSOCIATES FOR CONSULTING SERVICES PROVIDED TO THE COLUMBIA MEMORIAL HOSPITAL FOUNDATION. COLUMBIA MEMORIAL HOSPITAL FOUNDATION ALSO PAID $27,000 TO HILLARY LYONS FOR CONSULTING UNDER THE SAME CONTRACT.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1175194TotalCommunityBenefitExpense
Net Community Benefit Expense1175194NetCommunityBenefitExpense
Percent Of Total Expense0.01830PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense7801071TotalCommunityBenefitExpense
Direct Offsetting Revenue7086400DirectOffsettingRevenue
Net Community Benefit Expense714671NetCommunityBenefitExpense
Percent Of Total Expense0.01110PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8976265TotalCommunityBenefitExpense
Direct Offsetting Revenue7086400DirectOffsettingRevenue
Net Community Benefit Expense1889865NetCommunityBenefitExpense
Percent Of Total Expense0.02940PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense157257TotalCommunityBenefitExpense
Net Community Benefit Expense157257NetCommunityBenefitExpense
Percent Of Total Expense0.00240PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense13161TotalCommunityBenefitExpense
Direct Offsetting Revenue3700DirectOffsettingRevenue
Net Community Benefit Expense9461NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1437624TotalCommunityBenefitExpense
Direct Offsetting Revenue604693DirectOffsettingRevenue
Net Community Benefit Expense832931NetCommunityBenefitExpense
Percent Of Total Expense0.01290PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense110162TotalCommunityBenefitExpense
Net Community Benefit Expense110162NetCommunityBenefitExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1718204TotalCommunityBenefitExpense
Direct Offsetting Revenue608393DirectOffsettingRevenue
Net Community Benefit Expense1109811NetCommunityBenefitExpense
Percent Of Total Expense0.01710PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense10694469TotalCommunityBenefitExpense
Direct Offsetting Revenue7694793DirectOffsettingRevenue
Net Community Benefit Expense2999676NetCommunityBenefitExpense
Percent Of Total Expense0.04650PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense32852TotalCommunityBuildingExpense
Net Community Building Expense32852NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense32852TotalCommunityBuildingExpense
Net Community Building Expense32852NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,514,702BadDebtExpenseAmount

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 COASTAL HEALTH ASSURANCE
PHYSICIAN ASSC. MEDICAL CONTRACTS0.500000.50000
2 ASTORIA IMAGING LLC
MRI JOINT VENTURE0.510000.49000
FieldValueIRS element (for citing)
Number Of Hospital Facilities3NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (3 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalCritical Access HospitalCriticalAccessHospitalEr24 HoursEr24HoursOtherOther
COLUMBIA MEMORIAL HOSPITAL
12111 EXCHANGE STREETASTORIAOR97103XXXXOTHER
ASTORIA IMAGING LLC
22111 EXCHANGE STREETASTORIAOR97103MRI JOINT VENTURE
CMH HOME HEALTH AND HOSPICE
3486 12TH STREETASTORIAOR97103XHOME SERVICES

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COLUMBIA MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent200.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent400.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Medicaid MedicareXMedicaidMedicare
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On Nonpayment1ActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Collection Activities1CollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1CMH PROFESSIONAL OFFICE BUILDINGBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12055 EXCHANGE STREETAddressLine1
CityASTORIACity
StateORState
ZIP Code97103ZIPCode
FieldValueIRS element (for citing)
Facility TypeOFFICE SPACE LEASED TO PRIVATE HEALTHCARE PROVIDERSFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (5 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 V, SECTION B, LINE 19D: A UNIFORM PERCENTAGE REDUCTION IN CHARGES IS ITEMIZED IN THE BILL FOR INDIVIDUALS WHO DO NOT HAVE INSURANCE.COLUMBIA MEMORIAL HOSPITAL
ORREPORTS FILED WITH STATESPART VI, LINE 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
CLATSOP COMMUNITY COLLEGE
6540 LIBERTY LANEASTORIAOR9710393050550858936SPONSORSHIPS
ASTORIA BICENTENNIAL
101 15TH STASTORIAOR971039304538587500SPONSORSHIP
CITY OF ASTORIA
1095 DUANE STASTORIAOR971039360021187500SPONSORSHIPS
CLATSOP CARE CENTER HEALTH DISTRICT
947 OLNEY AVEASTORIAOR971039307250415760HOSPICE HOUSE
(no name)
SPONSORSHIP

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
ExplanationSHCEDULE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ROBERT HOLLAND
27574501000000000375800323325000
ERIK THORSEN
247274024000033246023685016350329840000
WILLIAM G RIVERS
15470801000005190082440294000207542000
RICHARD CRASS
34241808330003270288350372413000
EDOUARD DURET
3337520000061450323190372216000
RANDALL JOHNSON
276286000002500169650293501000
WILLIAM LACOST
477020000389060349900357900586706000
LESLIE BLASEWITZ
1338800500001015860170280156400273134000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1AASTORIA GOLF AND COUNTRY CLUB DUES FOR OFFICER ERIK THORSEN WERE PAID BY THE ORGANIZATION.
PART I, LINE 6MANAGEMENT BONUSES ARE CONTINGENT ON THE NET EARNINGS OF THE ORGANIZATION.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1THE HOSPITAL FACILITIES AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN270034718IssuerEIN
CUSIP Number046279BD6CUSIPNumber
Date Issued2007-08-16DateIssued
Issue Price18880000IssuePrice
Description Of PurposeCONSTRUCTION & EQUIPMENTDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds18880000TotalProceeds
Amount In Reserve Fund219791AmountInReserveFund
Capitalized Interest774925CapitalizedInterest
Issuance Costs From Proceeds546140IssuanceCostsFromProceeds
Credit Enhancement226835CreditEnhancement
Capital Expenditures18373574CapitalExpenditures
Other Spent Proceeds63564OtherSpentProceeds
Amount Unspent3AmountUnspent
Year Of Subst Completion2010YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements1AnyResearchAgreements
Engage Bond Counsel Research0EngageBondCounselResearch
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue1VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonWILLIAM C LACOSTNamePerson
Purpose Of LoanEDUCATION AND HOUSING ASSISTANCEPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$120,000OriginalPrincipalAmount
Default0Default
Approved By Board0ApprovedByBoard
Written Agreement1WrittenAgreement

Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
RANDY STEMPER
CMH BOARD MEMBER2186OWNER OF ASTORIA BUILDER'S SUPPLY. COMPETITIVELY BID AGAINST OTHER SUPPLIERS FOR RICKENBACH CONSTRUCTION. RICHKENBACH CONSTRUCTION CONTRACTED WITH CMH FOR VARIOUS CONSTURCTION IN 2011.0
HEATHER SEPPA
CMH BOARD MEMBER10206PRESIDENT OF BANK OF ASTORIA WHERE THE HOSPITAL HAS SEVERAL BANK ACCOUNTS AND PAYS ROUTINE BANKING TRANSACTION FEES.0
KEVIN BAXTER DO
CMH BOARD MEMBER72000HOSPICE MEDICAL DIRECTOR - BAXTER FAMILY MEDICINE, MEDICAL DIRECTOR FOR LOWER COLUMBIA HOSPICE (PART OF COLUMBIA MEMORIAL HOSPITAL)0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART VI, SECTION B, LINE 11A 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 12CTHE 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 15COMPENSATION 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 19THE 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 5:NET UNREALIZED LOSSES ON INVESTMENTS: -237,304. DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -2,537,648. NET ASSETS RELEASED FROM RESTRICTION 8,224. TOTAL TO FORM 990, PART XI, LINE 5: -2,766,728.CHANGES IN NET ASSETS OR FUND BALANCES:
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, 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTSKEY STATISTICS FOR 2011: INPATIENT ADMISSION INCLUDING NEWBORNS: 1,994 INPATIENT DAYS INCLUDING NEWBORNS: 5,221 SURGERY PATIENTS: 2,788 ANCILLARY VISITS: 38,492 LABORATORY TESTS: 129,090 IMAGING TOTALS: 33,806 CLINIC VISITS: 24,538 EMERGENCY & TRAUMA VISITIS: 12,613 URGENT CARE CLINIC VISITS: 5,870 HOME HEALTH VISITS: 3,245 HOSPICE PATIENT DAYS: 6,200 THE FOLLOWING ARE HIGHLIGHTS OF THE ACHIEVEMENTS IN EACH CATEGORY OF COLUMBIA MEMORIAL HOSPITAL'S MISSION STATEMENT. LEADERSHIP: IN THE PAST THREE YEARS, COLUMBIA MEMORIAL HOSPITAL (CMH) HAS REALIZED A 26% INCREASE IN THE NUMBER OF OUTPATIENT VISITS DUE TO THE ADDITION OF SEVERAL NEW CLINICS AND SERVICES INCLUDING: URGENT CARE, ORTHOPEDICS, UROLOGY, GENERAL SURGERY, PEDIATRICS, CARDIOLOGY, AND ONCOLOGY. CONSTRUCTION CONCLUDED IN 2010 ON THE REMODEL OF SURGERY, RECOVERY, ENDOSCOPY SUITE, SAME DAY SURGERY ROOMS, EMERGENCY ROOM, AND LABORATORY. ALL OF THE CONSTRUCTION CONTRACTS FOR THE CMH BUILDING AND REMODELING PROJECTS REQUIRE THE USE OF LOCAL CONTRACTORS AND BUSINESSES TO PROMOTE EMPLOYMENT AND STIMULATE THE LOCAL ECONOMY. CMH'S PATTERN OF GROWTH HAS ALSO BOOSTED EMPLOYMENT REALIZING AN 18% INCREASE IN FULL TIME EQUIVALENTS (FTES) SINCE 2008. SUCCESSFUL RECRUITMENT OF NEW PHYSICIANS PLAYED A CRITICAL PART IN INCREASING ACCESS TO HEALTHCARE LOCALLY. IN 2009 THROUGH 2011, TEN PHYSICIANS WERE RECRUITED INTO THE COMMUNITY. CARDIOLOGY SERVICES WHICH STARTED IN LATE 2010, WERE IN PLACE FOR THE ENTIRE YEAR OF 2011. CMH CONTINUES TO PLAY A CRUCIAL LEADERSHIP ROLE CONDUCTING NEEDS ASSESSMENTS, NETWORKING WITH OTHER LOCAL HEALTHCARE PROVIDERS AND COMMUNITY LEADERS, INCORPORATING NEEDS INTO LONG-TERM STRATEGIC PLANNING GOALS, AND ENSURING GOALS ARE REALIZED TO ENHANCE BOTH THE QUALITY AND QUANTITY OF HEALTHCARE SERVICES PROVIDED. EXCELLENCE: QUALITY IS THE NUMBER ONE PRIORITY AT CMH. THE HOSPITAL HAS A COMPREHENSIVE STRATEGIC PLANNING AND QUALITY IMPROVEMENT PROCESS. THE BOARD IS ACTIVELY ENGAGED AND RESPONSIBLE FOR THE OVERSIGHT OF BOTH INITIATIVES, MONITORED BY THE BOARD'S MULTI-DISCIPLINARY QUALITY OVERSIGHT COMMITTEE. EACH DEPARTMENT MANAGER ALSO HAS ACCOUNTABILITY IN THE PROCESS. PATIENT OUTCOMES AND OTHER QUALITY MEASURES ARE TRACKED AT THE DEPARTMENT LEVEL AND REPORTED ON A MONTHLY AND QUARTERLY BASIS TO THE ADMINISTRATIVE TEAM IN COMPARISON TO INTERNAL GOALS AND EXTERNAL BENCHMARKS. THE HOSPITAL PARTICIPATES IN THE HOSPITAL CONSUMER ASSESSMENT OF HEALTHCARE PROVIDERS AND SYSTEMS (HCAHPS) SURVEY EVEN THOUGH HCAHPS PARTICIPATION IS NOT MANDATORY FOR CAHS. CMH BECAME ACCREDITED BY THE HEALTHCARE FACILITIES ACCREDITATION PROGRAM (HFAP) EFFECTIVE FROM JULY 2011 THROUGH JUNE 2014. PRIOR TO THIS, CMH HAD BEEN ACCREDITED BY THE JOINT COMMISSION (JCAHO) SINCE NOVEMBER 2008. THIS IS NO SMALL TASK WITH THE INCREASED REQUIREMENTS TO PASS RIGOROUS QUALITY, SAFETY, AND COMPLIANCE AUDITS. SURVEYORS ARRIVE UNANNOUNCED TO VERIFY COMPLIANCE WITH INTERNAL POLICIES AS WELL AS WITH EXTERNAL REGULATIONS. PROVIDING AND PARTICIPATING IN EDUCATION OF PHYSICIANS, CMH EMPLOYEES, PATIENTS, VISITORS, AND COMMUNITY MEMBERS IS ANOTHER VITALLY IMPORTANT GOAL FOR CMH. SOME EXAMPLES OF EDUCATIONAL ACTIVITIES PROVIDED BY CMH INCLUDE: HEALTH OCCUPATIONS COURSES IN LOCAL HIGH SCHOOLS, JOB SHADOWING OPPORTUNITIES FOR STUDENTS, CLINIC SETTING FOR COLLEGE AND JOB CORPS CNA/CMA TRAINING, HEALTH FAIRS AND HEALTH SCREENING OPPORTUNITIES, EDUCATIONAL ARTICLES IN THE QUARTERLY NEWSLETTERS, "WIREDMD" ACCESS ON CAMPUS FOR PATIENTS AND VISITORS, EDUCATIONAL BROCHURES, AND COMMUNITY "DOC TALKS" ON VARIOUS MEDICAL CONDITIONS. CMH ENCOURAGES AND SUPPORTS EMPLOYEES IN OBTAINING HIGHER LEVEL CERTIFICATIONS AND ADVANCED DEGREES TO PROMOTE EXCELLENCE THROUGH EDUCATION IN THE YEARS TO COME. COMPASSION: CMH HAS ADOPTED THE "PLANETREE" PATIENT-CENTERED PHILOSOPHY TO PERSONALIZE, HUMANIZE, AND DEMYSTIFY THE HEALTHCARE EXPERIENCE FOR PATIENTS AND THEIR FAMILIES. CMH AND PLANETREE PROMOTE THE DEVELOPMENT AND IMPLEMENTATION OF INNOVATIVE MODELS OF HEALTHCARE THAT FOCUS ON HEALING AND NURTURING THE BODY, MIND, AND SPIRIT. CMH HAS IMPLEMENTED THE FOLLOWING INNOVATIVE SOLUTIONS TO ENHANCE THE HEALTHCARE EXPERIENCE AT OUR HOSPITAL; CARE PARTNERS, PET THERAPY, MASSAGE, REIKI, TAI CHI, MUSIC, ARTWORK, AROMATHERAPY, HEALING GARDEN, ROOM SERVICE, AND A FAMILY ROOM. SEVERAL TEAMS OF STAFF MEMBERS MEET REGULARLY TO EXPLORE AND DEVELOP NEW WAYS TO ENHANCE THE HEALING ENVIRONMENT AND OFFER COMPASSION AND SUPPORT TO PATIENTS AND THEIR FAMILIES. A PATIENT ADVISORY COMMITTEE CONSISTING OF LOCAL CITIZENS MEETS REGULARLY TO HELP EMBED THE PATIENTS PERSPECTIVE INTO DECISIONS MADE TO IMPROVE THE PATIENT-CENTERED DIRECTION OF CMH.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionControlled OrgControlledOrg
COLUMBIA MEMORIAL HOSPITAL FOUNDATION
2111 EXCHANGE STREETASTORIAOR97103931091701FUNDRAISING FOR THE HOSPITALOR501(C)31
COLUMBIA MEMORIAL HOSPITAL AUXILIARY
2111 EXCHANGE STREETASTORIAOR97103931306211PROVIDE VOLUNTEERSOR501(C)30

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStatePredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
ASTORIA IMAGING LLC
2111 EXCHANGE STREETASTORIAOR97103800240381MRI JOINT VENTUREORRELATED5176711737628000.51000
COASTAL HEALTH ASSURANCE
2111 EXCHANGE STREETASTORIAOR97103911818894PHOOR-17521145000.49000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs1RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
COLUMBIA MEMORIAL HOSPITAL FOUNDATION (IN-KIND CONTRIBUTION)
B132324ACTUAL
COLUMBIA MEMORIAL HOSPITAL FOUNDATION (IN-KIND CONTRIBUTION SALARY EXP)
N154709ACTUAL
ASTORIA IMAGING LLC (SALARY EXPENSE FOR MRI MNGMT TECHS & REGISTRATION)
N266704ACTUAL
COLUMBIA MEMORIAL HOSPITAL FOUNDATION
C8224ACTUAL
COLUMBIA MEMORIAL HOSPITAL FOUNDATION
P113075ACTUAL