2019-11-14T18:19:08-06:00 2018-12-31 KPMG LLP 1212 NORTH 96TH ST STE 300 Omaha NE 68114 990 2018-01-01 470379754 Children's Hospital & Medical Center % AMY HATCHER CHIL 4029556795 8200 DODGE STREET OMAHA NE 68114 AMY HATCHER CFO 4029556795 2019-11-14 true DONALD NEAL JR P00798244 4023481450 167.68.102.5 47006120193185000003 2019-11-14 P 65CF9D49F64C2267637B54237ED8CC7527705457 55718AD0153E791F3315D72D27656E543FED7AC8 2018 2020-01-14 16:20:31Z Rodrigo Lopez 8200 Dodge Street Omaha NE 68114 443614039 false X WWW.CHILDRENSOMAHA.ORG X 1948 NE CHILDREN'S HOSPITAL & MEDICAL CENTER DELIVERS EXTRAORDINARY CARE TO CHILDREN, EDUCATES HEALTH CARE PROFESSIONALS, AND PROMOTES PEDIATRIC RESEARCH 21 20 3409 238 194368 950277 5256733 4858054 380389206 422904596 -49047 629335 15504872 15222054 401101764 443614039 11048713 19154203 0 0 187415316 207855199 0 0 0 156979984 162223280 355444013 389232682 45657751 54381357 521346658 542357225 249964067 263982931 271382591 278374294 X TO IMPROVE THE LIFE OF EVERY CHILD - THROUGH DEDICATION TO EXCEPTIONAL CLINICAL CARE, RESEARCH, EDUCATION AND ADVOCACY. false false 315636908 19154203 435296499 THE HOSPITAL OPERATES A 145-BED PEDIATRIC HOSPITAL, WHICH INCLUDES SEVEN SURGICAL SUITES, A STATE OF THE ART HYBRID HEART CATHETERIZATION LAB, AN OUTPATIENT SURGERY CENTER, A HEART TRANSPLANT PROGRAM AND A FETAL CARE CENTER THAT FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. THE HOSPITAL WAS RECOGNIZED BY U.S. NEWS AND WORLD REPORT IN FIVE SPECIALTIES FOR CARDIOLOGY AND HEART SURGERY, PULMONOLOGY, GASTROENTEROLOGY AND GI SURGERY, ORTHOPEDICS, DIABETES, AND ENDOCRINOLOGY. CHILDREN'S SPECIALTY PEDIATRIC CENTER OFFERS MORE THAN 50 OUTPATIENT SPECIALTY CLINICS, PROVIDING DIAGNOSTICS, TREATMENT, AND THERAPY. IN ADDITION, CHILDREN'S PROVIDES OUTPATIENT BEHAVIORAL HEALTH AND A FULL ARRAY OF PEDIATRIC HOME HEALTHCARE SERVICES TO CHILDREN AND ADOLESCENTS WHO HAVE IMMEDIATE OR LONG-TERM HEALTH CARE NEEDS, INCLUDING HOME MEDICAL EQUIPMENT RENTALS AND SALES, HOME HEALTH NURSING, IN-HOME PRIVATE DUTY NURSING, AND HOME INFUSION THERAPY SERVICES. THE HOSPITAL IS HOME TO THE REGION'S ONLY LEVEL IV NEWBORN INTENSIVE CARE UNIT AND THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT WITH LEVEL II PEDIATRIC TRAUMA VERIFICATION. THE HOSPITAL ALSO PROVIDES SPECIALTY PEDIATRIC CARE SERVICES IN COMMUNITIES ACROSS A FIVE-STATE REGION. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE FIRST AND ONLY PEDIATRIC HOSPITAL IN NEBRASKA, AND THE ONLY PEDIATRIC HOSPITAL SERVING WESTERN IOWA AND NORTHWEST MISSOURI, TO RECEIVE PEDIATRIC TRAUMA VERIFICATION. 315636908 true true false true false false false false false true true false true false true true false true false false false false false false false false true true true true true true false false false false false false false false true false false false false false false true true true false false true 167 0 true 3409 true true true false false false false false false false false false true false X 21 20 false false false false false false false true true false false false true true true true true true true false X AMY HATCHER 4029556795 8200 DODGE STREET OMAHA NE 68114 X Rodrigo Lopez Chair 1.0 0.0 X X 0 0 0 Diane Duren Vice Chair 1.0 0.0 X X 0 0 0 Margaret Hershiser Secretary 1.0 0.0 X X 0 0 0 Jim Greisch Treasurer 1.0 0.0 X X 0 0 0 Richard Azizkhan MD President, CEO, 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Schedule D, Part X, Line 2 FIN 48 FOOTNOTE THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. 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X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X true X false false Schedule H, Part V, Line 5 AS PART OF THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY CONDUCTED ON BEHALF OF CHILDREN'S HOSPITAL & MEDICAL CENTER, BOYS TOWN NATIONAL RESEARCH HOSPITAL AND BUILDING HEALTHY FUTURES, KEY INFORMANTS (INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY) WERE CONTACTED BY EMAIL, INTRODUCED TO THE COMMUNITY HEALTH NEEDS ASSESSMENT KEY INFORMANT SURVEY AND PROVIDED A LINK TO TAKE THE SURVEY ONLINE; REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. SUPPORTING ORGANIZATIONS FOR THE CHNA INCLUDED: CHARLES DREW HEALTH CENTER, INC., DOUGLAS COUNTY HEALTH DEPARTMENT, LIVE WELL OMAHA, AND ONE WORLD COMMUNITY HEALTH CENTERS, INC. THESE POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS AMONG THE FAMILIES AND CHILDREN/ADOLESCENTS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. IN ALL, 166 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY, REPRESENTING COMMUNITY/BUSINESS LEADERS, PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, SOCIAL SERVICE PROVIDERS AND OTHER HEALTH CARE PROVIDERS. THESE KEY INFORMANTS REPRESENT ORGANIZATIONS THAT WORK WITH LOW-INCOME, MINORITY POPULATIONS, MEDICALLY UNDERSERVED POPULATIONS AND INDIVIDUALS WITH CHRONIC DISEASE CONDITIONS. Schedule H, Part V, Line 6a BOYS TOWN NATIONAL RESEARCH HOSPITAL Schedule H, Part V, Line 6b BUILDING HEALTHY FUTURES, CHARLES DREW HEALTH CENTER, INC., DOUGLAS COUNTY HEALTH DEPARTMENT, LIVE WELL OMAHA, AND ONE WORLD COMMUNITY HEALTH CENTERS, INC. Schedule H, Part V, Line 7a HTTPS://WWW.CHILDRENSOMAHA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-AD VOCACY/ Schedule H, Part V, Line 10A HTTPS://WWW.CHILDRENSOMAHA.ORG/WP-CONTENT/UPLOADS/2018/05/201618CHNAIMPLEM ENTATION.PDF Schedule H, Part V, Line 11 On November 29, 2018, the Board of Directors of Children's Hospital & Medical Center (Children's), which includes representatives from throughout the community, met to discuss this plan and the internal and external prioritization input for addressing the community health priorities identified through the 2018 Community Health Needs Assessment (CHNA). The Executive Committee has the power to transact all regular business of Children's. Upon review, the Executive Committee of the Board of Directors approved and adopted this CHNA and instructed Children's Center for the Child & Community (the Center) to develop a new implementation strategic plan for 2019-2021 to undertake these measures to meet the health needs of the community. Significant Health Needs of the Community 2018 Based on the information obtained through the Child & Adolescent CHNA and the guidelines set forth in Healthy People 2020, the following "Areas of Opportunity" represent the significant health needs of children and adolescents in the community. From these data sets, opportunities for children's health improvement exist in the area with regard to the following health issues. Areas of Opportunity Identified through this 2018 CHNA * Access to Health Services: - Difficulty Accessing Children's Healthcare - Finding a Physician - Appointment Availability - Lack of Transportation - Cost of Prescriptions * Cognitive & Behavioral Conditions: - Autism Prevalence - Cognitive & Behavioral Conditions ranked as a top concern in the Online Key Informant Survey. * Diabetes: - Childhood Diabetes Prevalence * Injury & Violence: - Age 1-4 Mortality - Children Exposed to Neighborhood Violence - Children Feeling Unsafe at School or Going To/From School * Mental Health: - Symptoms of Depression [ages 5-17] - Suicide Attempts [High Schoolers] - Diagnosed Anxiety [ages 5-17] - Chronic Worrying [ages 5-17] - Child Has Difficulty Sleeping [ages 5-17] - Lived with Someone with Serious Mental Health Issues - Family Stays Hopeful in Difficult Times - Mental & Emotional Health ranked as a top concern in the Online Key Informant Survey. * Neurological Conditions: - Brain Injuries/Concussions * Oral Health: - Condition of Teeth * Nutrition, Physical Activity, & Weight: - Overweight & Obesity - Fast Food Consumption - Nutrition, Physical Activity, and Weight ranked as a top concern in the Online Key Informant Survey. * Sexual Health: - Gonorrhea Incidence [Children/Adults] - Chlamydia Incidence [Children/Adults] - Condom Use [High Schoolers] - Use of Birth Control [High Schoolers] - Sexual Health ranked as a top concern in the Online Key Informant Survey. * Tobacco, Alcohol & Other Drugs: - Member of Household Smokes - Drinking & Driving [High Schoolers] - Lifetime Illicit Drug Use [High Schoolers] - Steroids (not Rx) - Heroin * Vison, Hearing, & Speech Conditions: - Recent Eye Exams - Chronic Ear Infections - Prevalence of Speech/Language Problems - Hearing Problems Based on the top health priorities identified through the 2015 CHNA process - and taking into account hospital resources and overall alignment with the hospital's mission, goals and strategic priorities - Children's focused on developing strategies and initiatives to improve: - Access to health care services - Injury and violence - Mental health - Nutrition, physical activity, & weight - Oral health - Vision, hearing & speech conditions - Asthma & other respiratory conditions - Sexual health In acknowledging the wide range of priority health issues that emerged from the CHNA process, Children's determined that it could only effectively focus on those which it deemed most pressing, most under-addressed and most within its ability to influence. Children's then created a 3-year implementation plan, to be carried out from 2016 through 2018, to address each strategic priority across our continuum of care, and identified appropriate resources to be included in each year's appropriate budget. 2018 Progress Summary Children's continues to progress in implementing the action plan that resulted from the 2015 Community Health Needs Assessment (CHNA) findings. Our team is working collaboratively across the organization to focus on hospital-based programs and services, community-based programs and partnerships that address each priority health issue identified through the CHNA process, guided by key strategies and specific tactics. Children's Center for the Child & Community serves as the infrastructure for community outreach activities. While each health issue is entirely unique, there is a common thread that connects them all: Children's is tasked to improve access to health care services, outreach and education to the community and the overall patient experience. Below are implementation highlights from each area that indicate how Children's is positively impacting the health needs of children and teens in our community. Children's Center for the Child & Community The Center is a statewide community health outreach hub of Children's, providing the infrastructure and leadership for both the internal and external partnerships around the pediatric CHNA planning and implementation. In 2018, the Center expanded its efforts to improve pediatric health statewide. Headquartered in Lincoln, Neb., Children's Center aims to integrate health care and public health efforts. The Center collaborates with communities across Nebraska to create local solutions to large-scale children's health issues, such as childhood obesity, poverty, injury prevention and food insecurity. Eight statewide strategic partnerships were formalized in 2018. Our strategic emphasis continues in the area of childhood obesity prevention, nutrition, physical activity and weight, which was the number one concern of community parents in the 2015 assessment. In another strategic effort, during 2018, Children's Preventing Childhood Obesity Community Grant program continued their learning collaborative led by Children's Center for the Child & Community and the Gretchen Swanson Center for Nutrition. The collaborative included skill building and technical assistance in the areas of planning, community engagement sustainability and data management. Children's also renewed seven "Preventing Childhood Obesity Community Scholarships" ($1,000 each) to college-bound high school seniors who plan to pursue a career related to health and wellness, with a significant focus on children. The other strategic efforts of the Center in the area of nutrition and physical activity are listed below in the 2018 highlights section. * Nutrition, Physical Activity & Weight - The Center launched a second Project ECHO (Extension for Community Healthcare Outcomes), a statewide learning collaborative that connects primary care providers across Nebraska with Children's specialists and leading national experts through free biweekly, online educational sessions on mental behavioral health. - Children's offered educational opportunities through Project ECHO that included free continuing medical education (CME) credits and optional participation in Maintenance of certification (MOC) Part IV quality improvement project through Children's. - Children's continues to bring health education into Omaha and southwest Iowa metro schools while expanding into Lancaster County classrooms through its sponsorship of GoNoodle, an online resource that helps local educators teach nutrition and physical activity. In 2018, 392 schools, 70,828 students and 3,260 teachers participated, logging more than 7.8 million minutes of movement. - Children's continued to provide Go NAP SACC (Nutrition and Physical Activity Self-Assessment for Child Care) technical assistance and training to childcare facilities statewide. Go NAP SACC is a partnership with Nebraska Department of Health and Human Services (NE DHHS) and is a component of the Step Up to Quality program for day care providers. The focus is to build healthy eating and physical activity habits in children within the childcare setting. In 2018, 25 Go NAP SACC trainers reached 280 early care & education professionals in 111 child care centers and homes that care for approximately 4,000 children. - In July 2018, the ENERGY Rx fitness program launched utilizing a newly created ENERGY Playbook. The Fitness program is a collaboration between the Center, the Lincoln YMCA, HEROES (Healthy Eating with Resources, Options and Everyday Strategies) pediatric weight management program, and primary care practices. This is a twice-weekly exercise program designed specifically for overweight and obese children. This new program has a research component in collaboration with the UNMC College of Public Health. (continue...) Schedule H, Part V, Line 11 (continued) - In 2018, Children's, in partnership with University of Nebraska - Lincoln (UNL) Extension, three farmer's markets, and one grocery store, continued the Double Up Food Bucks program. The effort increased the purchase of fresh fruits and vegetables by SNAP recipients in select Lincoln areas. Plans are underway to merge with other efforts, with a possible program expansion to other statewide sites. - Children's HEROES program continues to provide multidisciplinary clinical intervention for young people already experiencing medical complications from childhood obesity. The program includes Nebraska sites both in Omaha and Lincoln. - Other strategic tactics include Parenting U, a series of free parent education classes with topics focused on healthy eating and obesity prevention. * CHNA and Health Improvement Planning - In 2018, the management of the CHNA and health improvement planning processes transitioned to the Center. The Center has improved the process by revising the community survey to include more questions related to the social determinants of health. The Center engaged the community, especially the systems related to child health, and continues to collaborate with community stakeholders. * Early Childhood Health within communities - The Center led an Early Childhood Comprehensive Health Working Group (ECCHWG) and grew membership from an initial ten members representing six organizations to 70 individuals representing 38 organizations. (1) In collaboration with the ECCHWG and more than 100 community members, the Center completed an assessment using the MAPP (Mobilizing for Action through Planning and Partnerships) framework aimed specifically at early childhood. Together, they envisioned, "What are important characteristics/elements of a community where children are healthy and Kindergarten-ready?" (2) In 2018, the Center, along with ECCHWG, produced several issue briefs on community strategic issue, and explored a sustainable model to improve early childhood health via the Help Me Grow Model from Connecticut Children's Medical Center. (3) Dr. Karla Lester, the medical director for the Center, continues to serve as a Governor-appointed member to the Nebraska Early Childhood Interagency Coordinating Council (ECICC) which advises state government on improvement of services affecting young children and their families. * Literacy Improvement Program: - Four Children's Physicians (CP) offices (Creighton, Plattsmouth, Spring Valley, and UNMC) participated in Reach Out and Read, a nationally recognized program to improve literacy thanks to a donation made to CP. During well visits, 4,423 books were distributed since January 2018 (Creighton 709, Plattsmouth 868, Spring Valley 1,763, and UNMC 1,083). Priority Health Issues: Progress Highlights * Access to Health Care Services - CP's primary care network expanded into a Kearney, Neb., office location in July 2018; this is nearly 200 miles west of the main hospital in Omaha. This expansion increased access to pediatric health care services. - Walk-in services continued to expand within CP offices in 2018 with expanded walk-in physical days - four locations, two days; and have added walk-in flu vaccine clinics in all clinics on Saturdays. In addition, the ability to give caregiver/parent vaccine was added this past year. - CP implemented specialty visits at the CP office in Kearney - starting with Gastroenterology and Psychiatry. - In collaboration with behavioral health, there was expanded tele-psychiatry ability at several primary care offices. - In 2018, a consultant (Huron) worked with Children's Specialty Physicians (CSP) teams to increase efficiencies throughout outpatient specialty clinics and scheduling including a focus on early morning and evening visit times for family convenience. - Expanding the number of physician and advanced practice providers was another key strategy to improve access which is ongoing and actively occurring at Children's. The cardiology, pulmonology, palliative care, endocrinology, hemotology/oncology, gastroenterology, sports medicine, and neurology all added provider staff in 2018. - Across the Children's enterprise, 1,794 virtual care visits were performed in 2018. 97 percent of these visits were for Behavioral Health care while five other visit types were piloted (ADHD follow up, post-operative visit, lactation, rounding at Ambassador Health of Omaha and Lincoln Specialist visits). - An increasing number of outreach specialty clinic visits were held in 2018, with a few located greater than 50 miles away from the main campus (Lincoln, NE, Sioux City, IA and Dennison, IA). - The number of Children's outreach specialty clinic visits totaled 14,504 in 2018. * Care Transitions Team - There continues to be ongoing significant expansion in our Care Transitions department. This involves the outpatient and inpatient integration of social workers and nurse case managers across the continuum of care to assist children and their families in psychosocial aspects that affect health. o The care transitions focus in 2018 was to establish an enterprise-wide, patient-centered care coordination program that ensured high-risk and at-risk children were in the right setting to receive the right care across the entire continuum of care. The goal was to help children and their families manage their health, maintain their independence and improve their quality of life. o Ongoing 2018 initiatives to help reduce misuse of emergency department services: - Nurse case managers in the outpatient clinics reviewed frequent Emergency Department (ED) patients to determine if intervention would be appropriate and conducted a follow up phone call with patients that were seen in the ED. If appropriate, they were provided a level-of-care brochure and a listing of Urgent Care locations. - The ED care coordination team continued to offer care coordination in the ED seven days a week. - Care coordination teams across the enterprise continued to utilize Preliminary Risk Scores within the electronic health record to alert care coordination ED team members to review the patient chart and potentially meet with the family while they were in the current visit to provide appropriate interventions and supports. o To assess the Social determinants that affect health outcomes: - In 2018, CP expanded screening for food and housing insecurities during well-visits; these are known Social Determinants of Health (SDOH). There were 1,267 positive responses indicating food or housing insecurity. 60 percent were food-related and 40 percent were housing-related. Each location within CP had positive responses. * Injury & Violence Prevention - Children's Injury Prevention team provided 318 car seat checks in Children's fitting station in 2018. Children's provided another 428 car seat checks at community events, and gave out 260 safe car seats to families. - We continued to actively promote and explore increasing the number of community partners to help meet the demand for car seats and car seat education. Children's is working on grants to increase the number of Child Passenger Safety Technicians who will work in the growing immigrant and refugee populations in the area. Children's is also pursuing more car seat grants in order to provide more families with a safe car seat that fits their child. - In 2018, the emphasis on community outreach to increase child passenger safety seat checks through multiple community events has been implemented. Several of these events are specifically located and directed to the under-resourced Latino population in the Douglas County area. - A total of 905 children received free helmets and bike safety education from Children's in 2018. Hundreds more children were educated on safe bicycle skills and helmet use. - Children's continued to promote water safety/drowning prevention through partnership with the Joshua Collingsworth Memorial Foundation and Omaha Parks & Recreation. This initiative recognized a 24 percent reduction of total lifeguard rescues after life vest education was provided to all Omaha public pools. - In 2018, Children's significantly expanded Project Austin, a trauma outreach initiative that prepares rural hospitals and EMS providers to develop an emergency plan for each child and to have skill and knowledge training for the care of a medically complex child in their community. The program has newly enrolled 338 patients and has 529 actively enrolled patients. (continue...) Schedule H, Part V, Line 11 (continued) * Mental and Behavioral Health - Children's Behavioral Health expanded use of Tele-health services, improving access to care. More than 2,000 patients were seen in 2018 due to additional access hub sites. This is projected to eclipse 2,500 patients in 2019. - In 2018, Children's continued to partner with Westside Public Schools to continue the Student Assistance Program - a school-based mental health service that connects district families with Children's behavioral health team. This program saw 180 student referrals from the district during 2018 (approximating second semester 2017-2018 school year and 2018-2019 school year first semester). - In 2018, Children's also expanded behavioral health services into all CP primary care offices, resulting in more than 200 new patients. Children's also integrated behavioral health services into two oncology clinics as well as the Endocrinology DRIVE (Diabetes Resilience Independence Value and Empowerment), Cystic Fibrosis and Ulcerative Colitis/Crohn's outpatient clinics. - These efforts have allowed Children's Behavioral Health to log approximately 18,820 patient visits in 2018, an increase of approximately 19 percent from 2017. - In 2018, led by the Behavioral Health and Child Life team, the new Patient Assistance Team at Children's Hospital & Medical Center (PATCH) process created a pathway that facilitates communication between parents of Autism Spectrum Disorder, impacted patients and hospital staff. This helps ensure patient needs are clearly and efficiently identified and necessary modifications can be made to the care plan. A pilot PATCH process has begun within the outpatient surgical center and radiology departments, and has been well received by families and staff. Expansion throughout the enterprise is projected for 2019. * Oral Health - Oral health education is included in newborn booklets and discussions regarding oral health and dental home are incorporated into 12-month and 24-month well-check visits at CP locations. - Children's nursing case managers work with patients and families on the importance of pediatric oral health especially having a family dentist on an ongoing basis. - Children's continues to provide space within its Specialty Pediatric Center and the Outpatient Surgical Care suite for the UNMC College of Dentistry to treat children throughout the area with comprehensive oral health needs. * Vision, Hearing & Speech Conditions - Vision screenings are performed at 3-Year well-check visits, and hearing screenings are performed for each patient once between the 4-year and 6-year well-check visit at all CP locations. - In September 2018, Children's launched its Visionmobile, a mobile vision unit outfitted especially for pediatric vision care. The Visionmobile mission is to improve access to vision services for the underserved population, and its work first began at Omaha Public Schools. The program team included a full-time optometrist, an optician, care coordinator and van driver. During 2018, the Visionmobile visited 13 schools, providing comprehensive eye exams for 748 students and prescribing 427 pairs of glasses. Children's also provided and dispensed more than 100 pairs of glasses due to pairs being lost or broken. - The Child Vision Collaborative has been convened by Children's to connect with community child vision advocates. - Children's utilized five Colleges of nursing and allied health and interdisciplinary studies students to provide the manpower for vision screening. A Vision screening coordinator provided oversight and coordination of the events. In 2018, 14,642 students in 24 schools were screened for vision. In the first semester of the 2018-2019 school year, 39 percent of the children failed the vision screening and required a comprehensive eye exam, which is higher than the national average of 25 percent. * Asthma & Other Respiratory Conditions - Children's Project AIR (Asthma in-home Response) program is an ongoing collaboration with Omaha Healthy Kids Alliance. The program helps reduce asthma triggers in the home to prevent ED visits and hospitalizations. Patients who are identified have had three or more ED visits. The key collaborators from Children's who are referring families for this intensive healthy home and health environment evaluation and treatment are the CP primary care clinics & the Pulmonology and Allergy Clinics. - Children's Healthy Planet Asthma Project is progressing with the implementation of electronic health record improvements to enable better tracking of patients diagnosed with asthma. Work continues across the continuum with the care management program to reduce ED visits and hospital admissions due to asthma. In 2018, our care coordination team identified 70 patients who met the criteria for participation with 29 patients (41%) who enrolled and followed up with pulmonology or primary care within seven days. * Sexual Health - In 2016, CP developed an Adolescent Task Force to improve adolescent care throughout the organization. A standardized adolescent risk questionnaire assessed sexual health and other health risks (e.g. car safety and substance abuse), and provided an opportunity for the child to indicate they have questions for the provider about their health that may be confidential. The Adolescent Risk Questionnaire - which confidentially asked patients about their health risk behavior choices - was implemented during well visit exams and at other visits where the staff felt it was appropriate. o In 2018, this assessment was expanded to all 15 CP primary care offices. Since the implementation of the Adolescent Risk Questionnaire, Children's has increased the sexually transmitted infection (STI) testing by 85%. - Another barrier to appropriate STI testing was the inability to keep the testing confidential, as the tests are reported out to families by some third party payers on explanation of benefits documents. To address this barrier, CP has participated in a grant with the Women's Fund of Omaha's Adolescent Health Project. The project is designed to address the elevated Chlamydia/Gonorrhea rates in Douglas County amongst the 15-24 year old population as it is one of the highest in the nation. By participating in this grant, the CP offices in the metro Omaha region were able to offer free testing and treatment for their patients. * Women's Fund of Omaha - The Adolescent Health Project through the Women's Fund of Omaha has funded 1,149 Chlamydia/Gonorrhea tests at CP clinics since December 2017, out of the total 1,505 test administered. Participation in the grant has increased STI testing in our clinics by almost 900 tests per year compared to lab volumes prior to participation. Schedule H, Part V, Line 13b PRESUMPTIVE ELIGIBILITY CHILDREN'S RECOGNIZES THAT SOME PATIENTS WILL BE UNRESPONSIVE TO THE CHARITY CARE APPLICATION PROCESS DUE TO A VARIETY OF REASONS INCLUDING BUT NOT LIMITED TO: 1. LACK OF DOCUMENTATION REQUIRED TO COMPLY WITH THE TRADITIONAL CHARITY CARE APPLICATION REQUIREMENTS. 2. LACK OF THE EDUCATIONAL LEVEL TO UNDERSTAND AND COMPLETE THE CHARITY CARE APPLICATION. 3. FEAR THAT INFORMATION GATHERED DURING THE APPLICATION PROCESS WILL BE USED IN THE COLLECTION PROCESS IN THE EVENT THAT THE APPLICATION IS DENIED. 4. OUT OF STATE PATIENTS THAT DO NOT RESPOND TO COMPLETION OF A MEDICAID APPLICATION OR FINANCIAL ASSISTANCE APPLICATION. IN THE ABSENCE OF INFORMATION PROVIDED BY THE PATIENT OR IN CASES WHERE THE INFORMATION PROVIDED BY THE PATIENT IS INCOMPLETE, AN ASSESSMENT PROCESS UTILIZING A PREDICTIVE MODEL WILL BE DEPLOYED TO DETERMINE CHARITY CARE ELIGIBILITY. THE PREDICTIVE MODEL INCORPORATES INCOME AND HOUSEHOLD SIZE ESTIMATES, A SOCIO-ECONOMIC NEED FACTOR (WIC, SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM, HUD PROGRAMS), CENSUS BLOCK DATA, AS WELL AS INFORMATION ON HOME OWNERSHIP. THE APPLICATION OF THE PREDICTIVE SCORING PROCESS AND PRESUMPTIVE FINANCIAL ASSISTANCE WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT FOR ALL PATIENTS THAT HAVE NOT APPLIED FOR CHARITY CARE. CHILDREN'S IS NOT OBLIGATED TO NOTIFY THE PATIENT THAT THEY HAVE RECEIVED PRESUMPTIVE CHARITY CARE. Schedule H, Part V, Line 16a https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part V, Line 16b https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part V, Line 16c https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part V, Line 16j THE POLICY IS PROVIDED TO THE PUBLIC IN SUMMARY AND They are DIRECTED TO VISIT THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE FOR THE FULL POLICY. Schedule H, Part V, Line 24 AT CHILDREN'S, COMMERCIAL INSURERS, GOVERNMENT PAYORS AND SELF-PAY BILLING PARTIES ARE ALL BILLED THE SAME GROSS CHARGE RATE FOR EACH SPECIFIC PROCEDURE PERFORMED. GROSS CHARGES ON A FAP-PATIENT BILL ARE THEN DISCOUNTED ACCORDING TO THEIR FPG ELIGIBILITY WHICH REDUCES OR ELIMINATES THE AMOUNT THE PATIENT IS REQUIRED TO PAY. 2 LINCOLN CLINIC 5930 VANDERVOOT DR STE A LINCOLN NE 68516 PEDIATRIC CLINIC CAROLYN SCOTT RAINBOW HOUSE 7825 FARNAM DRIVE OMAHA NE 68114 MINIMUM TO NO-COST ACCOMMODATIONS FOR FAMILIES OF PATIENTS Schedule H, Part I, Line 3c FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. FINANCIAL ASSISTANCE IS AVAILABLE FOR MEDICALLY NECESSARY PROCEDURES AND SERVICES. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE COSMETIC AND OTHER ELECTIVE PROCEDURES, HELMET CLINIC, EATING DISORDERS PROGRAM AND HEROES WEIGHT MANAGEMENT PROGRAM. CERTIFICATION OR PROOF OF MEDICAID DENIAL IS A REQUIREMENT FOR FINANCIAL ASSISTANCE CONSIDERATION. FINANCIALLY RESPONSIBLE PARTIES WHO SUBMIT A COMPLETE AND VERIFIABLE APPLICATION FOR FINANCIAL ASSISTANCE (INCLUDING PROOF OF MEDICAID DENIAL) WILL BE CONSIDERED FOR FREE OR REDUCED ASSISTANCE ON THE BASIS OF FEDERAL POVERTY GUIDELINES (400% FPL LIMIT). FAMILIES THAT DO NOT QUALIFY FOR INCOME BASED FINANCIAL ASSISTANCE THAT HAVE VERIFIABLE OUT OF POCKET MEDICAL DEBT GREATER THAN 20% OF GROSS INCOME MAY QUALIFY FOR CATASTROPHIC ASSISTANCE LEAVING UP TO 1% OF THE FAMILY'S GROSS INCOME AS THE RESPONSIBILITY. PRESUMPTIVE ELIGIBILITY IS AVAILABLE IN A VARIETY OF CIRCUMSTANCES INCLUDING THE ABSENCE OF DOCUMENTATION REQUIRED TO COMPLY WITH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION REQUIREMENTS. THE PREDICTIVE INCORPORATES INCOME AND HOUSEHOLD SIZE ESTIMATES, A SOCIO-ECONOMIC NEED FACTOR, CENSUS BLOCK DATA, AS WELL AS INFORMATION ON HOME OWNERSHIP. Schedule H, Part I, Line 6a THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE ORGANIZATION. THE VALUES REPORTED IN THE 2018 COMMUNITY BENEFIT REPORT INCLUDE $4.3M IN FINANCIAL ASSISTANCE. Schedule H, Part I, Line 7 EXPLANATION OF THE COSTING METHODOLOGY USED TO CALCULATE SUBSIDIZED HEALTH SERVICES: SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING A COMBINATION OF CHILDREN'S HOSPITAL & MEDICAL CENTER'S COST ACCOUNTING SYSTEM AND A COST TO CHARGE RATIO CALCULATION SIMILAR TO WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. THE REPORTED SUBSIDIZED LOSS REPRESENTS THE DIFFERENCE IN NET REVENUE RECEIVED FROM ALL PAYORS LESS TOTAL OPERATING EXPENSES INCLUDING INDIRECT COSTS APPLICABLE TO EACH DEPARTMENT. UNREIMBURSED MEDICAID COSTS REPORTED ON LINE 7B AND OTHER OPERATING EXPENSE APPLICABLE TO THE DEPARTMENT REPORTED ELSEWHERE ON SCHEDULE H AS A COMMUNITY BENEFIT is EXCLUDED FROM THE OPERATING EXPENSE TOTAL AS ARE BAD DEBT AND NONPATIENT CARE EXPENSE ASSOCIATED WITH EACH DEPARTMENT. INDIRECT COSTS FOR EACH DEPARTMENT WERE CALCULATED BY APPLYING THE MEDICARE COST REPORT OVERHEAD RATE APPLICABLE TO THAT DEPARTMENT TO THE DEPARTMENT'S TOTAL OPERATING EXPENSES EXCLUDING UNREIMBURSED MEDICAID EXPENSES AND/OR ANY OTHER EXPENSE ALREADY REPORTED ELSEWHERE ON SCHEDULE H AS A COMMUNITY BENEFIT. Schedule H, Part I, Line 7G THE ORGANIZATION DID NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES. Schedule H, Part II COMMUNITY BUILDING ACTIVITIES CHILDREN'S HOSPITAL & MEDICAL CENTER SUPPORTS ECONOMIC DEVELOPMENT IN ITS SPONSORSHIP DONATIONS TO ORGANIZATIONS SUCH AS THE NEBRASKA CHAMBER OF COMMERCE & INDUSTRY. Schedule H, Part III, Line 2 DESCRIBE THE METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 & 3: BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE 2018 MEDICARE COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST VALUE. BAD DEBT EXPENSE AT 100% CHARGE VALUE $3,811,345 MEDICARE COST TO CHARGE RATIO X .383 BAD DEBT EXPENSE AT COST $1,459,745 ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY: THIS PROCESS INCLUDES IDENTIFYING CHARITY CARE FINANCIAL ASSISTANCE CODES CONGRUENT WITH THE FINANCIAL ASSISTANCE POLICY THAT WERE CHARGED TO BAD DEBT EXPENSE AT 100% CHARGE VALUE. THIS AMOUNT IS $0 FOR 2018 AND REFLECTS THE EFFORTS OF CHILDREN'S HOSPITAL & MEDICAL CENTER TO ENSURE THAT NO CHILD WITH A MEDICAL NEED IS TURNED AWAY DUE TO INABILITY TO PAY FOR HEALTH CARE. DESCRIBE HOW THE ORGANIZATION ACCOUNTS FOR DISCOUNTS OR PAYMENTS ON PATIENT ACCOUNTS IN DETERMINING BAD DEBT EXPENSE: BAD DEBT EXPENSE IS CREDITED FOR ANY PAYMENT RECEIVED ON ACCOUNTS PREVIOUSLY WRITTEN OFF. Schedule H, Part III, Line 4 ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. IN EVALUATING PATIENT ACCOUNTS RECEIVABLE BY FINANCIAL CLASS, MANAGEMENT REGULARLY REVIEWS AN ANALYSIS OF ITS HISTORICAL COLLECTIBILITY TRENDS ALONG WITH AN AGING OF ACCOUNTS RECEIVABLE. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS, COLLECTIBILITY IS DETERMINED BASED ON A COMBINATION OF HISTORICAL TRENDS AND CONTRACTUAL AGREEMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENTS, MANAGEMENT ANALYZES HISTORICAL TRENDS IN EACH OF ITS PREDETERMINED STAGES OF COLLECTIBILITY AND STATUS OF AGREED-UPON PAYMENT PLANS. THE DIFFERENCE BETWEEN THE STANDARD OR NEGOTIATED DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. Schedule H, Part III, Line 8 MEDICARE 2018 MEDICARE CHARGES REPORTED BY The Centers for Medicare and Medicaid Services (CMS) IN THE PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM FOR PROVIDER FYE 12/31 WERE MULTIPLIED BY THE 2018 COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST OF CARE RELATED TO THE REIMBURSEMENT PAYMENTS REPORTED ON Schedule H, Part III, LINE 5. Schedule H, Part III, Line 9b COLLECTION PRACTICES SELF PAY ACCOUNTS WITH NO VERIFIABLE INSURANCE AND BALANCE AFTER INSURANCE ACCOUNTS ARE CONSIDERED FOR FINANCIAL ASSISTANCE THROUGHOUT THE COLLECTION PROCESS FOR THOSE GUARANTORS WHO ARE FINANCIALLY UNABLE TO PAY, EITHER THROUGH A GOVERNMENT PROGRAM OR THROUGH CHILDREN'S HOSPITAL & MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM. ALL CORRESPONDENCE, INCLUDING STATEMENTS AND COLLECTION LETTERS STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. Schedule H, Part VI, Line 2 2-Needs Assessment Children's Hospital & Medical Center (Children's) uses numerous resources to benchmark, align and conduct assessments of the health care needs of children in the communities we serve. These resources include focused stakeholder input and prioritization, national public health (Healthy People 2020) and pediatric care standards. We also review data from the American Academy of Pediatrics, as listed in our 2018 Community Health Needs Assessment (CHNA) report, and trends as identified by Children's Hospital Association (CHA). During this 2018 Child and Adolescent CHNA, additional community feedback on prioritization of health needs was obtained with leadership and active participation within the Douglas County Mobilizing for Action through Planning and Partnerships (MAPP) process and the Live Well Omaha's 2018 Changemaker summit. Douglas County Health Department and Children's partnered to facilitate a series of strategic assessments (Forces of Change Assessment, a Local Public Health Systems Assessment and a Community Strengths and Themes Assessment) by using the MAPP process. This framework applies strategic thinking to the priority health issues to identify resources to meet the challenges and opportunities. On November 5, 2018, findings from this CHNA were presented at Live Well Omaha's 2018 Changemaker Summit. The Changemaker Summit is the region's largest multi-sector health conference, which gathers more than 170 leaders from across Douglas, Sarpy, Cass and Pottawattamie Counties to celebrate the milestones of our collective work and advance future work while learning from local, regional and national experts. At this event, data was shared reflecting the significant health issues identified from the research and the MAPP process. Individuals' ratings from this summit yielded the following prioritized list of community health needs for children and adolescents in the Omaha metro area: 1. Mental Health 2. Nutrition, Obesity & Physical Activity 3. Access to Health Services 4. Sexual Health 5. Tobacco, Alcohol & Other Drugs Organizations sponsoring or supporting this CHNA will use the information from this CHNA to develop implementation strategies to address the significant health needs in the community. The results of this prioritization exercise will be used to inform the development of action plans to guide community health improvement efforts in the coming years. By using this process in connection with the CHNA data, our community is positioned to improve the efficiency and effectiveness of local public health systems across the region. Several other current clinical assessments include the Pedi-Boost Risk score, a medical and social risk screening for all children who make an encounter with the enterprise. For those children with high or rising risk, a complete psychosocial assessment is performed by our care transition team of social workers or nurse case managers in the outpatient and inpatient setting. Several departments routinely utilize depression screening PHQ9 for those youth 12 and older. A postpartum depression screening is performed at 2 weeks, 2 months and 4 months for primary care well visits. New in 2018, within the primary care well visit is a brief food and housing insecurity screening. Internal resources that assist with the assessment of child health needs are Children's Family Advisory Councils, social workers and nurse case managers, physicians and clinical service units and IT analysts/reporters. An analysis of the information and/or data collected from these various resources is conducted to identify potential gaps in child health needs in the communities served. Needs that align with the hospital's mission and capacity are selected for review by administration, which prioritizes needs and authorizes implementation based on the scope or seriousness of the problem, availability of community resources, availability of funding, and/or alignment with the hospital's expertise and strategic goals. Schedule H, Part VI, Line 3 3-PATIENT EDUCATION OF ELIGIBILITY FINANCIALLY RESPONSIBLE PARTIES WHO EXPERIENCE DIFFICULTY IN MEETING THEIR FINANCIAL OBLIGATIONS WILL BE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGH GOVERNMENT PROGRAMS AND OTHER POTENTIAL FUNDING SOURCES OR ALTERNATIVELY QUALIFIED FOR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS IDEALLY DETERMINED EITHER PRIOR TO SERVICES BEING PROVIDED OR AT THE TIME SERVICES ARE RENDERED AND IS BASED UPON FAMILY/GUARANTOR INCOME, FAMILY SIZE AND OTHER SPECIAL CONSIDERATIONS. THE PRIMARY RESPONSBILITY TO IDENTIFY FINANCIAL NEED IS WITH THE ACCESS PATIENT ADVOCATES, CENTRAL BILLING OFFICE AND SOCIAL WORK STAFF. THESE STAFF MEMBERS ARE TRAINED TO IDENTIFY PATIENT NEEDS AND ANSWER FINANCIAL ASSISTANCE QUESTIONS. THERE ARE SEVERAL POINTS IN THE PATIENT EXPERIENCE WHERE FINANCIAL ASSISTANCE RESOURCES ARE OFFERED. THE FIRST OCCURS AT THE PRE-REGISTRATION OF INPATIENT ADMITS AND OUTPATIENTS PRESENTING THROUGH CARES AND FOR THOSE PATIENTS SCHEDULED IN THE SPECIALTY PEDIATRIC CENTER CLINICS. AT THIS TIME, ELECTRONIC ELIGIBILITY IS RAN ON THE INSURED. THE BENEFIT DETAIL INCLUDING DEDUCTIBLE, COPAYMENT AND COINSURANCE AMOUNTS ARE DISCUSSED WITH THE FAMILY. ALL INDIVIDUALS WHO ARE FINANCIALLY UNABLE TO PAY WILL BE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGH GOVERNMENT PROGRAMS AND OTHER POTENTIAL FUNDING SOURCES OR ALTERNATIVELY QUALIFIED FOR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. AT THE TIME OF REGISTRATION, INSURANCE IS DISCUSSED AND FAMILIES AGAIN ARE OFFERED THE ASSISTANCE OF ACCESS CENTER PATIENT ADVOCATES WHO ARE AVAILABLE MONDAY THROUGH FRIDAY. ALL SELF PAY FAMILIES ARE ENCOURAGED TO SPEAK TO AN ACCESS CENTER PATIENT ADVOCATE. CARE ESTIMATES OR QUESTIONS REGARDING ESTIMATE OF COST FOR UPCOMING TESTING IS DIRECTED TO THE PATIENT ADVOCATES AND THESE SERVICES ARE AGAIN OFFERED PRIOR TO ENDING THE CONVERSATION. FINANCIAL ASSISTANCE INFORMATION IS ALSO LOCATED IN THE PATIENT HANDBOOKS. PATIENT STATEMENTS INCLUDE LEAFLETS AND ALL MAILED CORRESPONDENCE INCLUDING BILLS, STATEMENTS, AND COLLECTION LETTERS STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. CHILDREN'S HOSPITAL & MEDICAL CENTER'S INTERNET WEBSITE ALSO OFFERS A FINANCIAL ASSISTANCE LINK THAT INFORMS READERS IF YOU ARE UNINSURED OR HAVE LIMITED INCOME, YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE THROUGH GOVERNMENT PROGRAMS OR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. THE WEBSITE EXPLAINS THAT DEPENDING ON INCOME LEVEL, ALL OR PART OF THE MEDICAL COSTS MAY BE FUNDED BY MEDICAID AND ALTERNATIVELY IF THEY ARE DETERMINED NOT ELIGIBLE FOR MEDICAID AFTER PROVIDIING ALL OF THE REQUIRED DOCUMENTATION THAT THEY MAY THEN APPLY FOR THE CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. CONTACT NUMBERS FOR THE PATIENT ADVOCATES AND HOURS OF SERVICE ARE PROVIDED. THE WEBSITE INCLUDES COPIES OF CHILDREN'S FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM AND THE PLAIN LANGUAGE SUMMARY IN ENGLISH, ARABIC, CHINESE, FRENCH, PERSIAN, SPANISH AND VIETNAMESE. THE WEBSITE ALSO INCLUDES AMOUNTS GENERALLY BILLED IN ENGLISH. ALL OTHER BILLING, PAYMENT AND FINANCIAL RESPONSIBILITY RELATED LINKS ON CHILDREN'S WEBSITE STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. THE FINANCIAL ASSISTANCE POLICY IS CURRENTLY AVAILABLE ON THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part VI, Line 4 4-COMMUNITY INFORMATION THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF DOUGLAS AND SARPY COUNTIES IN NEBRASKA AND POTTAWATTAMIE COUNTY IN IOWA. THE PRIMARY SERVICE AREA HAS A CURRENT AGGREGATE POPULATION OF APPROXIMATELY 852,672. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA. FOR THE YEAR ENDED DECEMBER 31, 2018, 50.9% OF THE HOSPITAL'S INPATIENT DISCHARGES WERE FROM PATIENTS RESIDING IN THE THREE-COUNTY PRIMARY SERVICE AREA. PATIENTS RESIDING IN THE SEVENTEEN-COUNTY SECONDARY SERVICE AREA ACCOUNTED FOR 19.6% OF TOTAL HOSPITAL INPATIENT DISCHARGES DURING THIS SAME TIME PERIOD. THE REMAINING 26.5% OF TOTAL DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE THE PRIMARY AND SECONDARY SERVICE AREAS. 2018 DEMOGRAPHIC SUMMARY OMAHA METRO MARKET AREA: DOUGLAS, SARPY AND POTTAWATTAMIE COUNTIES SOURCES: ESRI (BASED ON US CENSUS BUREAU), UNITED STATES CENSUS BUREAU AND CHILDREN'S HOSPITAL AND MEDICAL CENTER PATIENT ENCOUNTER DATABASE. COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 12 TOTAL POPULATION 852,672 PEDIATRIC POPULATION 214,197 AVERAGE HOUSEHOLD INCOME $88,261 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 11.5% UNDER AGE 18 15.3% PERCENT OF RESIDENTS ON MEDICAID 10.4% AGE POPULATION % OF TOTAL LESS THAN 18 214,197 25.1% 18 TO 24 80,015 9.4% 25 TO 44 241,830 28.4% 45 TO 64 203,977 23.9% 65+ 112,653 13.2% TOTAL 852,672 100.0% RACE POPULATION % OF TOTAL WHITE 630,684 74.0% HISPANIC 97,489 11.4% BLACK 68,411 8.0% ASIAN/PACIFIC ISLANDER 28,207 3.3% OTHER/2+ RACES 24,722 2.9% AM. IND/ALASKA NAT 3,159 0.4% TOTAL 852,672 100.00% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS:11.7% COUNTY # OF CENSUS TRACTS* TOTAL CNESUS TRACTS % OF TOTAL DOUGLAS 36 156 23.1% SARPY 12 43 27.9% POTTAWATTAMIE 3 30 10.0% TOTAL 51 229 22.3% *CENSUS TRACT IS A GEOGRAPHICAL DIVISION OF 500 TO 3,000 HOUSEHOLDS Schedule H, Part VI, Line 5 Proudly serving children since 1948, Children's Hospital & Medical Center (Children's) mission is to improve the life of every child through dedication to exceptional clinical care, research, education and advocacy. Children's Center for the Child & Community is a statewide community outreach hub of Children's. The Children's Center for the Child & Community was launched in 2016 to serve as the infrastructure for community health improvement, leading both internal and external partnerships around Pediatrics Community Health Needs Assessment (CHNA) planning and implementation. In 2018, Children's provided medical care for 149,700 children. Children's is the only full-service, pediatric health care center in Nebraska. Some of the programs and services Children's offered to patients were: Behavorial Health, Rehab Services, Home Health, Urgent Care, HEROES (childhood obesity), and specialty care clinics. In addition, Children's offers Hand in Hand Palliative Care, Family Resources, Child Life Specialists, Pastoral Care, Social Workers, Nurse Case Managers, Interpreters, Financial Counselors, Patient Advocates, and other programs to enhance the patient experience. Children's has achieved the Magnet designation for nursing excellence and its Pediatric Intensive Care Unit has earned a Silver Beacon Award for Excellence from the American Association of Critical Care Nurses. The hospital has achieved Stage 6 on the HIMSS Analytics EMR Adoption Models (EMRAM). Children's is also recognized as a 2018-19 Best Children's Hospital by U.S. News & World Report in five pediatric specialties: Cardiology and Heart Surgery, Gastroenterology and GI Surgery, Orthopedics, Pulmonology, and Diabetes & Endocrine Disorders. Ten of the Children's Physicians primary care offices have achieved the highest NCQA Patient Centered Medical Home (PCMH) certification. A pediatric affiliation established between Children's and the University of Nebraska Medical Center College of Medicine (UNMC) supports enhancements in pediatric education, research and clinical care. Children's is the primary teaching site for the family practice and joint pediatrics residency programs at Creighton University and UNMC. Children's is committed to ensuring that no child with a medical need is ever turned away due to a family's inability to pay for services. In 2018, our hospital: - Provided $5.8 million in services in the form of uncompensated care [charity care ($4.3 million) and bad debt write-offs ($1.5 million)] to families unable to pay. With 44% of patient care revenues devoted to the care of low-income children assisted by Medicaid, the Medicaid reimbursement shortfall for FY 2018 was $30.2 million less than the cost of care provided. - Contributed $1.4 million towards community health education aimed at promoting health and preventing illness and injury made available through the Kohl's Cares GoNoodle grant partnership, injury prevention, obesity prevention, Parenting U education classes, outreach educational classes, health fairs, Just Kids magazine, and the consumer website. Children's gives back to the community through advocacy services which are available to anyone suspecting child abuse or neglect and lodging for families of out-of-town patients is offered at the Carolyn Scott Rainbow House at little or no cost. - Contributed $25.8 million in pediatric health care education costs to educate tomorrow's healers. - Provided $1.7 million in cash and in-kind donations/sponsorships to benefit the broader community In 2018, Children's provided in total, more than $103 million in community benefits representing 29% of the hospital's operating expenses. Schedule H, Part VI, Line 6 6-AFFILIATED HEALTH CARE SYSTEM CHILDREN'S HOSPITAL & MEDICAL CENTER IS NOT AFFILIATED WITH A GREATER HEALTH CARE SYSTEM, BUT IS IT'S OWN HEALTH CARE SYSTEM WHICH THE HOSPITAL OPERATES THE FOLLOWING RELATED ORGANIZATIONS: - CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION - CHILDREN'S PHYSICIANS - CHILDREN'S HEALTH NETWORK Schedule H, Part VI, Line 7 7-STATE FILING OF COMMUNITY BENEFIT REPORT THE CHILDREN'S HOSPITAL & MEDICAL CENTER COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF NEBRASKA THROUGH THE NEBRASKA HOSPITAL ASSOCIATION, AND IS AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.CHILDRENSOMAHA.ORG/COMMUNITY-BENEFIT-INFORMATION true NE PEDIATRIC PRACTICE 8200 DODGE STREET OMAHA NE 68114 263064869 501(C)(3) 3963527 PEDIATRIC RESEARCH UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 985520 NE MED CTR OMAHA NE 68198 470049123 501(C)(3) 4031356 SUPPORT FOR MED SCH 2 CHARITY ASSISTANCE TO PATIENTS IN NEED 6830 11159320 BOOK WRITEOFF PAT ACCT Schedule I, Part I, Line 2 CHILDREN'S HOSPITAL & MEDICAL CENTER HAS A WRITTEN FINANCIAL ASSISTANCE/CHARITY CARE POLICY. THE AMOUNT OF FINANCIAL ASSISTANCE AN INDIVIDUAL CAN RECEIVE IS BASED ON THE ANNUAL GROSS INCOME THRESHOLDS USING THE CURRENT FEDERAL POVERTY LEVEL GUIDELINES. GRANTS TO ORGANIZATIONS ARE ONLY DISTRIBUTED TO 501(C)(3) ORGANIZATIONS BASED ON THE HOSPITAL'S EVALUATION CRITERIA. X X true true X X X X X true true false false false false false false false Richard Azizkhan MD President, CEO, Member 952461 0 354690 0 511846 0 35000 0 9765 0 1863762 0 486233 0 Deb Arnow SVP Pat Care Srvs & CNO -855 0 75889 0 236093 0 0 0 9896 0 321023 0 0 0 Michael Brown EVP Strategy & Transformation 560274 0 176712 0 223790 0 100096 0 13140 0 1074012 0 219250 0 Fernando Ferrer MD SVP & Surgeon-in-chief 723121 0 0 0 1029 0 109179 0 1612 0 834941 0 28326 0 Kathy English EVP & COO 451823 0 169493 0 4429 0 97939 0 8765 0 732449 0 0 0 Amy Hatcher SVP & CFO 373411 0 149970 0 85029 0 64903 0 8318 0 681631 0 82597 0 Christopher Maloney MD SVP & Chief Medical Officer 495288 0 0 0 21800 0 79979 0 327 0 597394 0 15764 0 Steven C Burnham SVP Physician Networks 338987 0 125996 0 6377 0 63973 0 13075 0 548408 0 0 0 Amy Bones SVP & General Counsel 286478 0 115325 0 57716 0 71721 0 7366 0 538606 0 52296 0 Suzanne Nocita SVP & CHRO 243191 0 75378 0 58878 0 63086 0 12797 0 453330 0 51230 0 Mark Stastny VP & CIO 264395 0 111590 0 97615 0 35342 0 11663 0 520605 0 49294 0 Jamie Drake MD Physician 397436 0 29750 0 366 0 13812 0 241 0 441605 0 0 0 Kari Krenzer Physician 369900 0 29750 0 2830 0 21738 0 17118 0 441336 0 0 0 Martin Beerman VP Market & Community Relation 262832 0 91677 0 45749 0 41801 0 1199 0 443258 0 42187 0 Rachel McCann MD Physician 348080 0 35000 0 2717 0 19250 0 15812 0 420859 0 0 0 Schedule J, Part I, Line 1a FIRST-CLASS TRAVEL WAS PAID FOR BY THE ORGANIZATION AND WAS SOLELY FOR BUSINESS PURPOSES. Schedule J, Part I, Line 1a RICHARD AZIZKHAN'S SOCIAL CLUB DUES ARE PAID FOR BY THE ORGANIZATION TO BE USED FOR BUSINESS PURPOSES. Schedule J, Part I, Line 4a THE FOLLOWING EMPLOYEES RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2018: DEBRA ARNOW $236,093 Schedule J, Part I, Line 4b THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN DURING 2018. THE AMOUNTS OF DEFERRED COMPENSATION DISTRIBUTED AND ACCRUED FOR EACH OF THE INDIVIDUALS DURING 2018 ARE AS FOLLOWS: MICHAEL BROWN $75,346 ACCRUAL, $219,250 PLAN DISTRIBUTION KATHY ENGLISH $73,189 ACCRUAL, $0 PLAN DISTRIBUTION STEPHEN C BURNHAM $44,723 ACCRUAL, $0 PLAN DISTRIBUTION RICHARD AZIZKHAN, M.D. $0 ACCRUAL, $486,233 PLAN DISTRIBUTION AMY HATCHER $48,403 ACCRUAL, $82,597 PLAN DISTRIBUTION AMY BONES $37,221 ACCRUAL, $52,296 PLAN DISTRIBUTION SUSAN NOCITA $0 ACCRUAL, $51,230 PLAN DISTRIBUTION CHRISTOPHER MALONEY, M.D. $63,479 ACCRUAL, $15,764 PLAN DISTRIBUTION FERNANDO FERRER, M.D. $92,679 ACCRUAL, $28,236 PLAN DISTRIBUTION MARK STASTNY $27,092 ACCRUAL, $49,294 PLAN DISTRIBUTION MARTIN BEERMAN $22,679 ACCRUAL, $42,187 PLAN DISTRIBUTION A HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230KT6 2008-08-12 100881609 REFUND BONDS (6/8/2007) true false false B HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 2014-09-10 19900000 REFUND BONDS (8/12/2008) false false false C HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230NJ5 2017-03-14 101075067 USED TO CONSTRUCT HUBBARD CENTER false false false D HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 2017-11-28 26885000 REFUND BONDS (8/12/2008) false false false A 65000000 0 100892260 0 0 0 751783 24826 0 2755000 97360681 0 2008 true false true true B 1280000 0 20416445 0 0 0 207632 0 0 0 20208813 0 2008 false true true true C 0 0 103562643 0 0 0 1064167 0 0 45195025 0 57303451 false false false true D 4190000 0 26885000 0 0 0 305601 0 0 0 26579399 0 true false true true A false true true true true true 0.00200 0.00200 false false false true B false true true true true true 0.00200 0.00200 false false false true C false false false false 0 false false false true D false true true true true true 0.00200 0.00200 false false false true A false false true true true true MORGAN STANLEY 25. false false false 0 false true B false false false true false false 0 false 0 false true C false true false false false false 0 false 0 false true D false false true true false false 0 false 0 false true A true B true C true D true SCHEDULE K, PART II, LINE 3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART IV, LINE 2C DATE THE REBATE COMPUTATION WAS PERFORMED: 10/02/2017 (2008 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 08/21/2018 (2014 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 05/21/2018 (2017B BONDS) RICHARD AZIZKHAN MD WIFE IS EMPLOYEE 128400 EMPLOYMENT false RICHARD AZIZKHAN MD SON IS EMPLOYEE 35937 EMPLOYMENT false Form 990, Part VI, Line 11b GOVERNANCE, MANAGEMENT, AND DISCLOSURE A COMPLETE COPY OF THE FORM 990, INCLUDING SCHEDULE J, IS MADE AVAILABLE TO THE EXECUTIVE COMMITTEE OF THE BOARD EXCLUDING THE MEDICAL STAFF PRESIDENT. THE FORM 990, EXCLUDING PART VII AND SCHEDULE J - COMPENSATION INFORMATION, IS MADE AVAILABLE TO THE REMAINDER OF THE BOARD OF DIRECTORS, INCLUDING THE MEDICAL STAFF PRESIDENT. BOTH ARE MADE AVAILABLE THROUGH THE DIRECTOR'S DESK WEBSITE PRIOR TO FILING WITH THE IRS. Form 990, Part VI, Line 12c POLICIES THE CONFLICT OF INTEREST POLICY APPLIES TO ANY PERSON IN A POSITION TO EXERCISE INFLUENCE IN CONNECTION WITH ANY CONTRACT, TRANSACTION OR ARRANGEMENT PRESENTED TO THE BOARD OR A BOARD COMMITTEE FOR APPROVAL (INTERESTED PERSON). INTERESTED PERSON INCLUDES BUT NOT LIMITED TO ANY DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWER, OR KEY EMPLOYEE. AN INTERESTED PERSON MUST ANNUALLY SUBMIT A COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE IN THE FORMAT PRESCRIBED BY THE GOVERNANCE COMMITTEE. EACH INTERESTED PERSON SHALL ANNUALLY ACKNOWLEDGE IN WRITING THAT HE OR SHE (A) HAS RECEIVED A COPY OF THIS POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) AGREES TO COMPLY WITH THE POLICY; (D) UNDERSTANDS THAT THE POLICY APPLIES TO THE BOARD AND COMMITTEES; (E) UNDERSTANDS THAT CHILDREN'S IS A NOT-FOR-PROFIT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES; (F) AGREES TO PROMPTLY REPORT TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDREN'S GENERAL COUNSEL ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICT OF INTEREST QUESTIONNAIRE; AND (G) STATES THAT THE INFORMATION PROVIDED IN THE CONFLICT OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF. AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES OR WHENEVER IT INVOLVES A MATTER OF BOARD ACTION. DISCLOSURE MEANS PROMPTLY PROVIDING THE MATERIAL FACTS OF AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDREN'S GENERAL COUNSEL (IN WRITING IF TIME ALLOWS) OR TO THE BOARD OR BOARD COMMITTEE REVIEWING THE CONTRACT, TRANSACTION OR ARRANGEMENT. CERTAIN CIRCUMSTANCES, IN ADDITION TO FINANCIAL INTERESTS, COULD GIVE RISE TO A POTENTIAL CONFLICT OF INTEREST, INCLUDING INSTANCES WHERE THE ACTIONS OR ACTIVITIES OF AN INDIVIDUAL ON BEHALF OF CHILDREN'S, ALSO INVOLVES OBTAINING A PERSONAL GAIN OR ADVANTAGE, OR COULD HAVE AN ADVERSE EFFECT ON CHILDREN'S INTERESTS. ALSO, DISCLOSING OR USING INFORMATION RELATING TO CHILDREN'S BUSINESS FOR THE PERSONAL PROFIT OR ADVANTAGE OF AN INDIVIDUAL OR HIS OR HER FAMILY WOULD GIVE RISE TO A CLAIM OF CONFLICT. FULL DISCLOSURE OF ANY SUCH SITUATION OR ANY OTHER CIRCUMSTANCES IN DOUBT SHOULD BE MADE. A POTENTIAL CONFLICT OF INTEREST DOES NOT NECESSARILY RISE TO THE LEVEL OF AN ACTUAL CONFLICT OF INTEREST, BUT ONCE RECOGNIZED, IT MUST IN EVERY CASE BE DISCLOSED AND EVALUATED. IN SOME INSTANCES, IT MAY BE SO SERIOUS THAT IT PREVENTS THE INDIVIDUAL FROM FURTHER PARTICIPATION IN CHILDREN'S DELIBERATIONS WITH RESPECT TO A PARTICULAR TRANSACTION, OR COULD BE SO PERVASIVE THAT THE INDIVIDUAL MAY BE DISQUALIFIED FROM CONTINUED AFFILIATION WITH CHILDREN'S. ON THE OTHER HAND, IT MAY BE OF LITTLE OR NO SIGNIFICANCE ONCE IT HAS BEEN DISCLOSED. THE GOVERNANCE COMMITTEE WILL CONSIDER THE FOLLOWING FACTORS, AMONG OTHER RELEVANT FACTS, WHEN DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS: (I) THE PROXIMITY OF THE INTERESTED PERSON TO THE DECISION-MAKING AUTHORITY OF THE OTHER ENTITY INVOLVED IN THE TRANSACTION OF BUSINESS ARRANGEMENT; (II) THE MAGNITUDE OF THE FINANCIAL INTEREST; (III) THE DEGREE TO WHICH THE INTERESTED PERSON MIGHT BENEFIT PERSONALLY IF A PARTICULAR TRANSACTION OR BUSINESS ARRANGEMENT WERE APPROVED; AND (IV) THE ABILITY OF THE INTERESTED PERSON TO MAKE AN INDEPENDENT DECISION BASED ONLY ON THE BEST INTEREST OF CHILDREN'S. THE GOVERNANCE COMMITTEE SHALL REVIEW EACH COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE, AND MAY MAKE SUCH FURTHER INVESTIGATION OF POTENTIAL CONFLICTS AS IT MAY DETERMINE APPROPRIATE. THE GOVERNANCE COMMITTEE SHALL MAKE APPROPRIATE REPORTS TO THE BOARD CONCERNING ITS REVIEW, ANY FURTHER INVESTIGATION, AND ITS RECOMMENDATIONS TO THE BOARD REGARDING ANY POTENTIAL CONFLICT OF INTEREST. WHENEVER AN INTERESTED PERSON (OR A PERSON OTHER THAN THE INTERESTED PERSON) VOLUNTARILY IDENTIFIES OR DISCLOSES A POTENTIAL CONFLICT OF INTEREST, THE REMAINING BOARD/COMMITTEE MEMBERS REVIEW AND DETERMINE WHETHER A CONFLICT EXISTS. ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS MAY VOTE TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS AND THE SUBJECT INTERESTED PERSON CANNOT BE PRESENT DURING THE VOTE. TRANSACTIONS OR BUSINESS ARRANGEMENTS INVOLVING INTERESTED PERSONS WITH CONFLICTS OF INTEREST MUST BE APPROVED IN ADVANCE BY A MAJORITY OF DISINTERESTED DIRECTORS. IN ORDER TO APPROVE AN ARRANGEMENT OR TRANSACTION INVOLVING AN ACTUAL CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED DIRECTORS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN CHILDREN'S BEST INTEREST, IS FAIR AND REASONABLE TO CHILDREN'S AND THAT, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN CASES IN WHICH AN INTERESTED PERSON HAS A FINANCIAL INTEREST IN A PROPOSED ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN, AT THE DISCRETION OF THE BOARD: (A) THE INTERESTED PERSON MAY BE REQUIRED TO LEAVE THE MEETING FOR THE GENERAL DISCUSSION OF THE MATTER AND THE BOARD VOTE; AND/OR (B) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION. THE GOVERNANCE COMMITTEE CAN RECOMMEND TO THE BOARD THAT A DIRECTOR OR A MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS BE ASKED TO RESIGN IN THE EVENT A CONFLICT OF INTEREST IS SO SUBSTANTIAL THAT IT WOULD BE INCOMPATIBLE WITH CHILDREN'S BEST INTERESTS TO HAVE SUCH AN INDIVIDUAL ON ITS BOARD/COMMITTEE. IF THE BOARD/COMMITTEE BELIEVES AN INTERESTED PERSON HAS FAILED TO COMPLY WITH THIS POLICY, THE BOARD SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND GIVE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE. AFTER HEARING THE RESPONSE AND CONDUCTING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD SHALL DETERMINE WHETHER SUCH PERSON HAS, IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THIS POLICY. IF THE BOARD DETERMINES THAT THERE HAS BEEN A VIOLATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION WHICH MAY INCLUDE REMOVAL FROM THE BOARD. Form 990, Part VI, Line 15b POLICIES EACH YEAR AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF EXECUTIVE COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE. EXECUTIVE BASE SALARIES ARE TARGETED FOR THE 50TH PERCENTILE OF THE MARKET. AN INDEPENDENT COMPANY ISSUES AN ANNUAL REASONABLENESS OPINION LETTER REGARDING THE APPROPRIATENESS OF THE EXECUTIVE PAY LEVELS. THE COMPENSATION COMMITTEE IS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE REVIEWS BASE PAY RANGES FOR ALL EXECUTIVES INCLUDING THE CHIEF EXECUTIVE OFFICER AND ALL EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS. THE BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING THE CEO'S PERFORMANCE WHICH AFFECTS HIS PAY RATE INDIRECTLY. Form 990, Part VI, Line 19 GOVERNANCE, MANAGEMENT, AND DISCLOSURE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. THE CHILDREN'S HOSPITAL & MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED THROUGH PUBLICLY AVAILABLE SOURCES SUCH AS EMMA.MSRB.ORG. Form 990, Part XI, Line 9 ($265,000) - CHANGE IN VALUE OF SPLIT INTEREST $903,493 - CHANGE IN VALUE OF SWAP ($47,535,180) - CAPITAL TRANSFERS FOUNDATION ($492,967) - CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK ($47,389,654) - TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHILDREN'S HOSPITAL FOUNDATION 8200 DODGE STREET OMAHA NE 68114 476105603 FUNDRAISING NE 501(C)(3) LINE 7 CHMC true CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA NE 68114 470689372 PED CLINICS NE 501(C)(3) LINE 10 CHMC true KENT INC 8200 DODGE STREET OMAHA NE 68114 470527928 REAL ESTATE NE CHMC C Corp 0 219495 1.00000 true CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA NE 68114 363967578 HEALTH NETWORK NE CHMC C Corp 0 0 1.00000 true false false true false false false false false false false false true true true true false true true true CHILDREN'S HOSPITAL FOUNDATION c 3320295 BOOK CHILDREN'S HOSPITAL FOUNDATION l,m,n 5787097 BOOK CHILDREN'S HOSPITAL FOUNDATION r 41748084 BOOK CHILDREN'S HEALTH NETWORK r 492968 BOOK