2018-05-15T10:20:12-05:00 2016-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2016-01-01 470379754 CHILDREN'S HOSPITAL & MEDICAL CENTER % AMY HATCHER CHIL 4029556795 8200 Dodge Street Omaha NE 68114 AMY HATCHER CFO 4029556795 2017-11-14 true DONALD NEAL JR P00798244 4023481450 2016 2022-09-23 18:48:47Z X Dr Richard Azizkhan 8200 Dodge Street Omaha NE 68114 366154330 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 19 18 2801 257 0 0 5959101 5325804 333556698 346427617 34904 278061 11191220 14122848 350741923 366154330 11579289 10492325 0 0 149183029 169226607 0 0 0 134677409 151731073 295439727 331450005 55302196 34704325 376179737 402885754 159157617 156376005 217022120 246509749 X TO IMPROVE THE LIFE OF EVERY CHILD - THROUGH DEDICATION TO EXCEPTIONAL CLINCIAL CARE, RESEARCH, EDUCATION AND ADVOCACY. false false 313983875 10492325 360384624 THE HOSPITAL OPERATES A 145 BED PEDIATRIC HOSPITAL, WHICH INCLUDES SEVEN SURGICAL SUITES, A HYBRID HEART CATHETERIZATION LAB, 40 OUTPATIENT SPECIALTY CLINICS, A 33 BED CHILDREN'S AMBULATORY RECOVERY AND EXPRESS STAY (CARES) UNIT, A HEART TRANSPLANT PROGRAM, A FETAL CARE CENTER WHICH FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH, A CHILDREN'S SPECIALTY PEDIATRIC CENTER, WHICH PROVIDES OUTPATIENT DIAGNOSTICS, TREATMENT, AND THERAPY IN ADDITION TO OFFERING OUTPATIENT EATING DISORDER SERVICES AND PROVIDING A FULL ARRAY OF PEDIATRIC HOME HEALTH CARE 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. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT WITH LEVEL II PEDIATRIC TRAUMA VERIFICATION IN THE REGION. CHILDREN'S HOSPITAL & MEDICAL CENTER ALSO PROVIDES SPECIALTY PEDIATRIC CARE SERVICES IN COMMUNITIES ACROSS NEBRASKA, IOWA, AND SOUTH DAKOTA. 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. 313983875 true true false true false false false false false true true false false 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 85 0 true 2801 true false false false false false false false false false false X 19 18 false false true 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 Lorraine Chang Secretary 1.0 0.0 X X 0 0 0 Jim Greisch Treasurer 1.0 0.0 X X 0 0 0 Margaret Hershiser Member 1.0 0.0 X 0 0 0 Brad Brabec MD Member 1.0 0.0 X 0 0 0 Joleen David Member 1.0 0.0 X 0 0 0 Dave Diamond Member 1.0 0.0 X 0 0 0 Robert Dunlay MD Member 1.0 0.0 X 0 0 0 Mark Hasebroock Member 1.0 0.0 X 0 0 0 Mike Homa Member 1.0 0.0 X 0 0 0 Sherrye Hutcherson Member 1.0 0.0 X 0 0 0 John Jenkins Member 1.0 0.0 X 0 0 0 Steve Lindsay Member 1.0 0.0 X 0 0 0 Samantha Mosser Member 1.0 0.0 X 0 0 0 Jay Snow MD Member 1.0 0.0 X 0 0 0 Jayesh Thakker MD Member 1.0 0.0 X 0 0 0 Scot Thompson Member 1.0 0.0 X 0 0 0 Richard Azizkhan MD President, CEO, Member 40.0 1.0 X X 1061572 0 164716 Gary A Perkins CEO Emeritus 40.0 0.0 X 767839 0 77715 Michael Brown EVP & Treasurer 40.0 0.0 X 659765 0 134104 Kathy English EVP & COO 40.0 0.0 X 835815 0 108057 Carl Gumbiner MD SVP - Med Affairs & CMO 40.0 0.0 X 690632 0 61757 Steven C Burnham SVP - Physician Networks 40.0 0.0 X 470724 0 63176 Amy Hatcher SVP & CFO 40.0 0.0 X 383004 0 59371 Debra Arnow SVP & CNO 40.0 0.0 X 373800 0 39753 Amy Bones SVP - General Counsel 40.0 0.0 X 277201 0 65766 Patricia Schulz SVP & CHRO 40.0 0.0 X 259821 0 74904 Jamie Drake MD Physician 40.0 0.0 X 391188 0 14801 Chandrika Rizal MD Physician 40.0 0.0 X 344053 0 39195 Mark Stastny VP - CIO 40.0 0.0 X 351424 0 49677 Rachel McCann MD Physician 40.0 0.0 X 395830 0 27913 Kari Krenzer MD PHYSICIAN 40.0 0.0 X 343503 0 36749 7606171 0 1017654 212 false true false Kiewit Construction Company 3921 Mason Street Omaha NE 68105 Building Consultants 4964801 Epic Systems Corp PO Box 88314 Milwaukee WI 53288 IT Support Services 3044132 Cross Country Staffing PO Box 404674 Atlanta GA 30384 Staffing Services 1985474 Precyse Solutions LLC 1275 Drummers Lane Suite 200 Wayne PA 19087 HIM Consultants 1247631 DARLAND CONSTRUCTION CO 4115 S 133RD STREET OMAHA NE 68137 BUILDING CONSULTANTS 1204687 14 4040025 1168304 117475 5325804 NET PATIENT REVENUE 621110 346427617 346427617 346427617 274211 274211 0 0 165841 165841 0 165841 165841 3850 3850 3850 3850 0 0 0 0 0 0 0 0 0 MANAGEMENT FEE INCOME 541610 6010303 6010303 METHODIST SERVICE 541900 982178 982178 OTHER REVENUE 900099 6964526 6964526 13957007 366154330 360384624 443902 3508427 3508427 6983898 6983898 0 0 5790609 5790609 0 133244131 133244131 7026550 7026550 13906833 13906833 9258484 9258484 0 567298 567298 384825 384825 45055 45055 0 0 30437127 24384309 6052818 4100292 4100292 51764759 51764759 8811142 8811142 0 7314838 7314838 1024168 1024168 0 0 4625625 4625625 11127946 11127946 23844646 23844646 1008475 1008475 COLLECTION EXPENSE 1840429 1840429 0 BUILDING MAINTENANCE 2998447 2998447 OPERATING LEASES 40982 40982 DUES & SUBSCRIPTIONS 513936 513936 1281083 1281083 331450005 313983875 17466130 0 1634338 3336156 73879708 52307087 3105000 3022000 58054509 63721788 0 0 0 0 0 0 3343055 3718461 4626340 6989131 406373137 177017854 194573662 229355283 0 0 12057997 12188259 12093673 12218158 0 0 12811455 16029431 376179737 402885754 47049474 48858039 0 0 0 0 93050209 89273512 0 0 0 0 5967547 5675659 483016 162985 12607371 12405810 159157617 156376005 X 213917120 243487749 3105000 3022000 0 0 217022120 246509749 376179737 402885754 X 34704325 -5216696 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 45055 45055 331404950 331450005 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 19630 56805 75525 45055 197015 250000 250000 250000 250000 1000000 1500000 53221749 20698028 249787 2488599 71680965 52709846 2540657 115359 2142005 2108 53221749 52569968 4571646 103409 4535177 52709846 47650277 6663819 833787 2577915 52569968 46288568 2703274 1220869 2562434 47650277 0.54400 0.07900 0.37700 false true true 21173431 21173431 248491673 88054175 160437498 16433102 10286553 6146549 116684753 78323088 38361665 3590178 354038 3236140 229355283 0 DEFERRED COMPENSATION LIABILIT 3279942 SWAP LIABILITY 5053148 NON-CONTROLLING INTEREST IN CP 4072720 12405810 X Schedule D, Part V, Line 4 TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, AND OPERATIONS OF THE CHILDREN'S HOSPITAL & MEDICAL CENTER. Schedule D, Part X, Line 2 FIN 48 FOOTNOTE IN ACCORDANCE WITH ASC SUBTOPIC 740-10, INCOME TAXES-OVERALL, 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. DURING 2016 AND 2015, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES. true true X true X true X true true false true true 3268464 3268464 0.00990 132777961 92997089 39780872 0.12000 136046425 92997089 43049336 0.12990 2326699 739236 1587463 0.00480 13025121 1168304 11856817 0.03580 127396690 89646018 37750672 0.11390 2952258 970445 1981813 0.00600 974345 974345 0.00290 146675113 92524003 54151110 0.16340 282721538 185521092 97200446 0.29330 10500 10500 10500 10500 true 1325331 547521 704522 -157001 X true true 1 1 CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 WWW.CHILDRENSOMAHA.ORG 260005 X X X X X CHILDREN'S HOSPITAL & MEDICAL CENTER 1 false false true X X X X X X X X 15 true true true true X CHILDRENSOMAHA.ORG/HEALTHNEEDSASSESSMENT X true 15 true See Part V, Section C false true X 200. 400. X X true true X X X true X SEE PART V X SEE PART V X SEE PART V 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 2015 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 SURVEY AND PROVIDED A LINK TO TAKE THE SURVEY ONLINE; REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. 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, 149 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY, REPRESENTING COMMUNITY/BUSINESS LEADERS, PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, SOCIAL SERVICES PROVIDERS AND OTHER HEALTH CARE PROVIDERS. THESE KEY INFORMANTS REPRESENT ORGANIZATIONS THAT WORK WITH LOW-INCOME, MINORITY POPULATIONS, MEDICALLY UNDERSERVED POPULATIONS AND THOSE WHO WORK WITH THOSE WITH CHRONIC DISEASE CONDITIONS. Schedule H, Part V, Line 6a BOYS TOWN NATIONAL RESEARCH HOSPITAL Schedule H, Part V, Line 6b BUILDING HEALTHY FUTURES Schedule H, Part V, Line 10A http://childrensomaha.org/UPLOADS/PUBLIC/DOCUMENTS/201618CHNAIMPLEMENTATIO N.PDF Schedule H, Part V, Line 11 The Executive Committee of the Board of Directors of Children's Hospital & Medical Center, which includes representatives from throughout the community, met to discuss this plan for addressing the community health priorities identified through our Community Health Needs Assessment. The Executive Committee of the Board has the power to transact all regular business of Children's during the period between meetings of the Board of Directors. Upon review, the Executive Committee of the Board of Directors approved and adopted this Implementation Strategy to undertake these measures to meet the health needs of the community. IN CONSIDERATION OF 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 HOSPITAL & MEDICAL CENTER FOCUSED ON DEVELOPING STRATEGIES AND INITIATIVES TO IMPROVE: * ACCESS TO HEALTH CARE SERVICES * INJURY & VIOLENCE * MENTAL HEALTH * NUTRITION, PHYSICAL ACTIVITY & WEIGHT * ORAL HEALTH * VISION, HEARING & SPEECH CONDITIONS * ASTHMA & OTHER RESPIRATORY CONDITIONS * SEXUAL HEALTH CHILDRENS HOSPITAL & MEDICAL CENTER 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 YEARS APPROPRIATE BUDGET. THE GREATEST AREA OF STRATEGIC EMPHASIS HAS BEEN CHILDHOOD OBESITY PREVENTION, NUTRITION, PHYSICAL ACTIVITY AND WEIGHT, WHICH WAS THE NUMBER ONE CONCERN OF COMMUNITY PARENTS IN THE 2015 ASSESSMENT. DURING 2016, CHILDREN'S PREVENTING CHILDHOOD OBESITY COMMUNITY GRANT PROGRAM AWARDED $125,000 TO 5 AREA NON-PROFIT PARTNERS TO IMPLEMENT PROGRAMS THAT TEACH HEALTHY NUTRITION AND FITNESS HABITS TO CHILDREN THROUGHOUT THE COMMUNITY. COLLECTIVELY, THESE PARTNERS PLAN TO REACH MORE THAN 12,000 CHILDREN WITH NUTRITION AND PHYSICAL ACTIVITY EDUCATION IN THE 2016-17 GRANT CYCLE. MEANWHILE, FIVE $1,000 RENEWABLE PREVENTING CHILDHOOD OBESITY COMMUNITY SCHOLARSHIPS WERE AWARDED TO COLLEGE-BOUND HIGH SCHOOL SENIORS WHO PLAN TO PURSUE A CAREER RELATED TO HEALTH AND WELLNESS WITH A SIGNIFICANT FOCUS ON CHILDREN. ANOTHER SEVEN $1,000 SCHOLARSHIPS WERE RENEWED. ONE SUCH GRANT RECIPIENT, COOKING MATTERS, WAS A FREE COURSE OFFERED AT CHILDREN'S THAT PROVIDED COOKING INSTRUCTION AND NUTRITION LESSONS TO LOCAL CHILDREN AND FAMILIES. IN 2016, CHILDREN'S LAUNCHED A NEW INITIATIVE TO IMPROVE PEDIATRIC HEALTH STATEWIDE; THE CENTER FOR THE CHILD & COMMUNITY. HEADQUARTERED IN LINCOLN, 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. IN ADDITION TO BUILDING PARTNERSHIPS THAT IMPROVE THE HEALTH OF CHILDREN, IT ALSO STRENGTHENS CHILDREN'S ROLE IN ADVOCACY AND HEALTH CARE POLICY. HALF OF NEBRASKA CHILDREN LIVE IN OR NEAR POVERTY. NEARLY HALF QUALIFY FOR FREE AND REDUCED MEALS AT SCHOOL. MEANWHILE, THE OBESITY EPIDEMIC CONTINUES TO RISE, DISPROPORTIONATELY AFFECTING VULNERABLE CHILDREN. CHRONIC, COMPLEX DISEASES ALSO PRESENT COMPLICATED HEALTH CHALLENGES FOR YOUNG PEOPLE AND THEIR FAMILIES. THESE STARK REALITIES, AND THE CHILDREN WHO EXPERIENCE THEM, ARE THE DRIVING FORCE BEHIND CHILDREN'S CENTER FOR THE CHILD & COMMUNITY. ANOTHER INITIATIVE AIMED AT CHILDHOOD OBESITY PREVENTION IS HEALTHY KOHL'S KIDS, A PARTNERSHIP WITH KOHL'S DEPARTMENT STORES THAT INCLUDES SCHOOL OUTREACH AND COMMUNITY EVENTS, AN INTERACTIVE WEBSITE WITH RECIPES AND VIDEOS, EXTENSIVE SOCIAL MEDIA AND ADVERTISING. CHILDREN'S BRINGS HEALTH EDUCATION INTO AREA CLASSROOMS THROUGH ITS SPONSORSHIP OF GONOODLE, AN ONLINE RESOURCE THAT HELPS LOCAL EDUCATORS TEACH NUTRITION AND PHYSICAL ACTIVITY. IN 2016, 340 SCHOOLS AND 69,242 STUDENTS PARTICIPATED. CHILDREN'S HEROES (HEALTHY EATING WITH RESOURCES, OPTIONS AND EVERYDAY STRATEGIES) PROGRAM PROVIDES MULTIDISCIPLINARY CLINICAL INTERNVENTION FOR YOUNG PEOPLE ALREADY EXPERIENCING MEDICAL COMPLICATIONS FROM CHILDHOOD OBESITY. THE PROGRAM EXPANDED TO LINCOLN IN 2015. THE HEROES PROGRAM TREATED 461 PATIENTS THROUGHOUT THE YEAR, INCLUDING 309 NEW PATIENTS. PROMOTION OF THE HEROES WEIGHT MANAGEMENT CLINIC AND BARIATRIC SURGERY PROGRAM IS UNDERWAY VIA TRADITIONAL MEDIA, INTERNAL COMMUNICATION VEHICLES (LIKE SPIRA MAGAZINE) AND SEVERAL VIDEO PRODUCTIONS FEATURING BARIATRIC PROGRAM PATIENTS. OTHER STRATEGIC TACTICS INCLUDE A CSA FARMERS MARKET AND PARENTING U, A SERIES OF FREE PARENT EDUCATION CLASSES WITH TOPICS FOCUSED ON HEALHTY EATING AND OBESITY PREVENTION. 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. TO ADDRESS ACCESS TO HEALTH CARE SERVICES, CHILDRENS PHYSICIANS WAS RELOCATED TO THE CHILDRENS PHYSICIANS CREIGHTON OFFICE IN 2016 AND PLANS TO RELOCATE THE CHILDRENS PHYSICANS EAGLE RUN OFFICE. EXTENDED HOURS FOR INFUSION SERVICES HAS BEEN IMPLEMENTED AND NEW EXTENDED HOURS FOR GASTROENTEROLOGY AND HEMATOLOGY/ONCOLOGY APPOINTMENTS WILL BEGIN IN JANUARY 2017. CHILDRENS PHYSICIANS CASE MANAGERS PROGRAM WAS IMPLEMENTED IN THE FALL OF 2016 TO ASSIST FAMILIES IN UTILIZING APPROPRIATE SERVICES, AVOIDING MISUSE, AND ACCESSING SERVICES IN A TIMELY MANNER. INJURY AND VIOLENCE PREVENTION IS BEING ADDRESSED IN THREE AREAS. CHILDRENS HOSPITAL & MEDICAL CENTER IS PROMOTING WATER SAFETY/DROWNING PREVENTION THROUGH PARTNERSHIP WITH THE JOSHUA COLLINGSWORTH MEMORIAL FOUNDATION AND OMAHA PARKS & RECREATION. ADDITIONALLY, AN INCREASE OF CHILD PASSENGER SAFETY SEAT CHECKS THROUGH MULTIPLE COMMUNITY EVENTS HAS BEEN IMPLEMENTED. ONE NEW TRAUMA OUTREACH INITIATIVE LAUNCHED STATEWIDE HAS BEEN PROJECT AUSTIN, A PROGRAM THAT PREPARES RURAL HOSPITALS AND EMS PROVIDERS FOR THE CARE OF A MEDICALLY COMPLEX CHILD IN THEIR COMMUNITY. MENTAL HEALTH IS BEING ADDRESSED THROUGH A PARTNERSHIP WITH WESTSIDE SCHOOLS IN THE FALL OF 2016, LAUNCHING A STUDENT ASSISTANCE PROGRAM, WHICH IS A SCHOOL-BASED MENTAL HEALTH SERVICE THAT CONNECTS DISTRICT FAMILIES WITH CHILDRENS BEHAVIORAL HEALTH TEAM. CHILDRENS HAS EXPANDED THE BEHAVIORAL HEALTHS USE OF TELE-HEALTH SERVICE TO THE HEROES CLINIC IN LINCOLN AS WELL AS ADDING A TELE-HEALTH HUB SITE IN MCCOOK. BEHAVIORAL HEALTH SERVICES HAS BEEN EXPANDED INTO ALL 13 CHILRENS PHYSICIANS PRIMARY CARE OFFICES. CHILDRENS HAS INTEGRATED BEHAVIORAL HEALTH SERVICE WITHIN A NEW FOCUS CLINIC FOR DIABETES MANAGEMENT AND COMPLIANCE, AS WELL AS BEING ON TARGET TO OFFER SERVICE TO CYSTIC FIBROSIS CLINIC. ORAL HEALTH EDUCATION WILL BE INCLUDED IN NEWBORN BOOKLETS. DISCUSSIONS REGARDING ORAL HEALTH AND DENTAL HOME HAS BEEN INCORPORATED INTO THE 12-MONTH AND 24-MONTH WELL-CHECK VISITS AT ALL CHILDRENS PHYSICIANS LOCATIONS. CHILDRENS CONTINUES TO PROVIDE SPACE WITHIN THE SPECIALTY PEDIATRIC CENTER FOR UNMC COLLEGE OF DENTISTRY TO TREAT CHILDREN THROUGHOUT THE AREA WITH ORAL HEALTH NEEDS. VISION SCREENINGS ARE PERFORMED AT 3-YEAR WELL-CHECK VISIT AND HEARING SCREENINGS ARE PERFORMED FOR EACH PATIENT ONCE BETWEEN THE 4-YEAR AND 6-YEAR WELL-CHECK VISITS AT CHILDRENS PHYSICIANS LOCATIONS. REFERRALS ARE MADE FOR ABNORMAL TESTING RESULTS. EDUCATION REGARDING THE IMPORTANCE OF HEALTH VISION AND HEARING ARE INCLUDED IN THE JUST KIDS ISSUE PUBLISHED IN JANUARY 2017. CHILDRENS CONTINUES TO EXPLORE COLLABORATIVE OPPORTUNITIES TO IMPROVE ACCESS TO VISION SERVICES FOR THE UNDERSERVED POPULATION. CHILDRENS PHYSICIANS HAS PARTNERED WITH OMAHA HEALTH KIDS ALLIANCE ON PROJECT AIR TO ASTHMA-PROOF HOMES OF SELECTED CHILDREN WITH SEVERE CASES OF ASTHMA. THIS HAS BEEN BUDGETED FOR IMPLEMENTATION IN 2017. CHILDRENS HEALTHY PLANET ASTHMA PROJECT HAS PROGRESSED WITH THE IMPLEMENTATION OF ELECTRONIC HEALTH RECORD IMPROVEMENTS THAT ENABLE BETTER TRACKING OF PATIENTS DIAGNOSED WITH ASTHMA. WORK CONTINUES ACROSS THE CONTINUUM WITH THE CARE MANAGEMENT PROGRAM TO REDUCE EMERGENCY ROOM VISITS AND HOSPITAL ADMISSIONS DUE TO ASTHMA. CHILDRENS PHYSICIANS HAS IMPLEMENTED A TASK FORCE WITH A GOAL OF SCREENING ALL SEXUALLY ACTIVE PATIENTS FOR STDS, WITH A LAUNCH EFFORT IN 2017. MEGAN CONNELLY, VP OF CHILDRENS PHYSICIANS OPERATIONS, JOINED THE WOMENS FUND OF OMAHAS ADOLESCENT HEALTH PROJECT ADVISORY BOARD IN AUGUST 2016. THE GOAL OF THE ADVISORY BOARD IS TO COMBAT EPIDEMIC STD INFECTION RATES IN THE COMMUNITY. 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 SECONDARY BAD DEBT ASSIGNMENT FOR ALL PATIENTS THAT HAVE NOT APPLIED FOR CHARITY CARE AND HAVE NOT MADE A PAYMENT ON THEIR ACCOUNT. CHILDREN'S IS NOT OBLIGATED TO NOTIFY THE PATIENT THAT THEY HAVE RECEIVED PRESUMPTIVE CHARITY CARE. Schedule H, Part V, Line 16a WWW.CHILDRENSOMAHA.ORG/FINANCIALASSISTANCE Schedule H, Part V, Line 16b http://www.childrensomaha.org/Uploads/Public/Documents/financial-assistanc e/fin-asst-app_english.pdf Schedule H, Part V, Line 16c http://www.childrensomaha.org/Uploads/Public/Documents/financial-assistanc e/fap-plain-language-summary.pdf Schedule H, Part V, Line 16j THE POLICY IS PROVIDED TO THE PUBLIC IN SUMMARY AND DIRECTED TO VISIT THE CHILDREN'S HOSPITAL 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. 6 W VILLAGE PTE URGENT CARE&AMBUL CLINICS 110 N 175TH STREET OMAHA NE 68118 URGENT CARE OPEN 6PM-10PM & ROTATING AMBULATORY CLINICS CHILDREN'S HOME HEALTHCARE 4156 S 52ND STREET OMAHA NE 68117 PEDIATRIC HOME HEALTH CARE SERVICES LINCOLN CLINIC 300 NORTH 44TH STREET LINCOLN NE 68503 PEDIATRIC CLINIC CAROLYN SCOTT RAINBOW HOUSE 7825 FARNAM DRIVE OMAHA NE 68114 MINIMUM TO NO-COST ACCOMMODATIONS FOR FAMILIES OF PATIENTS VAL VERDE URGENT CARE 9801 GILES ROAD SUITE 1 LA VISTA NE 68128 URGENT CARE OPEN 6PM-10PM DUNDEE URGENT CARE 4825 DODGE STREET OMAHA NE 68132 URGENT CARE OPEN 6PM-10PM 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 2016 COMMUNITY BENEFIT REPORT INCLUDE $3.3M 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 ARE 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 THE 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 NEBRASKA CHAMBER OF COMMERCE & INDUSTRY. Schedule H, Part III, Line 2-4 DESCRIBE THE METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 & 3: BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE 2015 MEDICARE COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST VALUE. BAD DEBT EXPENSE AT 100% CHARGE VALUE $2,831,903 MEDICARE COST TO CHARGE RATIO X .468 BAD DEBT EXPENSE AT COST $1,325,331 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 2016 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 REPORTED NET OF ANY PAYMENTS OR DISCOUNTS. Schedule H, Part III. Line 4 BAD DEBT EXPENSE THE COMPANY ADOPTED ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, HEALTH CARE ENTITIES (TOPIC 954): PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES, WHICH REQUIRES HEALTH CARE ENTITIES TO PRESENT THE PROVISION FOR BAD DEBT RELATING TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS RATHER THAN AS OPERATING EXPENSE. ADDITIONAL DISCLOSURES RELATING TO THE SOURCES OF PATIENT REVENUE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RELATED TO PATIENT ACCOUNTS RECEIVABLE ARE ALSO REQUIRED. THE ADOPTION OF THIS ASU HAD NO IMPACT ON THE FINANCIAL CONDITION, RESULTS OF OPERATIONS, OR CASH FLOWS. Schedule H, Part III, Line 8 MEDICARE 2016 MEDICARE CHARGES REPORTED BY CMS IN THE PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM FOR PROVIDER FYE 12/31 WERE MULTIPLIED BY THE 2016 COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST OF CARE RELATED TO THE REIMBURSEMENT PAYMENTS REPORTED ON 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 USES NUMEROUS RESOURCES TO CONDUCT ASSESSMENTS OF THE HEALTH CARE NEEDS OF CHILDREN IN THE COMMUNITIES WE SERVE. THESE RESOURCES INCLUDE NATIONAL PEDIATRIC CARE STANDARDS AND TRENDS AS IDENTIFIED BY CHILDREN'S HOSPITAL ASSOCIATION(CHA). INTERNAL RESOURCES THAT ASSIST WITH THE ASSESSMENT OF CHILD HEALTH NEEDS ARE THE FAMILY ADVISORY COUNCILS, PHYSICIANS AND CLINICAL SERVICE UNITS. 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, AVAILABILTY 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 RESPONSIBILITY TO IDENTIFY FINANCIAL NEED IS WITH THE ACCESS CENTER 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, ELIGIBILITY OF THE INSURED IS ELECTRONICALLY VERIFIED. THE BENEFIT DETAIL INCLUDING DEDUCTIBLE, COPAYMENT AND COINSURANCE AMOUNTS ARE DISCUSSED WITH THE FAMILY AT THAT TIME. 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 M-F. 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 REGISTRATION MANAGER 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 FINANCIAL COUNSELORS 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. WWW.CHILDRENSOMAHA.ORG\FINANCIALASSISTANCE 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 819,427. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA. FOR YEAR ENDED DECEMBER 31, 2016, 51.5% 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 19.3% OF TOTAL HOSPITAL INPATIENT DISCHARGES DURING THIS SAME TIME PERIOD. THE REMAINING 29.2% OF TOTAL DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE THE PRIMARY AND SECONDARY SERVICE AREAS. 2016 DEMOGRAPHIC SUMMARY OMAHA METRO MARKET AREA: DOUGLAS, SARPY AND POTTAWATTAMIE COUNTIES SOURCES: UNITED STATES CENSUS BUREAU AND CHILDREN'S HOSPITAL AND MEDICAL CENTER PATIENT ENCOUNTER DATABASE. COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 11 TOTAL POPULATION 819,427 PEDIATRIC POPULATION 213,673 AVERAGE HOUSEHOLD INCOME $81,209 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 12.8% UNDER AGE 18 17.6% PERCENT OF RESIDENTS ON MEDICAID 10.4% AGE POPULATION % OF TOTAL LESS THAN 18 213,673 26.1% 18 TO 24 75,668 9.2% 25 TO 44 231,674 28.3% 45 TO 64 200,070 24.4% 65+ 98,342 12.0% TOTAL 819,427 100.0% RACE POPULATION % OF TOTAL WHITE 618,831 75.52% BLACK 69,324 8.46% HISPANIC 85,876 10.48% ASIAN/PACIFIC ISLANDER 21,879 2.67% OTHER 20,322 2.48% AM. IND/ALASKA NAT. 3,195 0.39% TOTAL 819,427 100.00% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS: 15.1% COUNTY # OF CENSUS TRACTS* TOTAL CENSUS 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 5-PROMOTION OF COMMUNITY HEALTH PROUDLY SERVING CHILDREN SINCE 1948, CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE ONLY FULL-SERVICE, PEDIATRIC HEALTH CARE CENTER IN NEBRASKA. LOCATED IN OMAHA, IT PROVIDES EXPERTISE IN MORE THAN 50 PEDIATRIC SPECIALTY SERVICES TO CHILDREN AND FAMILIES ACROSS A FIVE-STATE REGION AND BEYOND. THE 145 BED, NON-PROFIT HOSPITAL HOUSES THE ONLY LEVEL II PEDIATRIC TRAUMA CENTER IN THE REGION AND OFFERS 24-HOUR, IN-HOUSE SERVICES BY PEDIATRIC CRITICAL CARE SPECIALISTS. THE CRITICAL CARE TRANSPORT TEAM PROVIDES STATE-OF-THE-ART CARE AND TRANSPORTATION TO CRITICALLY ILL AND INJURED NEONATES, INFANTS AND CHILDREN. CHILDREN'S IS ALSO HOME TO NEBRASKA'S ONLY LEVEL IV REGIONAL NEONATAL INTENSIVE CARE UNIT (NICU). CHILDREN'S OFFERS SEVEN SURGICAL SUITES, FIVE PROCEDURE ROOMS, A HYBRID CATHETERIZATION LAB, A PEDIATRIC INTENSIVE CARE UNIT (PICU), AND A FETAL CARE CENTER THAT FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. A REGIONAL HEART CENTER, CHILDREN'S PROVIDES EXPERTISE IN PEDIATRIC HEART TRANSPLANTATION. CHILDREN'S PEDIATRIC SPECIALISTS ALSO PROVIDE CARDIOLOGY, NEUROLOGY, ORTHOPAEDIC AND OTHER SERVICES IN OUTREACH CLINICS LOCATED IN SURROUNDING COMMUNITIES. IN ADDITION, CHILDREN'S OFFERS A FULL ARRAY OF PEDIATRIC HOME HEALTH CARE 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. 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 2016-17 BEST CHILDREN'S HOSPITAL BY U.S. NEWS & WORLD REPORT IN CARDIOLOGY AND HEART SURGERY, GASTROENTEROLOGY AND GI SURGERY AND ORTHOPAEDICS. 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 HOSPITAL AND MEDICAL CENTER 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 2016, OUR HOSPITAL: - PROVIDED $4.6 MILLION IN SERVICES IN THE FORM OF UNCOMPENSATED CARE [CHARITY CARE ($3.3 MILLION) AND BAD DEBT WRITE-OFFS ($1.3 MILLION)] TO FAMILIES UNABLE TO PAY. WITH 46% OF PATIENT CARE REVENUES DEVOTED TO THE CARE OF LOW-INCOME CHILDREN ASSISTED BY MEDICAID, THE MEDICAID REIMBURSEMENT SHORTFALL FOR FY 2016 WAS $40 MILLION LESS THAN THE COST OF THE CARE PROVIDED. - CONTRIBUTED $1.5 MILLION TOWARDS COMMUNITY HEALTH EDUCATION AIMED AT PROMOTING HEALTH AND PREVENTING ILLNESS AND INJURY MADE AVAILABLE THROUGH THE KOHL'S 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 $11.8 MILLION IN PEDIATRIC HEALTH CARE EDUCATION COSTS TO EDUCATE TOMORROW'S HEALERS. - PROVIDED $37.8 MILLION IN SUBSIDIZED CLINICAL HEALTH SERVICES AND PROGRAMS DESPITE A FINANCIAL LOSS TO THE ORGANIZATION IN ORDER TO MEET AN IDENTIFIED NEED IN THE COMMUNITY. SOME OF THE PROGRAMS AND SERVICES CHILDREN'S OFFERED TO PATIENTS WERE: BEHAVIORAL HEALTH, REHAB SERVICES, HOME HEALTH, URGENT CARE, HEROES (CHILDHOOD OBESITY), HAND IN HAND PALLIATIVE CARE, SPECIALTY CARE CLINICS, FAMILY RESOURCES, CHILD LIFE SPECIALISTS, PASTORAL CARE, SOCIAL WORKERS, INTERPRETERS, FINANCIAL COUNSELORS, PATIENT ADVOCATES AND OTHER PROGRAMS TO ENHANCE THE PATIENT EXPERIENCE. - PROVIDED $0.97 MILLION IN CASH AND IN-KIND DONATIONS/SPONSORSHIPS TO BENEFIT THE BROADER COMMUNITY. IN 2016, CHILDREN'S HOSPITAL & MEDICAL CENTER CONTRIBUTED IN TOTAL OVER $97 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 WITHIN WHICH THE HOSPITAL OPERATES THE FOLLOWING RELATED ORGANIZATIONS: - CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION - CHILDREN'S PHYSICIANS 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.CHILDRENSSNAPSHOT.ORG. true NE PEDIATRIC PRACTICE 8200 DODGE STREET OMAHA NE 68114 263064869 501(C)(3) 3359777 PEDIATRIC RESEARCH UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 985520 NE MED CTR OMAHA NE 68198 470049123 501(C)(3) 148650 PEDIATRIC RESEARCH PEDIATRIC RESEARCH 2 CHARITY ASSISTANCE TO PATIENTS IN NEED 6206 6983898 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 X true true X X X X X false true false false false false false false false Richard Azizkhan MD President, CEO, Member 742901 0 300000 0 18671 0 151913 0 12803 0 1226288 0 0 0 Gary A Perkins CEO Emeritus 2089 0 378749 0 387001 0 76333 0 1382 0 845554 0 0 0 Michael Brown EVP & Treasurer 401910 0 185632 0 72223 0 122028 0 12076 0 793869 0 69270 0 Kathy English EVP & COO 371055 0 174183 0 290577 0 101006 0 7051 0 943872 0 286855 0 Carl Gumbiner MD SVP - Med Affairs & CMO 351549 0 131115 0 207968 0 60153 0 1604 0 752389 0 201592 0 Steven C Burnham SVP - Physician Networks 277841 0 147856 0 45027 0 51252 0 11924 0 533900 0 39911 0 Amy Hatcher SVP & CFO 284617 0 96338 0 2049 0 52250 0 7121 0 442375 0 0 0 Debra Arnow SVP & CNO 250948 0 86005 0 36847 0 33900 0 5853 0 413553 0 0 0 Jamie Drake MD Physician 359989 0 30875 0 324 0 14589 0 212 0 405989 0 0 0 Chandrika Rizal MD Physician 314204 0 26000 0 3849 0 39038 0 157 0 383248 0 0 0 Mark Stastny VP - CIO 269943 0 77885 0 3596 0 38805 0 10872 0 401101 0 0 0 Rachel McCann MD Physician 361489 0 31158 0 3183 0 17216 0 10697 0 423743 0 0 0 Amy Bones SVP - General Counsel 205115 0 69404 0 2682 0 59171 0 6595 0 342967 0 0 0 Patricia Schulz SVP & CHRO 235493 0 20000 0 4328 0 63086 0 11818 0 334725 0 0 0 Kari Krenzer MD PHYSICIAN 309314 0 30875 0 3314 0 21020 0 15729 0 380252 0 0 0 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 4b THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN DURING 2016. THE AMOUNTS OF DEFERRED COMPENSATION DISTRIBUTED AND ACCRUED FOR EACH OF THE INDIVIDUALS DURING 2016 ARE AS FOLLOWS: MICHAEL BROWN $64,828 ACCRUAL, $69,270 PLAN DISTRIBUTION KATHY ENGLISH $59,156 ACCRUAL, $286,855 PLAN DISTRIBUTION CARL GUMBINER, MD $44,253 ACCRUAL, $201,592 PLAN DISTRIBUTION STEPHEN C BURNHAM $35,352 ACCRUAL, $39,911 PLAN DISTRIBUTION RICHARD AZIZKHAN, MD $118,013 ACCRUAL AMY HATCHER $36,350 ACCRUAL DEBRA ARNOW $32,216 ACCRUAL PAT SCHULZ $30,211 ACCRUAL AMY BONES $26,124 ACCRUAL Schedule J, Part II THE FIGURE FOR GARY A PERKINS ITEMIZED AT PART II B (III) OTHER REPORTABLE COMPENSATION INCLUDES A PAYMENT OF TWO HUNDRED TWENTY ONE THOUSAND AND NINETY FOUR DOLLARS REPRESENTING A CONTRIBUTION TO A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) FOR MR. PERKINS IN HIS CAPACITY AS A CHIEF EXECUTIVE OFFICER. THE SERP BENEFIT TARGET IS BASED ON MR. PERKINS 40 YEARS OF SERVICE AND WILL PROVIDE A MARKET COMPETITIVE BENEFIT IN THE OPINION OF THE HOSPITAL'S INDEPENDENT COMPENSATION CONSULTANT. A HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230KT6 2008-08-12 100881609 REF CHILD HOSP 2007 SERIES A & B true false false B HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 2014-09-10 19900000 ADV REF OF CHILD HOSP 2008 SERIES false false false A 12915000 17125000 100883157 5001548 0 0 751783 24826 0 2755000 92350000 0 2008 true false true true B 640000 0 20331457 0 0 18067950 207632 0 0 0 2055875 0 2008 false true false 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 A false false true true true true MORGAN STANLEY 25. false false false 0 false true B false true false false false false 0 false 0 false true A true B 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: 7/31/2013 Richard Azizkhan MD WIFE IS EMPLOYEE 25525 EMPLOYMENT false Richard Azizkhan MD SON IS EMPLOYEE 33463 EMPLOYMENT false Form 990, Part VI, Line 4 CHILDRENS HOSPITAL & MEDICAL CENTERS FOUNDING MISSION SO THAT ALL CHILDREN MAY HAVE A BETTER CHANCE TO LIVE ROOTED THE ORGANIZATION AND REFLECTED ITS HEART FOR ALMOST 70 YEARS. NOW, AS CHILDRENS EMBARKS ON A NEW ERA OF GROWTH AND TRANSFORMATION, THE HOSPITAL FINDS ITSELF AT A REFLECTION POINT. THE TIMING IS RIGHT TO MODERNIZE THE MISSION AS CHILDRENS EMBRACES WHO THEY ARE TODAY AND WHAT THEY ASPIRE TO BE. CHILDRENS HAS EXPANDED IN RECOGNITION, SIZE, OUTREACH, SERVICE, EXPERTISE, COLLABORATION AND REPUTATION. IT IS A HEALTHY ORGANIZATION THAT HAS A POWERFUL MANDATE TO PROVIDE ROUTINE-TO-COMPLEX CARE FOR ALL CHILDREN, AND THE HOSPITALS FOCUS NOW EXTENDS WELL BEYOND THEIR SURVIVAL TO THEIR QUALITY OF LIFE. CHILDRENS NEW MISSION BETTER REFLECTS THAT: TO IMPROVE THE LIFE OF EVERY CHILD THROUGH DEDICATION TO EXCEPTIONAL CLINCAL CARE, RESEARCH, EDUCATION AND ADVOCACY. GIVEN ALL THAT CHILDRENS IS TODAY, IT IS A MORE APPROPRIATE PROMISE TO PATIENTS AND THEIR FAMILIES. CHILDRENS NEW VISION IS EQUALLY INSPIRING: TO BE A GLOBAL LEADER IN CHILDRENS HEALTH. CHILDRENS COMMITS TO THIS BOLD, BRIGHT FUTURE WITH RESOLVE, OPTIMISM AND A STRONG SENSE OF RESPONSIBILITY BECAUSE THE CHILDREN AND FAMILIES SERVED BY THE HOSPITAL DESERVE NOTHING LESS. Form 990, Part VI, Line 11b A complete copy of the Form 990 is made available to the Executive Committee of the Board excluding the Medical Staff President. The Form 990, excluding 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 Directors 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 CONFLICTS OF INTEREST QUESTIONNAIRE IN THE FORMAT BY THE GOVERNANCE COMMITTEE FROM TIME TO TIME. 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 CONFLICTS OF INTEREST QUESTIONNAIRE; AND (G) STATES THAT THE INFORMATION PROVIDED IN THE CONFLICTS 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 WITH INTERESTED PERSON WITH CONFLICTS OF INTEREST MUST BE APPROVED IN ADVANCE BY A MAJORITY OF DISINTERESTED DIRECTORS. IN ORDER TO APPROVE AN ARRANGEMENT OF 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 IT'S 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 (SULLIVAN COTTER) CONDUCTS A MARKET ANALYSIS OF THE EXECUTIVE COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE. EXECUTIVE BASE SALARIES ARE TARGETED FOR THE 50TH PERCENTILE OF THE MARKET. SULLIVAN COTTER 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, EXECUTIVE VP & TREASURER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, CHIEF FINANCIAL OFFICER 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 CEOS 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 IN ADMINISTRATION. Form 990, Part XI, Line 9 ($83,000) - CHANGE IN VALUE OF SPLIT INTEREST $82,990 - MINORITY INTEREST IN CHILDREN'S PHYSICIANS $883,267 - CHANGE IN VALUE OF SWAP ($6,107,187) - CAPITAL TRANSFERS FOUNDATION $7,234 - CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK ($5,216,696) - 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 true false false true false true true true true false true true true CHILDREN'S HOSPITAL FOUNDATION c 4040025 BOOK CHILDREN'S HOSPITAL FOUNDATION LMNOQ -15517813 BOOK CHILDREN'S PHYSICIANS j 85810 BOOK CHILDREN'S HOSPITAL FOUNDATION r 21625000 BOOK CHILDREN'S PHYSICIANS G 2354095 BOOK