FURP.ORG / PUBLIC DATA EXPLORER

COLUMBIA LUTHERAN CHARITIES: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COLUMBIA LUTHERAN CHARITIES (EIN 93-0583856)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201123199349305052
Schema version
2010v3.4
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)
Timestamp2011-11-15T11:51:23-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1DELAP LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line14500 SW KRUSE WAY NO 200AddressLine1
CityLAKE OSWEGOCity
StateORState
ZIP Code97035ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

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 Signed2011-11-11DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWESLEY B HANSENName
Phone5036974118Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
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 Receipts62403301GrossReceipts
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 Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members13NbrIndependentVotingMembers
Total Nbr Employees499TotalNbrEmployees
Total Nbr Volunteers80TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year181927ContributionsGrantsPriorYear
Contributions Grants Current Year625022ContributionsGrantsCurrentYear
Program Service Revenue Prior Year52907333ProgramServiceRevenuePriorYear
Program Service Revenue CY58882182ProgramServiceRevenueCY
Investment Income Prior Year351059InvestmentIncomePriorYear
Investment Income Current Year762386InvestmentIncomeCurrentYear
Other Revenue Prior Year804315OtherRevenuePriorYear
Other Revenue Current Year640074OtherRevenueCurrentYear
Total Revenue Prior Year54244634TotalRevenuePriorYear
Total Revenue Current Year60909664TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year161186GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY66220GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year30386011SalariesEtcPriorYear
Salaries Etc Current Year32926677SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY27000TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year226494TotalFundrsngExpCurrentYear
Other Expense Prior Year22632877OtherExpensePriorYear
Other Expenses Current Year24171253OtherExpensesCurrentYear
Total Expenses Prior Year53180074TotalExpensesPriorYear
Total Expenses Current Year57191150TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1064560RevenuesLessExpensesPriorYear
Revenues Less Expenses CY3718514RevenuesLessExpensesCY
Total Assets BOY57411576TotalAssetsBOY
Total Assets EOY62073504TotalAssetsEOY
Total Liabilities BOY34202997TotalLiabilitiesBOY
Total Liabilities EOY35069993TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY23208579NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY27003511NetAssetsOrFundBalancesEOY
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
Expense49915777Expense
Grants66220Grants
Revenue59587069Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense49915777TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
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 Assets0ReportOtherAssets
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 Attached0FinancialStmtAttached
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
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 With1096124NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees499NumberOfEmployees
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 Members13NbrVotingGoverningBodyMembers
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 (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeOfficerOfficerFormerFormer
KATHERINE HELLBERG
BOARD MEMBER3.00X000
BILL LANDWEHR
BOARD MEMBER3.00X000
BILL LIND
BOARD MEMBER3.00X000
ED NELSON JR
BOARD MEMBER3.00X000
DAVID PHILLIPS
BOARD MEMBER3.00X000
HEATHER SEPPA
BOARD MEMBER3.00X000
MALCOLM SMITH
BOARD MEMBER3.00X000
RANDY STEMPER
BOARD MEMBER3.00X000
NANCY VELTKAMP
BOARD MEMBER3.00X000
PAUL F VOELLER MD
BOARD MEMBER3.00X000
CONSTANCE WAISANEN
BOARD MEMBER3.00X000
ROBERT HOLLAND
CHIEF OF STAFF40.00X268096026475XX
LESLIE BLASEWITZ
CCO40.00141689023720X
WILLIAM G RIVERS
CFO40.00127545022131X
ERIK THORSEN
COO40.00263047025219X
RANDALL JOHNSON
CRNA40.00264209021643X
KIMBERLY S ELTZROTH
PHYSICIAN40.00246902019197X
SAM K LIU
PHYSICIAN40.00247306037508X
WILLIAM C LACOST
PHYSICIAN40.00477008036444X
TERRY FINKLEIN
FORMER CEO40.00199587021266X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2235389TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation233603TotalOtherCompensation
Number Individuals GT100 K36NumberIndividualsGT100K
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 CONTRACTOR5186287
NORTH COAST EMERGENCY PHYSICIANS
2111 EXCHANGE STASTORIAOR97103EMERGENCY ROOM PHYSICIANS1673119
ANDERSON DABROWSKI ARCHITECTS
1430 SE 3RD AVE STE 200PORTLANDOR97214ARCHITECT322786
CPSI
6600 WALL STMOBILEAL36695SOFTWARE SUPPORT294799
DELAP LLP
4500 SW KRUSE WAY STE 200LAKE OSWEGOOR97035ACCOUNTING159377
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations19829RelatedOrganizations
Government Grants23831GovernmentGrants
All Other Contributions581362AllOtherContributions
Total Contributions625022TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OUTPATIENT REVENUE6219904872979748729797
INPATIENT REVENUE9000992568694825686948
EMERGENCY ROOM REVENUE9000992432460724324607
PROVISION FOR CHARITY900099-2002583-2002583
CONTRACTUAL ALLOWANCE900099-37856587-37856587
FieldValueIRS element (for citing)
Total Program Service Revenue58882182TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column411054TotalRevenueColumn
Exclusion$411,054ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real224575Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real439573Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-214998Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-214998TotalRevenueColumn
Exclusion-$214,998ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1223957Securities
Other181439Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities923014Securities
Other131050Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities300943Securities
Other50389Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column351332TotalRevenueColumn
Exclusion$351,332ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming2005GrossIncomeGaming

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column2005TotalRevenueColumn
Related Or Exempt Function Income2005RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
JOINT VENTURE621500423185423185
CAFETERIA AND VENDING722210150185$150,185
REBATES AND DISCOUNTS9000997186471864

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column207833TotalRevenueColumn
Related Or Exempt Function Income207833RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue853067TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column60909664TotalRevenueColumn
Related Or Exempt Function Income59587069RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$697,573ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total60001Total
Program Services60001ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total6219Total
Program Services6219ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total713889Total
Management And General602351ManagementAndGeneral
Fundraising111538Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total22967331Total
Program Services20980607ProgramServices
Management And General1962891ManagementAndGeneral
Fundraising23833Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1768470Total
Program Services1686661ProgramServices
Management And General75920ManagementAndGeneral
Fundraising5889Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5540993Total
Program Services4905638ProgramServices
Management And General615043ManagementAndGeneral
Fundraising20312Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1935994Total
Program Services1762658ProgramServices
Management And General159897ManagementAndGeneral
Fundraising13439Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total414296Total
Program Services75834ProgramServices
Management And General338462ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total169534Total
Program Services2250ProgramServices
Management And General152684ManagementAndGeneral
Fundraising14600Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total27000Total
Fundraising27000Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total28854Total
Management And General28854ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4379137Total
Program Services3904245ProgramServices
Management And General474892ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total228496Total
Program Services29526ProgramServices
Management And General198970ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7099306Total
Program Services6727758ProgramServices
Management And General369468ManagementAndGeneral
Fundraising2080Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total469482Total
Program Services249593ProgramServices
Management And General219889ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total677410Total
Program Services584089ProgramServices
Management And General85479ManagementAndGeneral
Fundraising7842Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total263575Total
Program Services179399ProgramServices
Management And General84176ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total60272Total
Program Services58619ProgramServices
Management And General1653ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total222607Total
Program Services170294ProgramServices
Management And General52313ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2735966Total
Program Services2406859ProgramServices
Management And General329107ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total743311Total
Program Services137901ProgramServices
Management And General605410ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE47779894777989
REPAIRS AND MAINTENANCE7943667908393527
RECRUITMENT FEES2918812839787903

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total814771Total
Program Services134820ProgramServices
Management And General679990ManagementAndGeneral
Fundraising-39Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total57191150Total
Program Services49915777ProgramServices
Management And General7048879ManagementAndGeneral
Fundraising226494Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY709348BOY
EOY3863253EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY11614704BOY
EOY11870113EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY299254BOY
EOY279430EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY692384BOY
EOY1000582EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY804151BOY
EOY1120305EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis51780658LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec24291079LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23637848BOY
EOY27489579EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY17808624BOY
EOY13820037EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY271689BOY
EOY208315EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1573574BOY
EOY2421890EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY57411576BOY
EOY62073504EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5336210BOY
EOY7408383EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY21622676BOY
EOY20342972EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY7244111BOY
EOY7318638EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY34202997BOY
EOY35069993EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23208579BOY
EOY27003511EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23208579BOY
EOY27003511EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY57411576BOY
EOY62073504EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses3718514ReconcilationRevenueExpenses
Reconcilation Other Changes76418ReconcilationOtherChanges
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 Basis21140488OtherCostOrOtherBasis
Depreciation9529023Depreciation
Book Value11611465BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis44640OtherCostOrOtherBasis
Depreciation30605Depreciation
Book Value14035BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis24204102OtherCostOrOtherBasis
Depreciation13618272Depreciation
Book Value10585830BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis5602694OtherCostOrOtherBasis
Depreciation1113179Depreciation
Book Value4489515BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings27489579TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (4 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
BOARD DESIGNATED - FUNDED DEPRECIATION11445876F
HELD BY TRUSTEE UNDER BOND INDENTURE AGR1831287F
BOARD DESIGNATED - HOSPICE539229F
BOARD DESIGNATED - CHAPLIANCY3645F
FieldValueIRS element (for citing)
Total Of Book Value Program Related13820037TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
DEFERRED COMPENSATION$94,312
MEDICAL MALPRACTICE CLAIMS LIABILITY$432,608
RETIREMENT PLAN LIABILITY$6,791,718
FieldValueIRS element (for citing)
Total Of Amounts7318638TotalOfAmounts
Total Revenue60909664TotalRevenue
Total Expenses57191150TotalExpenses
Excess Or Deficit For Year3718514ExcessOrDeficitForYear
Net Unrealized GL On Investments530158NetUnrealizedGLOnInvestments
Other-$453,740OtherAmount
Total Adjustments76418TotalAdjustments
Excess Or Deficit Per FS3794932ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt61029464TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments530158NetUnrealizedGainsInvestments
Other Revenues-410358OtherRevenues
Revenue Not Rptd F990119800RevenueNotRptdF990
Revenue Subtotal60909664RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99060909664TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt57293915TotExpensesEtcAuditedFinclStmt
Other Expenses Included439573OtherExpensesIncluded
Expenses Not Rptd F990439573ExpensesNotRptdF990
Expenses Subtotal56854342ExpensesSubtotal
Other Expenses Not Included336808OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt336808ExpensesNotRptdOnFinStmt
Total Expenses Per Form99057191150TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
PART XI, LINE 8 - OTHER ADJUSTMENTS:DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -453,740.
PART XII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE -439,573. RECLASS OTHER INCOME 29,215.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:RENTAL EXPENSE 439,573.
PART XIII, LINE 4B - OTHER ADJUSTMENTS:RECLASS FROM OTHER INCOME 336,808.

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 ASSOCIATES 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 Expense1050907TotalCommunityBenefitExpense
Net Community Benefit Expense1050907NetCommunityBenefitExpense
Percent Of Total Expense0.01840PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense6644118TotalCommunityBenefitExpense
Direct Offsetting Revenue5488279DirectOffsettingRevenue
Net Community Benefit Expense1155839NetCommunityBenefitExpense
Percent Of Total Expense0.02020PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense7695025TotalCommunityBenefitExpense
Direct Offsetting Revenue5488279DirectOffsettingRevenue
Net Community Benefit Expense2206746NetCommunityBenefitExpense
Percent Of Total Expense0.03860PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense145903TotalCommunityBenefitExpense
Direct Offsetting Revenue450DirectOffsettingRevenue
Net Community Benefit Expense145453NetCommunityBenefitExpense
Percent Of Total Expense0.00250PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense11625TotalCommunityBenefitExpense
Direct Offsetting Revenue2400DirectOffsettingRevenue
Net Community Benefit Expense9225NetCommunityBenefitExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense1455284TotalCommunityBenefitExpense
Direct Offsetting Revenue709201DirectOffsettingRevenue
Net Community Benefit Expense746083NetCommunityBenefitExpense
Percent Of Total Expense0.01300PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense58233TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense58233NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1671045TotalCommunityBenefitExpense
Direct Offsetting Revenue712051DirectOffsettingRevenue
Net Community Benefit Expense958994NetCommunityBenefitExpense
Percent Of Total Expense0.01670PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense9366070TotalCommunityBenefitExpense
Direct Offsetting Revenue6200330DirectOffsettingRevenue
Net Community Benefit Expense3165740NetCommunityBenefitExpense
Percent Of Total Expense0.05530PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense22305TotalCommunityBuildingExpense
Net Community Building Expense22305NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense22305TotalCommunityBuildingExpense
Net Community Building Expense22305NetCommunityBuildingExpense
Percent Of Total Expense0.00040PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,496,611BadDebtExpenseAmount
Amount Reimbursed By Medicare16272740AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare20858405CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4585665MedicareSurplusOrShortfall

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
MAGNETIC RESONANCE IMAGING(MRI)0.510000.49000
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 (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
CLATSOP CARE CENTER HEALTH DISTRICT
947 OLNEY AVEASTORIAOR9710393072504120960HOSPICE HOUSE
ASTORIA SCHOOL DISTRICT
785 ALAMEDAASTORIAOR9710393600029710000PLAYGROUND EQUIPMENT AT LOCAL SCHOOL
ASTORIA BICENTENNIAL CELEBRATION
101 15TH STASTORIAOR971039304538587500SPONSORSHIP

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE I, PART I, LINE 2:Identifier
ExplanationA CMH EMPLOYEE IS ASSIGNED TO MANGAGE THE GRANT 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 Payment0SeverancePayment
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
2680960000000264750294571000
LESLIE BLASEWITZ
1408990007900113530123670165409000
ERIK THORSEN
23146901000030578020832043870288266000
RANDALL JOHNSON
264209000002500213930285852000
KIMBERLY S ELTZROTH
2419020005000078180113790266099000
SAM K LIU
24313900041670161150213930284814000
WILLIAM C LACOST
45000800027000099690264750513452000
TERRY FINKLEIN
194505033000178202500210160220853000

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1AASTORIA GOLF AND COUNTRY CLUB DUES FOR OFFICERS TERRY FINKLEIN AND ERIK THORSEN WERE PAID BY THE ORGANIZATION.
PART I, LINE 1B
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 Fund211241AmountInReserveFund
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 Agreements0AnyResearchAgreements
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
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 (3 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
WILLIAM C LACOST
EDUCATION AND HOUSING ASSISTANCEX$120,000001
KIMBERLY S ELTZROTH
HOUSING ASSISTANCEX$15,000001
SAM LIU
HOUSING ASSISTANCEX$15,000001

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
RANDY STEMPER
CMH BOARD MEMBER4449OWNER OF ASTORIA BUILDER'S SUPPLY. COMPETITIVELY BID AGAINST OTHER SUPPLIERS FOR RICKENBACH CONSTRUCTION. RICHKENBACH CONSTRUCTION CONTRACTED WITH CMH TO COMPLETE THE THIRD FLOOR TENANT IMPROVEMENTS OF THE NEW PAVILION BUILDING.0
HEATHER SEPPA
CMH BOARD MEMBER6834PRESIDENT OF BANK OF ASTORIA WHERE THE HOSPITAL HAS SEVERAL BANK ACCOUNTS AND PAYS ROUTINE BANKING TRANSACTION FEES.0

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (8 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
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.
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 12C
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 B, LINE 15
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 VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 530,158. DEFINED BENEFIT RETIREMENT PLAN ADJUSTMENT -453,740. TOTAL TO FORM 990, PART XI, LINE 5: 76,418.FORM 990, PART XI, LINE 5:
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.FROM 990, PART XI LINE 2C:
KEY STATISTICS FOR 2010: INPATIENT ADMISSION INCLUDING NEWBORNS: 2,117 INPATIENT DAYS INCLUDING NEWBORNS: 6,015 SURGERY PATIENTS: 2,752 ANCILLARY VISITS: 35,120 LABORATORY TESTS: 126,200 IMAGING TOTALS: 31,344 CLINIC VISITS: 21,492 EMERGENCY & TRAUMA VISITIS: 13,402 URGENT CARE CLINIC VISITS: 5,665 HOME HEALTH VISITS: 3,292 HOSPICE PATIENT DAYS: 8,623 THE FOLLOWING ARE HIGHLIGHTS OF THE ACHIEVEMENTS IN EACH CATEGORY OF COLUMBIA MEMORIAL HOSPITAL'S MISSION STATEMENT. LEADERSHIP: IN THE PAST TWO YEARS, COLUMBIA MEMORIAL HOSPITAL (CMH) HAS REALIZED A 19% IN THE NUMBER OF OUTPATIENT VISITS DUE TO THE ADDITION OF SEVERAL NEW CLINICS AND SERVICES INCLUDING: URGENT CARE, ORTHOPEDICS, UROLOGY, GENERAL SURGERY, PEDIATRICS, CARDIAC REHABILITATION, INFUSION AND CHEMOTHERAPY. CONSTRUCTION CONTINUED INTO 2010 WITH 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 A 21% 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 SIX PHYSICIANS WERE RECRUITED INTO THE COMMUNITY AND ANOTHER FOUR WERE ADDED IN 2010. 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. A GROUP OF PHYSICIANS DRIVES OUR ACTIVE "QUASAR" COMMITTEE, FOCUSING ON PATIENT OUTCOMES AND DEVELOPMENT OF ACTION PLANS TO ENSURE EXCELLENCE IN PATIENT CARE. IN ADDITION, PEER REVIEWS ARE CONDUCTED THROUGHOUT THE HOSPITAL ON A ROUTINE BASIS FROM OTHER HEALTHCARE FACILITIES. PATIENT OUTCOMES AND OTHER QUALITY MEASURES ARE ALSO 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. CMH REMAINED A JOINT COMMISSION (JCAHO) ACCREDITED HOSPITAL THROUGHOUT 2010. THIS IS NO SMALL TASK WITH THE INCREASED REQUIREMENTS TO PASS RIGOROUS QUALITY, SAFETY, AND COMPLIANCE AUDITS. SURVEYORS ARRIVE UNANNOUNCED TO PERFORM A MULTITUDE OF "TRACERS" 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" 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, AND A FAMILY ROOM. A COMMITTEE 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.FORM 990 PART III, 4A: STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
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 XI, LINE 2C:

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 VENTUREORRELATED2885191736039000.51000
COASTAL HEALTH ASSURANCE
2111 EXCHANGE STREETASTORIAOR97103911818894PHOOR-4621145000.49000
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 (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
COLUMBIA MEMORIAL HOSPITAL FOUNDATION (IN-KIND CONTRIBUTION)
B119924ACTUAL
COLUMBIA MEMORIAL HOSPITAL FOUNDATION (IN-KIND CONTRIBUTION SALARY EXP)
N150380ACTUAL
ASTORIA IMAGING LLC (SALARY EXPENSE FOR MRI MNGMT TECHS & REGISTRATION)
N205029ACTUAL
COLUMBIA MEMORIAL HOSPITAL FOUNDATION
C513162ACTUAL