2020-11-16T10:02:01-06:00 2019-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2019-01-01 470379754 Children's Hospital & Medical Center % AMY HATCHER CHIL 4029556795 8200 DODGE STREET OMAHA NE 68114 AMY HATCHER CFO 4029556795 2020-11-10 true DONALD NEAL JR P00798244 4023481450 2020-11-03 199.206.0.5 47006120203215000001 2020-11-16 P 9C230E3C43A1AC01475832C9617E9CAF99CA9519 65CF9D49F64C2267637B54237ED8CC7527705457 2019 2021-01-29 14:40:06Z Chanda Chacon 8200 Dodge Street Omaha NE 68114 469906932 false X WWW.CHILDRENSOMAHA.ORG X 1948 NE CHILDREN'S HOSPITAL & MEDICAL CENTER DELIVERS EXTRAORDINARY CARE TO CHILDREN, EDUCATES HEALTH CARE PROFESSIONALS, AND PROMOTES PEDIATRIC RESEARCH. 19 18 3593 243 11049 -3555 4858054 4091756 422904596 451331530 629335 -234350 15222054 14666521 443614039 469855457 19154203 12864067 0 0 207855199 228418471 0 0 189779 162223280 181662243 389232682 422944781 54381357 46910676 542357225 641508810 263982931 291519183 278374294 349989627 X TO IMPROVE THE LIFE OF EVERY CHILD - THROUGH DEDICATION TO EXCEPTIONAL CLINICAL CARE, RESEARCH, EDUCATION AND ADVOCACY. false false 339068184 12864067 465324997 THE HOSPITAL OPERATES A 145-BED PEDIATRIC HOSPITAL, WHICH INCLUDES SEVEN SURGICAL SUITES, THREE PROCEDURE ROOMS, TWO HYBRID HEART CATHETERIZATION LABS, A PEDIATRIC INTENSIVE CARE UNIT (PICU) AND A FETAL CARE CENTER THAT FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. Children's has achieved the magnet designation for nursing excellence, and its pediatric and neonatal intensive care units have earned a beacon award for excellence from the american association of critical care nurses, which recognizes critical care units with excellent patient outcomes that exceed national benchmarks. THE HOSPITAL WAS RECOGNIZED BY U.S. NEWS AND WORLD REPORT FOR CARDIOLOGY AND HEART SURGERY, DIABETES AND ENDOCRINOLOGY, GASTROENTEROLOGY AND GI SURGERY, ORTHOPEDICS AND PULMONOLOGY. CHILDREN'S SPECIALTY PEDIATRIC CENTER OFFERS MORE THAN 50 OUTPATIENT SPECIALTY CLINICS, PROVIDING DIAGNOSTICS, TREATMENT, AND THERAPY. IN ADDITION, CHILDREN'S PROVIDES OUTPATIENT BEHAVIORAL HEALTH AND A FULL ARRAY OF PEDIATRIC HOME HEALTHCARE SERVICES TO CHILDREN AND ADOLESCENTS WHO HAVE IMMEDIATE OR LONG-TERM HEALTH CARE NEEDS, INCLUDING HOME MEDICAL EQUIPMENT RENTALS AND SALES, HOME HEALTH NURSING, IN-HOME PRIVATE DUTY NURSING AND HOME INFUSION THERAPY SERVICES. THE HOSPITAL IS HOME TO THE ONLY LEVEL IV NEWBORN INTENSIVE CARE UNIT AND THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT WITH LEVEL II PEDIATRIC TRAUMA VERIFICATION IN ITS SERVICE AREA. THE HOSPITAL ALSO PROVIDES SPECIALTY PEDIATRIC CARE SERVICES IN COMMUNITIES ACROSS A THREE-STATE REGION. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE FIRST AND ONLY PEDIATRIC HOSPITAL IN NEBRASKA, AND THE ONLY PEDIATRIC HOSPITAL SERVING WESTERN IOWA AND NORTHWEST MISSOURI, TO RECEIVE PEDIATRIC TRAUMA VERIFICATION. 339068184 true true false true false false false false false true true false false true true true false true false false false false false false false false true true true true true true false false false false false false false false true false false false false false false true true true false false true 195 0 true 3593 true true true false false false false false false false false false true false X 19 18 false false false false false false false true true false false false true true true true true true true false X AMY HATCHER 4029556795 8200 DODGE STREET OMAHA NE 68114 X Richard Azizkhan MD President/CEO thru 8/16/19 40.0 0.0 X X 1858535 0 9238 Fernando Ferrer MD SVP & SIC thru 6/30/19 40.0 0.0 X 1104201 0 95208 Michael Brown EVP Strategy & Transformation 40.0 0.0 X 936342 0 121478 Christopher Maloney M SVP & Chief Medical Officer 40.0 0.0 X 748731 0 87538 Kathy English EVP & COO 40.0 0.0 X 692332 0 114560 Amy Hatcher SVP & CFO 40.0 0.0 X 578540 0 83932 Steven C Burnham SVP Physician Networks 40.0 0.0 X 512262 0 80576 Amy Bones SVP & General Counsel 40.0 0.0 X 496435 0 73703 Suzanne Nocita SVP & CHRO 40.0 0.0 X 473330 0 33105 Nicole Villarreal MD Physician 40.0 0.0 X 451687 0 20643 Jamie Drake MD Physician 40.0 0.0 X 456288 0 3508 Anna Spagnoli MD SVP & PIC THRU 10/29/19 40.0 0.0 X 412882 0 32026 Kristin Grahn MD Physician 40.0 0.0 X 399291 0 20643 Malinda Bender MD Physician 40.0 0.0 X 395661 0 3786 Jerold Vuchak SVP & Chief Info Officer 40.0 0.0 X 317544 0 44541 Rodrigo Lopez Interim Pres/CEO beg 7/15/19 40.0 0.0 X X 296988 0 7949 Janel Allen SVP & CHRO beg 12/2/19 40.0 0.0 X 18981 0 380 Diane Duren Chair 1.0 0.0 X X 0 0 0 Margaret Hershiser Vice Chair 1.0 0.0 X X 0 0 0 Samantha Mosser Secretary 1.0 0.0 X X 0 0 0 Jim Greisch Treasurer 1.0 0.0 X X 0 0 0 Brad Brabec MD Member 1.0 0.0 X 0 0 0 Bradley Britigan MD Member 1.0 0.0 X 0 0 0 Joleen David Member 1.0 0.0 X 0 0 0 Dave Diamond Member 1.0 0.0 X 0 0 0 Robert Dunlay MD Member 1.0 0.0 X 0 0 0 Mark Hasebroock Member 1.0 0.0 X 0 0 0 John Jenkins Member 1.0 0.0 X 0 0 0 Steve Lindsay Member 1.0 0.0 X 0 0 0 Michael Robino Member 1.0 0.0 X 0 0 0 Amy Ryan Member 1.0 0.0 X 0 0 0 Paul Sammut MD Member 1.0 0.0 X 0 0 0 Stacy Scholtz Member 1.0 0.0 X 0 0 0 Jayesh Thakker MD Member 1.0 0.0 X 0 0 0 Scot Thompson Member 1.0 0.0 X 0 0 0 10150030 0 832814 256 false true false ALITHYA TRAVERCENT LLC 2425 N CENTRAL EXPRESSWAY STE 130 RICHARDSON TX 75080 CONSULTING SERVICES 1024872 RONCO CONSTRUCTION 1717 N 74TH ST OMAHA NE 68114 CONSTRUCTION 924988 REGIONAL PATHOLOGY SERVICES 983135 NEBRASKA MEDICAL CENTER OMAHA NE 68198 LABS - OUTSOURCED 712127 ABBOTT LABORATORIES INC 100 ABBOTT PARK RD ABBOTT PARK IL 60064 LABS - OUTSOURCED 631816 FRASER STRYKER PC LLO 409 S 17TH ST 500 OMAHA NE 68102 LEGAL SERVICES 570475 26 2803623 1211343 76790 4091756 NET PATIENT REVENUE 621110 451331530 451331530 451331530 -223900 -223900 0 0 662005 662005 0 662005 662005 41025 51475 -10450 -10450 -10450 0 0 0 0 0 0 0 0 0 MANAGEMENT FEE INCOME 541610 7728451 7728451 CAFETERIA INCOME 900099 1769718 1769718 CONTRACT SERVICES 541900 1164343 1153294 11049 3342004 3342004 14004516 469855457 465324997 11049 427655 243814 243814 12620253 12620253 0 0 8990538 8990538 0 174705542 150898061 23807481 8986177 7736777 1249400 23672195 18813007 4859188 12064019 10714011 1350008 3068 3068 878804 877669 1135 869007 869007 84126 84126 0 0 40362699 28797623 11565076 2364373 4169 2360204 54770560 53360891 1219890 189779 9953345 9782945 170400 0 8542617 3388379 5154238 876459 660725 215734 0 0 3010887 3000207 10680 25973881 25973881 20546930 8654770 11892160 1037396 1037396 BUILDING & GROUND MAINTENANCE 4061985 112452 3949533 EQUIPMENT MAINTENANCE 2426000 1674815 751185 BANK & SERVICE FEES 1174141 81579 1092562 COMMUNITY SERVICES 1148238 225381 922857 3577727 1443707 2134020 422944781 339068184 83686818 189779 5509170 7245584 83751779 66312294 2520000 2224000 71069790 91753043 0 0 0 0 0 0 7034648 7529349 7940489 7475819 644473202 235649725 286393941 408823477 0 0 2450687 1204396 57303451 0 0 0 18383270 48940848 542357225 641508810 75156400 84742439 0 0 151769 114378 176598743 171220477 0 0 0 0 5002955 4616217 314408 0 6758656 30825672 263982931 291519183 X 275854294 347765627 2520000 2224000 278374294 349989627 542357225 641508810 X 46910676 -7693 24712350 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 84126 84126 422860655 422944781 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 45055 63273 69794 84126 262248 250000 250000 250000 250000 1000000 1500000 false 88066716 5785740 768122 1838583 92781995 80139900 8481002 127409 681595 88066716 71680964 9780310 338557 1659931 80139900 53221748 20698028 249787 2488599 71680964 52709846 2540656 115359 2142005 2108 53221748 0.42400 0.07600 0.50000 false true true 37305638 37305638 291849449 118726576 173122873 18546749 11375999 7170750 134200304 105212320 28987984 162571062 334830 162236232 408823477 REC-EST 3RD PRTY PYR STTLMNT 15909970 OPERATING LEASE ROU ASSET, NET 10391844 FINANCING LEASE ROU ASSET, NET 8042797 INTERCOMPANY RECEIVABLE 10676818 INVESTMENT IN DEFERRED COMP 3919419 48940848 0 LEASE OBLIGATION - OPERATING 8399291 LEASE OBLIGATION - FINANCING 7387117 INTERCOMPANY PAYABLE 4148500 SWAP LIABILITY 4118478 DEFERRED COMP LIABILITY 3919419 CURRENT PORTION LEASE OBLIG-OP 2166497 CURRENT PORTION LEASE OBLIG-FI 686370 30825672 X Schedule D, Part V, Line 4 TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, AND OPERATIONS OF CHILDREN'S HOSPITAL & MEDICAL CENTER. Schedule D, Part X, Line 2 FIN 48 FOOTNOTE THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. DURING 2019 AND 2018, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES. true true X true X true X true true false true true 5250025 5250025 0.01240 162056590 122828427 39228163 0.09280 167306615 122828427 44478188 0.10520 2285704 638228 1647476 0.00390 20015536 1211343 18804193 0.04450 157674318 106765863 50908455 0.12040 110827 110827 0.00020 782023 782023 0.00180 180868408 108615434 72252974 0.17080 348175023 231443861 116731162 0.27600 7500 7500 7500 7500 true 4044869 83862 264684 -180822 X true true None 1 1 CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 WWW.CHILDRENSOMAHA.ORG 260005 X X X X X CHILDREN'S HOSPITAL & MEDICAL CENTER 1 false false true X X X X X X X X X 18 true true true true X See Part V, Section C X true 18 true See Part V, Section C false true X 200. 400. X X true true X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X true X false X X X true X false false Schedule H, Part V, Line 5 As part of the 2018 Community Health Needs Assessment Survey conducted on behalf Of Children's Hospital & Medical Center, Boys Town National Research Hospital And Building Healthy Futures, key informants (individuals who have a broad interest in the health of the community) were contacted by email, introduced to the community health needs assessment key informant survey and provided a link to take the survey online; reminder emails were sent as needed to increase participation. Supporting organizations for the CHNA included: Charles Drew Health Center, Inc., Douglas County Health Department, Live Well Omaha, and One World Community Health Centers, Inc. These potential participants were chosen because of their ability to identify primary concerns among the families and children/adolescents with whom they work, as well as of the community overall. In all, 166 community stakeholders took part in the online key informant survey, representing community/business leaders, physicians, public health representatives, social service providers and other health care providers. These key informants represent organizations that work with low-income, minority populations, medically underserved populations and individuals with chronic disease conditions. Schedule H, Part V, Line 6a Boys Town National Research Hospital Schedule H, Part V, Line 6b Building Healthy Futures, Charles Drew Health Center, Inc., Douglas County Health Department, Live Well Omaha, and One World Community Health Centers, Inc. Schedule H, Part V, Line 7A https://www.childrensomaha.org/get-involved/advocacy-outreach/community-ad vocacy/ SCHEDULE H, PART V, LINE 10A https://www.childrensomaha.org/get-involved/advocacy-outreach/community-ad vocacy/ Schedule H, Part V, Line 11 On November 29, 2018, The Board of Directors of Children's Hospital & Medical Center (Children's), which includes representatives from throughout the community, met to discuss this plan and the internal and external prioritization input for addressing the community health priorities identified through the 2018 Community Health Needs Assessment (CHNA). The Executive Committee has the power to transact all regular business of Children's. Upon review, the Executive Committee of The Board of Directors approved and adopted this CHNA and Instructed Children's Center for the Child & Community (The Center) to develop a new implementation strategic plan for 2019-2021 to undertake these measures to meet the health needs of the community. Significant Health Needs of the Community 2018 Based on the information obtained through the Child & Adolescent CHNA and the guidelines set forth in Healthy People 2020, the following areas of opportunity represent the significant health needs of children and adolescents in the community. From these data sets, opportunities for children's health improvement exist in the area with regard to the following health issues. Areas of Opportunity Identified through this 2018 CHNA *Access To Health Services: - Difficulty Accessing Children's Healthcare - Finding a Physician - Appointment Availability - Lack of Transportation - Cost of Prescriptions * Cognitive & Behavioral Conditions: - Autism Prevalence - Cognitive & Behavioral Conditions Ranked as a Top Concern in the Online Key Informant Survey. * Diabetes: - Childhood Diabetes Prevalence * Injury & Violence: - Age 1-4 Mortality - Children Exposed to Neighborhood Violence - Children Feeling Unsafe at School or Going to/from School * Mental/Behavioral Health: - Symptoms of Depression [Ages 5-17] - Suicide Attempts [High Schoolers] - Diagnosed Anxiety [Ages 5-17] - Chronic Worrying [Ages 5-17] - Child Has Difficulty Sleeping [Ages 5-17] - Lived With Someone with Serious Mental Health Issues - Family Stays Hopeful in Difficult Times - Mental & Emotional Health Ranked as a top concern in the Online Key Informant Survey. * Neurological Conditions: - Brain Injuries/Concussions * Oral Health: - Condition of Teeth * Nutrition, Physical Activity, & Obesity: - Overweight & Obesity - Fast Food Consumption - Nutrition, Physical Activity, and Weight ranked as a top concern in the Online Key Informant Survey. * Sexual Health: - Gonorrhea Incidence [Children/Adults] - Chlamydia Incidence [Children/Adults] - Condom Use [High Schoolers] - Use of Birth Control [High Schoolers] - Sexual Health Ranked as a Top Concern in the Online Key Informant Survey. * Tobacco, Alcohol & Other Drugs: - Member of Household Smokes - Drinking & Driving [High Schoolers] - Lifetime Illicit Drug Use [High Schoolers] - Steroids (Not Rx) - Heroin * Vision, Hearing, & Speech Conditions: - Recent Eye Exams - Chronic Ear Infections - Prevalence of Speech/Language Problems - Hearing Problems Based on the top health priorities identified through the 2018 CHNA process - and taking into account hospital resources and overall alignment with the Hospital's mission, goals and strategic priorities - Children's is committed to addressing the significant health needs identified in the Community Health Needs Assessment through programs, resources and collaborations targeting: - Access to Health Services - Mental/Behavioral Health - Sexual Health - Nutrition, Physical Activity, & Obesity In acknowledging the wide range of priority health issues that emerged from the CHNA process, Children's determined that it could only effectively focus on those which it deemed most pressing, most under-addressed and most within its ability to influence. Children's created a 3-year implementation plan, to be carried out from 2019 through 2021. The implementation plan addresses each strategic priority across our continuum of care, and identifies appropriate resources to be included in each year's appropriate budget. 2019 Progress Summary Children's continues to progress in implementing the action plan that resulted from the 2018 Community Health Needs Assessment (CHNA) findings. Our team is working collaboratively across the organization to focus on hospital-based programs and services, community-based programs and partnerships that address each priority health issue identified through the CHNA process, guided by key strategies and specific tactics. Children's Center for the Child & Community serves as the infrastructure for community outreach activities and provides management of the Implementation Strategy Plan (ISP). While each health issue is entirely unique, there is a common thread that connects them all: Children's is tasked to improve access to health care services, outreach and education to the community and the overall patient experience. Children's Center for the Child & Community The Center is a statewide community health outreach hub of Children's, providing the infrastructure and leadership for both the internal and external partnerships associated with the pediatric CHNA planning and implementation process. In 2019, the Center began to provide oversight and management of the Implementation Strategy Plan (ISP), which was adopted by the board in April 2019. Work groups were convened quarterly within Children's, and community partnerships were fostered to advance the four child health priorities. The Center also collaborates with local, state and National partners on child health strategies that have been identified in the community. Active partnerships are maintained with the Nebraska Department of Health and Human Services, the Nebraska Department of Education, University of Nebraska-Extension, local public health departments and many community-based organizations. An inventory of partnering organizations was completed with over 140 partners identified. In 2019, a key task of the ISP included establishing and defining the Targets and Impact Measures for the described key actions across each priority health area. This requires collaboration of both internal support and community engagement to determine the most meaningful ongoing collection and reporting format. The work to begin establishing and defining these key Targets began in 2019 and continues in 2020. Priority Health Issues: Progress Highlights Access to Health Care Services - In 2019, the ISP workgroup for Access to Care collaborated with ThriveVentures to create consensus between the community and clinical definitions of "Access to Care". This collaboration was a direct effort to address the lack of alignment between the community and clinical definitions of Access to Care, and to acknowledge that Children's had not made a measurable, positive impact in reducing Access to Care barriers. Given the complexity and varying definitions of Access to Care across the community and clinical spectrums, Children's needed to select a common and standardized Access to Care definition and framework in order to guide future Access to Care improvement work efforts. - To support LGBTQ+ children and adolescents, Children's created a Sexual Orientation Gender Identity (SOGI) committee. SOGI has representation across the enterprise to address the needs of this special population; best practice in care provision and patient experience throughout our organization. The committee began addressing a wide range of topics from documentation of gender and preferred name to reviewing policies to staff education. - Children's Physicians primary care network: Walk-in services continued to expand within CP offices in 2019, with expanded walk-in physical days and daily walk-in appointments at selected offices. This expansion increased access to pediatric health care services. - In collaboration with Behavioral Health, there was on-going expansion of Tele-Psychiatry patient visits at several primary care offices. There was also an increase in access to real-time consultative child psychiatry services for area physicians via an e-consult child psychiatrist Program. - Documenting referral pathways and linking them to referral guidelines were implemented as key 2019 strategies to improve access utilizing a continuous improvement model. These referral pathways created clinical standards for primary care to follow while patients waited for specialty care visits. This effort assisted in having children seen at the right place by the right providers with the right pre-evaluation work done to maximize the specialty care visit. Two specific referral pathways, the Headache Clinic and Weight and Wellness Clinic, became operationalized and refined in 2019. - Two Service line educator roles were created to coordinate all patient-facing messages and treatments within the Cardiology and urology/nephrology clinical teams. - Virtual care visits increased by 30% across the Children's enterprise, for a total of 2,346 virtual care visits performed in 2019. The majority of these visits were for Behavioral Health Ca Schedule H, Part V, Line 13b Presumptive Eligibility Children's recognizes that some patients will be unresponsive to the charity care application process due to a variety of reasons including but not limited to: 1. Lack of documentation required to comply with the traditional charity care application requirements. 2. Lack of the educational level to understand and complete the charity care application. 3. Fear that information gathered during the application process will be used in the collection process in the event that the application is denied. 4. Out of state patients that do not respond to completion of a Medicaid application or financial assistance application. In the absence of information provided by the patient or in cases where the information provided by the patient is incomplete, an assessment process utilizing a predictive model will be deployed to determine charity care eligibility. The predictive model incorporates income and household size estimates, a socio-economic need factor (WIC, Supplemental Nutrition Assistance Program, HUD Programs), Census block data, as well as information on home ownership. The application of the predictive scoring process and presumptive financial assistance will be deployed prior to bad debt assignment for all patients that have not applied for charity care. Children's is not obligated to notify the patient that they have received presumptive charity care. Schedule H, Part V, Line 16a https://www.childrensomaha.org/hospital-experience/insurance-billing- medical-records/financial-assistance/ Schedule H, Part V, Line 16b https://www.childrensomaha.org/hospital-experience/insurance-billing- medical-records/financial-assistance/ Schedule H, Part V, Line 16c https://www.childrensomaha.org/hospital-experience/insurance-billing- medical-records/financial-assistance/ Schedule H, Part V, Line 16j The policy is provided to the public in summary and they are directed to visit the Children's Hospital & Medical Center website for the full policy. Schedule H, Part V, Line 24 At Children's, commercial insurers, government payors and self-pay billing parties are all billed the same gross charge rate for each specific procedure performed. Gross charges on an FAP-patient bill are then discounted according to their FPG eligibility which reduces or eliminates the amount the patient is required to pay. 2 LINCOLN CLINIC 5930 VANDERVOOT DR STE A LINCOLN NE 68516 PEDIATRIC CLINIC CAROLYN SCOTT RAINBOW HOUSE 7825 FARNAM DRIVE OMAHA NE 68114 MINIMUM TO NO-COST ACCOMMODATIONS FOR FAMILIES OF PATIENTS Schedule H, Part I, Line 3c Federal poverty guidelines are used to determine eligibility for free or discounted care. Financial assistance is available for medically necessary procedures and services. Services not eligible for financial assistance include cosmetic and other elective procedures, helmet clinic, eating disorders program and the Weight and Wellness program. Certification or proof of Medicaid denial is a requirement for financial assistance consideration. Financially responsible parties who submit a complete and verifiable application for financial assistance (including proof of Medicaid denial) will be considered for free or reduced assistance on the basis of federal poverty guidelines (400% FPL limit). Families that do not qualify for income based financial assistance that have verifiable out of pocket medical debt greater than 20% of gross income may qualify for catastrophic assistance leaving up to 1% of the family's gross income as the responsibility. Presumptive eligibility is available in a variety of circumstances including the absence of documentation required to comply with the traditional financial assistance application requirements. The predictive model incorporates income and household size estimates, a socio-economic need factor, census block data, as well as information on home ownership. Schedule H, Part I, Line 6a The Community Benefit Report is prepared by the organization. The values reported in the 2019 Community Benefit Report include $5.3M in financial assistance. Schedule H, Part I, Line 7 Explanation of the costing methodology used to calculate subsidized health services: subsidized health services were calculated using a combination of Children's Hospital & Medical Center's cost accounting system and a cost to charge ratio calculation similar to worksheet 2 in the Schedule H instructions. The reported subsidized loss represents the difference in net revenue received from all payors less total operating expenses including indirect costs applicable to each department. Unreimbursed Medicaid costs reported on line 7b and other operating expense applicable to the department reported elsewhere on schedule h as a community benefit is excluded from the operating expense total as are bad debt and non-patient 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 Schedule H as a community benefit. Schedule H, Part I, Line 7G The organization did not include costs attributable to physician clinics as subsidized health services. Schedule H, Part II Community Building Activities Children's Hospital & Medical Center supports economic development in its sponsorship donations to organizations such as the Nebraska Chamber of Commerce & Industry. Schedule H, Part III, Line 2 Describe the methodology used to determine the amounts reported on lines 2 & 3: bad debt expense at 100% charge value was multiplied by the 2019 Medicare cost to charge ratio to arrive at an approximate cost value. BAD DEBT EXPENSE AT 100% CHARGE VALUE $9,723,243 MEDICARE COST TO CHARGE RATIO X .416 -------------- BAD DEBT EXPENSE AT COST $4,044,869 Estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy: this process includes identifying charity care financial assistance codes congruent with the financial assistance policy that were charged to bad debt expense at 100% charge value. This amount is $0 for 2019 and reflects the efforts of Children's Hospital & Medical Center to ensure that no child with a medical need is turned away due to inability to pay for health care. Describe how the organization accounts for discounts or payments on patient accounts in determining bad debt expense: bad debt expense is credited for any payment received on accounts previously written off. Schedule H, Part III, Line 4 Accounts receivable are reduced by an allowance for doubtful accounts and contractual adjustments. In evaluating patient accounts receivable by financial class, management regularly reviews an analysis of its historical collectability trends along with an aging of accounts receivable. For receivables associated with services provided to patients, collectability is determined based on a combination of historical trends and contractual agreements. For receivables associated with self-pay patients, including patients without insurance and patients with deductibles and copayments, management analyzes historical trends in each of its predetermined stages of collectability and status of agreed-upon payment plans. The difference between the standard or negotiated discounted rates and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Schedule H, Part III, Line 8 MEDICARE 2019 Medicare charges reported by the Centers For Medicare and Medicaid Services (CMS) in the provider statistical and reimbursement system for provider FYE 12/31 were multiplied by the 2019 cost to charge ratio to arrive at an approximate cost of care related to the reimbursement payments reported on Schedule H, Part III, Line 5. Schedule H, Part III, Line 9b COLLECTION PRACTICES Self-pay accounts with no verifiable insurance and balance after insurance accounts are considered for financial assistance throughout the collection process for those guarantors who are financially unable to pay, either through a government program or through Children's Hospital & Medical Center's financial assistance program. All correspondence, including statements and collection letters state that financial assistance may be available. Schedule H, Part VI, Line 2 2-NEEDS ASSESSMENT Children's Hospital & Medical Center (Children's) uses numerous resources to benchmark, align and conduct assessments of the health care needs of Children in the communities we serve. These resources include focused stakeholder input and prioritization, national public health (Healthy People 2020) and pediatric care standards. We also review data from the American Academy of Pediatrics, as listed in our 2018 Community Health Needs Assessment (CHNA) report, and trends as identified by Children's Hospital Association (CHA). During this 2018 Child And Adolescent CHNA, additional community feedback on prioritization of health needs was obtained with leadership and active participation within the Douglas County Mobilizing for Action Through Planning and Partnerships (MAPP) process and the Live Well Omaha's 2018 Changemaker Summit. Douglas County Health Department and Children's partnered to facilitate a series of strategic assessments (Forces of Change Assessment, a local public health systems assessment and a community strengths and themes assessment) by using the MAPP process. This framework applies strategic thinking to the priority health issues to identify resources to meet the challenges and opportunities. On November 5, 2018, findings from this CHNA were presented at Live Well Omaha's 2018 Changemaker Summit. The Changemaker Summit is the region's largest multi-sector health conference, which gathers more than 170 leaders from across Douglas, Sarpy, Cass and Pottawattamie counties to celebrate the milestones of our collective work and advance future work while learning from local, regional and national experts. At this event, data was shared reflecting the significant health issues identified from the research and the MAPP process. Individuals' ratings from this summit yielded the following prioritized list of community health needs for children and adolescents in the Omaha metro area: 1. Mental Health 2. Nutrition, Obesity & Physical Activity 3. Access to Health Services 4. Sexual Health 5. Tobacco, Alcohol & Other Drugs Organizations sponsoring or supporting this CHNA will use the information from this CHNA to develop implementation strategies to address the significant health needs in the community. The results of this prioritization exercise will be used to inform the development of action plans to guide community health improvement efforts in the coming years. By using this process in connection with the CHNA data, our community is positioned to improve the efficiency and effectiveness of local public Health systems across the region. Several other current clinical assessments include the Pedi-Boost Risk Score, a medical and social risk screening for all children who make an encounter with the enterprise. For those children with high or rising risk, a complete psychosocial assessment is performed by our Care Transition Team of social workers or nurse case managers in the outpatient and inpatient setting. Several departments routinely utilize depression screening PHQ9 for those youth 12 and older. A postpartum depression screening is performed at 2 weeks, 2 months and 4 months for primary care well visits. In 2019, a screening question about transportation challenges was added to the domestic violence, food insecurity and housing insecurity screening questions at each primary care well visit. Internal resources that assist with the assessment of child health needs are Children's Family Advisory Councils, social workers and nurse case managers, physicians and clinical service units and IT analysts/reporters. 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. Schedule H, Part VI, Line 3 3-Patient Education of Eligibility Financially responsible parties who experience difficulty in meeting their financial obligations will be encouraged to and assisted in applying for financial help through government programs and other potential funding sources or alternatively qualified for Children's Financial Assistance Program. Eligibility for financial assistance is ideally determined either prior to services being provided or at the time services are rendered and is based upon family/guarantor income, family size and other special considerations. The primary responsibility to identify financial need is with the access patient advocates, central billing office and social work staff. These staff members are trained to identify patient needs and answer financial assistance questions. There are several points in the patient experience where financial assistance resources are offered. The first occurs at the pre-registration of inpatient admits and outpatients presenting through cares and for those patients scheduled in the Specialty Pediatric Center clinics. At this time, electronic eligibility is ran on the insured. The benefit detail including deductible, copayment and coinsurance amounts are discussed with the family. All individuals who are financially unable to pay will be encouraged to and assisted in applying for financial help through government programs and other potential funding sources or alternatively qualified for Children's Financial Assistance Program. At the time of registration, insurance is discussed and families again are offered the assistance of Access Center Patient Advocates who are available Monday through Friday. All self-pay families are encouraged to speak to an Access Center Patient Advocate. Care estimates or questions regarding estimate of cost for upcoming testing are directed to the Patient Advocates and these services are again offered prior to ending the conversation. Financial assistance information is also located in the patient handbooks. Patient statements and all 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 they are uninsured or have limited income, they 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, they may then apply for the Children's Financial Assistance Program. Contact numbers for the Patient Advocates and hours of service are provided. The website includes copies of Children's Financial Assistance Policy, the Financial Assistance Application Form and the Plain Language Summary in English, Arabic, Chinese, French, Persian, Spanish and Vietnamese. The website also includes Amounts Generally Billed in English. All other billing, payment and financial responsibility related links on Children's website state that financial assistance may be available. The Financial Assistance Policy is currently available on the Children's Hospital & Medical Center website and is also available upon request. https://www.childrensomaha.org/hospital-experience/insurance-billing- medical-records/financial-assistance/ Schedule H, Part VI, Line 4 4-COMMUNITY INFORMATION The hospital's primary service area consists of Douglas and Sarpy counties in Nebraska and Pottawattamie County in Iowa. The primary service area has a current aggregate population of approximately 865,034. The hospital's secondary service area consists of eight surrounding counties in Nebraska and nine surrounding counties in Iowa. For the year ended December 31, 2019, 51.9% of the hospital's inpatient discharges were from patients residing in the three-county primary service area. Patients residing in the seventeen-county secondary service area accounted for 19.8% of total hospital inpatient discharges during this same time period. The remaining 28.3% of total discharges were from patients residing outside the primary and secondary service areas. 2019 DEMOGRAPHIC SUMMARY Omaha Metro Market Area: Douglas, Sarpy and Pottawattamie COUNTIES SOURCES: ESRI (Based on US Census Bureau), United States Census Bureau and Children's Hospital and Medical Center Patient Encounter Database. COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 12 TOTAL POPULATION 865,034 PEDIATRIC POPULATION 215,725 AVERAGE HOUSEHOLD INCOME $88,761 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 10.1% UNDER AGE 18 11.8% PERCENT OF RESIDENTS ON MEDICAID 9.7% AGE POPULATION %OF TOTAL LESS THAN 18 215,725 25.0% 18 TO 24 79,416 9.2% 25 TO 44 247,558 28.6% 45 TO 64 202,729 23.4% 65+ 119,606 13.8% TOTAL 865,034 100.0% RACE POPULATION %OF TOTAL WHITE 643,370 74.4% HISPANIC 96,262 11.1% BLACK 71,602 8.3% ASIAN/PACIFIC ISLANDER 26,828 3.1% OTHER/2+ RACES 24,013 2.8% AM. IND/ALASKA NAT 2,959 0.3% TOTAL 865,034 100.0% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS: 14.1% COUNTY # OF CENSUS TRACTS* TOTAL CENSUS TRACTS % OF TOTAL DOUGLAS 36 156 23.1% SARPY 12 43 27.9% POTTAWATTAMIE 3 30 10.0% TOTAL 51 229 22.3% *CENSUS TRACT IS A GEOGRAPHICAL DIVISION OF 500 TO 3,000 HOUSEHOLDS Schedule H, Part VI, Line 5 Proudly serving children since 1948, Children's Hospital & Medical Center (Children's) mission is to improve the life of every child through dedication to exceptional clinical care, research, education and advocacy. Children's Center for The Child & Community is a statewide community outreach hub of Children's. The Children's Center for The Child & Community was launched in 2016 to serve as the infrastructure for community health improvement, leading both internal and external partnerships around pediatrics Community Health Needs Assessment (CHNA) planning and implementation. A leader in pediatric health care, Children's offers unique resources to children across a three-state region and beyond, and conducts more than 500,000 patient encounters each year. Children's is the only full-service, pediatric health care center in Nebraska. Some of the programs and services Children's offered to patients were: Behavioral Health, Rehab Services, Home Health, Urgent Care, Weight & Wellness, and Specialty Care Clinics. In addition, Children's offers Palliative Care, Family Resources, Child Life Specialists, Pastoral Care, Social Workers, Nurse Case Managers, Interpreters, Financial Counselors, Patient Advocates, and other programs to enhance the patient experience. Children's has achieved the Magnet Designation for nursing excellence, and its Pediatric and Neonatal Intensive Care Units have earned a Beacon Award for Excellence from the American Association of Critical Care Nurses, which recognizes critical care units with excellent patient outcomes that exceed national benchmarks. Children's has been named by U.S. News & World Report as one of the nation's Best Children's Hospitals, nationally ranked in cardiology and heart surgery, diabetes and endocrinology, gastroenterology and GI surgery, orthopedics, and pulmonology. U.S. News recognizes hospitals with excellent survival rates, patient safety, specialized staff, and hospital reputation. All of the Children's Physicians primary care offices have achieved the highest NCQA Patient Centered Medical Home (PCMH) certification. 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 serves as the primary academic medical training location for the UNMC Department of Pediatrics. - Provided $9.3 million in services in the form of uncompensated care [charity care ($5.3 million) and bad debt write-offs ($4.0 million)] to families unable to pay. With 46% of patient care revenues devoted to the care of low-income children assisted by Medicaid, the Medicaid reimbursement shortfall for FY 2019 was $39.2 million less than the cost of care provided. Children's 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. - Contributed $1.6 million towards community health education aimed at promoting health and preventing illness and injury made available through the Kohl's Cares GoNoodle grant partnership, injury prevention, obesity prevention, Parenting U education classes, outreach educational classes, health fairs, Just Kids Magazine, and the consumer website. Children's gives back to the community through advocacy services which are available to anyone suspecting child abuse or neglect, and lodging for families of out-of-town patients is offered at the Carolyn Scott Rainbow House at no cost. - Contributed $18.8 million in pediatric health care education costs to educate tomorrow's healers. - Provided $782 thousand in cash and in-kind donations/sponsorships to benefit the broader community In 2019, Children's provided in total, more than $116 million in community benefits, representing 28% of the hospital's operating expenses. Schedule H, Part VI, Line 6 6-AFFILIATED HEALTH CARE SYSTEM Children's Hospital & Medical Center is not affiliated with a greater health care system, but is its own health care system which the hospital operates the following related organizations: - Children's Hospital & Medical Center Foundation - Children's Physicians - Children's Health Network Schedule H, Part VI, Line 7 7-STATE FILING OF COMMUNITY BENEFIT REPORT The Children's Hospital & Medical Center Community Benefit Report is filed in the state of Nebraska through the Nebraska Hospital Association, and is available to the public on the website at: WWW.CHILDRENSOMAHA.ORG/COMMUNITY-BENEFIT-INFORMATION true NE PEDIATRIC PRACTICE 8200 DODGE STREET OMAHA NE 68114 263064869 501(C)(3) 110827 PEDIATRIC RESEARCH UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 985520 NE MED CTR OMAHA NE 68198 470049123 501(C)(3) 132987 SUPPORT FOR MED SCH SUPPORT FOR MED SCH 2 CHARITY ASSISTANCE TO PATIENTS IN NEED 8838 12620253 BOOK WRITEOFF PAT ACCT Schedule I, Part I, Line 2 CHILDREN'S HOSPITAL & MEDICAL CENTER HAS A WRITTEN FINANCIAL ASSISTANCE/CHARITY CARE POLICY. THE AMOUNT OF FINANCIAL ASSISTANCE AN INDIVIDUAL CAN RECEIVE IS BASED ON THE ANNUAL GROSS INCOME THRESHOLDS USING THE CURRENT FEDERAL POVERTY LEVEL GUIDELINES. GRANTS TO ORGANIZATIONS ARE ONLY DISTRIBUTED TO 501(C)(3) ORGANIZATIONS BASED ON THE HOSPITAL'S EVALUATION CRITERIA. X true true X X X X X true true false false false false false false false Rodrigo Lopez Interim Pres/CEO beg 7/15/19 290697 0 0 0 6291 0 7784 0 166 0 304938 0 0 0 Michael Brown EVP Strategy & Transformation 482951 0 216059 0 237332 0 102857 0 18621 0 1057820 0 228734 0 Christopher Maloney MD SVP & Chief Medical Officer 522568 0 216519 0 9644 0 82796 0 4742 0 836269 0 0 0 Kathy English EVP & COO 483920 0 195636 0 12776 0 102576 0 11984 0 806892 0 0 0 Amy Hatcher SVP & CFO 415975 0 158359 0 4206 0 70747 0 13185 0 662472 0 0 0 Steven C Burnham SVP Physician Networks 360840 0 143362 0 8060 0 66100 0 14476 0 592838 0 0 0 Amy Bones SVP & General Counsel 375773 0 113139 0 7523 0 65273 0 8431 0 570139 0 0 0 Suzanne Nocita SVP & CHRO 322507 0 102302 0 48521 0 18443 0 14662 0 506435 0 37209 0 Jerold Vuchak SVP & Chief Info Officer 261763 0 0 0 55781 0 36432 0 8110 0 362086 0 0 0 Jamie Drake MD Physician 422604 0 31500 0 2184 0 0 0 3508 0 459796 0 0 0 Nicole Villarreal MD Physician 414649 0 35000 0 2038 0 0 0 20643 0 472330 0 0 0 Anna Spagnoli MD SVP & PIC THRU 10/29/19 184954 0 151692 0 76236 0 31921 0 105 0 444908 0 0 0 Kristin Grahn MD Physician 362101 0 35000 0 2190 0 0 0 20643 0 419934 0 0 0 Malinda Bender MD Physician 358515 0 35000 0 2146 0 0 0 3786 0 399447 0 0 0 Richard Azizkhan MD President/CEO thru 8/16/19 819310 0 423893 0 615332 0 0 0 9238 0 1867773 0 194445 0 Fernando Ferrer MD SVP & SIC thru 6/30/19 408101 0 309666 0 386434 0 95208 0 0 0 1199409 0 0 0 Schedule J, Part I, Line 1A Richard Azizkhan's social club dues were paid for by the organization to be used for business purposes. The social club membership was canceled in August 2019 upon the retirement of Dr. Azizkhan. Schedule J, Part I, Line 4A SEVERANCE PAYMENTS THE FOLLOWING EMPLOYEES RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2019: RICHARD AZIZKHAN, M.D. $402,647 FERNANDO FERRER, M.D. $381,553 ANNA SPAGNOLI, M.D. $74,143 Schedule J, Part I, Line 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN DURING 2019. THE AMOUNTS OF DEFERRED COMPENSATION DISTRIBUTED AND ACCRUED FOR EACH OF THE INDIVIDUALS DURING 2019 ARE AS FOLLOWS: MICHAEL BROWN $77,028 ACCRUAL, $228,734 PLAN DISTRIBUTION KATHY ENGLISH $76,276 ACCRUAL, $0 PLAN DISTRIBUTION STEPHEN C BURNHAM $46,166 ACCRUAL, $0 PLAN DISTRIBUTION RICHARD AZIZKHAN, M.D. $0 ACCRUAL, $194,445 PLAN DISTRIBUTION AMY HATCHER $52,847 ACCRUAL, $0 PLAN DISTRIBUTION AMY BONES $47,658 ACCRUAL, $0 PLAN DISTRIBUTION SUZANNE NOCITA $0 ACCRUAL, $37,209 PLAN DISTRIBUTION CHRISTOPHER MALONEY, M.D. $64,896 ACCRUAL, $0 PLAN DISTRIBUTION FERNANDO FERRER, M.D. $95,208 ACCRUAL, $0 PLAN DISTRIBUTION ANNA SPAGNOLI, M.D. $31,921 ACCRUAL, $0 PLAN DISTRIBUTION JEROLD VUCHAK $31,696 ACCRUAL, $0 PLAN DISTRIBUTION A HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230KT6 2008-08-12 100881609 REFUND BONDS (6/8/2007) true false false B HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 2014-09-10 19900000 REFUND BONDS (8/12/2008) false false false C HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230NJ5 2017-03-14 101075067 USED TO CONSTRUCT HUBBARD CENTER F false false false D HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 2017-11-28 26885000 REFUND BONDS (8/12/2008) false false false A 66445000 0 100892260 0 0 0 751783 24826 0 2755000 97360681 0 2008 true false true true B 1615000 0 20416445 0 0 0 207632 0 0 0 20208813 0 2008 false true true true C 0 0 104280765 0 0 0 1064167 0 0 103216598 0 0 false false true true D 6855000 0 26885000 0 0 0 305601 0 0 26579399 0 0 2008 true false true true A false true true true true true 0.00200 0.00200 false false false true B false true true true true true 0.00200 0.00200 false false false true C false false false false 0 false false false true D false true true true true true 0.00200 0.00200 false false false true A false false true true true true MORGAN STANLEY 25. false false false 0 false true B false false false true false false 0 false 0 false true C false true false false false false 0 false 0 false true D false false true true false false 0 false 0 false true A true B true C true D true SCHEDULE K, PART II, LINE 3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART IV, LINE 2C DATE THE REBATE COMPUTATION WAS PERFORMED: 10/02/2017 (2008 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 08/21/2018 (2014 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 05/21/2018 (2017B BONDS) RICHARD AZIZKHAN MD WIFE IS EMPLOYEE 204371 EMPLOYMENT false RICHARD AZIZKHAN MD SON IS EMPLOYEE 36022 EMPLOYMENT false Form 990, Part VI, Line 11B GOVERNANCE, MANAGEMENT, AND DISCLOSURE A COMPLETE COPY OF THE FORM 990, INCLUDING SCHEDULE J, IS MADE AVAILABLE TO THE EXECUTIVE COMMITTEE OF THE BOARD EXCLUDING THE MEDICAL STAFF PRESIDENT. THE FORM 990, EXCLUDING PART VII AND SCHEDULE J - COMPENSATION INFORMATION, IS MADE AVAILABLE TO THE REMAINDER OF THE BOARD OF DIRECTORS, INCLUDING THE MEDICAL STAFF PRESIDENT. BOTH ARE MADE AVAILABLE THROUGH THE DIRECTOR'S DESK WEBSITE PRIOR TO FILING WITH THE IRS. Form 990, Part VI, Line 12C Policies The Conflict of Interest Policy applies to any person in a position to exercise influence in connection with any contract, transaction or arrangement presented to the Board or a Board committee for approval (Covered Person). Covered Person includes (but is not limited to) any Director, Officer, member of a committee with board-delegated power, or Key Employee/Staff. All Covered Persons must annually submit a completed Conflict of Interest Questionnaire in the format prescribed by the Governance Committee from time to time. Each Covered Person shall annually acknowledge in writing that he or she (a) has received a copy of this policy; (b) has read and understands the policy; (c) agrees to comply with the policy; (d) understands that the policy applies to the Board and committees; (e) understands that Children's is a not-for-profit organization that must engage primarily in exempt activities; (f) agrees to promptly report to the Chair of the Governance Committee, the Conflict of Interest/Independence Determination subcommittee (the Subcommittee) and Children's General Counsel any change to matters previously disclosed on the Conflict of Interest Questionnaire; and (g) states that the information he or she will provide in the Conflict of Interest Questionnaire is true and accurate to the best of his or her knowledge and belief. A Covered Person has a continuing obligation to disclose any potential Conflict of Interest or any situations that could create an appearance of a conflict of interest. Such disclosure shall be made promptly any time an actual, apparent or potential conflict of interest arises or whenever it involves a matter of Board/committee action. Disclosure means promptly providing the material facts of an actual, apparent or potential conflict of interest to the Chair of the Governance Committee, the Subcommittee and Children's General Counsel (in writing if time allows) or to the Board or Board committee reviewing the contract, transaction or arrangement. The Subcommittee will be convened to consider the disclosure. Certain circumstances, in addition to Financial Interests, could give rise to a potential Conflict of Interest, including instances where the actions or activities of an individual on behalf of Children's also involve obtaining a personal gain or advantage, or could have an adverse effect on Children's interests. A Covered Person must also make a disclosure whenever he or she has a personal, non-familial relationship that could impact, or appear to impact, the Board member's ability to exercise their independent judgment in carrying out the director's fiduciary responsibilities. Also, disclosing or using information relating to Children's business for the personal profit or advantage of an individual or his or her family, or other colleagues of the director, or disclosing matters discussed during board or committee meetings, could give rise to a claim of conflict and must not occur. A potential conflict of interest, or the appearance of a conflict of interest, does not necessarily rise to the level of an actual conflict of interest, but once recognized, it must in every case be disclosed and evaluated. In some instances, it may be so serious that it prevents the individual from further participation in Children's deliberations with respect to a particular transaction, or could be so pervasive that the individual may be disqualified from continued affiliation with Children's. On the other hand, it may be of little or no significance once it has been disclosed. The Subcommittee will consider the following factors, among other relevant facts, when determining whether an actual conflict of interest exists: (i) the proximity of the Covered Person to the decision-making authority of the other entity involved in the transaction or business arrangement; (ii) the magnitude of the Financial Interest or personal interest; (iii) the degree to which the Covered Person might benefit personally if a particular transaction or business arrangement were approved; (iv) the ability of the Covered Person to make an independent decision based only on the best interest of Children's; and (v) such other factors that may be relevant to the particular matter. The Subcommittee shall review each completed Conflict of Interest Questionnaire, and may make such further investigation of potential conflicts as it may determine appropriate. The Subcommittee shall make appropriate reports to the Board concerning its review, any further investigation, and its recommendations to the Board regarding any potential or actual Conflict of Interest, or any appearance of a conflict of interest. Whenever a Covered Person (or a person other than the Covered Person) voluntarily identifies or discloses a potential Conflict of Interest, the Subcommittee shall follow the same procedure outlined above. Transactions or business arrangements with Covered Persons with Conflicts of Interest must be approved in advance by a majority of Independent Directors. In order to approve an arrangement or transaction involving an actual Conflict of Interest, the Board must first find, by majority vote of Independent Directors, at a meeting at which a quorum is present, that the arrangement or transaction is in Children's best interest, is fair and reasonable to Children's and that, after reasonable investigation, the Independent Directors have determined that a more advantageous transaction or arrangement cannot be obtained with reasonable efforts under the circumstances. The Conflicted Director will recuse himself/herself. In cases in which a Covered Person has an interest or a relationship that calls into question the ability of the Covered Person to act solely in Children's best interests, the following additional steps may be taken, at the discretion of the Board or the Subcommittee: (a) The Covered Person will be required to leave the meeting for the general discussion of the matter and the Board vote; (b) The Subcommittee can recommend to the Board that a Director or a member of a committee with Board-delegated powers be asked to resign in the event a Conflict of Interest is so substantial that it would be incompatible with Children's best interests to have such an individual on its Board/committee. If the Board/Subcommittee believes a Covered Person has failed to comply with this policy, the Board shall inform that person of the basis for its belief and give that person an opportunity to address the alleged failure. After hearing the response and conducting such further investigation as may be warranted under the circumstances, the Board/Subcommittee shall determine whether such person has, in fact, violated the disclosure requirements of this policy. If the Board determines that there has been a violation, the Board shall take appropriate disciplinary and corrective action which may include removal from the Board. At any Board/Subcommittee meeting at which a conflict of interest issue is addressed, the minutes of the Board/Subcommittee meeting shall reflect the process that was followed and the actions taken by the Board/Subcommittee. Form 990, Part VI, Line 15B POLICIES EACH YEAR AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF THE EXECUTIVE COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPANY ISSUES AN ANNUAL REASONABLENESS OPINION LETTER REGARDING THE APPROPRIATENESS OF THE EXECUTIVE PAY LEVELS. THE COMPENSATION COMMITTEE IS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE REVIEWS BASE PAY RANGES FOR ALL EXECUTIVES, INCLUDING THE CHIEF EXECUTIVE OFFICER, AND ALL EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS. THE BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING THE CEO'S PERFORMANCE WHICH AFFECTS HIS PAY RATE INDIRECTLY. Form 990, Part VI, Line 19 GOVERNANCE, MANAGEMENT, AND DISCLOSURE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. THE CHILDREN'S HOSPITAL & MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED IN ADMINISTRATION. Form 990, Part XI, Line 9 ($296,000) - CHANGE IN VALUE OF SPLIT INTEREST ($376,909) - CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK $25,385,259 - CAPITAL TRANSFERS FOUNDATION -------------- $24,712,350 - TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHILDREN'S HOSPITAL FOUNDATION 8200 DODGE STREET OMAHA NE 68114 476105603 FUNDRAISING NE 501(C)(3) LINE 7 CHMC true CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA NE 68114 470689372 PED CLINICS NE 501(C)(3) LINE 10 CHMC true KENT INC 8200 DODGE STREET OMAHA NE 68114 470527928 REAL ESTATE NE CHMC C Corp 0 219495 1.00000 true CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA NE 68114 363967578 HEALTH NETWORK NE CHMC C Corp 0 0 1.00000 true false false true false false false false false false false false true true true true false true true true CHILDREN'S HOSPITAL FOUNDATION c 2803623 BOOK CHILDREN'S HOSPITAL FOUNDATION L,M,N 25597533 BOOK CHILDREN'S HOSPITAL FOUNDATION r 212274 BOOK CHILDREN'S HEALTH NETWORK r 376909 BOOK