2014-05-15T15:37:54-05:00 2013-06-30 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2012-07-01 911858433 THE NEBRASKA MEDICAL CENTER % STEPHANIE DAUBERT NEBR 4025594000 988145 NEBRASKA MEDICAL CENTER Suite OMAHA NE 681988145 Stephanie Daubert 4025522889 2014-05-15 true 4023481450 2012 2015-11-30 17:44:51Z WILLIAM DINSMOOR 987400 NEBRASKA MEDICAL CENTER OMAHA NE 681987400 781434613 false X www.nebraskamed.com X 1997 NE To be the region's premier medical provider by serving our patients and community through extraordinary care, the finest people and academic and private practice medicine. 12 8 6601 758 3686961 6021010 4951878 803756761 746303783 8473453 10357225 10826695 12119720 829077919 773732606 114453911 113208617 0 0 311005305 315326031 70742 53667 1155660 377138177 330730497 802668135 759318812 26409784 14413794 797174434 837949195 242689546 253733299 554484888 584215896 X TO BE THE REGION'S PREMIER MEDICAL PROVIDER BY SERVING OUR PATIENTS AND COMMUNITY THROUGH EXTRAORDINARY CARE, THE FINEST PEOPLE AND ACADEMIC AND PRIVATE PRACTICE MEDICINE. false false 155083637 27582105 172189424 Oncology Service Line Cancer treatment services offered by the Corporation include treatment of lymphoma, leukemia, head and neck, breast, gastrointestinal, lung, prostate, gynecologic, blood, bone marrow, brain and spine cancers. The patients are supported by research that is conducted on the Corporation/UNMC campus. The Corporation and partner UNMC Eppley Cancer Institute is the only clinical cancer center in its service area designated by the National Cancer Institute. In addition to treatment and clinical trials The Corporation offers support groups, social work, pain management, and a variety of additional patient supportive services. In the fall of 2008, the corporation opened a new cancer center near Village Pointe offering outpatient services in effort to serve the growing demand for excellent cancer care closer to patients' homes. In the fall of 2011, the corporation opened a cancer clinic and treatment center at Bellevue Medical Center. In addition, as one of the busiest programs in the world, the Bone Marrow Transplantation program served 136 patients in the year ended June 30, 2013. The program benefits from the research conducted on the Corporation/UNMC campus and the Cooperative Care program which assists patients to prepare for and recover from the transplant in a home-like setting with a care partner of their choosing. The program is housed in the Lied Transplant Center and recognizes the importance of environment to the patient's overall well-being. During fiscal year 2013, the Oncology Service Line incurred over 88,000 cases and over 20,000 patient days. Approximately 40% of the net revenue was derived from inpatient cases. 94831861 17143729 98303706 CARDIOVASCULAR SERVICE LINE The Corporation provides a wide range of Cardiovascular services from diet counseling to surgical procedures and rehabilitation. The Corporation has been successful in recruiting physicians and has the only heart failure specialist in the region and the only heart failure program certified by The Joint Commission in the state of Nebraska. The Congestive Heart Failure program and Acute Myocardial Infarction program each received the "Gold Seal of Approval" certification from American Heart Association and are certified by The Joint Commission. These services are the first and only nationally certified programs of their kind in the state of Nebraska. The Chest Pain Center has received full Chest Pain Center Accreditation from the Society of Chest Pain Centers. The Nebraska Medical Center has been recognized for service excellence under the J.D. Power and Associates Distinguished Hospital Program. We have the only Joint Commission certified Destination Therapy program in the state and are the only hospital in the region performing heart transplants and implanting total artificial hearts. The hospital treats patients from the surrounding region and in the year ended June 30, 2013, approximately 421 open heart surgeries were performed, 20 heart transplants, 33 mechanical circulatory system device implantations, and 3 Total Artificial Heart implantations were performed. 72261357 10284108 74376555 Solid Organ Transplantation Service Line The Corporation operates one of the busiest solid organ transplant programs in the world. In the year ended June 30, 2013, the Corporation performed 265 solid organ transplants including liver, kidney, heart, pancreas and small bowel. The success of the Corporation's solid organ transplant program is heightened by research done on the Corporation/UNMC campus. Patients have come to the Corporation for single-or multiple-organ transplant from all 50 states and five continents. During fiscal year 2013, the Solid Organ Transplantation Service Line incurred over 33,580 cases and 13,100 patient days. Approximately 74% of the revenue was derived from inpatient cases. 71068317 12855144 72853606 Neurolgy Service Line 255901376 45343531 255635796 All Other Hospital 107108385 0 79551070 Other Program Services 434078078 58198675 408040472 756254933 true true false true false false false true false true true false false false true true false true false false true false false true false false true true true true true true false false false false false false false false true true true false false false false true true true false false true 486 0 true 6601 true true true false false false false false false false false false X 12 8 true false false false true true true true true false false false true true true true true true true true false X STEPHANIE DAUBERT 4025522889 988145 NEBRASKA MEDICAL CENTER OMAHA NE 681988145 X Bruce R Lauritzen 1.0 0.0 X X 0 0 0 Mogens C Bay 1.0 0.0 X X 0 0 0 Bruce Grewcock 1.0 0.0 X X 0 0 0 Duane W Acklie 1.0 0.0 X 0 0 0 James T Canedy 1.0 0.0 X 0 0 0 Ronald Hollins MD 1.0 0.0 X 0 0 0 Harold Maurer MD 1.0 0.0 X 0 0 0 Gail Walling Yanney MD 1.0 0.0 X 0 0 0 James Young 1.0 0.0 X 0 0 0 Marlin G Stahl MD 1.0 54.0 X 21394 0 0 James B Milliken 1.0 0.0 X X 0 0 0 Bradley E Britigan MD 1.0 0.0 X 0 0 0 Nancy Keegan 1.0 0.0 X 0 0 0 James E McClurg PhD 1.0 0.0 X Glenn A Fosdick 55.0 0.0 X 1677825 0 172976 Stephen Smith MD 55.0 0.0 X 810770 0 139559 William Dinsmoor 54.0 1.0 X 714949 0 139082 Joe Graham 55.0 0.0 X 680032 0 134570 Rosanna Morris 54.0 1.0 X 553474 0 98659 Randall J Hallett 55.0 0.0 X 305050 0 24789 Louis Burgher MD 1.0 54.0 X 307565 0 6642 Thomas Macy 55.0 0.0 X 236892 0 35376 Natale Ponticello 55.0 0.0 X 302319 0 26683 Tadd Pullin 55.0 0.0 X 409145 0 81473 Theresa Franco 55.0 0.0 X 252285 0 27690 Deborah Istas 55.0 0.0 X 248592 0 24586 Jorge Parodi 55.0 0.0 X 250299 0 30071 Ruta Davidson 55.0 0.0 X 329225 0 28764 Michael Powell 55.0 0.0 X 204215 0 33824 Charles Lakso 55.0 0.0 X 221314 0 24362 Lisa McClane 55.0 0.0 X 192753 0 10252 Julie Lazure 55.0 0.0 X 176634 0 27915 Connie Ogden 55.0 0.0 X 180469 0 18760 Jana Danielson 55.0 0.0 X 188191 0 16674 Donald Futrell 55.0 0.0 X 192460 0 25311 David S Fuller 55.0 0.0 X 254935 0 28549 Lianne Stevens 55.0 0.0 X 264581 0 25725 Marcel Devetten MD 55.0 0.0 X 206327 0 23467 Michael D Johnson 55.0 0.0 X 306165 0 19516 Cynthia Owen 55.0 0.0 X 265198 0 26292 STEVEN J WEES MD 55.0 0.0 X 245085 0 18169 Martin Carmody 0.0 0.0 X 243225 0 0 10241368 0 1269736 263 true true false UNMC PHYSICIANS 988101 NE MED CTR OMAHA NE 681988101 MEDICAL SERVICES 16535492 KIEWIT BUILDING GROUP 3921 MASON ST OMAHA NE 68105 CONSTRUCTION 6710514 CARDINAL HEALTH 5840 F STREET OMAHA NE 68117 MANAGEMENT FEE 7083512 UNMC 984290 NE MED CTR OMAHA NE 681984290 MEDICAL SERVICES 18058678 EPIC SYSTEMS CORPORATION 1979 MILKY WAY VERONA WI 53593 IT SERVICES / EHR 11559288 140 941347 4010531 305547 4951878 NET PATIENT REVENUE 900099 729906639 729906639 LAB ADMINISTRATION 900099 5709068 5709068 EHR INCENTIVE PAYMENTS 900099 4188653 4188653 REMOTE PHARMACY SERVICES 446110 4080294 3606657 473637 LIED HOSPITALITY 900099 932001 932001 1487128 1487128 746303783 9507122 9507122 0 0 3468086 546730 3468086 546730 4014816 2188431 1826385 8374274 177836 7615174 86833 759100 91003 850103 850103 0 0 0 ENVIRONMENTAL SERVICES 900099 3123012 3123012 ONE CHART FEES 446110 847529 725000 122529 CHILD CARE 624410 761393 761393 3372970 2470606 902364 8104904 773732606 752910157 3686961 12183610 72249744 72249744 40958873 40958873 0 0 9830677 9491624 339053 0 243946264 243584272 361992 23445792 23417053 28739 20169108 20131448 37660 17934190 17895102 39088 0 1112758 1112758 795461 795461 57839 57839 53667 53667 210216 210216 54994086 54940629 53457 3958826 3958826 4505139 4483402 21737 0 0 5871053 5871053 975616 960404 15212 0 374344 371730 2614 2469458 2469458 0 47269489 47260512 8977 3954547 3954547 MEDICAL AND CLINICAL EXPENSE 151069237 151069237 MAINTENANCE/GROUNDS UPKEEP 17863953 17830470 33483 OTHER UNMC/UNMC-P 14958062 14958062 EQUIPMENT RENTALS/LEASES 7567277 7518221 49056 12723136 12612211 110925 759318812 756254933 1908219 1155660 41697888 84597960 185577791 162423912 410396 164895 101354366 110896687 0 0 0 0 3085245 4057952 4232728 4171169 9157216 11218829 871635625 500024111 366438088 371611514 47532017 38777618 9053596 9936693 0 0 0 0 28635103 40091966 797174434 837949195 115099905 124368293 0 0 0 0 67544073 77386744 0 0 0 0 15031181 10353473 0 0 45014387 41624789 242689546 253733299 X 543173579 572891657 9692282 9672927 1619027 1651312 554484888 584215896 797174434 837949195 X 14413794 1632757 13684457 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 57839 57839 false Schedule C, Part II-B, Line 1I Lobbying Expenses This amount consists of hospital lobbying dues paid through annual dues of the National and State Hospital Associations and an amount paid to Bromm & Associates, llc (Law Firms) for lobbying. 630351 X false 11324608 608313 378953 976891 11334983 9728657 2441330 111526 956905 11324608 15906146 -3167621 274128 3283996 9728657 14503430 1477127 356880 0 431291 15906146 14479431 1306796 159785 0 1442582 14503430 0.15000 0.85000 false false 12337152 12337152 170897124 93211234 77685890 5464537 2543981 2920556 678706556 400127705 278578851 4230256 4141191 89065 371611514 0 OTHER LONG TERM LIABILITIES 13004867 DUE TO AFFILIATES 15918310 EST. THIRD PARTY PAYOR SETTLEMENT 12701612 41624789 X Schedule D, Part III, Line 4 Description of Art Collection The hospital displays its collection of art throughout the walls of the organization. It is a collection of images & portraits taken of various cultures around the world & portrays the hospital's culture of providing medical care to people of all cultures. SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS The majority of the endowment funds held by the hospital are held in order to earn interest in order to provide scholarships or education for employees of the hospital. The term endowment funds include charitable gift annuities. The contributions were made to the hospital and interest is paid back to the contributor as an annuity until the time of their passing. When this occurs, the balance of the annuity is no longer endowed. SCHEDULE D, PART X FIN 48 FOOTNOTE NMC HAS adopted FASB Interpretation No. 48, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109 (FIN 48). FIN 48 provides specific guidance on how to address uncertainty in accounting for income tax assets and liabilities, prescribing recognition thresholds and measurement attributes. THERE WERE NO UNCERTAIN TAX POSITIONS AT JUNE 30, 2013 OR 2012. North America Program Services Promote Medical Care 4705 Europe (Including Iceland and Greenland) Program Services Promote Medical Care 5933 Sub-Saharan Africa Program Services Promote Medical Care 8335 East Asia and the Pacific Program Services Promote Medical Care 16887 South Asia Program Services Promote Medical Care 21279 Middle East and North Africa Program Services Promote Medical Care 7410 64549 64549 false false false false false false International Activities Schedule F, Part 1 INTERNATIONAL ACTIVITIES INCLUDE TRAVEL TO THESE REGIONS FOR MARKETING AND PROMOTION OF INTERNATIONAL PROGRAM OF THE NEBRASKA MEDICAL CENTER INCLUDING PATIENT CARE, TRAINING, AND EDUCATION. X X X X X true Bethany Ochsner Grant Writing false 5000 35667 0 Gobel Philanthropy Chad Gobel Consultant false 0 18000 0 5000 53667 0 true true X true X true X true true true false true true 5226 13862617 13862617 0.01720 58705 99451285 71976607 27474678 0.03410 1332 1877274 1223316 653957 0.00080 65263 115191176 73199923 41991252 0.05210 14 127089 2596353 1622160 974193 0.00120 6 670 17195311 7878051 9317260 0.01160 11 33184828 27440794 5744034 0.00710 1 3250770 662113 2588657 0.00320 6 216 54840219 54840219 0.06810 38 127975 111067481 37603118 73464363 0.09120 38 193238 226258657 110803041 115455615 0.14330 1 242978 14000 228978 0.00030 2 1000 3959 0 3959 2 452 199067 0 199067 0.00020 5 1452 446004 14000 432004 0.00050 true 21325331 156488166 173487406 -16999240 X true true NEB ORTHO HOSPITAL ORTHOPEDIC HOSPITAL 0.45940 BELLEVUE MEDICAL CTR Acute Care Hospital 0.67630 0.10080 2 1 The Nebraska Medical Center

987400 NEBRASKA MEDICAL CENTER OMAHA NE 68198

X X X X A 2 Bellevue Medical Center LLC

2500 Bellevue Medical Center Drive Bellevue NE 68123

X X X A GROUP A true X X X X X X X X X 12 true true true X X X X X false false true true 200. true 400. true X X X X X true true X X true false X X X X true X false false 9 Nebraska Medical Center Radiology

2727 S 144th St Ste 120 Omaha NE 68144

Provider Based Radiology Department Nebraska Medical Center Laboratory

2727 S 144th St Ste 160 Omaha NE 68144

Provider Based Laboratory Department NMC - Bellevue Pharmacy

2510 Bellevue Medical Ctr Dr Ste Bellevue NE 68123

Pharmacy Cancer Ctr at VillAge Point Med Center

111 N 175th Street Omaha NE 68118

ONCOLOGY, RADIOLOGY, PATHOLOGY TREATMENT, RADIATION ONCOLOGY Pharmacy , Treatment NMC - Bellevue Cancer Services

2510 Bellevue Med Ctr Dr Bellevue NE 68123

Infusion Services Oncology Clinic NMC Cardiology Imaging

2727 S 144th St STE 290 Omaha NE 68144

Cardiology Imaging NMC Bellevue Cardiology Imaging

2500 Bellevue Med Ctr Dr STE 250 Bellevue NE 68123

Cardiology Imaging NMC VILLAGE POINT ENDOSCOPY CENTER

111 NORTH 175TH STREET OMAHA NE 68118

ENDOSCOPY SERVICES NMC - BELLEVUE CANCER SERVICES

2500 MEDICAL CENTER DRIVE RMS 224-2 BELLEVUE NE 68123

INFUSION SERVICES Part I, Line 3C Not applicable as the organization does follow FPG to determine eligibility for providing fee care to low income individuals. Part I, Line 6A The Organization's community benefit report can be accessed at http://www.nebraskamed.com/about-us/community/community-benefit-report. Bellevue Medical Center is not a 501(c)(3) tax-exempt hospital and is therefore not required to and does not file a community benefit report. Part I, Line 7G Physician Clinics were included in the subsidized health services calculation resulting in additional net community benefit expense of $1,046,264. Part I, Line 7, Column F THE PERCENT OF CHARITY CARE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST AS A PERCENT OF TOTAL EXPENSES LESS BAD DEBT IS 14.33%. NMC OWNS APPROXIMATELY 67% OF BMC AND THAT PERCENTAGE OF EXPENSES IS INCLUDED IN ORDER TO PROPERLY CALCULATE THE TABLE 7 PERCENTAGES. THE DENOMINATOR USED TO CALCULATE THE COST TO CHARGE RATIO IS $805,334,354. Part I, Line 7 These numbers are computed in a cost accounting system that produces a cost for every service the hospital provides. Relative value units, for seven categories of expense, are updated annually for each patient service which keeps the cost accounting current. These costs per unit values are applied to the patient utilization to compute the total cost. The cost accounted total is tied back to the Hospital's financial statements to ensure system integrity. Part II, Community Building Activities Community-building activities are designed to address the root causes of health problems. Poverty, homelessness and environmental problems all contribute to poor health. The types of programs included in this category support workforce development and training programs to provide employment and leadership skills training, job shadowing for students interested in health careers and economic development support grants to help revitalize low-income areas and businesses. Part III, Line 2 & 4 The organization's footnotes to the consolidated financial statements do not contain a footnote specifically covering bad debt expense. Though patient income may qualify them for financial assistance, the patient has obligations as well to complete financial assistance forms and to submit supporting documentation to qualify. Patients who provide this information and qualify for assistance would never go to bad debt. Therefore, it is reasonable to state that our bad debt expense is for those unwilling to pay or unwilling to work with us to provide financial assistance if available. If an account is completely written off to bad debt, the total cost via the cost accounting system is applied. If only a portion of the account was written off to bad debt, then bad debt as a percentage of charge is then applied to the total cost for the encounter to estimate the cost associated with the bad debt. The amount that goes to collections is patient liability. Not collecting these dollars is a direct expense to the organization. As a not-for-profit healthcare organization, it is our responsibility to help anyone who presents themselves with a health issue; as such we have less control over what gets recognized as bad debt. To compute bad debt at cost, management used all discharged cases in prior fiscal year with bad debt write-off. The write-off was computed as a percentage of charge and then multiplied by the total cost (determined by a detailed cost accounting methodology) to estimate the cost of bad debt. Part III, Line 8 Overall Medicare patients produce a negative 7% margin on Gross Charges. This is spread across most of our Product lines. Our heaviest losses are from the inpatient Neurology, Oncology and Cardiac product lines and from Oncology and Surgery on the outpatient side. In general Medicare inpatients do cover the direct costs of providing their care. However, the indirect costs to support the hospital must be accounted for and turns the margin negative. These numbers are computed in a cost accounting system that produces a cost for every service the hospital provides. The system is updated annually and tied to our Financial Statements to ensure integrity of the product line profitability statements. Part III, Line 9B A patient known to qualify for financial assistance (once all paperwork is received and approved) are flagged in the system and monitored accordingly to ensure financial assistance is "posted" to the patient account. When the 12 month approval expires, patients are contacted if services have been rendered within the last six months to discuss submittal of new information for continuation of assistance. If patients no longer qualify, other payments options are discussed per organizational policy. Reports are utilized for follow up purposes. Patients who qualify for 100% assistance do not receive guarantor statements (bills) from the organization. Patients who qualify for an 80% or 60% discount work with customer service or collection staff to outline payment arrangements according to set policy. Part V We do not have rehabilitation, free standing diagnostic facilities, or skilled nursing. Our off site diagnostic services are included on our hospital license and our hospital ancillary services are hospital based and included on our license. Part V, Section B, Line 3 (CHNA) For The Nebraska Medical Center and Bellevue Medical Center For the comprehensive CHNA process, a steering committee comprised of key stakeholders from area health systems, local county health department representatives, and key informants from several community agencies worked collaboratively to oversee the process. The CHNA steering committee retained Professional Research Consultants (PRC), Inc. to conduct the survey. PRC is a nationally recognized health care consulting firm with extensive experience conducting CHNAs such as this in hundreds of communities across the United States since 1994. INPUT FROM COMMUNITY STAKEHOLDERS Key informant focus group discussions included representation from all of the assessed counties. Focus group participants were chosen because of their ability to provide input regarding vulnerable or medically underserved populations, minorities, and/or populations with chronic disease. Eighty-seven community stakeholders, including physicians, other health professionals, social service providers, and business and community leaders participated in focus group sessions: A full list of participating key informant focus groups and their areas of expertise can be found here: http://www.nebraskamed.com/about-us/community/community-health-needs-asses sments CHNA Steering Committee Participant Names Below is a listing of the participants and the sponsoring organizations represented in the original CHNA Steering Committee formed in 2011. Alegent Creighton Health: Beth Llewellyn- Vice President, Mission Integration Mikki Frost- Director, Community Benefit and Healthier Communities Douglas County Health Department: Dr. Adi Pour- Health Director Mary Balluff- Division Chief, Community Health and Nutrition Services Live Well Omaha: Kerri Peterson- Executive Director Methodist Health System: Ken Klaasmeyer- Vice President Ruth Freed- Director of Clinical Alignment Jeff Prochaska- Director, Strategic Planning Visiting Nurses Association/Pottawattamie County: Kris Stapp- Vice President, Community Health Service Sarpy/Cass County Health Department: Diane Kelly- Health Director The Nebraska Medical Center: Tadd Pullin- Senior Vice President, Marketing, Strategic Planning and Network Ops Annette Wolfe- Director, Strategic Planning Leslie Spethman- Gift Officer/Community Relations and Community Benefit Part V, Section B, Line 4 The CHNA was conducted with other hospital and community based facilities as listed below: The Nebraska Medical Center and Bellevue Medical Center Alegent Creighton Health System Methodist Health System Douglas, Sarpy, Cass and Pottawatomie County Health Departments Live Well Omaha Part V, Section B, Line 7 TNMC has current programs and services in place to address each of the nine CHNA- identified community needs. However, in order to make meaningful impact, and to use its finances most effectively and efficiently, TNMC will place a primary focus on Diabetes, Heart and Stroke, and Access to care. However, it has no plans to discontinue other community benefit efforts addressing the remaining CHNA-identified needs, and may touch upon each of these categories within its efforts to address issues surrounding access to care in underserved populations. Further, in order to ensure all identified needs will be addressed in the community, TNMC met with the other local health systems and County health departments to discuss the CHNA-identified community needs and look for opportunities to collaborate. The identified needs not being addressed by TNMC are identified as Nutrition/Weights Status, Maternal, Infant, and Child Health, Mental Disorders and Substance Abuse, Oral Health, and Sexually Transmitted Diseases. Each of these remaining CHNA-identified needs are being addressed by one of the other community health systems, local university medical schools, County health departments, or community-based organizations. A full listing of these are provided in TNMC's CHNA report and can be found here: http://www.nebraskamed.com/about-us/community/community-health-needs-asses sments. BMC is majority owned by the Nebraska Medical Center (NMC). UNMC Physicians has a minority ownership. Both organizations are 501(c)(3) organizations. It was determined that the community had a need for medical services that was not currently being fulfilled. Between the two organizations they own over 80% of BMC. Part V, Section B, Line 12H POLICY FN16: DISCOUNT/FINANCIAL ADJUSTMENTS TALKS ABOUT "DISCOUNTS FOR PATIENTS WITH NON THIRD-PARTY PAYMENT SOURCE," DISCOUNTS, SIMILAR TO DISCOUNTS OFFERED TO MANAGED CARE PLANS, ARE OFFERED FOR MOST PATIENTS THAT DO NOT HAVE THIRD-PARTY INSURANCE AND DO NOT MEET THE GUIDELINES FOR GOVERNMENTAL ASSISTANCE PROGRAMS. THIS DISCOUNT IS SUBJECT TO CHANGE BASED ON THE RATES AGREED UPON THROUGH MANAGED CARE CONTRACTS. THESE DISCOUNTS ARE INDEPENDENT OF THE CHARITY ADJUSTMENTS, AND THAT CHARITY ADJUSTMENTS ARE APPLIED AFTER THE SELF-PAY ADJUSTMENT IS APPLIED TO THE BILLED CHARGES. Part V, Section B, Line 14G INFORMATION ON HOW TO GET FINANCIAL ASSISTANCE IS POSTED ON THE WEBSITE UNDER PATIENT FRIENDLY BILLING WHICH IS LOCATED UNDER THE PATIENT & VISITORS SECTION. THERE ARE DEPARTMENTS LISTED WITH PHONE NUMBERS TO CALL FOR MORE INFORMATION OR TO SET UP AN APPOINTMENT. Schedule H, Part VI, Line 2 Needs Assessment NMC uses disease incidence and prevalence data, leading causes of death, community health status research and supply and demand analysis to assess the health care needs of the communities it serves. ADDITIONALLY, NMC ENGAGED PROFESSIONAL RESEARCH CONSULTANTS (PRC) TO PERFORM A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN COLLABORATION WITH THE LOCAL HEALTH SYSTEMS AND COUNTY HEALTH DEPARTMENTS. Schedule H, Part VI, Line 3 Patient Education of Eligibility for Assistance NMC and BMC employ Financial Counselors, Customer Service Staff and Collection Staff, all of whom are trained in assisting our patients with resolution of patient liability. Depending upon individual patient needs, payment arrangements or financial assistance may be offered to assist our customers with resolution of patient balances. Additionally, the organization works with our self pay population to pursue coverage through state, federal or local programs. Charity Care Policy: This policy outlines the guidelines Patient Financial Services (PFS) will use to ensure adequate and appropriate follow up is completed in order for qualifying patients to receive charity care. PFS will work with patients to find payment solutions when available. This policy is written to ensure a fair and comprehensive system of distributing charity care to financially burdened patients within the available resources of NMC in a manner that does not discriminate based on race, creed, color, sex, national origin, religion or age. Policy: A. Charity care is available when all other recovery sources have been exhausted. B. Charity care is provided to patients who have demonstrated inability to meet their financial obligation to NMC. C. Charity care will not be approved for elective and/or cosmetic care. D. Charity care may be approved in the instance of catastrophic care as defined. 1. This could be occasioned by a personal catastrophe or unavoidable crisis affecting an individual who would otherwise be able to pay for service, or a person who has income above poverty level but is still not able to pay the entire cost of service. 2. A patient generally may qualify for catastrophic charity care in instances where the patient liability is in excess of 25% of annual household income. E. All transplant and IRP patients must meet with a Transplant Financial Counselor to secure financial clearance. Transplant and IRP patients must pass financial screening (ACCESS-FIC-082) or must be approved via the Transplant Variance Policy (FN 21) Charity approval for other services prior to consideration for transplant does not meet this requirement. F. Prior approval for charity care does not apply for future elective or cosmetic procedures. GUIDELINES: A. Identification process 1) The hospital maintains a separate policy in order to assure compliance with the emergency medical treatment and active labor act (EMTALA) and a separate patient rights and organizational ethics policy. This charity care policy is subject to the terms of those policies. 2) Financial counselors authorized by NMC will identify patients requiring financial screening. B. Verification of Insurance Eligibility and Benefits 1) The patient will execute an assignment of insurance benefits on behalf of the hospital. 2) Verification of eligibility, benefits, and payer source will be performed in a timely manner according to patient finance and access services departmental procedures. C. Financial Counseling 1) Financial Counselors and contracted vendors will assist patients requiring financial assistance. 2) Financial Counselors and vendors will assist patients in seeking reimbursement from local, state, and federal programs when there is no other source of payment as well as assisting patients with applications or making appointments to qualify for government programs. 3) Patients are responsible for follow up meetings with an agency that may provide financial resources for health care services. Charity assistance may be terminated at any time due to non compliance with this expectation. Schedule H, Part VI, Line 4 Community Information WE SERVE MANY COMMUNITIES, INTERNATIONAL, REGIONAL, STATE AND LOCAL OMAHA. THE STATISTICS BELOW DESCRIBE OUR "LOCAL" OMAHA COMMUNITY DEFINED AS DOUGLAS AND SARPY COUNTIES IN NEBRASKA. THIS LOCAL AREA REPRESENTS APPROXIMATELY 70% OF OUR INPATIENT AND OUTPATIENT DISCHARGES AND VISITS. THE 2013 ESTIMATED POPULATION FOR THIS LOCAL AREA IS 697,118. THE ESTIMATED RACE BREAKDOWN OF THE POPULATION IS BELOW. WHITE NON-HISPANIC 518,009 74.3% BLACK NON-HISPANIC 69,290 9.9% ASIAN NON-HISPANIC 19,587 2.8% HISPANIC 74,398 10.7% ALL OTHERS 15,834 2.3% THERE ARE ELEVEN HOSPITALS IN NEBRASKA TO SERVE THE LOCAL COMMUNITY. METHODIST HOSPITAL, METHODIST WOMEN'S HOSPITAL, LAKESIDE HOSPITAL, BERGAN MERCY MEDICAL CENTER, MIDLANDS HOSPITAL, CREIGHTON MEDICAL CENTER, CHILDREN'S HOSPITAL, IMMANUEL HOSPITAL, NEBRASKA ORTHOPAEDIC HOSPITAL, BMC AND NMC. THERE ARE FOUR DESIGNATED MEDICALLY UNDERSERVED AREAS IN DOUGLAS COUNTY (THREE AREAS) AND SARPY COUNTY (ONE AREA.) Douglas County Median household income, (2008-2012) = $53,295 Persons below poverty level, percent (2008-2012) = 14.0% (74,377 based on 2012 population estimate) Sarpy County Median household income, (2008-2012) = $69,269 Persons below poverty level, percent (2008-2012) = 6.6% (10,946 based on 2012 population estimate) IN THE 2012 FISCAL YEAR, THERE WERE 12,914 MEDICAID CLAIMS IN THE LOCAL COMMUNITY AND 3,686 UNINSURED OR SELF PAY CLAIMS. OF THESE, NMC SERVED 30.4% OF THE MEDICAID CLAIMS AND 39.0% OF THE UNINSURED (OR SELF PAY). Schedule H, Part II and Part VI, Line 5 Community Building Activities and Promotion of Health NMC RECOGNIZES THE COMMUNITY BENEFIT OF ADDRESSING ROOT CAUSES OF POOR HEALTH IN ORDER TO IMPROVE COMMUNITY HEALTH. THE HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES THROUGHOUT THE PAST YEAR DESIGNED TO ADDRESS THESE ROOT CAUSES. INCLUDED IN THIS TOTAL ARE THE HOSPITAL'S EFFORTS TO SUPPORT THE MID-AMERICA HOSPITAL ALLIANCE (MAHA); AN ALLIANCE OF RURAL AND CRITICAL ACCESS HOSPITALS IN THE REGION OF WHICH THE HOSPITAL IS A FOUNDING MEMBER. THE HOSPITAL SPENDS TIME COORDINATING RESOURCES TO ENSURE SMALLER, RURAL HOSPITALS CAN HAVE ACCESS TO THE EXPERTISE AND SERVICES OF A LARGE ACADEMIC MEDICAL CENTER. NMC PROVIDES HUMAN RESOURCE CONSULTING SERVICES TO HELP THESE SMALLER INSTITUTIONS ADDRESS WIDESPREAD HEALTH CARE WORKFORCE SHORTAGES IN RURAL AREAS. THE HOSPITAL'S COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROGRAMS INTENDED TO DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. MANY HOSPITAL STAFF MEMBERS GIVE EDUCATIONAL PRESENTATIONS ON THE HEALTH PROFESSIONS AND PROVIDE MOCK INTERVIEW TRAINING TO AREA STUDENTS. NMC ALSO PROVIDES JOB SHADOWING OPPORTUNITIES TO UNDERGRADUATE STUDENTS WHO WISH TO EXPLORE THE HEALTH CAREERS. ADDITIONALLY, THE HOSPITAL HAS THE ONLY BIO-CONTAINMENT UNIT IN THE STATE, CONTRIBUTING TO DISASTER PREPAREDNESS ABOVE AND BEYOND LICENSURE REQUIREMENTS. MEMBERS OF THE HOSPITAL'S CRITICAL CARE AND TRAUMA STAFF SHARE THE EXPERTISE BY PARTICIPATING IN COMMUNITY COALITIONS TO IMPROVE SAFETY AND REDUCE ACCIDENTS AMONG CHILDREN, TEENS, AND SENIORS. THE HOSPITAL works to ENCOURAGE ECONOMIC GROWTH AND DEVELOPMENT BY SUPPORTING AN ECONOMIC DEVELOPMENT PARTNERSHIP AIMED AT THE DEVELOPMENT OF NEW BUSINESS IN THE CITY'S URBAN AREAS. BMC HAS PARTICIPATED IN, AND HOSTED A NUMBER OF EVENTS DESIGNED TO PROMOTE A HEALTHIER COMMUNITY. IN ADDITION TO FINANCIAL SUPPORT OF SEVERAL COMMUNITY-BASED CHARITABLE ORGANIZATIONS AND THE LOCAL CHAMBER OF COMMERCE, THE HOSPITAL'S LEADERSHIP TEAM IS ACTIVE ON COMMUNITY BOARDS. BMC ALSO HOSTS FREE MONTHLY "HEALTHY REVIEW" TALKS WHERE A PHYSICIAN GIVES AN EDUCATIONAL PRESENTATION ON VARIOUS DISEASES AND CONDITIONS. THESE INITIATIVES DEMONSTRATE BMC'S MISSION TO SUPPORT THE HEALTHCARE NEEDS OF THE COMMUNITY BY PROVIDING A HEALING ENVIRONMENT FOCUSED ON QUALITY, COMPASSION, AND PERSONALIZED CARE ALONG WITH ITS ONGOING COMMITMENT TO CREATE A HEALTHIER COMMUNITY THROUGHOUT ITS SERVICE AREA. Other Information NMC IS A NONPROFIT HOSPITAL MEETING THE REQUIREMENTS OF REVENUE RULING 69-545. IN SUMMARY, THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS WITHOUT REGARD TO ABILITY TO PAY, THE HOSPITAL ALSO HAS A BOARD COMPRISED OF MEMBERS FROM THE COMMUNITY, THEY HAVE AN OPEN MEDICAL STAFF POLICY, THEY ACCEPT PATIENTS PAYING THEIR BILLS WITH MEDICAID AND MEDICARE, AND THEY USE THE SURPLUS OF THEIR FUNDS TO IMPROVE THEIR FACILITIES, EQUIPMENT, PATIENT CARE, MEDICAL TRAINING, EDUCATION, AND RESEARCH. BMC IS A HOSPITAL, HOWEVER, IT IS NOT A TAX EXEMPT ORGANIZATION, AND THEREFORE THIS QUESTION IS NOT APPLICABLE. Schedule H, Part VI, Line 6 Neither NMC nor BMC are in an affiliated healthcare system. Schedule H, Part VI, Line 7 NMC files a community benefit report with the Nebraska Hospital Association annually. BMC is not required to file a community benefit report in any state, but voluntarily files an annual report with the Nebraska Hospital Association. true American Heart Association 10100 J Street Ste A Omaha NE 68127 135613797 501(c)(3) 13000 General Support March of Dimes 11840 Nicholas Street Omaha NE 68154 131846366 501(c)(3) 7000 General Support Salvation Army 3612 Cuming Street Omaha NE 68131 362167910 501(c)(3) 15000 General Support Hope Medical Outreach Coalition 4920 S 30th Street Omaha NE 68107 470548990 501(c)(3) 25500 General Support Joslyn Art Museum 2200 Dodge St Omaha NE 68102 470384577 501(c)(3) 50000 General Support The Durham Western Heritage Museum 801 S 10th St Omaha NE 68108 470556061 501(c)(3) 75000 General support UNMC Physicians 988101 Ne Med Ctr Omaha NE 681988101 470785575 501(c)(3) 28077050 Support Operations University of Nebraska Medical Center 986800 Ne Med Ctr Omaha NE 681986800 470049123 GOVT 29930252 Support Operations Board of Regents of the Univ of NE 3835 Holdrege Lincoln NE 68583 470049123 GOVT 6000000 General support Clarkson College 101 S 42nd Street Omaha NE 681312739 363649217 501(c)(3) 1797726 General support Mid-America Council 12401 W Maple Rd Omaha NE 681641853 470376545 501(c)(3) 20000 General support Wellness Council of the Midlands 12565 W Center Rd Ste 220 Omaha NE 68144 470642708 501(c)(3) 10000 General support University of Nebraska Foundation 6901 Dodge Street Omaha NE 68198 470379839 501(c)(3) 30000 General support Legal Aid of Nebraska 1904 Farnam St 5th Floor Omaha NE 68102 470483506 501(c)(3) 41643 PATIENTS LEGAL AID Make a Wish 11926 Arbor St Ste 102 Omaha NE 68144 470671096 501(c)(3) 7500 General support Ronald McDonald House 620 S 38th Street Omaha NE 681051104 470755104 501(c)(3) 6365 General support Harbor House (Hospice House) 7415 Cedar Street Omaha NE 681242367 364003095 501(c)(3) 100000 General Support Intercultural Senior Center 2021 U Street Omaha NE 68107 272460810 501(c)(3) 6000 General Support Friends of UNMC Cancer Center 985950 Ne Med Ctr Omaha NE 68198 470809725 501(c)(3) 9500 General Support United Way of the Midlands 1805 Harney St Omaha NE 68102 470376605 501(c)(3) 8390 General Support Clarkson Regional Health Services Inc 988145 Ne Med Ctr Omaha NE 681988145 470376531 501(c)(3) 6000000 General Support Latino Center of the Midlands 4821 South 24th St Omaha NE 68107 237208431 501(c)(3) 9818 General Support Heart of Ministry Center 2222 Binney Street Omaha NE 68110 810614816 501(c)(3) 10000 General Support 23 0 Financial Assistance (Charity Care) 5226 40912972 Book Charity Care Financial Assistance (Pharmaceuticals) 475 45901 Book Emerg Drug Fund Review and Approval of Charitable Contributions Schedule I, Part I, Line 1 The Nebraska Medical Center (NMC) has a committee whose responsibility is to review and approve or disprove requests for sponsorship. This committee is comprised of key executives and other members of the leadership team, as well as representatives from the University of Nebraska Medical Center. Decisions are made on each request individually based on a set of guidelines established by the organization. In order to effectively evaluate and review the many requests we receive, each request is brought before our Sponsorships and Charitable Contributions Committee for consideration. This committee is comprised of key executives and other members of the hospital leadership team. The committee considers each request individually, and contributions are made based on three primary objectives: 1)To support the community need for resources addressing Nebraska's leading causes of death; including cancer, stroke and heart disease. 2)To align with organizations furthering NMC's charitable mission to support causes which significantly impact the overall health status of the community. 3)To support organizations which impact favorably the public image of the hospital and enhance existing partnerships or initiatives. If a sponsorship or charitable contribution request falls within our three primary objectives, the following criteria are then applied to further assist the committee in making funding decisions: 1)Organization must provide proof of 501(c)(3) status from the IRS, or nonprofit designation as a governmental or tribal entity. 2)All requests must be received in writing- no phone requests will be considered 3)Requestor must be able to provide the organization's Non-Discrimination Policy 4)Must be able to provide an organizational operating budget and project budget upon request 5)Proposal must include a list of board members, directors, and key project staff members and the role they serve in the organization. 6)Request must include a brief narrative of the project, including an estimate of numbers of people served by the request and location of communities impacted by the organization's mission. 7)Requests for sponsorship need to be submitted at least 90 days prior to the event, with requests over $10,000 being submitted by March 1 for consideration in the next fiscal year. Groups, Programs and Activities not supported by NMC: 1)Organizations without IRS 501(c)(3) or equivalent tax exempt status 2)Organizations that discriminate on the basis of age, disability, religion, ethnic origin, gender, or sexual orientation 3)Organizations with divisive or litigious public agendas 4)Member based organizations, including chambers of commerce, rotary clubs or IRS 501(c)(4) legions and associations 5)Municipalities, including fire and police departments or related social service groups and political organizations 6)Religious organizations or sectarian programs for religious purposes 7)Fraternal organizations, social clubs, sports teams or clubs, athletic competitions 8)Endowments 9)Multiyear requests and pledges 10)Individuals requesting loans, debt retirements, scholarship or fellowship assistance 11)Travel- including student trips or tours 12)Marketing activities or promotional merchandise 13)Purchase or maintenance of vehicles 14)Film or video projects, including documentaries 15)Beauty pageants Grant Monitoring Procedures Schedule I, Part I, Line 2 Based on the detailed gift policy outlined in Part I, Line 1, the funds are only provided for charitable purposes, and those organizations that receive monies from NMC are required to follow their 501(c)(3) requirements surrounding the use of funds received. X true true X X X X X X true true false true false true false false false Lianne Stevens 195999 0 0 0 68582 0 20253 0 5472 0 290306 0 0 0 Glenn A Fosdick 656554 0 374000 0 647271 0 165798 0 15415 0 1859038 0 617726 0 Stephen Smith MD 472061 0 210000 0 128709 0 133653 0 9612 0 954035 0 108965 0 William Dinsmoor 418333 0 175000 0 121616 0 135242 0 7054 0 857245 0 115088 0 Joe Graham 391329 0 170000 0 118703 0 123741 0 14960 0 818733 0 112258 0 Rosanna Morris 317231 0 140000 0 96243 0 98659 0 624 0 652757 0 90132 0 Marcel Devetten MD 204902 0 0 0 1425 0 17588 0 5879 0 229794 0 0 0 Michael D Johnson 304959 0 0 0 1206 0 10687 0 9165 0 326017 0 0 0 Randall J Hallett 230760 0 61115 0 13175 0 17611 0 11039 0 333700 0 0 0 Louis Burgher MD 307565 0 0 0 0 0 0 0 6642 0 314207 0 0 0 Thomas Macy 235874 0 0 0 1018 0 22125 0 13633 0 272650 0 0 0 Natale Ponticello 251912 0 37298 0 13109 0 25172 0 3569 0 331060 0 0 0 Tadd Pullin 341476 0 49676 0 17993 0 74216 0 7881 0 491242 0 0 0 Theresa Franco 227999 0 23316 0 970 0 18081 0 9609 0 279975 0 0 0 Deborah Istas 229765 0 17265 0 1562 0 23977 0 2097 0 274666 0 0 0 Jorge Parodi 220739 0 17052 0 12508 0 20385 0 10796 0 281480 0 0 0 Ruta Davidson 230561 0 97112 0 1552 0 16043 0 13861 0 359129 0 0 0 Michael Powell 197767 0 0 0 6448 0 23199 0 10625 0 238039 0 0 0 Charles Lakso 219803 0 0 0 1511 0 16915 0 7447 0 245676 0 0 0 Lisa McClane 191439 0 0 0 1314 0 7751 0 3989 0 204493 0 0 0 Julie Lazure 175452 0 0 0 1182 0 19237 0 10364 0 206235 0 0 0 Connie Ogden 179258 0 0 0 1211 0 18760 0 2174 0 201403 0 0 0 Jana Danielson 187470 0 0 0 721 0 14673 0 2272 0 205136 0 0 0 Donald Futrell 191145 0 0 0 1315 0 15883 0 11834 0 220177 0 0 0 David S Fuller 209399 0 20000 0 25536 0 21436 0 7113 0 283484 0 0 0 Martin Carmody 0 0 0 0 243225 0 0 0 0 0 243225 0 0 0 Cynthia Owen 257653 0 0 0 7545 0 24928 0 1364 0 291490 0 0 0 STEVEN J WEES MD 191930 0 51813 0 1342 0 9756 0 11821 0 266662 0 0 0 SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS THE FOLLOWING EMPLOYEES WERE TERMINATED DURING FISCAL YEAR 2013 AND RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2012: Lianne Stevens $67,901.39 Martin Carmody $243,225.00 SCHEDULE J, PART I, LINE 4B NONQUALIFIED RETIREMENT PLANS Certain executives do participate in supplemental nonqualified retirement plans. A payout occurred during the year from a supplemental nonqualified plan to the following individuals: Glenn Fosdick $617,726 William Dinsmoor $115,088 Stephen Smith $108,965 Joe Graham $112,258 Rosanna Morris $ 90,132 SCHEDULE J, PART I, LINE 5 & 6 CONTINGENT COMPENSATION The organization's revenues and net earnings are taken into consideration when calculating executive incentive compensation in addition to other non-financial factors. Executive incentive compensation is determined by several key metrics that are established by The Nebraska Medical Center Board of Directors. These metrics are inclusive of strategic, financial, operational and quality outcomes. On an annual basis, The Nebraska Medical Center Board of Directors reviews achievement of preset targets and approves incentives when warranted. These performance payments are in lieu of a typical executive's base pay. The board of directors and executives determined it is in the best interest of the organization to have a portion of their base pay subject to forfeiture unless the pre-determined financial and non-financial factors discussed above are achieved. Incentive compensation related to FY12 performance were paid to the following individuals: Glenn Fosdick $374,000.00 Stephen Smith, MD $210,000.00 Joe Graham $170,000.00 William Dinsmoor $175,000.00 Rosanna Morris $140,000.00 Tadd Pullin $ 49,676.00 Randall Hallet $ 61,115.00 Nat Ponticello $ 37,298.00 Theresa Franco $ 23,316.00 Jorge Parodi $ 17,052.00 Deb Istas $ 17,265.00 Paulette Davidson $ 97,112.00 David Fuller $ 20,000.00 A HOSPITAL AUTH NO 2 OF DOUGLAS COUNTY NE 521440769 000000000 2010-09-28 10000000 HOSPITAL FACILITIES & EQUIPMENT false false false B HOSPITAL AUTH NO 2 OF DOUGLAS COUNTY NE 521440769 000000000 2003-12-10 41762267 REFUND BOND ISSUE false false false C HOSPITAL AUTH NO 2 OF DOUGLAS COUNTY NE 521440769 000000000 2011-06-01 10000000 HOSPITAL FACILITIES & EQUIPMENT false false false A 0 0 10002474 0 0 0 0 0 0 10002474 0 0 2010 false false true true B 24510000 0 41762267 4171305 0 0 834246 0 0 3768 36879309 0 1994 true false true true C 0 0 10000115 0 0 0 0 0 0 10000115 0 0 2011 false false true true A false false true true true true 0.00500 0.00500 false false false true B 0 true C false false true true true true 0.00500 0.00500 false false false true A false true false false 0 false 0 false true B false false true true false false 0 false 0 false true C false true false false 0 false 0 false true A true B true C true BOND ISSUE - PRIVATE BUSINESS USE 0 SCH. K PART III, Column B PER THE INSTRUCTIONS, THIS PART IS NOT TO BE COMPLETED FOR POST-DECEMBER 31, 2002 BOND ISSUES WHICH REFUND A PRE- JANUARY 2003 ISSUE. BOND ISSUE - PROCEEDS PART II, LINE 3, COLUMN B - THE TOTAL PROCEEDS DO NOT EQUAL THE SUMMATION OF LINES 4 -12 DUE TO TRANSFERRED OR REPLACEMENT PROCEEDS IN LINE 4. PART II, LINE 4, COLUMN B THE RESERVE AMOUNT IS HIGHER THAN THE REQUIRED RESERVE DUE TO APPRECIATION OF THE INVESTMENT AT 6/30/2013. A HOSPITAL AUTH NO 2 OF DOUGLAS COUNTY NE 521440769 000000000 2011-12-01 52000000 HOSPITAL FACILITIES & EPIC false false false B HOSPITAL AUTH NO 2 OF DOUGLAS COUNTY NE 521440769 000000000 2009-04-29 10000000 HOSPITAL FACILITIES & EQUIPMENT false false false A 0 0 52000000 0 0 0 0 0 0 48601413 0 0 2012 false false false true B 0 0 10000000 0 0 0 0 0 0 10000000 0 0 2009 false false true true A false false true true true true 0.00500 0.00000 0.00500 false false false true B false false true true true true 0.00500 0.00000 0.00500 false false false true A false true false false 0 false 0 false true B false true false false 0 false 0 false true A true B true Bruce Lauritzen PRESIDENT 1ST NATL BANK 29150355 SUPPLIES, SERVICES, LEASE false Bruce Grewcock Kiewit Construction, Pres 6314851 CONSTRUCTION SERVICES false Canedy Pullin Fosdick Dinsmoor Simplywell Board Members 546692 Services, supplies, rental false SMITHCANEDYDINSMOORPULLINMACY NOH LLC BOARD MEMBERS 1963589 SERVICES AND SUPPLIES false William Dinsmoor WIFE IS EMPLOYEE 190766 EMPLOYMENT false William Dinsmoor BROTHER IS EMPLOYEE 30822 EMPLOYMENT false Louis Burgher MD DAUGHTER IS EMPLOYEE 62741 EMPLOYMENT false Joe B Graham DAUGHTER IS EMPLOYEE 56901 EMPLOYMENT false Deb Istas SON IS EMPLOYEE 38193 Employment false BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS PART IV 1.) THE SERVICES THAT ARE PROVIDED BY FIRST NATIONAL BANK OF OMAHA CONSIST OF PURCHASED SUPPLIES AND SERVICES AND TAX EXEMPT FINANCING. THE FINANCING IS APPROXIMATELY 99% OF THE TOTAL AMOUNT OF THE TRANSACTION. 2.) THE SERVICES THAT ARE PROVIDED BY KIEWIT CONSTRUCTION CONSIST OF CONSTRUCTION CONTRACTS FOR PROJECTS THROUGHOUT THE CAMPUS. 3.) THE TRANSACTIONS WITH SIMPLYWELL CONSISTS OF RENTAL INCOME TO NMC FOR tHE LEASE OF SPACE AND OTHER INCOME FOR SALE OF SERVICES AND SUPPLIES, SUCH AS PARKING, SUPPLY CHAIN AND PHONE SERVICES. APPROXIMATELY 80% OF THE TOTAL TRANSACTION RELATES TO PAYMENTS TO SIMPLYWELL FOR THE WELLNESS PROGRAM FOR NMC EMPLOYEES. 4.) THE SERVICES PROVIDED TO/FROM NOH LLC ARE COMPRISED OF RENT, SUPPLIES AND SERVICES. X 2 305547 Market Value Stock false true true PART I, LINE 32B TNMC USES FIRST NATIONAL BANK OF OMAHA FOR INVESTMENT SERVICES. PART OF THESE SERVICES IS TO SELL NONCASH CONTRIBUTIONS RECEIVED BY THE CORPORATION. Members Form 990, Part VI, Line 6 The corporation has two members, The Board of Regents of the University of Nebraska ("Board of Regents") and Clarkson Regional Health Services, Inc. ("CRHS") Governing Body Appointment Form 990, Part VI, Line 7a and 7b Board of Regents and CRHS each appoint six members to the Board of Directors. Board of Regents and CRHS are required to approve the following decisions made by the Nebraska Medical Center Board of Directors: a)Amendments to the Corporation's Articles of Incorporation & Bylaws b)Amendments to, or declarations of default under, the Joint Operating Agreement ("JOA") c)Merger, liquidation or dissolution of the Corporation d)Retention of respective ownership of all property, plant and equipment, subject to the terms of the lease or management agreement with the Corporation set forth in the JOA e)Disposition of defined Member assets valued in excess of a stated amount f)Additional capital investments in the Corporation not set forth in the JOA g)Capital expenditures by the Members for defined projects relating to the Corporation in excess of a stated amount h)Debt issuance for defined projects unrelated to the Corporation i)Admission of additional participants in the Corporation if such admission is beyond the powers delegated Review of 990 Prior to Filing Form 990, Part VI, Line 11B A copy of the Form 990 was presented to the Audit Committee of the Board of Directors. In addition, the Board of Directors were provided a link to Guidestar.org and a password after it was filed. Monitoring and Enforcement of Board Independence Form 990, Part VI, Line 12c Each member of the Board of Directors, Officers and Key Employees discloses annually that he/she is either an Officer, Director, Member, Owner, Agent or associated in some manner with delineated business entities that either have or might reasonably be expected to have a business relationship with NMC. Each Board Member agrees to make conflicts known and withdraw from participation in deliberations if a subsequent conflict arises. Disclosure statements are distributed annually and monitored by the corporate compliance officer for completion. Any disclosed conflicts are brought to the attention of the Chairman of the Board for Board Members and Officers or to the Officers for Key Employees. Compensation of Officers, Directors and Key Employees Form 990, Part VI, Line 15a & 15b Senior Executive compensation is governed through the by-laws for NMC. In accordance with provisions set forth in the by-laws for NMC, an Executive Compensation Committee is appointed by the Board of Directors. The Board of Directors engages a third party consultant to provide comparable data for review of executive salaries, assess the overall compensation and benefit package and provide advice to the Executive Compensation Committee on compensation and regulatory matters. The Committee reviews the data and recommendations provided by the consultant which is based on competitive assessments with peer organizations and national trends. The following is a brief summary of the consultant's work: Fact Finding: Collect pertinent information about NMC and its executive total compensation programs (salaries, incentive award levels, benefits and prerequisites). Analysis of Total Compensation: Using NMC's existing compensation philosophy as the basis of the study, analyze all elements of the Executive Compensation Program, both individually and in aggregate. Using a proprietary database and published surveys, compare NMC compensation and benefit program and practices to those in its national peer group of organizations similar in size and complexity. Present a Written Report to the Compensation Committee which summarizes: 1)Best practices and regulatory requirements for governing executive pay 2)Competitive analysis of the cash compensation program 3)Competitive analysis of the levels and provisions of the benefit program 4)Opportunities for strengthening the program 5)Recommendations, as appropiate Governing Documents, Conflict of Interest Policy, Financial Statements Form 990, Part VI, Line 19 The governing documents, conflict of interest policy and financial statements are typically not made available to the public. However, if someone comes into the Accounting Department and requests to view the documents, they would be made available to view in the office. Business and Family Relationships Form 990, Part VI, Line 2 Mr. Bruce Grewcock and Mr. Mogens Bay have a business relationship (through board of directors relationship). Mr. William Dinsmoor, Mr. Glenn Fosdick, Dr. James Canedy and Mr. Tadd Pullin have a business relationship (through board of directors relationship). Dr. Marlin Stahl and Dr. James Canedy have a business relationship (through board of directors relationship). Mr. Joe Graham, Mr. William Dinsmoor, Dr. Marlin Stahl, Ms. Ruta Davidson, and Mr. Charles Lakso have a business relationship. MR. GLENN FOSDICK, MR. WILLIAM DINSMOOR, MR. JOE GRAHAM, AND DR. STEPHEN SMITH HAVE A BUSINESS RELATIONSHIP (THROUGH BOARD OF DIRECTORS RELATIONSHIP). Mr. William Dinsmoor, Dr. James Canedy, Mr. Thomas Macy, Mr. Joe Graham, Dr. Stephen Smith, and Dr. Marlin Stahl have a business relationship (through board of directors relationship). Mr. William Dinsmoor and Dr. James Canedy have a business relationship (through board of directors relationship). Mr. William Dinsmoor, Mr. Tadd Pullin, Mr. Tom Macy, and Dr. Stephen Smith have a business relationship (through board of directors relationship). MR. MOGENS BAY AND MR. J.B. MILLIKEN HAVE A BUSINESS RELATIONSHIP (THROUGH BOARD OF DIRECTORS RELATIONSHIP). OTHER PROGRAM SERVICES FORM 990, PART III, LINE 4D Neuroology Service Line The core services include precise diagnosis and treatment of stroke and vascular disease, movement and memory disorders, multiple sclerosis brain and spinal tumors, spine as well as epilepsy. The Epilepsy Center is the only level 4 center in the region and treats patients from the state of Nebraska and the region. The Corporation has one of few magnetoencephalograph (MEG) scanners and trained MEG scientists in the region. The MEG can detect brain activity in much greater detail and with more accuracy than previous methods and will advance patient care and research opportunities greatly. The Corporation has earned the American Heart Association/American Stroke Association's Get With The Guidelines Stroke Gold plus Achievement Award. Get With The Guidelines is a hospital-based, quality-improvement program designed to ensure hospitals consistently care for cardiac and stroke patients following the most up-to-date guidelines and recommendations. The Corporation also hosts the only young adult stroke support group to address the emotion and physical challenges of recovering from stroke. In addition, U.S. News and World Report surveyed the nation's roughly 5,000 hospitals to come up with this year's list of Best Hospitals. Fewer than 150 of those hospitals are nationally ranked. Of the 16 specialties studied by U.S. News and World Report, The Nebraska Medical Center was recognized in 9, including Neurology and Neurosurgery. During fiscal year 2013, Neurosciences incurred over 2,900 inpatients with over 13,700 patient days and over 15,800 outpatient billing units Approximately 67% of the revenue was derived from inpatient cases All Other Hospital Services With a history dating back to 1869, The Nebraska Medical Center was formed with the merging of Bishop Clarkson Memorial Hospital and University Hospital and continues to attract patients from the region and around the world. The Nebraska Medical Center is a tertiary/quaternary academic medical center. The Corporation is the largest health care facility in the state with more than 5,000 employees and over 900 physicians on staff practicing in all major specialties and sub-specialties. Besides several key services in cardiology, oncology, transplant and neurology, the hospital offers comprehensive care in women's services for obstetrics and gynecology, as well as pediatric services, orthopedics, rheumatology, and pulmonary care. In addition, the Corporation has one of the region's largest hyperbaric medicine programs. The medical center also has one of the few biocontainment units in the United States equipped to safely care for those exposed to highly contagious, dangerous diseases. Its diabetes center is a recognized education program by the American Diabetes Association and has earned the Joint Commission's gold Seal of Approval for Advanced Inpatient Diabetes Care. In 2013, The Nebraska Medical Center opened the most comprehensive weight management program in the region, designed and directed by physicians who specialize in medical weight management and bariatric surgery. In partnership with UNMC, The Nebraska Medical Center also embarked on the construction of the Fred & Pamela Buffett Cancer Center, the largest single project ever on campus. The project will be completed in 2016 and scheduled to open in early 2017. RECONCILIATION OF NET ASSETS 990, PART XI, LINE 9 Change in Noncontrolling Interest (431,786) Equity Changes in Subs. 1,087,263 Change in Pension Accts 14,019,666 Net Assets Released (552,082) Clarkson College Net Income (1,352,242) Clarkson College Fund Balance 264,980 Investment in ACA (36,342) Investment in Midlands Choice 685,000 Total 13,684,457 Community Hospital Association PO Box 107 405 East Main St Fairfax MO 64446 440537826 Acute Care MO 501(c)(3) Line 4 NMC true Community Healthcare Foundation Inc PO Box 107 405 East Main St Fairfax MO 64446 431757553 Financial Sup MO 501(c)(3) Line 4 Com Hosp Asc true NHS Clarkson Hospital Service League 988145 Nebraska Medical Center Omaha NE 68198 476028036 Support TNMC NE 501(c)(3) L11,TypeIII NA false Clarkson College 101 South 42nd Street Omaha NE 68131 363649217 College NE 501(c)(3) LINE 2 NMC true Bellevue Med Ctr 2500 BMC Dr BELLEVUE NE 68123 204305186 Acute Care NE NMC Related -408804 28909942 false 0 true 0.67630 ACA LLC 8511 WEST DODGE ROAD OMAHA NE 68114 271784907 HEALTHCARE NE NH PARTNERS related -169099 174966 false 0 false 0.50000 NC LAB LLC 8303 DODGE STREET OMAHA NE 68114 461173104 DIAGNOSTIC SVC NE NMC RELATED 0 0 false 0 true 0.50000 NHS Orthopaedic Services Inc 988145 Nebraska Medical Center Omaha NE 681988145 470845238 Investment Sv NE NMC C Corp 3263798 14711410 1.00000 true Nebraska Health Partners Inc 988145 Nebraska Medical Center Omaha NE 681988145 470816463 Management NE NMC C Corp 740078 3367522 1.00000 true false true true true false false false false false true true true false true true false false false false CLARKSON COLLEGE b 1797726 BOOK BELLEVUE MEDICAL CENTER d 21313822 BOOK BELLEVUE MEDICAL CENTER j 24416222 BOOK CLARKSON COLLEGE j 11840781 BOOK BELLEVUE MEDICAL CENTER L 3926752 BOOK CLARKSON COLLEGE L 1724985 BOOK NEBRASKA HEALTH PARTNERS INC O 327767 BOOK