2015-08-17T11:21:39-05:00 2014-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2014-01-01 470379754 Children's Hospital & Medical Center % AMY HATCHER CHIL 4029554116 8200 DODGE STREET Suite OMAHA NE 68114 Amy Hatcher CFO 4029556795 2015-08-14 true Donald Neal Jr P00798244 4023481450 2014 2016-04-25 22:37:26Z Gary A Perkins 8200 Dodge Street Omaha NE 68114 320804050 false X WWW.CHILDRENSOMAHA.ORG X 1948 NE A FAMILY-CENTERED REGIONAL PROVIDER DEDICATED TO COST-EFFECTIVE, QUALITY HEALTHCARE SERVICES & ADVOCACY FOR CHILDREN, WHILE ACTIVELY PROMOTING HEALTHCARE EDUCATION & RESEARCH 19 17 2298 276 0 0 5247394 7002656 271056356 303558654 1201279 -401079 9290238 10634802 286795267 320795033 9948119 10879794 0 0 117409613 127539977 0 0 0 117608041 126627869 244965773 265047640 41829494 55747393 303127732 346342684 149951600 160231749 153176132 186110935 X SO THAT ALL CHILDREN MAY HAVE A BETTER CHANCE TO LIVE, CHILDREN'S HOSPITAL & MEDICAL CENTER DELIVERS EXTRAORDINARY CARE TO CHILDREN, EDUCATES HEALTH CARE PROFESSIONALS, AND PROMOTES PEDIATRIC RESEARCH. false false 252211249 10879794 314056210 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. THE FETAL CARE CENTER FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. CHILDREN'S HOSPITAL & MEDICAL CENTER ALSO PROVIDES SPECIALTY PEDIATRIC CARE SERVICES IN LINCOLN, KEARNEY, GRAND ISLAND, HASTINGS, NORTH PLATTE, COLUMBUS, NORFOLK, AND HOLDREGE, NEBRASKA; SIOUX FALLS AND RAPID CITY, SOUTH DAKOTA; AND SIOUX CITY, IOWA. 252211249 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 false false false false false false false true true true false false true 62 0 true 2298 true false false false false false false false false false false X 19 17 false false false false false false false true true false false true true true true true true true true false X AMY HATCHER 4029556795 8200 DODGE STREET OMAHA NE 68114 X Jim Simpson Chair 1.0 0.0 X X 0 0 0 Rodrigo Lopez Vice Chair 1.0 0.0 X X 0 0 0 Rich Anderl Secretary 1.0 0.0 X X 0 0 0 Matthew Miller Treasurer 1.0 0.0 X X 0 0 0 Brad Brabec MD Member 1.0 0.0 X 0 0 0 Dan Hamann Member 1.0 0.0 X 0 0 0 Diane Duren Member 1.0 0.0 X 0 0 0 Ellen Wright Member 1.0 0.0 X 0 0 0 Ivan Gilreath Member 1.0 0.0 X 0 0 0 Jayesh Thakker MD Member 1.0 0.0 X 0 0 0 Jim Greisch Member 1.0 0.0 X 0 0 0 John Jenkins Member 1.0 0.0 X 0 0 0 Joleen David Member 1.0 0.0 X 0 0 0 Lorraine Chang Member 1.0 0.0 X 0 0 0 Robert Dunlay MD Member 1.0 0.0 X 0 0 0 Scot Thompson Member 1.0 0.0 X 0 0 0 Sherrye Hutcherson Member 1.0 0.0 X 0 0 0 Kent Kronberg MD Member 40.0 0.0 X 227194 0 30989 Gary A Perkins President, CEO, Member 40.0 1.0 X X 1103752 0 67027 Amy Hatcher CFO 40.0 0.0 X 135252 0 4839 Michael Brown EVP & Treasurer 40.0 0.0 X 615029 0 66238 Carl Gumbiner MD SVP - Med Affairs & CMO 40.0 0.0 X 521059 0 47399 Kathy English EVP & COO 40.0 0.0 X 584180 0 81889 Steven C Burnham SVP Physician Networks 26.0 14.0 X 391757 0 48640 George Reynolds VP-CIO/CMIO 40.0 0.0 X 596172 0 54283 Corliss L Lovstad VP Human Resources 40.0 0.0 X 326705 0 44821 Debra Arnow RN VP - Patient Care & CNO 40.0 0.0 X 347680 0 22137 Jamie Drake MD Physician 40.0 0.0 X 333095 0 15828 Michael K Wilczewski MD Physician 40.0 0.0 X 320049 0 21035 5501924 0 505125 116 false true false Kiewit Construction Company 3921 Mason Street Omaha NE 68105 Building Consultants 15634355 Epic Systems Corp PO Box 88314 Milwaukee WI 53288 IT Support Services 3129359 Pyramid Healthcare Solutions 14141 46th Street North Clearwater FL 33762 Staffing Services 1208077 Allscripts Solutions Corporation PO Box 8538-0133 Lockbox 077133 Philadelphia PA 19171 IT Support Services 1065878 CLH Architects PC 3705 N 200th Street Elkhorn NE 68022 Building Consultants 934059 8 5734510 1174646 93500 7002656 NET PATIENT REVENUE 621110 302337502 302337502 ELECTRONIC HEALTH RECORDS 900099 1221152 1221152 303558654 -392062 -392062 0 0 137246 137246 0 137246 137246 9017 -9017 -9017 -9017 0 0 0 MANAGEMENT FEE INCOME 541610 5252728 5252728 METHODIST SERVICE 541900 913605 913605 TRANSPORT INCOME 900099 334594 334594 3996629 3996629 10497556 320795033 314056210 -263833 6057648 6057648 4822146 4822146 0 0 3866891 3866891 0 101404259 101404259 5564573 5564573 9627015 9627015 7077239 7077239 0 261286 261286 259164 259164 56805 56805 0 0 21866126 17547586 4318540 3227850 3227850 43723432 43723432 5493003 5493003 0 7031426 7031426 786878 786878 0 0 5310430 5310430 10326295 10326295 21278789 21278789 1008081 1008081 COLLECTION EXPENSE 1832189 1832189 BUILDING MAINTENANCE 1299873 1299873 OPERATING LEASES 643697 643697 DUES & SUBSCRIPTIONS 415029 415029 1807516 1807516 265047640 252211249 12836391 0 1766853 2116253 30542812 42721265 3347000 3297000 51042858 54651581 0 0 0 0 0 0 2928674 2990843 2545151 3041575 367087141 167656516 177599348 199430625 0 0 10343018 12067766 9305743 11246873 0 0 13706275 14778903 303127732 346342684 36431293 44057687 0 0 13898 0 97250051 96715255 0 0 0 0 6475268 6233303 0 800077 9781090 12425427 149951600 160231749 X 149829132 182813935 3347000 3297000 0 0 153176132 186110935 303127732 346342684 X 55747393 -22812590 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 56805 56805 264990835 265047640 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 21188 30194 19630 56805 127817 250000 250000 250000 250000 1000000 1500000 52569968 4571646 103409 4535177 52709846 47650277 6663819 833787 2577915 52569968 46288568 2703274 1220869 2562434 47650277 46369324 1889083 836292 2806131 46288568 47818091 734290 2140797 4323854 46369324 0.73200 0.10200 0.16600 false true true 13483765 13483765 197413820 72171753 125242067 12515953 9554673 2961280 128414481 85411990 43002491 15259122 518100 14741022 199430625 0 DEFERRED COMPENSATION LIABILITY 2492069 SWAP LIABILITY 6184400 NON-CONTROLLING INTEREST IN CP LIAB 3748958 12425427 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 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 2014 AND 2013, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES. true true X true X 185. true X true true false true true 2169966 0 2169966 0.00820 93741691 75345793 18395898 0.06940 95911657 75345793 20565864 0.07760 1635457 418851 1216606 0.00460 11472754 1174646 10298108 0.03890 104766280 79524300 25241980 0.09520 3028706 3028706 0.01140 3810221 3810221 0.01440 124713418 81117797 43595621 0.16450 220625075 156463590 64161485 0.24210 10500 10500 10500 10500 true 2698094 185777 293902 -108125 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 X 12 true true false true X CHILDRENSOMAHA.ORG/HEALTHNEEDSASSESSMENT X true 12 false true false true X 185. 400. X X true true X X true X X X X X X X true false true X false false 5 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 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 2014 COMMUNITY BENEFIT REPORT INCLUDE $2.2M 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, Lines 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 2014 MEDICARE COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST VALUE. BAD DEBT EXPENSE AT 100% CHARGE VALUE $5,995,764 MEDICARE COST TO CHARGE RATIO X .45 BAD DEBT EXPENSE AT COST $2,698,094 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 2014 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 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 2014 MEDICARE CHARGES REPORTED BY CMS IN THE PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM FOR PROVIDER FYE 12/31 WERE MULTIPLIED BY THE 2014 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 COUNCIL, 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, AVAILABILITY OF COMMUNITY RESOURCES, AVAILABILITY OF FUNDING, AND/OR ALIGNMENT WITH THE HOSPITAL'S EXPERTISE AND STRATEGIC GOALS. IN 2012, CHILDREN'S COLLABORATED WITH BOYS TOWN NATIONAL RESEARCH HOSPITAL IN OMAHA TO PLAN AND CONDUCT A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT SURVEY FOCUSING SOLELY ON PEDIATRICS IN 2012. PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC) WAS HIRED TO GATHER DATA TO ASSIST IN DETERMINING THE HEALTH STATUS, BEHAVIORS AND NEEDS OF CHILDREN AND ADOLESCENTS IN THE OMAHA METROPOLITAN AREA. 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 FINANCIAL COUNSELORS, PATIENT FINANCIAL SERVICES, 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, CO-PAYMENT 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 FINANCIAL COUNSELORS WHO ARE AVAILABLE M-F. ALL SELF PAY FAMILIES ARE ENCOURAGED TO SPEAK TO A FINANCIAL COUNSELOR. 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 PROVIDING 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. ALL OTHER BILLING, PAYMENT AND FINANCIAL RESPONSIBILITY RELATED LINKS ON CHILDREN'S WEBSITE STATES 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 803,362. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA. FOR YEAR ENDED DECEMBER 31, 2014, 57% 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% OF TOTAL HOSPITAL INPATIENT DISCHARGES DURING THIS SAME TIME PERIOD. THE REMAINING 24% OF TOTAL DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE THE PRIMARY AND SECONDARY SERVICE AREAS. 2014 DEMOGRAPHIC SUMMARY OMAHA METRO MARKET AREA: DOUGLAS, SARPY AND POTTAWATTAMIE COUNTIES SOURCES: UNITED STATES CENSUS BUREAU AND CHILDREN'S HOSPITAL & MEDICAL CENTER PATIENT ENCOUNTER DATABASE. COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 12 TOTAL POPULATION 803,362 PEDIATRIC POPULATION 207,203 AVERAGE HOUSEHOLD INCOME $72,535 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 12.6% UNDER AGE 18 17.7% PERCENT OF RESIDENTS ON MEDICAID 13.4% AGE POPULATION % OF TOTAL LESS THAN 18 207,203 25.8% 18 TO 24 78,299 9.7% 25 TO 44 227,344 28.3% 45 TO 64 196,033 24.4% 65+ 94,483 11.8% TOTAL 803,362 100.0% RACE POPULATION % OF TOTAL WHITE 612,647 76.3% BLACK 67,871 8.4% HISPANIC 80,332 10.0% ASIAN/PACIFIC ISLANDER 19,195 2.4% OTHER 20,230 2.5% AM. IND./ALASKA NAT. 3,087 0.4% TOTAL 803,362 100.0% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS: 12.0% COUNTY # OF CENSUS TRACTS* TOTAL CENSUS TRACTS % OF TOTAL DOUGLAS 36 156 23.1% SARPY 3 43 7.0% POTTAWATTAMIE 3 30 10.0% TOTAL 42 229 18.3% *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 AND MEDICAL CENTER IS THE ONLY FULL-SERVICE, PEDIATRIC HEALTH CARE CENTER IN NEBRASKA. LOCATED IN OMAHA, IT PROVIDES EXPERTISE IN MORE THAN 30 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 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 MODEL (EMRAM). CHILDREN'S IS ALSO RANKED AS A BEST IN CHILDREN'S HOSPITAL BY U.S NEWS & WORLD REPORT IN ORTHOPAEDICS, PULMONOLOGY, CARDIOLOGY AND HEART SURGERY, AND GASTROENTEROLOGY AND GI SURGERY. 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 2014, OUR HOSPITAL: -PROVIDED $4.9 MILLION IN SERVICES IN THE FORM OF UNCOMPENSATED CARE\CHARITY CARE ($2.2 MILLION) AND BAD DEBT WRITE-OFFS ($2.7 MILLION) TO FAMILIES UNABLE TO PAY THE BILLS ASSOCIATED WITH THEIR CHILDREN'S MEDICAL CARE. WITH 40 PERCENT OF PATIENT CARE REVENUES DEVOTED TO THE CARE OF LOW-INCOME CHILDREN ASSISTED BY MEDICAID, THE MEDICAID REIMBURSEMENT SHORTFALL FOR FY 2014 WAS $18.4 MILLION LESS THAN THE COST OF THE CARE PROVIDED. -CONTRIBUTED $1.2 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, LOW-COST LODGING FOR FAMILIES OF OUT-OF-TOWN PATIENTS IS OFFERED AT THE CAROLYN SCOTT RAINBOW HOUSE. -CONTRIBUTED $10.3 MILLION IN PEDIATRIC HEALTH CARE EDUCATION COSTS TO EDUCATE TOMORROW'S HEALERS AND AN ADDITIONAL $3.0 MILLION TO SUPPORT PEDIATRIC EDUCATION, RESEARCH AND CLINICAL CARE THAT WILL IN TURN IMPROVE THE HEALTH CARE OF ALL CHILDREN. IN 2014, THE HOSPITAL SUPPORTED THE JOINT CREIGHTON-NEBRASKA UNIVERSITIES HEALTH FOUNDATION PEDIATRICS RESIDENCY PROGRAMS AT UNMC AND CREIGHTON UNIVERSITY, AS WELL AS MANY OF THE REGION'S NURSING AND HEALTH PROFESSIONAL SCHOOLS. -PROVIDED $25.2 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 $3.8 MILLION IN CASH AND IN-KIND DONATIONS/SPONSORSHIPS TO BENEFIT THE BROADER COMMUNITY INCLUDING A $3.0 MILLION GRANT TO THE UNIVERSITY OF NEBRASKA FOUNDATION TO FUND CHILDHOOD ONCOLOGY RESEARCH AT THE FRED AND PAMELA BUFFET CANCER CENTER. IN 2014, CHILDREN'S HOSPITAL AND MEDICAL CENTER CONTRIBUTED IN TOTAL OVER $64 MILLION IN COMMUNITY BENEFITS REPRESENTING 24 PERCENT OF THE HOSPITAL'S OPERATING EXPENSES. Schedule H, Part VI, Line 6 6-AFFILIATED HEALTH CARE SYSTEM CHILDREN'S HOSPITAL AND 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 Schedule H, Part VI, Line 7 7- STATE FILING OF COMMUNITY BENEFIT REPORT THE CHILDREN'S HOSPITAL AND 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) 3218900 PEDIATRIC RESEARCH UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 985520 NE MED CTR OMAHA NE 68198 470049123 501(C)(3) 2838748 PEDIATRIC RESEARCH 2 CHARITY ASSISTANCE TO PATIENTS IN NEED 5672 4822146 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 IS BASED ON THE ANNUAL GROSS INCOME THRESHOLDS USING THE CURRENT FEDERAL POVERTY LEVEL GUIDELINES. GRANTS ARE ONLY DISTRIBUTED TO 501(c)(3) ORGANIZATIONS BASED ON THE HOSPITAL'S EVALUATION CRITERIA. X true true X X X X X false true false false false false false false false Kent Kronberg MD Member 208666 0 14536 0 3992 0 20928 0 10061 0 258183 0 0 0 Gary A Perkins President, CEO, Member 577666 0 351945 0 174141 0 55500 0 11527 0 1170779 0 0 0 Michael Brown EVP & Treasurer 337166 0 219377 0 58486 0 54753 0 11485 0 681267 0 0 0 Carl Gumbiner MD SVP - Med Affairs & CMO 334200 0 169154 0 17705 0 45801 0 1598 0 568458 0 0 0 Kathy English EVP & COO 332338 0 170625 0 81217 0 75027 0 6862 0 666069 0 0 0 Steven C Burnham SVP Physician Networks 263056 0 107198 0 21503 0 42084 0 6556 0 440397 0 0 0 George Reynolds VP-CIO/CMIO 399957 0 191320 0 4895 0 38300 0 15983 0 650455 0 0 0 Corliss L Lovstad VP Human Resources 229698 0 92656 0 4351 0 38300 0 6521 0 371526 0 0 0 Debra Arnow RN VP - Patient Care & CNO 238250 0 103951 0 5479 0 15600 0 6537 0 369817 0 0 0 Jamie Drake MD Physician 303800 0 29057 0 238 0 15600 0 228 0 348923 0 0 0 Michael K Wilczewski MD Physician 290553 0 28790 0 706 0 20800 0 235 0 341084 0 0 0 Schedule J, Part I, Line 1a GARY A PERKINS' 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 2014. THE AMOUNTS of DEFERRED COMPENSATION distributed and accrued FOR EACH OF THE INDIVIDUALS DURING 2014 ARE AS FOLLOWS: MICHAEL BROWN $33,953 Accrual, $54,205 Plan Distribution KATHY ENGLISH $30,458 Accrual, $78,425 Plan Distribution CARL GUMBINER, MD $30,201 Accrual, $11,456 Plan Distribution STEPHEN C BURNHAM $26,484 Accrual, $3,917 Plan Distribution Schedule J, Part II THE FIGURE FOR GARY A PERKINS ITEMIZED AT PART II B (III) "OTHER REPORTABLE COMPENSATION" INCLUDES A PAYMENT OF ONE HUNDRED TWENTY FIVE THOUSAND NINE HUNDRED AND SEVENTY TWO 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 CHILD HOSP 2008 SERIES B false false false A 6190000 17125000 100881946 5000337 0 0 751783 24826 0 2755000 92350000 0 2008 true false true true B 0 0 19959419 0 0 19751787 207632 0 0 0 0 0 2008 false true false true A false false false false 0 false false false true B false false false false 0 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 Form 990, Part VI, Line 11b THE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS THROUGH THE DIRECTOR'S DESK WEBSITE AND AN OVERVIEW WILL BE PRESENTED TO THE EXECUTIVE COMMITTEE OF CHILDREN'S HOSPITAL & MEDICAL CENTER 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 15 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 THE TOP FIVE EXECUTIVES (CHIEF EXECUTIVE OFFICER, EXECUTIVE VP & TREASURER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER, AND SENIOR VP PHYSICIAN NETWORKS) 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 IN ADMINISTRATION. Form 990, Part XI, Line 9 ($50,000) - CHANGE IN VALUE OF SPLIT INTEREST $1,294,086 - MINORITY INTEREST IN CHILDREN'S PHYSICIANS ($1,579,529) - CHANGE IN VALUE OF SWAP ($19,911,879) - CAPITAL TRANSFERS FOUNDATION $2,100 - CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK ($2,567,368) - LOSS ON EXTINGUISHMENT OF BOND ($22,812,590) - TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHILDREN'S HOSPITAL & MEDICAL CENTER FDN 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 9 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 true false true true true true false true true true CHILDREN'S HOSPITAL & MEDICAL CENTER FDN c 5734510 BOOK CHILDREN'S HOSPITAL & MEDICAL CENTER FDN lmnoq -13903121 BOOK CHILDREN'S PHYSICIANS j 509640 BOOK CHILDREN'S HOSPITAL & MEDICAL CENTER FDN r 33815000 BOOK