2025-11-04T14:08:03-06:00 2024-12-31 390859910 BAKER TILLY ADVISORY GROUP LP 805 SW BROADWAY STE 1400 PORTLAND OR 97205 990 2024-01-01 931091701 COLUMBIA MEMORIAL HOSPITAL FOUNDATION COLU 5033254321 2111 EXCHANGE STREET ASTORIA OR 97103 JOHN CRAWFORD SECRETARY/TREASURER 5033254321 2025-11-04 1 1 WENDY CAMPOS P00448102 5032421447 2025-10-29 2024 2025-03-06 01:10:19Z ERIK THORSEN 2111 EXCHANGE STREET ASTORIA OR 97103 2166202 0 X WWW.COLUMBIAMEMORIAL.ORG/GIVING/CMH-FOUNDATION/ X 1991 OR COLUMBIA MEMORIAL HOSPITAL FOUNDATION (CMHF), WAS CREATED TO SUPPORT COLUMBIAN LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL (CMH) (EIN #93-0583856). FUNDRAISING REVENUES ARE RELEASED TO CMH TO COVER THE COSTS OF CERTAIN PROGRAMS AND EQUIPMENT. SALARIES, PAYROLL TAXES, BENEFITS AND OTHER ADMINISTRATIVE EXPENSES ARE PAID BY CMH AS AN IN KIND CONTRIBUTION TO CMHF. CMHF IS ULTIMATELY GOVERNED BY CMH AND THEREFORE CMHF MUST FOLLOW POLICIES OF CMH. 18 17 0 40 0 0 3130210 1579714 0 0 72463 266662 58987 56790 3261660 1903166 43063 35047 0 0 0 0 0 0 0 6564 54340 49627 89387 3212033 1813779 5626341 7641771 13212 12680 5613129 7629091 COLUMBIA MEMORIAL HOSPITAL FOUNDATION ESTABLISHES AND MAINTAINS RELATIONSHIPS THAT GENERATE PHILANTHROPIC SUPPORT TO ENHANCE COLUMBIA MEMORIAL HOSPITAL'S ABILITY TO PROVIDE EXCELLENCE IN HEALTHCARE. 0 0 54223 35047 IN SUPPORT OF COLUMBIA MEMORIAL HOSPITAL (ID: 93:0583856), COLUMBIA MEMORIAL HOSPITAL FOUNDATION (CMHF) RAISED FUNDS WITH THE HELP OF COMMUNITY MEMBERS AND EMPLOYEES. FUNDS THAT WERE RAISED IN 2024 WERE PUT TOWARDS A FUND WHICH WILL ASSIST IN BUILDING THE EXPANSION OF THE HOSPITAL. THIS COLUMBIA MEMORIAL HOSPITAL PROJECT WILL WORK TO EXPAND OUR FACILITIES AND INCREASE OUR SERVICES. 14121 IN SUPPORT OF COLUMBIA MEMORIAL HOSPITAL (ID: 93-0583856), LOWER COLUMBIA HOSPICE (LCH) COLLECTS VARIOUS MEMORIAL DONATIONS FROM THE FAMILIES AND FRIENDS OF DEPARTED PATIENTS PREVIOUSLY IN HOSPICE CARE OR VIA LCH SPONSORED EVENTS LIKE THE ANNUAL RACE TO THE BAR. THESE FUNDS ARE USED TO ASSIST PATIENTS IN HOSPICE CARE. 68344 1 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 2 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 18 17 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X JOHN CRAWFORD 5033254321 2111 EXCHANGE STREET ASTORIA OR 97103 ERIK THORSEN CEO 1.00 40.00 X X 0 849421 57140 MARK KUJALA EXECUTIVE DIRECTOR 4.00 40.00 X 0 167279 38045 BILL GARVIN BOARD CHAIR 4.00 X X 0 0 0 LINDA MORELAND TREASURER & SECRETARY 4.00 X X 0 0 0 AMBER HILL DIRECTOR 4.00 X 0 0 0 AVERY RAWSON DIRECTOR 4.00 X 0 0 0 BETSY JOHNSON EMERITUS DIRECTOR 1.00 X 0 0 0 BREE PHILLIPS DIRECTOR 4.00 X 0 0 0 CHRISTOPHER JONES DIRECTOR 4.00 X 0 0 0 JOHN CRAWFORD DIRECTOR 4.00 X 0 0 0 KIM SUPPLE DIRECTOR 4.00 X 0 0 0 KURTIS BIRDENO DIRECTOR 4.00 X 0 0 0 MICHELLE MURRAY DIRECTOR 4.00 X 0 0 0 MIKE AUTIO EMERITUS DIRECTOR 1.00 X 0 0 0 MIKE BROSIUS DIRECTOR 4.00 X 0 0 0 MIKE MURDOCK MD DIRECTOR 4.00 X 0 0 0 REGINA MYSLIWIEC MD DIRECTOR 4.00 X 0 0 0 ROBERT HOLLAND MD EX-OFFICIO 4.00 X 0 0 0 SARAH ENGLUND DIRECTOR 4.00 X 0 0 0 0 1016700 95185 0 0 0 0 0 85000 1494714 1579714 244143 244143 135974 113455 22519 22519 22519 206371 85000 149581 56790 56790 1903166 0 0 323452 35047 35047 8002 8002 13041 13041 HOSPICE FEES 33297 33297 89387 68344 21043 0 112600 187345 2324547 950446 3180194 6494980 9000 9000 5626341 7641771 13212 12680 13212 12680 X 1758618 2020631 3854511 5608460 5613129 7629091 5626341 7641771 X 1813779 199320 2863 X 0 1 X 1 0 X X 1 COLUMBIA LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL 930583856 3 1 0 0 1 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 SCHEDULE A, PART IV, SECTION A, LINE 6 THE FILING ORGANIZATION MADE GRANTS TO INDIVIDUALS THAT ARE PART OF THE CHARITABLE CLASS BENEFITED BY ITS SUPPORTED ORGANIZATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14 7015 1798293 6812 47411 122889 3757655 1 1 2226 2226 2226 2226 2226 2226 1758 468 2226 1290 468 1758 0.00000 1.00000 0.00000 0 0 0 LONG-TERM ANNUITIES PAYABLE 12680 12680 X PART X, LINE 2: INCOME TAX POSITIONS THAT MEET A MORE-LIKELY-THAN-NOT RECOGNITION THRESHOLD ARE MEASURED AT THE LARGEST AMOUNT OF INCOME TAX BENEFIT THAT IS MORE THAN 50% LIKELY OF BEING REALIZED UPON SETTLEMENT WITH THE APPLICABLE TAXING AUTHORITY. THE PORTION OF THE BENEFITS ASSOCIATED WITH INCOME TAX POSITIONS TAKEN THAT EXCEEDS THE AMOUNT MEASURED AS DESCRIBED ABOVE WOULD BE REFLECTED AS A LIABILITY FOR UNRECOGNIZED INCOME TAX BENEFITS IN CHARITIES' CONSOLIDATED BALANCE SHEETS ALONG WITH ANY ASSOCIATED INTEREST AND PENALTIES THAT WOULD BE PAYABLE TO THE TAXING AUTHORITIES UPON EXAMINATION. INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS WOULD BE CLASSIFIED AS INCOME TAXES IN CHARITIES' CONSOLIDATED STATEMENTS OF OPERATIONS. THERE WERE NO UNRECOGNIZED INCOME TAX BENEFITS, NOR ANY INTEREST AND PENALTIES ASSOCIATED WITH UNRECOGNIZED INCOME TAX BENEFITS, ACCRUED OR EXPENSED AS OF AND FOR THE YEARS ENDED DECEMBER 31, 2024 AND 2023. DIAMOND DERBY 291371 85000 206371 45240 25824 78517 291371 85000 206371 45240 25824 78517 149581 56790 0 FRIENDSHIP FUND GRANTS 30 28235 EMERGENCY FINANCIAL ASSISTANCE PROVIDED TO EMPLOYEES WHO ARE EXPERIENCING PERSONAL FINANCIAL CRISIS. ARM IN ARM AGAINST CANCER GRANTS 23 6812 TO PROVIDE ASSISTANCE TO CANCER PATIENTS FOR SUPPORT AND FOLLOW UP TREATMENTS. X X 0 1 0 0 0 0 0 0 0 ERIK THORSEN CEO 0 600994 0 115035 0 133392 0 31515 0 25625 0 906561 0 0 MARK KUJALA EXECUTIVE DIRECTOR 0 137464 0 15036 0 14779 0 13945 0 24100 0 205324 0 0 PART I, LINE 4B ERIK THORSEN, CEO, IS PARTICIPATING IN A 457(F) PLAN OF A RELATED ORGNIZATION WHICH STARTED IN 2015. COLUMBIA MEMORIAL HOSPITAL CONTRIBUTED $78,843 TO THE PLAN IN 2024. CONTRIBUTIONS ARE MADE THROUGHOUT THE YEAR AND DISTRIBUTED AT THE BEGINNING OF THE FOLLOWING YEAR. THE DISTRIBUTION IS INCLUDED IN TAXABLE INCOME. PART I, LINE 3 COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE: COMPENSATION OF ALL OFFICERS IS REVIEWED WITH COMPARABILITY DATA BY A THIRD PARTY CONSULTANT. THE RESULTS OF THE STUDY ARE REVIEWED AND DISCUSSED AT THE BOARD OF TRUSTEES MEETING. PART 1, LINE 1A DISCRETIONARY SPENDING ACCOUNT: BASED ON SIGNED EMPLOYMENT CONTRACTS, COLUMBIA MEMORIAL HOSPITAL PAID ONE LUMP SUM PAYMENT ON THE FIRST PAY-PERIOD OF EACH YEAR TO COVER DISCRETIONARY EXPENSE OF ERIK THORSEN, CEO. IN ADDITION, COLUMBIA MEMORIAL HOSPITAL PAID TO COVER THE CEO CAR, WHICH IS INCLUDED IN TAXABLE INCOME. AMOUNTS FOR THE DISCRETIONARY SPENDING ACCOUNT ARE ALSO INCLUDED IN TAXABLE INCOME. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: BASED ON SIGNED EMPLOYMENT CONTRACTS, COLUMBIA MEMORIAL HOSPITAL REIMBURSED MONTHLY COUNTRY CLUB MEMBERSHIP DUES FOR ERIK THORSEN, CEO AND ROTARY CLUB DUES FOR ERIK THORSEN, CEO. THESE EXPENSES WERE SUBMITTED ON MONTHLY EXPENSE REPORTS OR DIRECT INVOICES FROM THE CLUB AND WERE REVIEWED AND APPROVED IN ACCORDANCE WITH THE ORGANIZATION'S FINANCIAL AUTHORITY POLICY AND BUSINESS EXPENSE POLICY. FORM 990, PART V, LINE 1A,B AND 2A SINCE ALL ACCOUNTS PAYABLE, PAYROLL AND PAYROLL TAXES ARE INITIALLY PAID BY CMH. W-2 AND W-3 FORMS ARE FILED BY CMH. SOME EXPENSES ARE LATER REIMBURSED BY CMHF. FORM 990, PART VI, SECTION A, LINE 6 COLUMBIA MEMORIAL HOSPITAL IS THE SOLE MEMBER OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A COLUMBIA MEMORIAL HOSPITAL HAS THE POWER TO APPOINT AND REMOVE MAJORITY OF BOARD MEMBERS OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B GOVERNANCE DECISIONS ARE SUBJECT TO APPROVAL BY THE COLUMBIA MEMORIAL HOSPITAL BOARD OF TRUSTEES. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE 990 IS PROVIDED TO ALL BOARD OF TRUSTEE MEMBERS FOR REVIEW AND DISCUSSION PRIOR TO FINALIZING AND FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD OF DIRECTORS. ALL BOARD MEMBERS MUST SIGN AND DATE THE CONFLICT OF INTEREST POLICY ACKNOWLEDGEMENT, QUESTIONNAIRE AND DISCLOSURE STATEMENT. ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST AT THE BOARD LEVEL ARE DISCUSSED AT THE BOARD MEETING. ACTUAL CONFLICT OF INTERESTS ARE ADDRESSED, DOCUMENTED AND FILED IN A CONFIDENTIAL PERSONNEL FILE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF ALL OFFICERS WAS REVIEWED WITH COMPARABILITY DATA BY A THIRD-PARTY CONSULTANT. THE RESULTS OF THE STUDY WERE REVIEWED AND DISCUSSED AT A BOARD OF TRUSTEES' MEETING OF A RELATED ORGANIZATION, CMH. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL INFORMATION ARE AVAILABLE UPON REQUEST AT COLUMBIA MEMORIAL HOSPITAL. FORM 990, PART XI, LINE 9: DONOR RESTRICTED GAIN 2,863. COLUMBIA LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 930583856 HEALTHCARE PROVIDER OR 501(C)(3) LINE 3 N/A 0 CMH AUXILIARY 2111 EXCHANGE STREET ASTORIA OR 97103 931306211 HOSPITAL GIFT SHOP OR 501(C)(3) LINE 12A, I COLUMBIA LUTHERAN CHARITIES DBA COLUMBIA MEMORIAL HOSPITAL 0 COASTAL HEALTH ASSURANCE INC 2111 EXCHANGE STREET ASTORIA OR 97103 911818894 PHYSICIAN ASSOCIATION, MEDICAL CONTRACT MANAGEMENT OR N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0