2021-01-18T14:52:14-06:00 2020-06-30 990 2019-07-01 470439599 MADONNA REHABILITATION HOSPITAL MADO 4024133000 5401 SOUTH STREET LINCOLN NE 685062134 MICHAEL HEDDERMAN EXECUTIVE VP & CFO 4024133000 2021-01-18 2019 2022-09-23 18:48:47Z MICHAEL HEDDERMAN 5401 SOUTH STREET LINCOLN NE 685062134 176470831 0 X WWW.MADONNA.ORG X 1967 NE MADONNA REHABILITATION HOSPITALS IS A CATHOLIC ORGANIZATION THAT EXISTS TO PROVIDE A FULL CONTINUUM OF WORLD-CLASS MEDICAL AND PHYSICAL REHABILITATION SERVICES TO CHILDREN AND ADULTS THROUGHOUT THE NATION. WE REHABILITATE THOSE WHO HAVE SUSTAINED INJURIES OR DISABLING CONDITIONS SUCH AS BRAIN INJURIES, SPINAL CORD INJURIES, STROKE, NEUROLOGICAL DISEASES AND PULMONARY CONDITIONS SO THEY CAN FULLY PARTICIPATE IN LIFE; LEAD RESEARCH TO IMPROVE OUTCOMES; AND PROMOTE WELLNESS THROUGH COMMUNITY PROGRAMS. 21 20 2535 414 0 0 661772 867593 166074014 173569301 3129248 2033937 0 0 169865034 176470831 0 0 0 0 115450921 119072138 0 0 0 42790863 46839369 158241784 165911507 11623250 10559324 253284762 275407581 94879245 106397435 158405517 169010146 X MADONNA REHABILITATION HOSPITALS IS A CATHOLIC ORGANIZATION THAT EXISTS TO PROVIDE A FULL CONTINUUM OF WORLD-CLASS MEDICAL AND PHYSICAL REHABILITATION SERVICES TO CHILDREN AND ADULTS THROUGHOUT THE NATION. WE REHABILITATE THOSE WHO HAVE SUSTAINED INJURIES OR DISABLING CONDITIONS SUCH AS BRAIN INJURIES, SPINAL CORD INJURIES, STROKE, NEUROLOGICAL DISEASES AND PULMONARY CONDITIONS SO THEY CAN FULLY PARTICIPATE IN LIFE; LEAD RESEARCH TO IMPROVE OUTCOMES; AND PROMOTE WELLNESS THROUGH COMMUNITY PROGRAMS. 0 0 96671067 127354220 MADONNA FULFILLS THIS MISSION BY DELIVERING EXPERT AND COMPREHENSIVE REHABILITATION, TREATING EACH PERSON AS A UNIQUE INDIVIDUAL. MADONNA'S HOSPITALS INTEGRATE THE PHYSICAL, PSYCHOLOGICAL, SOCIAL, SPIRITUAL AND VOCATIONAL ASPECTS OF EACH PATIENT'S LIFE. THE HOSPITALS' PROGRAMS SUPPORT THE UNMET NEEDS OF OUR COMMUNITY AND REGION AND ARE DEVOTED TO RETURNING PEOPLE TO THEIR HOMES, COMMUNITIES AND JOBS OR SCHOOL. IN FY 2020 MADONNA ADMITTED 2,309 HOSPITAL INPATIENTS FROM 19 STATES. THE HOSPITAL RECEIVED REFERRALS FROM 841 PHYSICIANS AND 105 HOSPITALS OR HEALTH CARE FACILITIES. IN FY 2020, MADONNA OPERATED TWO INPATIENT REHABILITATION FACILITIES (IRF): MADONNA REHABILITATION HOSPITAL LINCOLN (MRH-L) AND MADONNA REHABILITATION HOSPITAL OMAHA (MRH-O) AND TWO LONG TERM CARE HOSPITALS: MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN (MRSH-L) AND MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA (MRSH-O). MRH-L, MRH-O, MRSH-L AND MRSH-O OFFER COMPREHENSIVE CARE TO ENSURE CONTINUITY AS PATIENTS' PROGRESS IN THEIR RECOVERY OR FROM ONE HOSPITAL TO ANOTHER. ALL HOSPITALS EMPLOY AN INTERDISCIPLINARY TEAM APPROACH INVOLVING THE PATIENT AND FAMILY, REFERRING PHYSICIAN, REHABILITATION PHYSICIAN, CASE MANAGER, NUTRITION THERAPIST, RESPIRATORY THERAPIST, REHABILITATION NURSE, PHYSICAL AND OCCUPATIONAL THERAPISTS, ORTHOTIC AND PROSTHETIC TECHNICIAN, PSYCHOLOGIST, SOCIAL WORKERS, SPEECH-LANGUAGE PATHOLOGISTS, THERAPEUTIC RECREATION SPECIALISTS, VOCATIONAL REHABILITATION CONSULTANTS AND SPIRITUAL CARE COUNSELORS. MADONNA'S EXPERIENCED STAFF TREATS THOUSANDS OF INDIVIDUALS THROUGH INPATIENT AND OUTPATIENT SERVICES EVERY YEAR, OFFERING EVERY PATIENT THE LATEST TECHNIQUES AND METHODS TO PRODUCE THE BEST RESULTS. AS ONE OF THE LARGEST, FREESTANDING REHABILITATION HOSPITAL SYSTEMS IN THE UNITED STATES, MADONNA PROVIDES:O INTENSIVE THERAPY PROGRAMMINGO PROGRAMS WITH LESS INTENSIVE THERAPY, DEPENDING ON THE NEEDS OF THE PATIENTO 24-HOUR REHABILITATION NURSING AND PHYSICIAN SUPERVISIONO A CONTINUUM OF SERVICES TO ENSURE PROGRESS IS MAINTAINED FROM INPATIENT TO OUTPATIENT PROGRAMSOUR SPECIALTY REHABILITATION PROGRAMS FOCUS ON THE NEEDS OF CHILDREN AND ADULTS FOLLOWING TRAUMATIC INJURY AND ILLNESS, INCLUDING: BRAIN INJURY, SPINAL CORD INJURY, STROKE, PULMONARY CONDITIONS AND MAJOR MULTIPLE TRAUMA. MADONNA REHABILITATION HOSPITAL HAS MORE SEPARATE COMMISSION ON THE ACCREDITATION OF REHABILITATION FACILITIES (CARF) ACCREDITATIONS IN THE AREA OF MEDICAL REHABILITATION THAN ANY OTHER HOSPITAL IN THE NATION (31 PROGRAMS). THESE PROGRAMS ARE: " INPATIENT REHABILITATION PROGRAMS" BRAIN INJURY PROGRAM - INPATIENT/OUTPATIENT (ADULT AND PEDIATRIC)" SPINAL CORD SPECIALTY PROGRAM - INPATIENT/OUTPATIENT (ADULT AND PEDIATRIC)" STROKE SPECIALTY PROGRAM - INPATIENT/OUTPATIENT (ADULT AND PEDIATRIC)" PEDIATRIC SPECIALTY PROGRAM - INPATIENT/OUTPATIENT" INTERDISCIPLINARY OUTPATIENT MEDICAL REHABILITATION PROGRAMS - MULTIPLE SERVICEMADONNA REHABILITATION HOSPITAL LINCOLN PATIENTS AT MRH-L RANK IN THE TOP 2% NATIONALLY IN TERMS OF COMPLEXITY, WHILE DISCHARGING BACK TO COMMUNITY SETTINGS AT A HIGHER RATE ACCORDING TO INDUSTRY BENCHMARKS. DESPITE THIS COMPLEXITY, 74% OF PATIENTS DISCHARGED DIRECTLY TO A COMMUNITY SETTING, COMPARED TO EREHAB BENCHMARK OF 70%. PATIENTS AT MRH-L MADE HIGHER FUNCTIONAL GAINS IN AREAS SUCH AS MOBILITY, SELF CARE, COMMUNICATION AND COGNITION THAN THE NATION AND DISCHARGED AT A HIGHER FUNCTIONAL LEVEL OVERALL. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRH-L WAS 77%. MADONNA REHABILITATION HOSPITAL OMAHA MRH-O IS COMPLETING ITS FOURTH YEAR OF OPERATION IN OCTOBER OF 2020. THE HOSPITAL OVERALL RETURNED 72.8% OF PATIENTS TO A COMMUNITY DESTINATION RATHER THAN TO AN INSTITUTION, APPROXIMATING EREHAB BENCHMARKS. PATIENTS AT MRH-O MADE HIGHER FUNCTIONAL GAINS IN AREAS SUCH AS MOBILITY, SELF CARE, COMMUNICATION AND COGNITION THAN THE NATION AND DISCHARGED AT A HIGHER FUNCTIONAL LEVEL OVERALL. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRH-O WAS 87%. MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN MRSH-L FY 2020 PATIENT DISCHARGE TO HOME OR TO AN ACUTE REHABILITATION HOSPITAL TO CONTINUE THEIR RECOVERY WAS 46% FOR THE YEAR. 73.7% OF PATIENTS ADMITTED ON A MECHANICAL VENTILATOR WEANED IN AN AVERAGE OF 20 DAYS. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRSH-L WAS 77%.MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA MRSH-O FY 2020 PATIENT DISCHARGE TO HOME OR TO AN ACUTE REHABILITATION HOSPITAL TO CONTINUE THEIR RECOVERY WAS 51% FOR THE YEAR. 75.7% OF PATIENTS ADMITTED ON A MECHANICAL VENTILATOR WEANED IN AN AVERAGE OF 11 DAYS. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRSH-O WAS 87%. 24242425 22940562 ST. JANE DE CHANTAL (ST. JANE) IS COMPRISED OF A 34-BED VENTILATOR AND SPECIAL CARE UNIT (VAU/SN), A 26-BED TRANSITIONAL CARE REHABILITATION UNIT (TCU) AND A 66-BED NURSING HOME. ST. JANE EXPANDED ITS CONTINUUM OF CARE FOR CLINICALLY COMPLEX PATIENTS BY COMPLETING AN EXPANSION OF TCU PATIENT ROOMS. 10439646 9193759 MADONNA THERAPYPLUS IS COMMITTED TO PROVIDING EXCELLENT PATIENT CARE FOR PATIENTS WHO NEED OUTPATIENT REHABILITATION. THERAPYPLUS OFFERS A RANGE OF REHABILITATION SERVICES FROM SPORTS INJURIES AND SINGLE SERVICE ORTHOPEDIC SPRAINS, STRAINS AND POST-OPERATIVE CARE TO COMPREHENSIVE REHABILITATION FOR NEUROLOGICAL CONDITIONS. THERAPYPLUS INCLUDES THE FIT FOR WORK PROGRAM, WHICH COMBINES OCCUPATIONAL HEALTH, WELLNESS, SAFETY AND COORDINATION OF WORKERS' COMPENSATION WITH THE EXPERT SERVICES CONVENIENTLY AVAILABLE FROM MADONNA REHABILITATION HOSPITALS, MADONNA THERAPYPLUS OUTPATIENT CLINICS AND MADONNA PROACTIVE.IN FY 2020, THERAPYPLUS OUTPATIENT VOLUME WAS SIGNIFICANTLY IMPACTED DUE TO COVID-19. FORTUNATELY THE OUTPATIENT BUSINESS MODEL HAS MULTIPLE LOCATIONS, AND WERE ABLE TO CONSOLIDATE AND DIRECT NEURO SERVICES TO THE OFF-SITE CLINICS TO ENSURE PATIENT SAFETY AND PROPER INFECTION CONTROL PRACTICES. MANY PATIENTS CANCELLED THERAPY SESSIONS AND AVOIDED OUTPATIENT ALL TOGETHER DUE TO CONCERN OVER COVID.IN FY2020, THERAPYPLUS EXPANDED WORK COMP SERVICES THROUGH DOT PHYSICALS AT NORTHWEST CLINIC AND LPS SCREENS AT PROACTIVE, INITIATED THE MILD TRAUMATIC BRAIN INJURY COMPREHENSIVE ASSESSMENT IN OMAHA, EXPANDED VOICE SERVICES IN OMAHA, AND PROVIDED TELEHEALTH SERVICES AT ALL LOCATIONS DURING THE COVID-19 PANDEMIC. 15138280 14080760 MADONNA PROACTIVE IS A MEDICALLY-BASED HEALTH, FITNESS AND WELLNESS FACILITY AND THE FIRST TO BE BASED ON A REHABILITATION MODEL. MADONNA PROACTIVE PROVIDES MEDICAL, THERAPEUTIC AND EDUCATIONAL FITNESS AND WELLNESS EXPERTISE IN ADDITION TO THE LATEST TECHNOLOGY.IN FY 2020, PROACTIVE HAS INCREASED COLLABORATION WITH THERAPYPLUS AND MADONNA'S RESEARCH INSTITUTE TO DEVELOP AND IMPLEMENT MEDICALLY-BASED PROGRAMS THAT FACILITATE THE CONTINUUM OF CARE. 15138280 14080760 146491418 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 49 0 1 2535 1 0 0 0 0 0 0 0 0 0 0 0 0 X 21 20 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL HEDDERMAN 4024133000 5401 SOUTH STREET LINCOLN NE 685062134 KEVIN WERTS CHAIRPERSON 1.00 X X 0 0 0 DAVID GANNON MD VICE CHAIRPERSON 1.00 X X 0 0 0 PAUL DONGILLI PRESIDENT AND CEO 40.00 1.00 X X 632432 0 33049 FR JOHN SULLIVAN VICE PRESIDENT 1.00 X X 0 0 0 WILL DOUGLAS SECRETARY 1.00 X X 0 0 0 LAUREN PUGLIESE TREASURER 1.00 X X 0 0 0 SCOTT BECKER CPA MEMBER 1.00 X 0 0 0 JOHN BERGMEYER MEMBER 1.00 X 0 0 0 BARBARA BRADEN PHD MEMBER 1.00 X 0 0 0 MARK FAHLESON MEMBER 1.00 X 0 0 0 KACEY LEMPKA CPA MEMBER 1.00 X 0 0 0 MIKE MCCRORY MEMBER 1.00 X 0 0 0 BRAD NIETFELDT MEMBER 1.00 X 0 0 0 GARY PERKINS MEMBER 1.00 X 0 0 0 SARAH PILLEN MEMBER 1.00 X 0 0 0 LYNN ROPER MEMBER 1.00 X 0 0 0 PATRICK SPETHMAN MEMBER 1.00 X 0 0 0 GREG VASEK MEMBER 1.00 X 0 0 0 TIFFANY VERZAL MEMBER 1.00 X 0 0 0 TERRY ZACH MD MEMBER 1.00 X 0 0 0 DAN VOKOUN MEMBER 1.00 0.00 X 0 0 0 VICTOR WITKOWICZ EXECUTIVE VP-CFO 40.00 X 447436 0 31674 DR THOMAS STALDER VP OF MEDICAL AFFAIRS/CHIE 40.00 X 378370 0 17035 SUSAN K KLANECKY VP PATIENT CARE 40.00 X 231611 0 21794 CHRISTOPHER A LEE VP REHABILITATION 40.00 X 235973 0 29345 LOU ANN MANSKE VICE PRESIDENT HUMAN RESOU 40.00 X 214161 0 16614 LYNN R HALLOWELL-GOTTSLEBEN VICE PRESIDENT COMMUNITY S 40.00 X 188825 0 20751 LINDA S SUNDELL-SULLIVAN VICE PRESIDENT REFERRAL RE 40.00 X 174661 0 22073 DANIEL GRIESS VP FACILITIES MANAGEMENT S 40.00 X 229409 0 16805 MICHAEL HEDDERMAN VP AND CFO 40.00 X 241103 0 7841 ADAM T KAFKA STAFF PHYSIATRIST 40.00 X 534935 0 21649 JIAXIN TRAN STAFF PHYSIATRIST 40.00 X 492839 0 16232 MORGAN L LAHOLT STAFF PHYSIATRIST 40.00 X 467571 0 21681 PAUL L KRABBENHOFT STAFF PHYSIATRIST 40.00 X 342486 0 23481 MATTHEW DRIEWER STAFF PHYSIATRIST 40.00 X 288098 0 19965 5099910 0 319989 69 0 1 0 UNMC 985045 NEBRASKA MEDICAL CENTER OMAHA NE 68198 MEDICAL EDUCATION 1632938 RTG MEDICAL 1005 E 23RD ST STE 200 FREMONT NE 68025 MEDICAL SERVICES 1127098 NEBRASKA MEDICINE 4350 DEWEY AVE OMAHA NE 68105 MEDICAL SERVICES 962152 FUSION MEDICAL STAFFING LLC PO BOX 82674 LINCOLN NE 685012674 STAFFING SERVICES 673776 NOLL HEALTHCARE NETWORK 12905 W DODGE RD OMAHA NE 68154 MEDICAL SERVICES 468432 24 814735 52858 169802 867593 PATIENT SERVICE REVENUE, NET 900099 127354220 127354220 LONG-TERM CARE 900099 22940562 22940562 OUTPATIENT 900099 9193759 9193759 PHYSICIAN SERVICES 900099 7336568 7336568 6744192 6744192 173569301 2033937 2033937 176470831 173569301 0 2033937 2973981 2973981 93257963 84585673 8672290 2591603 2541603 50000 13429549 12449633 979916 6819042 6299664 519378 155280 31869 123411 63436 63436 41933 41933 125722 125722 12856869 11502072 1354797 870059 99238 770821 12353124 12051343 301781 1786740 737942 1048798 2725655 1966753 758902 582359 519053 63306 382113 344719 37394 3283679 3283679 10039189 8917291 1121898 714523 714523 MISCELLANEOUS 858688 446363 412325 165911507 146491418 19420089 0 24076567 38598810 31823545 31818824 1542712 1713920 2048048 1822902 227894288 105259200 125066710 122635088 68727180 78175346 642691 253284762 275407581 15098931 27954015 77174558 75257116 2605756 3186304 94879245 106397435 X 158405367 168964691 150 45455 158405517 169010146 253284762 275407581 X 10559324 45305 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 41933 41933 0 PART II-B, LINE 1: MADONNA REHABILITATION HOSPITAL ("MADONNA") HAS RETAINED THE LOBBYING SERVICES OF A LOCAL LOBBYING FIRM TO MONITOR LEGISLATION AT THE STATE LEVEL IN NEBRASKA IMPACTING NEBRASKA HOSPITALS AND LONG TERM CARE FACILITIES GENERALLY, AND MADONNA SPECIFICALLY. MADONNA IS A MEMBER OF THE NEBRASKA HOSPITAL ASSOCIATION ("NHA"). AS PART OF ITS ACTIVITIES, THE NHA PROVIDES LOBBYING SERVICES AND MONITORS STATE LEGISLATION OF CONCERN TO ITS MEMBERS. ON THE NATIONAL LEVEL, MADONNA IS A MEMBER OF THE AMERICAN REHABILITATION PROVIDERS ASSOCIATION ("AMRPA") AND THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS ("NALTH"). AMONG OTHER SERVICES PROVIDED TO ITS MEMBERS, AMRPA AND NALTH LOBBY AND MONITOR FEDERAL LEGISLATION ON BEHALF OF THEIR MEMBERS. 9127148 9127148 135921565 50217038 85704527 75170169 53059230 22110939 7675406 1982932 5692474 122635088 457 PLANS 1943613 LEASE LIABILITY 642691 NON-CURRENT PORTION OF WORK COMP 600000 3186304 X 176055241 -415590 -415590 176470831 0 176470831 165911507 0 165911507 0 165911507 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2020 AND 2019, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: GRANTS AND BEQUESTS FOR PURCHASE OF PLANT & EQUIP -415,590. 1 1 X 1 X 300.000000000000 0 1 1 0 1 1 1216875 1216875 0.00730 3326885 3326885 0.02010 4543760 4543760 0.02740 671082 671082 0.00400 1738028 1738028 0.01050 230636 230636 0.00140 755840 755840 0.00460 734474 734474 0.00440 4130060 4130060 0.02490 8673820 8673820 0.05230 2 598332 12614 585718 0.00350 2 598332 12614 585718 0.00350 1 2921760 0 48604322 62392794 -13788472 X 1 1 4 1 MADONNA REHABILITATION HOSPITAL LINCOLN 5401 SOUTH STREET LINCOLN NE 685062134 WWW.MADONNA.ORG 500005 X ACUTE REHABILITATION HOSPITAL A 2 MADONNA LONG TERM CARE HOSPITAL 5401 SOUTH STREET LINCOLN NE 685062134 WWW.MADONNA.ORG 507001 X LONG TERM CARE HOSPITAL A 3 MADONNA REHABILITATION HOSPITAL OMAHA 17500 BURKE STREET OMAHA NE 681182244 WWW.MADONNA.ORG H000130 X ACUTE REHABILITATION HOSPITAL A 4 MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA 17500 BURKE STREET OMAHA NE 681182244 WWW.MADONNA.ORG H000129 X LONG TERM CARE HOSPITAL A MADONNA REHABILITATION HOSPITAL 0 0 1 X X X X X X X X 18 1 0 0 1 X HTTP://WWW.MADONNA.ORG/MY-MADONNA/CHNA.HTML X 1 18 0 1 0 1 X 300.000000000000 X X X X X 1 1 X X X 1 X WWW.MADONNA.ORG/IMAGES/UPLOADS-USERS/MADONNA-FINANCIAL-ASSISTANCE-POLICY-95 X WWW.MADONNA.ORG/IMAGES/UPLOADS-USERS/MADONNA-FINANCIAL-ASSISTANCE-POLICY-95 X WWW.MADONNA.ORG/IMAGES/UPLOADS-USERS/PLAIN-LANGUAGE-SUMMARY-FINAL.PDF X X X X X 1 X 0 X X X X 0 X X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: MADONNA REHABILITATION HOSPITAL LINCOLN, - FACILITY 2: MADONNA LONG TERM CARE HOSPITAL, - FACILITY 3: MADONNA REHABILITATION HOSPITAL OMAHA, - FACILITY 4: MADONNA REHABILITATION SPECIALTY HOSPITAL OMAH MADONNA REHABILITATION HOSPITAL PART V, SECTION B, LINE 5: MADONNA USES MULTIPLE AVENUES TO COLLECT DATA REGARDING THE NEEDS OF ITS COMMUNITY, INCLUDING PATIENT SATISFACTION SURVEYS, MEETING MINUTES FROM LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS, CAPITAL CAMPAIGN REQUESTS AND OTHER DATA SOURCES. THIS IS AN ONGOING PROCESS THAT IS INTEGRATED INTO STRATEGIC PLANNING AND ANNUAL GOAL SETTING. A NEEDS ASSESSMENT QUESTIONNAIRE WAS DISTRIBUTED TO THE COMMUNITY AND THE RESULTS WERE COLLECTED AND ANALYZED IN FISCAL YEAR 2019 (TAX YEAR 2018). THE RESULTS WERE DISCUSSED AT STRATEGIC PLANNING COMMITTEE MEETINGS DURING THE PLANNING PHASES FOR FISCAL YEAR 2020. HOSPITAL LEADERSHIP REGULARLY REVIEWS AND DISCUSSES COMMUNITY NEEDS DURING WEEKLY ADMINISTRATIVE TEAM MEETINGS. MANY OF THESE NEEDS ARE ADDRESSED THROUGH CAPITAL ITEM REQUESTS AND PROGRAMMING UPDATES AND/OR ADDITIONS. ADDITIONALLY, COMMUNITY NEEDS ARE BROUGHT FORTH AND DISCUSSED IN NUMEROUS ORGANIZATIONAL AND INDIVIDUAL MEETINGS AT ALL LEVELS. MADONNA REHABILITATION HOSPITAL EXECUTIVES, MANAGERS AND CLINICIANS ARE ENCOURAGED TO MEET WITH THEIR COUNTERPARTS IN PEER INSTITUTIONS AND TO PURSUE LEADERSHIP POSITIONS IN THEIR AREAS OF EXPERTISE. EACH YEAR, MADONNA STAFF MEMBERS ARE ELECTED AND/OR ARE APPOINTED TO BOARDS, SPECIAL TASK FORCES AND OTHER LEADERSHIP POSITIONS. IN THESE POSITIONS, MADONNA STAFF GETS DIRECT INPUT FROM COLLEAGUES IN AFFILIATED ORGANIZATIONS AND WITH PATIENTS IN THE COMMUNITY SERVED. MADONNA REHABILITATION HOSPITAL PART V, SECTION B, LINE 11: PURPOSE FOR THE PLANTHIS IMPLEMENTATION STRATEGY (STRATEGY) ADDRESSES THE PRIORITIZED COMMUNITY HEALTH CARE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED FOR THE FISCAL 2019 YEAR AND APPROVED BY THE HOSPITAL'S BOARD OF DIRECTORS. THE PLAN ALSO MEETS THE REQUIREMENTS FOR COMMUNITY BENEFIT PLANNING AS SET FORTH IN SECTION 501(R) OF THE INTERNAL REVENUE CODE (THE "CODE") AS PART OF THE AFFORDABLE CARE ACT. THE CHNA FOR MADONNA REHABILITATION HOSPITAL MAY BE REVIEWED IN ITS ENTIRETY AT HTTPS://WWW.MADONNA.ORG/IMAGES/UPLOADS-USERS/COMMUNITY_HEALTH_NEEDS_ASSESSMENT_FY1819_FINAL.PDFAREAS OF FOCUSAS A RESULT OF THE ANALYSIS, THREE AREAS WERE IDENTIFIED AS THE PRIORITIES ON WHICH MADONNA WILL FOCUS FOR THE NEXT THREE YEARS. THESE THREE NEEDS ARE: LINCOLN CAMPUS PHYSICAL PLANT ALIGNMENT WITH CLINICAL NEEDS, LINCOLN CAMPUS CLINICAL AND ANCILLARY SERVICES EXPANSION, AND THE NEBRASKA PHYSIATRY RESIDENCY PROGRAM.PRIORITY #1: ALIGN THE LINCOLN CAMPUS PHYSICAL PLANT WITH SPACE REQUIRED TO MEET THE CLINICAL NEEDS OF A HIGH-ACUITY, SPECIALIZED PATIENT POPULATION (MADONNA'S "COMMUNITY").STRATEGY: EXPAND AND CONSTRUCT PHYSICAL SPACE TO SUPPORT THE SPECIALIZED EQUIPMENT, CUTTING EDGE TECHNOLOGY AND FAMILY INVOLVEMENT REQUIRED FOR PHYSICAL MEDICINE AND REHABILITATION PROGRAMS.PRIORITY #2: EXPAND LINCOLN CAMPUS ON-SITE CLINICAL AND ANCILLARY SERVICES REQUIRED TO MEET THE CLINICAL NEEDS OF A HIGH-ACUITY, SPECIALIZED PATIENT POPULATION (MADONNA'S "COMMUNITY").STRATEGY: IMPLEMENT/EXPAND APPROPRIATE ON-SITE DIAGNOSTIC IMAGING, LABORATORY, TELEMETRY, SPECIALIZED PHYSICIAN SERVICES AND NURSING SKILLS TO IMPROVE PATIENT QUALITY AND OUTCOMES. PRIORITY #3: COMPLETE THE IMPLEMENTATION OF THE NEWLY ESTABLISHED PHYSICAL MEDICINE AND REHABILITATION GRADUATE MEDICAL EDUCATION RESIDENCY TRAINING PROGRAM. STRATEGY: IN COLLABORATION WITH THE UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF MEDICINE (UNMC-COM), GRADUALLY INCREASE THE NUMBER OF RESIDENTS TO THE FOUR YEAR PROGRAM CAPACITY OF 16 RESIDENTS IN 2022. ADDITIONALLY, IN COLLABORATION WITH UNMC-COM, RECRUIT AND FILL ALL REQUIRED FACULTY POSITIONS.NEXT STEPSTHIS IMPLEMENTATION STRATEGY WILL BE EXECUTED OVER THE NEXT THREE YEARS. PERIODIC EVALUATION OF OBJECTIVES FOR EACH IDENTIFIED PRIORITY WILL BE CONDUCTED TO ASSURE THAT MADONNA IS ON TRACK TO COMPLETE THE PLAN AS DESCRIBED. AT THE END OF FISCAL YEAR 2022 MADONNA REHABILITATION HOSPITAL WILL REVIEW THE IMPLEMENTATION STRATEGY AND REPORT ON THE SUCCESS EXPERIENCED THROUGH THE COLLABORATIVE EFFORTS OF IMPROVING THE HEALTH NEEDS OF THE COMMUNITY. MADONNA REHABILITATION HOSPITAL PART V, SECTION B, LINE 13B: FPG IS USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF FINANCIAL ASSISTANCE IS GRANTED, IT IS FOR FREE CARE ONLY. MADONNA REHABILITATION HOSPITAL PART V, SECTION B, LINE 20E: MADONNA REHABILITATION HOSPITAL OFFERS THE FOLLOWING:1. ASSISTANCE WITH FILLING OUT APPLICATIONS FOR SSI, SSD, MEDICAID AND/OR GENERAL ASSISTANCE2. ADVOCATE FOR THE PATIENT WITH THIRD PARTY PAYERS, GOVERNMENT PAYERS, AND OTHER ENTITIES THAT MAY RESTRICT OR DENY BENEFITS INAPPROPRIATELY3. ASSIST PATIENT/FAMILIES WITH BILLING/PAYMENT QUESTIONS FROM PRIOR STAYS TO HELP ESCALATE RESOLUTION AND ENSURE THAT ALL APPROPRIATE DOCUMENTS HAVE BEEN RETURNED TO THE PAYER FOR CLAIMS ADJUDICATION4. EXTENDED PAYMENT PLANS5. LIABILITY SETTLEMENT PENDING WITHOUT ANY OTHER PAYER SOURCE6. COURTESY CALLS AT TIME OF FINAL NOTICE AND PRIOR TO LISTING FOR COLLECTIONS PART V, SECTION B FACILITY REPORTING GROUP B FACILITY REPORTING GROUP - A, PART V, SECTION B, LINE 22D: THE AMOUNT OF FINANCIAL ASSISTANCE IS CONSIDERED TO BE 100% OF CHARGES LESS THE CONTRACTUAL ADJUSTMENT FOR AMOUNTS GENERALLY BILLED (AGB). AGB IS THE WEIGHTED AVERAGE PERCENTAGE AS CALCULATED BY DIVIDING THE SUM OF COMMERCIAL AND MEDICARE CONTRACTUAL ADJUSTMENTS BY THE SUM OF COMMERCIAL AND MEDICARE GROSS CHARGES. 4 1 - ST JANE DE CHANTAL 2200 S 52ND STREET LINCOLN NE 685062134 NURSING FACILITY (NF) 2 - MADONNA THERAPY PLUS 5401 SOUTH STREET LINCOLN NE 685062134 OUTPATIENT CLINICS (4) 3 - MADONNA PROACTIVE HEALTH & FITNESS 7111 STEPHANIE LANE LINCOLN NE 68516 MEDICAL FITNESS CENTER 4 - REHABILITATION SPECIALISTS 5445 SOUTH STREET LINCOLN NE 685062134 INPATIENT & OUTPATIENT PHYSICIAN CLINIC PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC IN THE ANNUAL REPORT AT WWW.MADONNA.ORG/NEWS/REPORT.HTML. PART I, LINE 7: MEDICARE LOSSES HAVE INCREASED SIGNIFICANTLY IN RECENT YEARS AND NO LONGER APPROXIMATE THE COSTS INCURRED TO SERVE MEDICARE PATIENTS. THIS IS DUE TO REIMBURSEMENT METHODOLOGY CHANGES THAT HAVE RESULTED IN DECREASING PAYMENTS DESPITE INFLATIONARY GROWTH IN COSTS. PART II, COMMUNITY BUILDING ACTIVITIES: MADONNA'S MEDICALLY BASED HEALTH AND FITNESS CENTER (MADONNA PROACTIVE) IS FOCUSED ON IMPROVING THE OVERALL WELLNESS OF THE COMMUNITY BY REDUCING CHRONIC RISK FACTORS THROUGH VARIOUS HEALTH PROGRAMS.MADONNA'S ADAPTIVE SPORTS PROGRAM PROVIDES OPPORTUNITIES FOR CHILDREN AND ADULTS WITH ACQUIRED PHYSICAL DISABILITIES TO PARTICIPATE IN RECREATIONAL ACTIVITIES THAT ARE DESIGNED TO PROMOTE PHYSICAL HEALTH AND WELLNESS. THE PROGRAM IS OPEN TO MADONNA INPATIENTS AND OUTPATIENTS AS WELL AS COMMUNITY MEMBERS. PART III, LINE 4: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND ASSESSES THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON ANALYSIS OF PAYMENT HISTORY. THOSE TRANSITION ACCOUNTS ARE CONSIDERED IN CONJUNCTION WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT CERTAIN PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN MANY CASES, THE HOSPITAL IS ABLE TO NEGOTIATE PAYMENT SUBSEQUENT TO THE INITIAL DETERMINATION OF THE COLLECTABILITY OF THE ACCOUNT. IN THESE CASES, THE HOSPITAL RECORDS ADDITIONAL CONTRACTUAL ALLOWANCES AND DISCOUNTS. UPON CONSIDERATION OF THE FACT CERTAIN PATIENT ACCOUNTS THAT WERE PREVIOUSLY ALLOWED FOR ARE COLLECTED THROUGH NEGOTIATION AND ADJUSTED AT THE TIME OF PAYMENT, THE HOSPITAL HAS DETERMINED THE PROVISION FOR BAD DEBTS IS NOT SIGNIFICANT TO THE FINANCIAL STATEMENTS AND HAS COMBINED WITH CONTRACTUAL ALLOWANCES AND DISCOUNTS. PART III, LINE 8: A COST ACCOUNTING SYSTEM IS USED BY MADONNA AND IT ADDRESSES ALL PATIENT SEGMENTS. NONE OF THE SHORTFALL HAS BEEN REPORTED AS COMMUNITY BENEFIT. PART III, LINE 9B: ALL CHARGES FOR PATIENTS FOUND ELIGIBLE FOR FINANCIAL ASSISTANCE ARE WAIVED. ONCE THIS ELIGIBILITY IS CONFIRMED, ALL COLLECTION ACTIVITIES ARE DISCONTINUED. PART VI, LINE 2: MADONNA USES MULTIPLE AVENUES TO COLLECT DATA REGARDING THE NEEDS OF ITS COMMUNITY, INCLUDING PATIENT SATISFACTION SURVEYS, MEETING MINUTES FROM LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS, CAPITAL CAMPAIGN REQUESTS AND OTHER DATA SOURCES. THIS IS AN ONGOING PROCESS THAT IS INTEGRATED INTO STRATEGIC PLANNING AND ANNUAL GOAL SETTING. A NEEDS ASSESSMENT QUESTIONNAIRE WAS DISTRIBUTED TO THE COMMUNITY AND THE RESULTS WERE COLLECTED AND ANALYZED IN FISCAL YEAR 2019 (TAX YEAR 2018). THE RESULTS WERE DISCUSSED AT STRATEGIC PLANNING COMMITTEE MEETINGS DURING THE PLANNING PHASES FOR FISCAL YEAR 2020. HOSPITAL LEADERSHIP REGULARLY REVIEWS AND DISCUSSES COMMUNITY NEEDS DURING WEEKLY ADMINISTRATIVE TEAM MEETINGS. MANY OF THESE NEEDS ARE ADDRESSED THROUGH CAPITAL ITEM REQUESTS AND PROGRAMMING UPDATES AND/OR ADDITIONS. ADDITIONALLY, COMMUNITY NEEDS ARE BROUGHT FORTH AND DISCUSSED IN NUMEROUS ORGANIZATIONAL AND INDIVIDUAL MEETINGS AT ALL LEVELS. MADONNA REHABILITATION HOSPITAL EXECUTIVES, MANAGERS AND CLINICIANS ARE ENCOURAGED TO MEET WITH THEIR COUNTERPARTS IN PEER INSTITUTIONS AND TO PURSUE LEADERSHIP POSITIONS IN THEIR AREAS OF EXPERTISE. EACH YEAR, MADONNA STAFF MEMBERS ARE ELECTED AND/OR ARE APPOINTED TO BOARDS, SPECIAL TASK FORCES AND OTHER LEADERSHIP POSITIONS. IN THESE POSITIONS, MADONNA STAFF GETS DIRECT INPUT FROM COLLEAGUES IN AFFILIATED ORGANIZATIONS AND WITH PATIENTS IN THE COMMUNITY SERVED. PART VI, LINE 3: THE INSURANCE STATUS OF ALL PATIENTS IS ASSESSED AT THE TIME OF ADMISSION. THE ADMISSIONS PROCESS INCLUDES REGULAR COMMUNICATION WITH PATIENTS AND THEIR FAMILIES, AND INSURANCE STATUS IS A SIGNIFICANT PART OF THIS PROCESS. PATIENTS WITHOUT INSURANCE ARE ASSISTED IN THEIR APPLICATIONS FOR MEDICAID IF IT APPEARS THEY MAY QUALIFY. PATIENTS WHOSE MEDICAID APPLICATIONS ARE PENDING ARE REGULARLY ADMITTED. FINANCIAL ASSISTANCE IS GRANTED TO PATIENTS WHO ARE DENIED FOR MEDICAID BUT ARE UNABLE TO PAY, IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: THE DESCRIPTION OF MADONNA REHABILITATION HOSPITAL'S COMMUNITY IN THE 2019 CHNA:MADONNA IS ONE OF THE NATION'S LARGEST SPECIALIZED REHABILITATION HOSPITALS. MADONNA TREATS CHILDREN AND ADULTS WITH COMPLEX DISABILITIES DUE TO TRAUMATIC BRAIN INJURY, SPINAL CORD INJURY, STROKE, NEUROLOGICAL DISORDERS, BURNS, PULMONARY DISEASE, AND OTHER DISABLING CONDITIONS. THIS IS MADONNA'S "COMMUNITY" - THE PEOPLE WHO REQUIRE INPATIENT POST-ACUTE PHYSICAL REHABILITATION TO REDUCE OR ELIMINATE IMPAIRMENTS, ACTIVITY LIMITATIONS, AND PARTICIPATION RESTRICTIONS. UNLIKE ACUTE CARE HOSPITALS, MADONNA DOES NOT DEFINE "COMMUNITY SERVED" AS A GEOGRAPHIC AREA, BUT RATHER BY THE PRIORITY POPULATION THAT REQUIRES THESE HIGHLY SPECIALIZED SERVICES. THIS POPULATION INCLUDES PEOPLE OF ALL AGES, GENDER, INCOME LEVEL, AND RACE FROM THROUGHOUT THE COUNTRY. PART VI, LINE 5: IN AN EFFORT TO MEET THE GROWING NEEDS OF THE PEDIATRIC POPULATION, MADONNA HAS EXPANDED ITS DESIGNATED AREA AND FEATURES A PEDIATRIC THERAPY GYM, ALLOWING THE YOUNGEST PATIENTS TO RECEIVE AGE-APPROPRIATE REHABILITATION SERVICES. MADONNA HAS ALSO RENOVATED THE KIT SCOTT THERAPEUTIC LEARNING CENTER. THE GOAL OF THE LEARNING CENTER IS TO HELP STUDENTS SUCCESSFULLY TRANSITION BACK TO THEIR HOME AND SCHOOL SETTINGS. MADONNA ALSO PROVIDES SERVICES TO THE COMMUNITY WHICH WOULD OTHERWISE BE UNAVAILABLE OR UNDERSERVED, SUCH AS COMMUNITY MEDICAL TRANSPORTATIONS. MADONNA PHYSICIANS AND THERAPISTS ALSO PRESENT AT NUMEROUS CONFERENCES THROUGHOUT THE YEAR, PROVIDING RECOGNIZED EXPERTISE TO THE COMMUNITY ON REHABILITATION AND OTHER RELEVANT TOPICS. IN ADDITION TO OUR MEDICAL FACILITIES (WHICH INCLUDE LINCOLN'S FIRST MEDICAL FITNESS FACILITY), MADONNA PROVIDES VOLUNTEER AND FINANCIAL SUPPORT TO THE COMMUNITY. MADONNA EMPLOYEES DONATE HUNDREDS OF UNITS OF BLOOD ONSITE EACH YEAR AND SERVE MORE THAN 1,000 MEALS EACH YEAR AT MATT TALBOT KITCHEN. FINANCIAL SUPPORT INCLUDE INDIVIDUAL EMPLOYEE AND ORGANIZATIONAL DONATIONS OF MONEY AND SUPPLIES TO PATIENTS AND THEIR FAMILIES, AREA FOOD BANKS, CHURCHES, MISSIONARIES, SOCIAL SERVICES ORGANIZATIONS, AND HEALTH ASSOCIATIONS. IN SOME CASES, MADONNA ORGANIZES FUNDRAISERS DESIGNED TO BENEFIT THESE ORGANIZATIONS.OUTSIDE ORGANIZATIONS ARE ALSO ALLOWED TO USE MADONNA'S MEETING ROOMS AT NO CHARGE. PART VI, LINE 7, REPORTS FILED WITH STATES NE X X X X X 0 0 0 0 0 0 0 0 0 PAUL DONGILLI PRESIDENT AND CEO 549683 0 82749 0 0 0 28724 0 4325 0 665481 0 0 0 VICTOR WITKOWICZ EXECUTIVE VP-CFO 348080 0 99356 0 0 0 29753 0 1921 0 479110 0 0 0 DR THOMAS STALDER VP OF MEDICAL AFFAIRS/CHIE 340435 0 37935 0 0 0 15500 0 1535 0 395405 0 0 0 SUSAN K KLANECKY VP PATIENT CARE 208419 0 23192 0 0 0 16575 0 5219 0 253405 0 0 0 CHRISTOPHER A LEE VP REHABILITATION 212781 0 23192 0 0 0 22488 0 6857 0 265318 0 0 0 LOU ANN MANSKE VICE PRESIDENT HUMAN RESOU 193274 0 20887 0 0 0 16312 0 302 0 230775 0 0 0 LYNN R HALLOWELL-GOTTSLEBEN VICE PRESIDENT COMMUNITY S 170388 0 18437 0 0 0 17481 0 3270 0 209576 0 0 0 LINDA S SUNDELL-SULLIVAN VICE PRESIDENT REFERRAL RE 157853 0 16808 0 0 0 18870 0 3203 0 196734 0 0 0 DANIEL GRIESS VP FACILITIES MANAGEMENT S 206890 0 22519 0 0 0 15862 0 943 0 246214 0 0 0 MICHAEL HEDDERMAN VP AND CFO 215587 0 25516 0 0 0 2500 0 5341 0 248944 0 0 0 ADAM T KAFKA STAFF PHYSIATRIST 534935 0 0 0 0 0 14337 0 7312 0 556584 0 0 0 JIAXIN TRAN STAFF PHYSIATRIST 492839 0 0 0 0 0 15000 0 1232 0 509071 0 0 0 MORGAN L LAHOLT STAFF PHYSIATRIST 467571 0 0 0 0 0 16480 0 5201 0 489252 0 0 0 PAUL L KRABBENHOFT STAFF PHYSIATRIST 342486 0 0 0 0 0 15000 0 8481 0 365967 0 0 0 MATTHEW DRIEWER STAFF PHYSIATRIST 288098 0 0 0 0 0 15479 0 4486 0 308063 0 0 0 PART I, LINE 5 ALL HOSPITAL MANAGERS, APPROXIMATELY SEVENTY, ARE ELIGIBLE PARTICIPANTS OF THE HOSPITAL'S MANAGEMENT INCENTIVE COMPENSATION PLAN. THE PLAN PROVIDES A STRUCTURE FOR MEASURING THE HOSPITAL'S OVERALL QUALITY AND FINANCIAL PERFORMANCE. THIS PLAN ALLOWS FOR RECOGNITION AND COMPENSATION WHEN THE HOSPITAL'S PERFORMANCE EXCEEDS BASELINE CRITERIA. UPON ACHIEVEMENT OF AN ESTABLISHED QUALITY BENCHMARK, COMPENSATION IS DETERMINED BASED UPON A FIXED FORMULA ENCOMPASSING REVENUES, EARNINGS AND PARTICIPANTS' WAGES. THE FORMULA IS APPLIED EQUALLY TO ALL PARTICIPANTS. PART I, LINE 6 SEE EXPLANATION FOR LINE 5. A HOSPITAL AUTHORITY NO 2 - OF DOUGLAS COUNTY NE 521440796 SUPPLINFO 2014-09-25 86048946 CONSTRUCT, EQUIP, AND FURNISH NEW HOSPITAL FACILITY IN OMAHA, NE. 0 0 0 A 6995000 86048946 5911150 989867 79147929 2016 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 SCHEDULE K SUPPLENTAL INFORMATION CUSIP NUMBERS INCLUDE THE FOLLOWING: 25923P AA3 25923P AB1 25923P AC9 25923P AD7 25923P AE5 25923P AF2 25923P AS4 25923P AG0 25923P AH8 25923P AJ4 25923P AV7 25923P AK1 25923P AL9 25923P AM7 25923P AN5 25923P AP0 25923P AR6 25923P AT2 25923P AU9 25923P AQ8 PART IV, LINE 2C: REBATE COMPUTATION PERFORMED MAY 15, 2018. X VARIOUS OTHER 136 169802 COST 0 0 1 1 PART I, LINE 32B: MADONNA REHABILITATION HOSPITAL USES ITS SUPPORTING ORGANIZATION, THE MADONNA FOUNDATION, TO SOLICIT, PROCESS AND SELL NONCASH CONTRIBUTIONS. FORM 990, PART VI, SECTION A, LINE 3 FOOD SERVICE OPERATIONS ARE CONTRACTED WITH ARAMARK; AN OUTSIDE MANAGEMENT CORPORATION. NO CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY ARAMARK DURING THE TAX YEAR. FORM 990, PART VI, SECTION A, LINE 6 THE DIOCESAN HEALTH MINISTRIES, A NEBRASKA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF MADONNA REHABILITATION HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A THE DIOCESAN HEALTH MINISTRIES MAY DESIGNATE ONE MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS, AS PROVIDED IN THE ORGANIZATION'S ARTICLES OF INCORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER, DIOCESAN HEALTH MINISTRIES, HAS FINAL APPROVAL OF: (1) CHANGES IN PHILOSOPHY AND MISSION; (2) MATTERS INVOLVING SALE, LEASE, TRANSFER, EXCHANGE, DISPOSITION, PLEDGE OR ALIENATION OF REAL PROPERTY IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00); (3) MATTERS INVOLVING PURCHASE AND/OR ENCUMBRANCE WITH DEBT, IN ANY WAY, OF REAL PROPERTY IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00); (4) COMMUNITY MEMBERS NOMINATED TO SERVE ON THE BOARD OF DIRECTORS; (5) AMENDMENTS, ALTERATIONS OR CHANGES IN THE ARTICLES OF INCORPORATION OR BYLAWS; (6) THE ANNUAL CAPITAL BUDGET; (7) CEO SELECTION; (8) MERGER, CONSOLIDATION, DISSOLUTION. THE BOARD OF DIRECTORS APPROVES AND FORWARDS TO THE MEMBER, FOR ITS REVIEW THE ANNUAL REPORT AND THE OPERATING BUDGET. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE ORGANIZATION'S FORM 990, THE CHIEF FINANCIAL OFFICER PRESENTS THE COMPLETED FORM 990 AND AN EXECUTIVE OVERVIEW OF THE FORM 990 TO THE FINANCE AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED MEETING. THE FINANCE AND AUDIT COMMITTEE APPROVES A MOTION TO ACCEPT AND FORWARD TO THE BOARD OF DIRECTORS THE FORM 990. SUBSEQUENTLY, THE FINANCE AND AUDIT COMMITTEE BOARD CHAIRPERSON (THE ORGANIZATION'S BOARD TREASURER) PRESENTS THE FORM 990 TO THE BOARD OF DIRECTORS. UPON BOARD RESOLUTION TO ACCEPT THE FORM 990 THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY DISTRIBUTES ITS CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO DIRECTORS, OFFICERS AND KEY EMPLOYEES. THE RESPONSES ARE REVIEWED BY THE BOARD OF DIRECTORS AND ITS COUNSEL, AND ANY APPROPRIATE ACTION IS TAKEN, BASED UPON THOSE RESPONSES AND THE SUBSEQUENT REVIEW. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE WILL MAKE RECOMMENDATIONS FOR THE ANNUAL COMPENSATION OF THE CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF FINANCIAL OFFICER (CFO). THE MADONNA EXECUTIVE COMPENSATION PLAN REQUIRES NATIONAL SALARY BENCHMARKS BE USED FOR THE CEO AND CFO POSITIONS. -BASE SALARY: THE EXECUTIVE COMPENSATION COMMITTEE ANNUALLY DETERMINES THE CEO'S BASE SALARY BY REVIEWING 990 DATA FROM NONPROFIT REHABILITATION HOSPITALS AT A NATIONAL LEVEL AS WELL AS OTHER RELEVANT DATA. IDEALLY, THE DATA FROM NONPROFIT REHABILITATION HOSPITALS SHOULD BE FOR HOSPITALS WITHIN APPROXIMATELY PLUS OR MINUS 50% OF MADONNA'S GROSS REVENUES RECOGNIZING A NEED FOR A MINIMUM OF AT LEAST EIGHT COMPARABLE SIZED INSTITUTIONS. THE ANALYSIS INCLUDES REPORTING THE SALARIES FOR BENCHMARK FIRMS (FROM 990 DATA) REPORTED BY THE VICE PRESIDENT HUMAN RESOURCES. OTHER SOURCES OF INFORMATION AND DATA MAY BE USED AS NEEDED FROM THIRD PARTY SALARY SURVEYS IN ADDITION TO OR IN LIEU OF 990 DATA AS DEEMED NECESSARY FROM YEAR TO YEAR. THE ANNUAL COMPENSATION ADJUSTMENT FOR THE CEO AND CFO IS TO REPRESENT BOTH THE MARKET CHANGES AND THE MERIT PERFORMANCE. FORM 990, PART VI, SECTION C, LINE 19 SUMMARIZED FINANCIAL INFORMATION IS MADE AVAILABLE TO THE PUBLIC ON AN ANNUAL BASIS THROUGH THE PUBLICATION OF THE HOSPITAL'S PUBLIC ANNUAL REPORT. IN ADDITION, THE PUBLIC ANNUAL REPORT IS AVAILABLE ON THE HOSPITAL'S WEBSITE. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART XI, LINE 9: CHANGE IN TEMPORARILY RESTRICTED NET ASSET 45,305. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MADONNA RECEIVED CARES RELIEF FUNDING THAT WILL BE TREATED AS A FEDERAL AWARD SUBJECT TO A SINGLE AUDIT. MADONNA FOUNDATION 5401 SOUTH STREET LINCOLN NE 68506 237159940 FUNDRAISING SUPPORT NE 501(C)(3) LINE 12B, II MADONNA REHABILITATION HOSPITAL 1 MADONNA INC 5401 SOUTH STREET LINCOLN NE 68506 363397284 HEALTHCARE MANAGEMENT NE 501(C)(3) LINE 12B, II MADONNA REHABILITATION HOSPITAL 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 MADONNA FOUNDATION L 144000 FINANCIAL RECORD MADONNA FOUNDATION M 1185117 FINANCIAL RECORD MADONNA FOUNDATION P 915226 FINANCIAL RECORD MADONNA FOUNDATION S 814733 FINANCIAL RECORD MADONNA INC S 20573 FINANCIAL RECORD