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CHILDRENS HOSPITAL & MEDICAL CENTER: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CHILDRENS HOSPITAL & MEDICAL CENTER (EIN 47-0379754)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-08-15
IRS object ID
201312279349303701
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-08-15T14:58:54-05:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1Two Central Park Plaza Suite 1501AddressLine1
CityOmahaCity
StateNEState
ZIP Code681021626ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN470379754EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1CHILDREN'S HOSPITAL & MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% MICHAEL J BROWNInCareOfName
Name ControlCHILNameControl
Phone4029554116Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18200 DODGE STREETAddressLine1
Address Line2SuiteAddressLine2
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameMICHAEL J BROWNName
TitleSR. VICE PRESIDENT & CFOTitle
Phone4023481450Phone
Date Signed2013-06-17DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone4023481450Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonGARY A PERKINSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line18200 DODGE STREETAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode
FieldValueIRS element (for citing)
Gross Receipts260308300GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.CHILDRENSOMAHA.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1948YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionA FAMILY-CENTERED REGIONAL PROVIDER DEDICATED TO COST-EFFECTIVE, QUALITY HEALTHCARE Services & ADVOCACY FOR CHILDREN, INFANTS THROUGH ADOLESCENTS, WHILE ACTIVELY PROMOTING HEALTHCARE EDUCATION & Research.ActivityOrMissionDescription
Nbr Voting Members Governing Body20NbrVotingMembersGoverningBody
Nbr Independent Voting Members18NbrIndependentVotingMembers
Total Nbr Employees2099TotalNbrEmployees
Total Nbr Volunteers280TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year4284969ContributionsGrantsPriorYear
Contributions Grants Current Year4665324ContributionsGrantsCurrentYear
Program Service Revenue Prior Year211631952ProgramServiceRevenuePriorYear
Program Service Revenue CY246707174ProgramServiceRevenueCY
Investment Income Prior Year-204156InvestmentIncomePriorYear
Investment Income Current Year431017InvestmentIncomeCurrentYear
Other Revenue Prior Year8394992OtherRevenuePriorYear
Other Revenue Current Year8485976OtherRevenueCurrentYear
Total Revenue Prior Year224107757TotalRevenuePriorYear
Total Revenue Current Year260289491TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3711498GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3534362GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year103961568SalariesEtcPriorYear
Salaries Etc Current Year113752755SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year102288591OtherExpensePriorYear
Other Expenses Current Year117059623OtherExpensesCurrentYear
Total Expenses Prior Year209961657TotalExpensesPriorYear
Total Expenses Current Year234346740TotalExpensesCurrentYear
Revenues Less Expenses Prior Year14146100RevenuesLessExpensesPriorYear
Revenues Less Expenses CY25942751RevenuesLessExpensesCY
Total Assets BOY280529833TotalAssetsBOY
Total Assets EOY288797973TotalAssetsEOY
Total Liabilities BOY150153513TotalLiabilitiesBOY
Total Liabilities EOY156047414TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY130376320NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY132750559NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionSO 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.MissionDescription
Significant New Program ServicestrueSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense219625875Expense
Grants3534362Grants
Revenue254806030Revenue
DescriptionSEE SCHEDULE ODescription
Total Program Service Expense219625875TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109657NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2099NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members20NbrVotingGoverningBodyMembers
Number Independent Voting Members18NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMICHAEL J BROWNNamePerson
Telephone Number4029554116TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18200 DODGE STREETAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (28 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
BARBARA SCHAEFER
CHAIR1.0XX000
JIM SIMPSON
VICE CHAIR1.0XX000
DEB PERRY MD
SECRETARY1.0XX000
DAN HAMANN
TREASURY1.0XX000
JIM LANDEN
MEMBER1.0X000
SUSAN WEIDNER
MEMBER1.0X000
STEVE RAYNOR MD
MEMBER1.0X000
DANA BRADFORD
MEMBER1.0X000
SID DINSDALE
MEMBER1.0X000
ERIC BUTLER
MEMBER1.0X000
SUZANNE SCOTT
MEMBER1.0X000
ROWEN ZETTERMAN MD
MEMBER1.0X000
RICH ANDERL
MEMBER1.0X000
RODRIGO LOPEZ
MEMBER1.0X000
MATTHEW MILLER
MEMBER1.0X000
ELLEN WRIGHT
MEMBER1.0X000
BRADLEY BRITIGAN MD
MEMBER1.0X000
LORRAINE CHANG
MEMBER1.0X000
JOHN MOORE MD
MEMBER40.0X214405030243
GARY A PERKINS FACHE
PRESIDENT/CEO/MEMBER40.0XX1163217063128
KATHY ENGLISH
EVP/COO40.0X451061048337
MICHAEL BROWN
SVP/CFO40.0X495535033392
CARL GUMBINER MD
SVP/CMO40.0X428224013468
GEORGE E REYNOLDS MD
VP/CMIO/CIO40.0461126050293X
BETSY J STEPHENSON MD
PHYSICIAN40.0280461037212X
JOHN ANDERSEN MD
PHYSICIAN40.0339643021661X
CHANDRIKA RIZAL MD
PHYSICIAN40.0279323037186X
RACHEL MCCANN MD
PHYSICIAN40.0271696024878X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4384691TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation359798TotalOtherCompensation
Number Individuals GT100 K95NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
EPIC SYSTEMS CORP
PO BOX 88314MILWAUKEEWI532880314IT SUPPORT SERVICES3290366
ALLSCRIPTS HEALTHCARE LLC
PO BOX 8538-0133PHILADELPHIAPA191710133IT SUPPORT SERVICES3166237
KIEWIT BUILDING GROUP INC
3921 MASON STREETOMAHANE681051840CONSTRUCTION2204063
PYRAMID HEALTHCARE SOLUTION
PO BOX 17389CLEARWATERFL337620389MGMT STAFFING SVC.1088431
ELECTRIC COMPANY OF OMAHA
815 S 21ST STREETOMAHANE68103ELECTRICAL CONTRACT.795834
FieldValueIRS element (for citing)
Number Of Contractors GT100 K17NumberOfContractorsGT100K
Related Organizations3722281RelatedOrganizations
Government Grants858560GovernmentGrants
All Other Contributions84483AllOtherContributions
Total Contributions4665324TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT SERVICE REVENUE621110245250052245250052
ELECTRONIC HEALTH RECORD90009914571221457122
FieldValueIRS element (for citing)
Total Program Service Revenue246707174TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column449826TotalRevenueColumn
Exclusion$449,826ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real387120Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real387120Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column387120TotalRevenueColumn
Exclusion$387,120ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other18809Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-18809Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-18809TotalRevenueColumn
Exclusion-$18,809ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
Unrelated Business Revenue0UnrelatedBusinessRevenue

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MGMT FEE54161044278554427855
EDUCATION & SUPPORT611710238142238142
METHODIST SVC541900759823759823

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column2673036TotalRevenueColumn
Related Or Exempt Function Income2673036RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue8098856TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column260289491TotalRevenueColumn
Related Or Exempt Function Income254806030RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$818,137ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total538000Total
Program Services538000ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2996362Total
Program Services2996362ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3252442Total
Management And General3252442ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total91118200Total
Program Services91118200ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total4944604Total
Program Services4944604ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total8062496Total
Program Services8062496ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total6375013Total
Program Services6375013ProgramServices

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total186887Total
Program Services186887ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total180000Total
Program Services180000ProgramServices

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total30194Total
Program Services30194ProgramServices
Fundraising0Fundraising

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total19295702Total
Program Services12720706ProgramServices
Management And General6574996ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total3020200Total
Management And General3020200ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total35373405Total
Program Services35373405ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total6369423Total
Program Services6369423ProgramServices

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total6518290Total
Program Services6518290ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total742543Total
Program Services742543ProgramServices

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total5815255Total
Program Services5815255ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total13683599Total
Program Services13683599ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total19186148Total
Program Services19186148ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total1450274Total
Management And General1450274ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
COLLECTION EXPENSE15638421563842
BUILDING MAINTENANCE14178531417853
OPERATING LEASES990062990062
PROFESSIONAL DUES & SUBSCRIP.422953422953

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total812993Total
Program Services812993ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total234346740Total
Program Services219625875ProgramServices
Management And General14720865ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4134523BOY
EOY4838045EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY36009436BOY
EOY34419889EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY1408000BOY
EOY1393000EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY37143949BOY
EOY44941480EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2855497BOY
EOY2925999EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY1904593BOY
EOY2290189EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis317518672LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec144330893LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY173927761BOY
EOY173187779EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY8443454BOY
EOY9067627EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY4137356BOY
EOY5745639EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY179340BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY10385924BOY
EOY9988326EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY280529833BOY
EOY288797973EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY31997654BOY
EOY37476155EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY55627BOY
EOY73072EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY100380922BOY
EOY100332906EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY6896147BOY
EOY6695569EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY10823163BOY
EOY11469712EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY150153513BOY
EOY156047414EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY128968320BOY
EOY131357559EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1408000BOY
EOY1393000EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY130376320BOY
EOY132750559EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY280529833BOY
EOY288797973EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses25942751ReconcilationRevenueExpenses
Reconcilation Other Changes-23568512ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying

Total Direct Lobbying TotalDirectLobbying

FieldValueIRS element (for citing)
Filing Organizations Totals30194FilingOrganizationsTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals30194FilingOrganizationsTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals234316546FilingOrganizationsTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

FieldValueIRS element (for citing)
Filing Organizations Totals234346740FilingOrganizationsTotals

Lobbying Nontaxable LobbyingNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals1000000FilingOrganizationsTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

FieldValueIRS element (for citing)
Filing Organizations Totals250000FilingOrganizationsTotals
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Current Year Minus21000000CurrentYearMinus2
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Current Year Minus2250000CurrentYearMinus2
Current Year Minus1250000CurrentYearMinus1
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Schedule D IRS990ScheduleD

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Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

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Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
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Land Land

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Buildings Buildings

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Equipment Equipment

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MINORITY INTEREST IN CP LIAB$1,915,212
SWAP LIABILITY$7,913,581
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Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
SCHEDULE D, PART V, LINE 4TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, AND OPERATIONS OF THE CHILDREN'S HOSPITAL & MEDICAL CENTER.
SCHEDULE D, PART X, LINE 2IN ACCORDANCE WITH ASC SUBTOPIC 740-10, INCOME TAXES-OVERALL, THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITION 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 2012 AND 2011, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES.FIN 48 FOOTNOTE

Schedule H IRS990ScheduleH

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Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

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Unreimbursed Medicaid UnreimbursedMedicaid

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Total Charity Care TotalCharityCare

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Community Health Services CommunityHealthServices

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Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
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Subsidized Health Services SubsidizedHealthServices

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Research Research

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Economic Development EconomicDevelopment

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Coalition Building CoalitionBuilding

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Total Total

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Bad Debt Expense ReportedfalseBadDebtExpenseReported
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Medicare Surplus Or Shortfall-216700MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

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Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

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Name Name

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FieldValueIRS element (for citing)
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Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

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Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

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Other Facilities OtherFacilities (6 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
W VILLAGE PTE URGENT CARE&AMBUL CLINICS
110 N 175TH STREETOMAHANE68118UCC OPENS 6AM-10PM & ROTATING AMBULATORY CLINICS
CHILDREN'S HOME HEALTHCARE
4156 S 52ND STREETOMAHANE68117PEDIATRIC HOME HEALTH CARE SERVICES
CHILDREN'S HOME HEALTHCARE WORLD
7815 FARNAM STREETOMAHANE68114PRIVATE DUTY PEDIATRIC NURSING CENTER
LINCOLN CLINIC
300 NORTH 44TH STREETLINCOLNNE68503PEDIATRIC CLINIC
CAROLYN SCOTT RAINBOW HOUSE
7815 HARNEY STREETOMAHANE68114MINIMUM TO NO-COST ACCOMODATIONS FOR FAMILIES OF PATIENTS
VAL VERDE URGENT CARE
9801 GILES ROAD SUITE 1LA VISTANE68128UCC OPENS 6AM-10PM

Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 3CIf the organization did not use FPG to determine eligibility, describe the income based criteria for determining eligibility for free or discounted care. 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 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 charity care 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.
PART I, LINE 6AThe community benefit report is prepared by the organization. The values reported in the 2012 Community Benefit report include $1.5M in FINANCIAL assistance.
PART I, LINE 7GThe organization did not include costs attributable to physician clinics as subsidized health services.
PART I, LINE 7Explanation of the costing methodology used to calculate subsidized health services: A subsidized health service benefit was calculated for the NICU, emergency and trauma care, urgent care, behavioral health, and ambulatory care clinic outpatient services recognizing that these areas operate at a negative margin when the indirect costs of operation are considered. A cost to charge ratio calculation similar to worksheet 2 in the schedule H instructions is used. The reported subsidized loss represents the difference in net revenue received from all payors PLUS any miscellaneous operating revenue reported by the department 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.
PART IIChildren's Hospital & Medical Center supports "economic development" in its sponsorship donations to organizations such as Nebraska Chamber of Commerce & Industry. Children's Hospital and Medical Center goes beyond joint commission requirements to ensure community disaster readiness through our committee work involvement with the Omaha Medical Management Response team.Community Building Activities
PART III, Section A, Line 4New Accounting Standard Effective December 31, 2011, 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. Describe the costing method used to determine the amounts reported on lines 2 & 3: Bad debt expense at 100% charge value was multiplied by the 2012 Medicare Cost to Charge Ratio to arrive at an approximate cost value. Bad debt expense at 100% charge value $4,179,102 Medicare Cost to Charge Ratio x .4917 Bad debt expense at cost $2,055,000 Estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's charity care 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 2012 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.Bad Debt Expense
PART III, Section B, Line 8Describe the extent to which any shortfall reported in line 7 should be treated as a community benefit and the costing methodology used to determine the amount reported on line 6 and indicate what costing methodology was used. 2012 Medicare charges reported by CMS in the Provider Statistical and Reimbursement System for provider FYE 12/31 were multiplied by the 2012 cost to charge ratio to arrive at an approximate cost of care related to the reimbursement payments reported on line 5.Medicare
PART III, Section C, Line 9bDoes the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. Administrative policy: Collection of Self Pay and Balance After Insurance monies 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 Centers financial assistance program. All correspondence, including statements and collection letters state that Financial Assistance may be available.Collection Practices
PART V, SECTION B, LINE 3AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, THERE WERE FIVE FOCUS GROUPS HELD FEBRUARY 29 TO MARCH 1, 2012. the participants in these focus groups included 46 key informants, including physicians, other health professionals, social service providers, business leaders, and other community leaders with input and expertise regarding the community youth. A LIST OF RECOMMENDED PARTICIPANTS FOR THE FOCUS GROUPS WAS PROVIDED BY THE SPONSORS OF THIS STUDY. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS AMONG THE FAMILIES AND CHILDREN/ADOLESCENTS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED A REPRESENTATIVE OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICIALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. PART V, SECTION B, LINE 4 BOYS TOWN NATIONAL RESEARCH HOSPITAL PART V, SECTION B, LINE 7 ACTIONS HAVE BEEN IMPLEMENTED BY CHILDREN'S IN ALL SEVEN AREAS WHICH EMERGED AS HEALTH PRIORITIES IN NEED OF INTERVENTION BASED ON THE 2012 CHILD & ADOLESCENT COMMUNITY HEALTH NEEDS ASSESSMENT: OBESITY AND NUTRITION INJURY AND SAFETY ACCESS TO HEALTHCARE ASTHMA MENTAL HEALTH SUSTANCE ABUSE SEXUAL ACTIVITY ALTHOUGH ACTIONS HAVE BEEN IMPLEMENTED TO ADDRESS SEXUAL ACTIVITY AND SEXUALLY TRANSMITTED INFECTIONS, THESE ISSUES ARE NOT AREAS OF EMPHASIS FOR CHILDREN'S HOSPITAL & MEDICAL CENTER DUE TO THE SIGNIFICANT INVOLVEMENT OF COMMUNITY PUBLIC HEALTH ENTITIES (SUCH AS THE DOUGLAS COUNTY, NE HEALTH DEPARTMENT) WHICH HAVE MADE THIS CONCERN A HIGH ACTION ITEM FOR THEIR TEAMS AND PROGRAMS. PART V, SECTION B, LINE 14g In regard to 14b, the policy is provided to the public in summary and directed to visit the Children's Hospital website for the full policy.
PART V, SECTION B, LINE 20DIndicate how the hospital facility determined the amounts billed to individuals who did not have insurance covering emergency or other medically necessary care: At Children's, commercial insurers, government payors and self-pay billing parties are all billed the same gross charge rate for each specific procedure performed (as opposed to a DRG rate). Upon request, self-pay billings are eligible for a 10% discount for prompt payment. Federal Poverty Guidelines are used to determine eligibility for free or discounted care. Financial assistance is available for medically necessary procedures and services. 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 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 tradition charity care application requirements. PART V, SECTION B, LINE 22 AT CHILDREN'S - COMMERCIAL INSURERS, GOVERNMENT PAYORS AND SELF-PAY BILLING PARTIES ARE ALL BILLED THE SAME GROSS CHARGE RATE FOR EACH SPECIFIC PROCEDURE PERFORMED. GROSS CHARGES ON AN FAP-PATIENT BILL ARE THEN DISCOUNTED ACCORDING TO THEIR FPG ELIGIBILITY WHICH REDUCES OR ELIMINATES THE AMOUNT THE PATIENT IS REQUIRED TO PAY.
PART VIChildren'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 Child Health Corporation of America (CHCA) and the National Association of Children's Hospitals and Related Institutions (NACHRI). There are many local and state reports available for our use, including Vital Statistics, the Douglas County Health Department, United Way of the Midlands, Our Healthy Community Partnership (in which we are a member partner), and Kids Count in Nebraska. The hospital conducts consumer surveys, as well as medical staff and referring physician surveys, to help identify gaps in service(s). In addition to analyzing internal utilization of services, data is available to track utilization of services by all providers in the communities served by Children's. Other 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. Preofessional Research Consultants, Inc. (PRC) has been hired to gather data to assist in determining the health status, behaviors and needs of children and adolescents in the Omaha Metropolitan area.2-NEEDS ASSESSMENT
PART VIFinancially 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. Brochures which explain the billing process are available. 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 PART VI 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 786,683. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA. FOR YEAR ENDED DECEMBER 31, 2012, 58% 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 18% 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. 2012 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 786,683 PEDIATRIC POPULATION 204,639 AVERAGE HOUSEHOLD INCOME $68,288 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 12.9% UNDER AGE 18 17.7% PERCENT OF RESIDENTS ON MEDICAID 14.0% AGE POPULATION % OF TOTAL LESS THAN 18 204,639 26.0% 18 TO 24 77,529 9.9% 25 TO 44 222,369 28.3% 45 TO 64 195,039 24.8% 65+ 87,107 11.0% TOTAL 786,683 100.0% RACE POPULATION % OF TOTAL WHITE 598,621 76.0% BLACK 67,727 8.6% HISPANIC 80,201 10.3% ASIAN/PACIFIC ISLANDER 19,759 2.5% OTHER 16,132 2.1% AM. IND./ALASKA NAT. 3,736 0.5% TOTAL 786,683 100.0% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS: 9.9% 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.3- PATIENT EDUCATION OF ELIGIBILITY
PART VIProudly 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 141 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. The team currently has the ability to transport these patients utilizing a dedicated ground ambulance, helicopter or fixed wing aircraft. Children's has achieved the Magnet designation for nursing excellence, is an InfoWorld 100 award winner for innovation in information technology and has received recognition in U.S. News and World Report's Best Children's Hospitals ranking 41 IN ORTHOPEDICS, AND 45 in 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 2012, our hospital: -Provided $3.5 million in services in the form of uncompensated care\charity care ($1.5 million) and bad debt write-offs(2.0 million) to families unable to pay the bills associated with their children's medical care. With 43 percent of patient care revenues devoted to the care of low-income children assisted by Medicaid, the Medicaid reimbursement shortfall for FY 2012 was $24 million less than the cost of the care provided. This amount has been steadily increasing and is expected to continue to rise with an uncertain national economic future. -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 classes, health fairs, Just Kids magazine and the consumer web site. Public health assistance is available through social work, pastoral and spiritual, child life services, financial counseling and a variety of support groups. 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, agency representation, community event sponsorships and charitable donations. -Contributed $6.8 million in pediatric health care education costs to educate tomorrow's healers and an additional $1.1 million to support pediatric education, research and clinical care that will in turn improve the health care of all children. In 2012, 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 $32.0 million in subsidized clinical health services, or programs offered despite financial loss because they meet an identified community need. The emergency department and emergency transport services, in addition to behavioral health and many of the ambulatory clinic programs all operate at negative margins. Non-billed services provided include financial counseling, pastoral and spiritual care, social work and child life services provided at no cost or nominal to the patient. In 2012, Children's Hospital and Medical Center contributed in total over $67 million in community benefits representing 31 percent of the hospital's operating expenses.5- PROMOTION OF COMMUNITY HEALTH
PART VIChildren's Hospital and Medical Center is not affiliated with a greater health care system, but is its' own health care system which the hospital operates the following related organizations: - Children's Hospital & Medical Center Foundation - Children's PHYSICIANS6-AFFILIATED HEALTH CARE SYSTEM
PART VIThe 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. Internet Site: www.childrensomaha.org7- STATE FILING OF COMMUNITY BENEFIT REPORT

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrant
Ne Pediatric Practice Inc
8200 Dodge StOmahaNE68114263064869501(c)(3)447000Pediatrics/Research
University of NE College of Medicine
985520 NE Med CtrOmahaNE68198470049123501(c)(3)91000PEDIATRICS/RESEARCH
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantCHARITY CARE ASSISTANCE TO THOSE PATIENTS IN NEEDTypeOfGrant
Number Of Recipients3435NumberOfRecipients
Amount Of Non Cash Assistance2996362AmountOfNonCashAssistance
Method Of ValuationBookMethodOfValuation
Description Of Non Cash AssistanceWRITE OFF PAT. ACCTSDescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierSCHEDULE I, PART I, LINE 2Identifier
ExplanationCHILDREN'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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOHN MOORE MD
MEMBER202398010688013190178990123440244648000
GARY A PERKINS FACHE
PRESIDENT/CEO/MEMBER495622027893703886580538280930001226345000
KATHY ENGLISH
EVP/COO309514095414046133039000093370499398000
MICHAEL BROWN
SVP/CFO30236201625750305980200000133920528927000
CARL GUMBINER MD
SVP/CMO31220001114740455001250009680441692000
GEORGE E REYNOLDS MD
VP/CMIO/CIO357077099363046860370000132930511419000
BETSY J STEPHENSON MD
PHYSICIAN2668060124880116703700002120317673000
JOHN ANDERSEN MD
PHYSICIAN32462201387501146013404082570361304000
CHANDRIKA RIZAL MD
PHYSICIAN2634760124880335903700001860316509000
RACHEL MCCANN MD
PHYSICIAN254766013875030550125000123780296574000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierExplanationExplanation
PART I, LINE 1AGARY PERKINS' SOCIAL CLUBS DUES ARE PAID FOR BY THE ORGANIZATION TO BE USED FOR BUSINESS PURPOSES.
PART II, COLUMN B (III)THE FIGURE FOR GARY A. PERKINS ITEMIZED AT PART II B (III) "OTHER REPORTABLE COMPENSATION" INCLUDES A PAYMENT OF THREE HUNDRED SEVENTY THOUSAND DOLLARS REPRESENTING A CONTRIBUTION TO A SUPPLEMENT EXECUTIVE RETIREMENT PLAN ("SERP") FOR MR. PERKINS IN HIS CAPACITY AS CHIEF EXECUTIVE OFFICER. THE SERP BENEFIT TARGET IS BASED ON MR. PERKINS 30 YEARS OF SERVICE AND WILL PROVIDE A MARKET COMPETITIVE BENEFIT IN THE OPINION OF THE HOSPITAL'S INDEPENDENT COMPENSATION CONSULTANT.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1HOSP AUTHORITY NO 2 OF DOUGLAS CO NEBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN521440796IssuerEIN
CUSIP Number259230KT6CUSIPNumber
Date Issued2008-08-12DateIssued
Issue Price100881609IssuePrice
Description Of PurposeREFUND CHILD HOSP 2007 SERIES A&BDescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired0AmountRetired
Amount Bond Defeased0AmountBondDefeased
Total Proceeds100881787TotalProceeds
Amount In Reserve Fund5000178AmountInReserveFund
Capitalized Interest0CapitalizedInterest
Refunding Escrow0RefundingEscrow
Issuance Costs From Proceeds751783IssuanceCostsFromProceeds
Credit Enhancement24826CreditEnhancement
Working Capital Expenditures0WorkingCapitalExpenditures
Capital Expenditures2755000CapitalExpenditures
Other Spent Proceeds92350000OtherSpentProceeds
Amount Unspent0AmountUnspent
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtyfalseMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay TesttrueBondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed PropfalseChangeInUseBondFinancedProp
Prcntge Bond Financed Prop0.00000PrcntgeBondFinancedProp
Remedial Action TakenfalseRemedialActionTaken
Non Qualified Bond Remed ProcdrstrueNonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T FiledfalseForm8038TFiled
Rebate Not Due YettrueRebateNotDueYet
Exception To RebatetrueExceptionToRebate
No Rebate DuefalseNoRebateDue
Variable Rate IssuetrueVariableRateIssue
Hedge Identified In Books And RecdstrueHedgeIdentifiedInBooksAndRecds

Name Of Hedge Provider NameOfHedgeProvider

FieldValueIRS element (for citing)
Business Name Line1MORGAN STANLEYBusinessNameLine1
FieldValueIRS element (for citing)
Term Of Hedge25.TermOfHedge
Superintegrated HedgefalseSuperintegratedHedge
Hedge TerminatedfalseHedgeTerminated
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line10BusinessNameLine1
FieldValueIRS element (for citing)
Gross Proceeds InvestedfalseGrossProceedsInvested
Written Proc To Monitor ReqstrueWrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective ActiontrueProcToUndertkCorrectiveAction

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierSCHEDULE K, PART II, LINE 3Identifier
Return Reference0ReturnReference
ExplanationTHE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART III, LINE 2THE HOSPITAL'S NEW FETAL CARE CENTER, WHICH OPENED IN JULY 2012, FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENTIAL DEFECTS BEFORE BIRTH. SINCE OPENING, THE FETAL CARE CENTER HAS ASSISTED MORE THAN 40 FAMILIES WITH THE COORDINATION OF OUTPATIENT CARE AND SPECIALIST CONSULTATIONS.
FORM 990, PART III, LINE 4ATHE HOSPITAL OPERATES A 141 BED PEDIATRIC HOSPITAL, WHICH INCLUDES SEVEN SURGICAL SUITES, A HYBRID HEART CATHETERIZATION LAB, 30 OUTPATIENT SPECIALITY CLINICS, AND A 33 BED OUTPATIENT "DAY HOSPITAL" KNOWN AS THE CHILDREN'S AMBULATORY RECOVERY AND EXPRESS STAY(CARES) UNIT, THE CHILDREN'S SPECALITY 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, CENTER BASED PRIVATE DUTY NURSING AT CHILDREN'S HOME HEALTHCARE'S WORLD, AND HOME INFUSION THERAPY SERVICES. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT IN THE REGION. IN 2012, CHILDREN'S HOSPITAL & MEDICAL CENTER RECEIVED LEVEL II PEDIATRIC TRAUMA VERIFICATION AND OPENED A NEW FETAL CARE CENTER. CHILDREN'S IS THE FIRST AND ONLY HOSPITAL IN NEBRASKA, AND THE ONLY 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 SPECIALITY PEDIATRIC CARE SERVICES IN LINCOLN, KEARNEY, GRAND ISLAND, HASTINGS, NORTH PLATTE, COLUMBUS, NORTHFOLK, AND HOLDREGE, NEBRASKA; SIOUX FALLS AND RAPID CITY, SOUTH DAKOTA; AND SIOUX CITY,IOWA.
FORM 990, PART VI, LINE 11bTHE FORM 990 WILL BE AVAILABLE FOR ALL BOARD MEMBERS THROUGH THE BOARD PORTAL ON THE INTRANET AND AN OVERVIEW WILL BE PRESENTED TO THE EXECUTIVE COMMITTEE PRIOR TO FILING WITH THE IRS.GOVERNANCE, MANAGEMENT, AND DISCLOSURE
Form 990, Part VI, Line 12CTHE CONFLICTS 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 OF DIRECTORS OR A BOARD COMMITTEE FOR APPROVAL (INTERESTED PERSON). THIS INCLUDES, BUT IS NOT LIMITED TO, ANY DIRECTOR, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD-DESIGNATED POWERS. EACH INTERESTED PERSON HAS THE OBLIGATION TO ANNUALLY SUBMIT A COMPLETED CONFLICTS OF INTEREST QUESTIONNAIRE AND HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST PROMPTLY. EACH INTERESTED PERSON SIGNS ANNUALLY AN ACKNOWLEDGEMENT THAT STATES THAT THE INTERESTED PERSON HAS RECEIVED, READ AND UNDERSTANDS THE CONFLICT OF INTEREST POLICY, AGREES TO COMPLY WITH THE POLICY; UNDERSTANDS THAT THE POLICY APPLIES TO THE BOARD OF DIRECTORS AND COMMITTEES; UNDERSTANDS THAT CHILDREN'S HOSPITAL & MEDICAL CENTER IS A NOT-FOR-PROFIT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES; AGREES TO REPORT TO THE GENERAL COUNSEL ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICTS OF INTEREST QUESTIONNAIRE; STATES THAT THE INFORMATION PROVIDED IN THE CONFLICTS OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF. THE GOVERNANCE COMMITTEE REVIEWS EACH COMPLETED CONFLICTS OF INTEREST QUESTIONNAIRE TO DETERMINE IF ANY FURTHER INVESTIGATION OF POTENTIAL CONFLICTS IS NECESSARY. WHEN A POTENTIAL CONFLICT IS VOLUNTARILY IDENTIFIED BY AN INTERESTED PERSON OR THROUGH DISCLOSURE BY ANOTHER PERSON, THE REMAINING BOARD/COMMITTEE MEMBERS REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT EXISTS. ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS MAY VOTE TO DETERMINE WHETHER A CONFLICT EXISTS. THE INTERESTED PERSON IN QUESTION CANNOT BE PRESENT DURING THE VOTE. IF A CONFLICT OF INTEREST EXISTS, THE DISINTERESTED BOARD/COMMITTEE MEMBERS DETERMINE WHETHER A MORE ADVANTAGEOUS CONTRACT, TRANSACTION OR ARRANGEMENT SHOULD BE OBTAINED. WHEN CONSIDERING WHETHER TO ENTER INTO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT, ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS CAN VOTE TO DETERMINE IF IT IS IN THE BEST INTEREST OF CHILDREN'S AND FOR CHILDREN'S OWN BENEFIT. THE INTERESTED PERSON MAY BE REQUIRED TO LEAVE THE ROOM WHEN THE MATTER IS DISCUSSED AND IS REQUIRED TO LEAVE THE ROOM WHEN THE MATTER IS VOTED ON. ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS MAY VOTE ON THE MATTER. FAILURE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY MAY RESULT IN REMOVAL FROM THE BOARD.POLICIES
Form 990, Part VI, Line 15EACH YEAR AN INDEPENDENT COMPANY (TOWERS WATSON) 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. TOWERS WATSON 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 CHANGE FOR THE TOP FIVE EXECUTIVES (CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, 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.POLICIES
Form 990, Part VI, Line 19GOVERNING 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.GOVERNANCE, MANAGEMENT, AND DISCLOSURE
FORM 990 PART XI, LINE 9MINORITY INTEREST IN CHILDEN'S PHYSICIANS 1,072,189 CHANGE IN VALUE OF SWAP 162,931 CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK 1,800 CAPITAL TRANSFERS CHILDREN'S PHYSICIANS 1,000,000 CAPITAL TRANSFERS CHILDREN'S HOSPITAL & MEDICAL CENTER FND (25,805,432) TOTAL CHANGES IN NET ASSETS (23,568,512)Other Changes in Net Assets

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
CHILDREN'S HOSPITAL & MEDICAL CENTER FDN
8200 DODGE STREETOMAHANE68114476105603FUNDRAISINGNE501(C)(3)LINE 7CHMCtrue
CHILDREN'S PHYSICIANS
8200 DODGE STREETOMAHANE68144470689372PED. CLINICNE501(C)(3)LINE 9CHMCtrue

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnershipControlled OrgControlledOrg
KENT INC
8200 DODGE STREETOMAHANE68114470527928REAL ESTATENECHMCC corp02194951.00000true
CHILDREN'S HEALTH NETWORK
8200 DODGE STREETOMAHANE68114363967578HEALTH NETWORKNECHMCC corp001.00000true
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgstrueRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgstruePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
CHILDREN'S HOSPITAL & MEDICAL CENTER FND
C3722281BOOK
CHILDREN'S HOSPITAL & MEDICAL CENTER FND
LMNOQ2477539BOOK
CHILDREN'S PHYSICIANS
S1000000BOOK
CHILDREN'S PHYSICIANS
J244500BOOK
CHILDREN'S HOSPITAL & MEDICAL CENTER FND
R23327893BOOK