2014-08-13T13:06:26-05:00 2013-12-31 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2013-01-01 470379754 CHILDREN'S HOSPITAL & MEDICAL CENTER % MICHAEL J BROWN CHIL 4029554116 8200 DODGE STREET Suite OMAHA NE 68114 MICHAEL J BROWN SR. 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SCHEDULE D, PART X, LINE 2 FIN 48 FOOTNOTE IN ACCORDANCE WITH ASC SUBTOPIC 740-10, INCOME TAXES-OVERALL, THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITION IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. DURING 2013 AND 2012, 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 3928772 3928772 0.01600 87619784 66934037 20685747 0.08440 91548556 66934037 24614519 0.10040 2064074 322850 1741224 0.00710 7969637 890147 7079490 0.02890 67274850 38336390 28938460 0.11810 1178088 1178088 0.00480 517351 517351 0.00210 79004000 39549387 39454613 0.16100 170552556 106483424 64069132 0.26140 10000 10000 10000 10000 false 2070100 0 170477 280905 -110428 X true true 1 1 CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 www.childrensomaha.org License # 260005 X X X X X CHILDREN'S HOSPITAL & MEDICAL CENTER true X X X X X X X X X 12 true true true X childrensomaha.org/healthneedsassessment X X X X X X X X X false false true true 200. true 400. true X X X X true true X X X X X true false true X false false Part V, Section B, Line 3 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, THERE WERE FIVE FOCUS GROUPS HELD FEBRUARY 29 TO MARCH 1, 2012. THE PARTICIPANTS IN THESE FOCUS GROUPS INCLUDED 46 KEY INFORMANTS, INCLUDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, BUSINESS LEADERS, AND OTHER COMMUNITY LEADERS WITH INPUT AND EXPERTISE REGARDING THE COMMUNITY YOUTH. A LIST OF RECOMMENDED PARTICIPANTS FOR THE FOCUS GROUPS WAS PROVIDED BY THE SPONSORS OF THIS STUDY. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS AMONG THE FAMILIES AND CHILDREN/ADOLESCENTS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED A REPRESENTATIVE OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. PART V, SECTION B, LINE 4 BOYS TOWN NATIONAL RESEARCH HOSPITAL PART V, SECTION B, LINE 7 ACTIONS HAVE BEEN IMPLEMENTED BY CHILDREN'S IN ALL SEVEN AREAS WHICH EMERGED AS HEALTH PRIORITIES IN NEED OF INTERVENTION BASED ON THE 2012 CHILD & ADOLESCENT COMMUNITY HEALTH NEEDS ASSESSMENT: OBESITY AND NUTRITION, INJURY AND SAFETY, ACCESS TO HEALTHCARE, ASTHMA, MENTAL HEALTH, SUBSTANCE ABUSE, AND SEXUAL ACTIVITY. ALTHOUGH ACTIONS HAVE BEEN IMPLEMENTED TO ADDRESS SEXUAL ACTIVITY AND SEXUALLY TRANSMITTED INFECTIONS, THESE ISSUES ARE NOT AREAS OF EMPHASIS FOR CHILDREN'S HOSPITAL & MEDICAL CENTER DUE TO THE SIGNIFICANT INVOLVEMENT OF COMMUNITY PUBLIC HEALTH ENTITIES (SUCH AS THE DOUGLAS COUNTY, NE HEALTH DEPARTMENT) WHICH HAVE MADE THIS CONCERN A HIGH ACTION ITEM FOR THEIR TEAMS AND PROGRAMS. PART V, SECTION B, LINE 14G IN REGARD TO 14g, THE POLICY IS PROVIDED TO THE PUBLIC IN SUMMARY AND DIRECTED TO VISIT THE CHILDREN'S HOSPITAL WEBSITE FOR THE FULL POLICY. PART V, SECTION B, LINE 20D Indicate how the hospital facility determined the amounts billed to individuals who did not have insurance covering emergency or other medically necessary care: At Children's, commercial insurers, government payors and self-pay billing parties are all billed the same gross charge rate for each specific procedure performed (as opposed to a DRG rate). Upon request, self-pay billings are eligible for a 10% discount for prompt payment. Federal Poverty Guidelines are used to determine eligibility for free or discounted care. Financial assistance is available for medically necessary procedures and services. Financially responsible parties who submit a complete and verifiable Application for Financial Assistance (including proof of Medicaid denial) will be considered for free or reduced assistance on the basis of Federal Poverty Guidelines (400% FPL limit). Families that do not qualify for income based financial assistance that have verifiable out of pocket medical debt greater than 20% of gross income may qualify for catastrophic assistance leaving 1% of the family's gross income as the responsibility. Presumptive Eligibility is available in a variety of circumstances including the absence of documentation required to comply with the traditional charity care application requirements. PART V, SECTION B, LINE 22 AT CHILDREN'S - COMMERCIAL INSURERS, GOVERNMENT PAYORS AND SELF-PAY BILLING PARTIES ARE ALL BILLED THE SAME GROSS CHARGE RATE FOR EACH SPECIFIC PROCEDURE PERFORMED. GROSS CHARGES ON A FAP-PATIENT BILL ARE THEN DISCOUNTED ACCORDING TO THEIR FPG ELIGIBILITY WHICH REDUCES OR ELIMINATES THE AMOUNT THE PATIENT IS REQUIRED TO PAY. 6 W VILLAGE PTE URGENT CARE&AMBUL CLINICS 110 N 175TH STREET OMAHA NE 68118 UCC OPENS 6PM-10PM & ROTATING AMBULATORY CLINICS CHILDREN'S HOME HEALTHCARE 4156 S 52ND STREET OMAHA NE 68117 PEDIATRIC HOME HEALTH CARE SERVICES CHILDREN'S HOME HEALTHCARE WORLD 7815 FARNAM STREET OMAHA NE 68114 PRIVATE DUTY PEDIATRIC NURSING CENTER LINCOLN CLINIC 300 NORTH 44TH STREET LINCOLN NE 68503 PEDIATRIC CLINIC CAROLYN SCOTT RAINBOW HOUSE 7815 HARNEY STREET OMAHA NE 68114 MINIMUM TO NO-COST ACCOMODATIONS FOR FAMILIES OF PATIENTS VAL VERDE URGENT CARE 9801 GILES ROAD SUITE 1 LA VISTA NE 68128 UCC OPENS 6PM-10PM PART I, LINE 3C If the organization did not use FPG to determine eligibility, describe the income based criteria for determining eligibility for free or discounted care. Federal Poverty Guidelines are used to determine eligibility for free or discounted care. Financial assistance is available for medically necessary procedures and services. Services not eligible for financial assistance include cosmetic and other elective procedures, helmet clinic, eating disorders program and HEROES weight management program. Certification or proof of Medicaid denial is a requirement for financial assistance consideration. Financially responsible parties who submit a complete and verifiable Application for Financial Assistance (including proof of Medicaid denial) will be considered for free or reduced assistance on the basis of Federal Poverty Guidelines (400% FPL limit). Families that do not qualify for income based financial assistance that have verifiable out of pocket medical debt greater than 20% of gross income may qualify for catastrophic assistance leaving 1% of the family's gross income as the responsibility. Presumptive Eligibility is available in a variety of circumstances including the absence of documentation required to comply with the traditional charity care application requirements. The predictive incorporates income and household size estimates, a socio-economic need factor, census block data, as well as information on home ownership. PART I, LINE 6A The community benefit report is prepared by the organization. The values reported in the 2013 Community Benefit report include $3.9M in FINANCIAL assistance. PART I, LINE 7G The organization did not include costs attributable to physician clinics as subsidized health services. PART I, LINE 7 EXPLANATION OF THE COSTING METHODOLOGY USED TO CALCULATE SUBSIDIZED HEALTH SERVICES: A SUBSIDIZED HEALTH SERVICE BENEFIT WAS CALCULATED FOR THE NICU, EMERGENCY AND TRAUMA CARE, URGENT CARE, BEHAVIORAL HEALTH, AND AMBULATORY CARE CLINIC OUTPATIENT SERVICES RECOGNIZING THAT THESE AREAS OPERATE AT A NEGATIVE MARGIN WHEN THE INDIRECT COSTS OF OPERATION ARE CONSIDERED. A COST TO CHARGE RATIO CALCULATION SIMILAR TO WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS IS USED. THE REPORTED SUBSIDIZED LOSS REPRESENTS THE DIFFERENCE IN NET REVENUE RECEIVED FROM ALL PAYORS LESS TOTAL OPERATING EXPENSES INCLUDING INDIRECT COSTS APPLICABLE TO EACH DEPARTMENT. UNREIMBURSED MEDICAID COSTS REPORTED ON LINE 7B AND OTHER OPERATING EXPENSE APPLICABLE TO THE DEPARTMENT REPORTED ELSEWHERE ON SCHEDULE H AS A COMMUNITY BENEFIT ARE EXCLUDED FROM THE OPERATING EXPENSE TOTAL AS ARE BAD DEBT AND NONPATIENT CARE EXPENSE ASSOCIATED WITH EACH DEPARTMENT. INDIRECT COSTS FOR EACH DEPARTMENT WERE CALCULATED BY APPLYING THE MEDICARE COST REPORT OVERHEAD RATE APPLICABLE TO THAT DEPARTMENT TO THE DEPARTMENT'S TOTAL OPERATING EXPENSES EXCLUDING UNREIMBURSED MEDICAID EXPENSES AND/OR ANY OTHER EXPENSE ALREADY REPORTED ELSEWHERE ON THE SCHEDULE H AS A COMMUNITY BENEFIT. PART II Community Building Activities Children's Hospital & Medical Center supports "economic development" in its sponsorship donations to organizations such as Nebraska Chamber of Commerce & Industry. PART III, Section A, Line 4 Bad Debt Expense THE COMPANY ADOPTED ACCOUNTING STANDARDS UPDATE (ASU) 2011-07, HEALTH CARE ENTITIES (TOPIC 954): PRESENTATION AND DISCLOSURE OF PATIENT SERVICE REVENUE, PROVISION FOR BAD DEBTS, AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH CARE ENTITIES, WHICH REQUIRES HEALTH CARE ENTITIES TO PRESENT THE PROVISION FOR BAD DEBT RELATING TO PATIENT SERVICE REVENUE AS A DEDUCTION FROM PATIENT SERVICE REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS RATHER THAN AS OPERATING EXPENSE. ADDITIONAL DISCLOSURES RELATING TO THE SOURCES OF PATIENT REVENUE AND THE ALLOWANCE FOR DOUBTFUL ACCOUNTS RELATED TO PATIENT ACCOUNTS RECEIVABLE ARE ALSO REQUIRED. THE ADOPTION OF THIS ASU HAD NO IMPACT ON THE FINANCIAL CONDITION, RESULTS OF OPERATIONS, OR CASH FLOWS. Part III, Section A, Line 2 DESCRIBE THE COSTING METHOD USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 & 3: BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE 2013 MEDICARE COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST VALUE. BAD DEBT EXPENSE AT 100% CHARGE VALUE $4,641,480 MEDICARE COST TO CHARGE RATIO X .4460 BAD DEBT EXPENSE AT COST $2,070,100 ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY: THIS PROCESS INCLUDES IDENTIFYING "CHARITY CARE" FINANCIAL ASSISTANCE CODES CONGRUENT WITH THE FINANCIAL ASSISTANCE POLICY THAT WERE CHARGED TO BAD DEBT EXPENSE AT 100% CHARGE VALUE. THIS AMOUNT IS $0 FOR 2013 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. PART III, Section B, Line 8 Medicare DESCRIBE THE EXTENT TO WHICH ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT AND THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 AND INDICATE WHAT COSTING METHODOLOGY WAS USED. 2013 MEDICARE CHARGES REPORTED BY CMS IN THE PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM FOR PROVIDER FYE 12/31 WERE MULTIPLIED BY THE 2013 COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST OF CARE RELATED TO THE REIMBURSEMENT PAYMENTS REPORTED ON LINE 5. PART III, Section C, Line 9b Collection Practices DOES THE ORGANIZATION'S COLLECTION POLICY CONTAIN PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. ADMINISTRATIVE POLICY: COLLECTION OF SELF PAY AND BALANCE AFTER INSURANCE MONIES, SELF PAY ACCOUNTS WITH NO VERIFIABLE INSURANCE AND BALANCE AFTER INSURANCE ACCOUNTS ARE CONSIDERED FOR FINANCIAL ASSISTANCE THROUGHOUT THE COLLECTION PROCESS FOR THOSE GUARANTORS WHO ARE FINANCIALLY UNABLE TO PAY, EITHER THROUGH A GOVERNMENT PROGRAM OR THROUGH CHILDREN'S HOSPITAL & MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM. ALL CORRESPONDENCE, INCLUDING STATEMENTS AND COLLECTION LETTERS STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. PART VI 2-NEEDS ASSESSMENT CHILDREN'S HOSPITAL & MEDICAL CENTER USES NUMEROUS RESOURCES TO CONDUCT ASSESSMENTS OF THE HEALTH CARE NEEDS OF CHILDREN IN THE COMMUNITIES WE SERVE. THESE RESOURCES INCLUDE NATIONAL PEDIATRIC CARE STANDARDS AND TRENDS AS IDENTIFIED BY CHILDREN'S HOSPITAL ASSOCIATION (CHA). INTERNAL RESOURCES THAT ASSIST WITH THE ASSESSMENT OF CHILD HEALTH NEEDS ARE THE FAMILY ADVISORY COUNCIL, PHYSICIANS AND CLINICAL SERVICE UNITS. AN ANALYSIS OF THE INFORMATION AND/OR DATA COLLECTED FROM THESE VARIOUS RESOURCES IS CONDUCTED TO IDENTIFY POTENTIAL GAPS IN CHILD HEALTH NEEDS IN THE COMMUNITIES SERVED. NEEDS THAT ALIGN WITH THE HOSPITAL'S MISSION AND CAPACITY ARE SELECTED FOR REVIEW BY ADMINISTRATION, WHICH PRIORITIZES NEEDS AND AUTHORIZES IMPLEMENTATION BASED ON THE SCOPE OR SERIOUSNESS OF THE PROBLEM, AVAILABILITY OF COMMUNITY RESOURCES, AVAILABILITY OF FUNDING, AND/OR ALIGNMENT WITH THE HOSPITAL'S EXPERTISE AND STRATEGIC GOALS. IN 2012, CHILDREN'S COLLABORATED WITH BOYS TOWN NATIONAL RESEARCH HOSPITAL IN OMAHA TO PLAN AND CONDUCT A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT SURVEY FOCUSING SOLELY ON PEDIATRICS IN 2012. PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC) WAS HIRED TO GATHER DATA TO ASSIST IN DETERMINING THE HEALTH STATUS, BEHAVIORS AND NEEDS OF CHILDREN AND ADOLESCENTS IN THE OMAHA METROPOLITAN AREA. PART VI 3- PATIENT EDUCATION OF ELIGIBILITY FINANCIALLY RESPONSIBLE PARTIES WHO EXPERIENCE DIFFICULTY IN MEETING THEIR FINANCIAL OBLIGATIONS WILL BE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGH GOVERNMENT PROGRAMS AND OTHER POTENTIAL FUNDING SOURCES OR ALTERNATIVELY QUALIFIED FOR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS IDEALLY DETERMINED EITHER PRIOR TO SERVICES BEING PROVIDED OR AT THE TIME SERVICES ARE RENDERED AND IS BASED UPON FAMILY/GUARANTOR INCOME, FAMILY SIZE AND OTHER SPECIAL CONSIDERATIONS. THE PRIMARY RESPONSIBILITY TO IDENTIFY FINANCIAL NEED IS WITH THE FINANCIAL COUNSELORS, PATIENT FINANCIAL SERVICES, AND SOCIAL WORK STAFF. THESE STAFF MEMBERS ARE TRAINED TO IDENTIFY PATIENT NEEDS AND ANSWER FINANCIAL ASSISTANCE QUESTIONS. THERE ARE SEVERAL POINTS IN THE PATIENT EXPERIENCE WHERE FINANCIAL ASSISTANCE RESOURCES ARE OFFERED. THE FIRST OCCURS AT THE PRE-REGISTRATION OF INPATIENT ADMITS AND OUTPATIENTS PRESENTING THROUGH Children's Ambulatory Recovery and Extended Stay (CARES) AND FOR THOSE PATIENTS SCHEDULED IN THE SPECIALTY PEDIATRIC CENTER CLINICS. AT THIS TIME, ELECTRONIC ELIGIBILITY IS RAN ON THE INSURED. THE BENEFIT DETAIL INCLUDING DEDUCTIBLE, CO-PAYMENT AND COINSURANCE AMOUNTS ARE DISCUSSED WITH THE FAMILY AT THAT TIME. ALL INDIVIDUALS WHO ARE FINANCIALLY UNABLE TO PAY WILL BE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGH GOVERNMENT PROGRAMS AND OTHER POTENTIAL FUNDING SOURCES OR ALTERNATIVELY QUALIFIED FOR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. AT THE TIME OF REGISTRATION, INSURANCE IS DISCUSSED AND FAMILIES AGAIN ARE OFFERED THE ASSISTANCE OF FINANCIAL COUNSELORS WHO ARE AVAILABLE M-F. ALL SELF PAY FAMILIES ARE ENCOURAGED TO SPEAK TO A FINANCIAL COUNSELOR. CARE ESTIMATES OR QUESTIONS REGARDING ESTIMATE OF COST FOR UPCOMING TESTING IS DIRECTED TO THE PATIENT REGISTRATION MANAGER AND THESE SERVICES ARE AGAIN OFFERED PRIOR TO ENDING THE CONVERSATION. FINANCIAL ASSISTANCE INFORMATION IS ALSO LOCATED IN THE PATIENT HANDBOOKS. PATIENT STATEMENTS INCLUDE LEAFLETS AND ALL MAILED CORRESPONDENCE INCLUDING BILLS, STATEMENTS, AND COLLECTION LETTERS STATE THAT "FINANCIAL ASSISTANCE MAY BE AVAILABLE." CHILDREN'S HOSPITAL & MEDICAL CENTER'S INTERNET WEBSITE ALSO OFFERS A "FINANCIAL ASSISTANCE" LINK THAT INFORMS READERS "IF YOU ARE UNINSURED OR HAVE LIMITED INCOME, YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE THROUGH GOVERNMENT PROGRAMS OR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM". THE WEBSITE EXPLAINS THAT DEPENDING ON INCOME LEVEL, ALL OR PART OF THE MEDICAL COSTS MAY BE FUNDED BY MEDICAID AND ALTERNATIVELY IF THEY ARE DETERMINED "NOT ELIGIBLE" FOR MEDICAID AFTER PROVIDING ALL OF THE REQUIRED DOCUMENTATION THAT THEY MAY THEN APPLY FOR THE CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. CONTACT NUMBERS FOR THE FINANCIAL COUNSELORS AND HOURS OF SERVICE ARE PROVIDED. ALL OTHER BILLING, PAYMENT AND FINANCIAL RESPONSIBILITY RELATED LINKS ON CHILDREN'S WEBSITE STATES THAT "FINANCIAL ASSISTANCE MAY BE AVAILABLE." THE FINANCIAL ASSISTANCE POLICY IS CURRENTLY AVAILABLE ON THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE AT WWW.CHILDRENSOMAHA.ORG/FINANCIALASSISTANCE AND IS ALSO AVAILABLE UPON REQUEST. PART VI 4- COMMUNITY INFORMATION THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF DOUGLAS AND SARPY COUNTIES IN NEBRASKA AND POTTAWATTAMIE COUNTY IN IOWA. THE PRIMARY SERVICE AREA HAS A CURRENT AGGREGATE POPULATION OF APPROXIMATELY 795,752. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA. FOR YEAR ENDED DECEMBER 31, 2013, 58% OF THE HOSPITAL'S INPATIENT DISCHARGES WERE FROM PATIENTS RESIDING IN THE THREE-COUNTY PRIMARY SERVICE AREA. PATIENTS RESIDING IN THE SEVENTEEN-COUNTY SECONDARY SERVICE AREA ACCOUNTED FOR 19% OF TOTAL HOSPITAL INPATIENT DISCHARGES DURING THIS SAME TIME PERIOD. THE REMAINING 23% OF TOTAL DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE THE PRIMARY AND SECONDARY SERVICE AREAS. 2013 DEMOGRAPHIC SUMMARY OMAHA METRO MARKET AREA: DOUGLAS, SARPY AND POTTAWATTAMIE COUNTIES SOURCES: UNITED STATES CENSUS BUREAU AND CHILDREN'S HOSPITAL & MEDICAL CENTER PATIENT ENCOUNTER DATABASE. COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 12 TOTAL POPULATION 795,752 PEDIATRIC POPULATION 206,040 AVERAGE HOUSEHOLD INCOME $76,078 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 13.2% UNDER AGE 18 18.1% PERCENT OF RESIDENTS ON MEDICAID 13.8% AGE POPULATION % OF TOTAL LESS THAN 18 206,040 25.9% 18 TO 24 78,333 9.9% 25 TO 44 224,774 28.2% 45 TO 64 196,140 24.6% 65+ 90,465 11.4% TOTAL 795,752 100.0% RACE POPULATION % OF TOTAL WHITE 603,976 75.9% BLACK 67,639 8.5% HISPANIC 81,962 10.3% ASIAN/PACIFIC ISLANDER 19,894 2.5% OTHER 19,098 2.4% AM. IND./ALASKA NAT. 3,183 0.4% TOTAL 795,752 100.0% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE PERCENTAGE OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS: 12.0% COUNTY # OF CENSUS TRACTS* TOTAL CENSUS TRACTS % OF TOTAL DOUGLAS 36 156 23.1% SARPY 3 43 7.0% POTTAWATTAMIE 3 30 10.0% TOTAL 42 229 18.3% *CENSUS TRACT IS A GEOGRAPHICAL DIVISION OF 500 TO 3,000 HOUSEHOLDS. PART VI 5- PROMOTION OF COMMUNITY HEALTH PROUDLY SERVING CHILDREN SINCE 1948, CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE ONLY FULL-SERVICE, PEDIATRIC HEALTH CARE CENTER IN NEBRASKA. LOCATED IN OMAHA, IT PROVIDES EXPERTISE IN MORE THAN 30 PEDIATRIC SPECIALTY SERVICES TO CHILDREN AND FAMILIES ACROSS A FIVE-STATE REGION AND BEYOND. THE 145 BED, NON-PROFIT HOSPITAL HOUSES THE ONLY LEVEL II PEDIATRIC TRAUMA CENTER IN THE REGION AND OFFERS 24-HOUR, IN-HOUSE SERVICES BY PEDIATRIC CRITICAL CARE SPECIALISTS. THE CRITICAL CARE TRANSPORT TEAM PROVIDES STATE-OF-THE-ART CARE AND TRANSPORTATION TO CRITICALLY ILL AND INJURED NEONATES, INFANTS AND CHILDREN. CHILDREN'S HAS ACHIEVED THE MAGNET DESIGNATION FOR NURSING EXCELLENCE AND ITS PEDIATRIC INTENSIVE CARE UNIT HAS EARNED A SILVER BEACON AWARD FOR EXCELLENCE FROM THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES. THE HOSPITAL HAS ACHIEVED STAGE 6 ON THE HIMSS ANALYTICS EMR ADOPTION MODELSM (EMRAM). CHILDREN'S IS ALSO RANKED AS A BEST IN CHILDREN'S HOSPITAL BY U.S NEWS & WORLD REPORT IN ORTHOPAEDICS, PULMONOLOGY, CARDIOLOGY AND HEART SURGERY, AND GASTROENTEROLOGY AND GI SURGERY. A PEDIATRIC AFFILIATION ESTABLISHED BETWEEN CHILDREN'S AND THE UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF MEDICINE (UNMC) SUPPORTS ENHANCEMENTS IN PEDIATRIC EDUCATION, RESEARCH AND CLINICAL CARE. CHILDREN'S IS THE PRIMARY TEACHING SITE FOR THE FAMILY PRACTICE AND JOINT PEDIATRICS RESIDENCY PROGRAMS AT CREIGHTON UNIVERSITY AND UNMC. CHILDREN'S HOSPITAL & MEDICAL CENTER IS COMMITTED TO ENSURING THAT NO CHILD WITH A MEDICAL NEED IS EVER TURNED AWAY DUE TO A FAMILY'S INABILITY TO PAY FOR SERVICES. IN 2013, OUR HOSPITAL: -PROVIDED $5.9 MILLION IN SERVICES IN THE FORM OF UNCOMPENSATED CARE\CHARITY CARE ($3.9 MILLION) AND BAD DEBT WRITE-OFFS($2.0 MILLION) TO FAMILIES UNABLE TO PAY THE BILLS ASSOCIATED WITH THEIR CHILDREN'S MEDICAL CARE. WITH 42 PERCENT OF PATIENT CARE REVENUES DEVOTED TO THE CARE OF LOW-INCOME CHILDREN ASSISTED BY MEDICAID, THE MEDICAID REIMBURSEMENT SHORTFALL FOR FY 2013 WAS $20.7 MILLION LESS THAN THE COST OF THE CARE PROVIDED. -CONTRIBUTED $1.7 MILLION TOWARDS COMMUNITY HEALTH EDUCATION AIMED AT PROMOTING HEALTH AND PREVENTING ILLNESS AND INJURY MADE AVAILABLE THROUGH THE KOHL'S INJURY PREVENTION, OBESITY PREVENTION, PARENTING U EDUCATION CLASSES, OUTREACH CLASSES, HEALTH FAIRS, JUST KIDS MAGAZINE AND THE CONSUMER WEB SITE. PUBLIC HEALTH ASSISTANCE IS AVAILABLE THROUGH SOCIAL WORK, PASTORAL AND SPIRITUAL, CHILD LIFE SERVICES, FINANCIAL COUNSELING AND A VARIETY OF SUPPORT GROUPS. CHILDREN'S GIVES BACK TO THE COMMUNITY THROUGH ADVOCACY SERVICES WHICH ARE AVAILABLE TO ANYONE SUSPECTING CHILD ABUSE OR NEGLECT, LOW-COST LODGING FOR FAMILIES OF OUT-OF-TOWN PATIENTS, AGENCY REPRESENTATION, COMMUNITY EVENT SPONSORSHIPS AND CHARITABLE DONATIONS. -CONTRIBUTED $7.1 MILLION IN PEDIATRIC HEALTH CARE EDUCATION COSTS TO EDUCATE TOMORROW'S HEALERS AND AN ADDITIONAL $1.2 MILLION TO SUPPORT PEDIATRIC EDUCATION, RESEARCH AND CLINICAL CARE THAT WILL IN TURN IMPROVE THE HEALTH CARE OF ALL CHILDREN. IN 2013, THE HOSPITAL SUPPORTED THE JOINT CREIGHTON-NEBRASKA UNIVERSITIES HEALTH FOUNDATION PEDIATRICS RESIDENCY PROGRAMS AT UNMC AND CREIGHTON UNIVERSITY, AS WELL AS MANY OF THE REGION'S NURSING AND HEALTH PROFESSIONAL SCHOOLS. -PROVIDED $28.9 MILLION IN SUBSIDIZED CLINICAL HEALTH SERVICES, OR PROGRAMS OFFERED DESPITE FINANCIAL LOSS BECAUSE THEY MEET AN IDENTIFIED COMMUNITY NEED. THE EMERGENCY DEPARTMENT AND EMERGENCY TRANSPORT SERVICES, IN ADDITION TO BEHAVIORAL HEALTH AND MANY OF THE AMBULATORY CLINIC PROGRAMS ALL OPERATE AT NEGATIVE MARGINS. NON-BILLED SERVICES PROVIDED INCLUDE FINANCIAL COUNSELING, PASTORAL AND SPIRITUAL CARE, SOCIAL WORK AND CHILD LIFE SERVICES PROVIDED AT NO COST OR NOMINAL TO THE PATIENT. IN 2013, CHILDREN'S HOSPITAL & MEDICAL CENTER CONTRIBUTED IN TOTAL OVER $64 MILLION IN COMMUNITY BENEFITS REPRESENTING 26 PERCENT OF THE HOSPITAL'S OPERATING EXPENSES. PART VI 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 PART VI 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.childrensSNAPSHOT.org. true Ne Pediatric Practice Inc 8200 Dodge St Omaha NE 68114 263064869 501(c)(3) 1021709 Pediatrics/Research University of NE College of Medicine 985520 NE Med Ctr Omaha NE 68198 470049123 501(c)(3) 117659 PEDIATRICS/RESEARCH 2 CHARITY CARE ASSISTANCE TO THOSE PATIENTS IN NEED 5139 8808751 Book WRITE OFF PAT. ACCTS SCHEDULE I, PART I, LINE 2 CHILDREN'S HOSPITAL & MEDICAL CENTER HAS A WRITTEN FINANCIAL ASSISTANCE/CHARITY CARE POLICY. THE AMOUNT OF FINANCIAL ASSISTANCE IS BASED ON THE ANNUAL GROSS INCOME THRESHOLDS USING THE CURRENT FEDERAL POVERTY LEVEL GUIDELINES. GRANTS ARE ONLY DISTRIBUTED TO 501(C)(3) ORGANIZATIONS BASED ON THE HOSPITAL'S EVALUATION CRITERIA. X true true X X X X false true false false false false false false false JOHN MOORE MD MEMBER/Physician 217037 0 13968 0 2621 0 19168 0 12889 0 265683 0 0 0 KATHY ENGLISH EVP/COO 319905 0 146540 0 52755 0 68742 0 6134 0 594076 0 0 0 MICHAEL BROWN SVP/CFO 316142 0 195585 0 39817 0 51635 0 10631 0 613810 0 0 0 CARL GUMBINER MD SVP/CMO 322200 0 161931 0 19555 0 41798 0 1589 0 547073 0 0 0 GEORGE E REYNOLDS MD VP/CMIO/CIO 374721 0 145089 0 4826 0 37900 0 14733 0 577269 0 0 0 GARY A PERKINS FACHE PRESIDENT/CEO/MEMBER 511727 0 316063 0 386726 0 54747 0 9889 0 1279152 0 0 0 JOHN ANDRESEN MD PHYSICIAN 283213 0 21231 0 1163 0 16619 0 8481 0 330707 0 0 0 RACHEL MCCANN MD PHYSICIAN 272366 0 20183 0 3058 0 15300 0 13328 0 324235 0 0 0 STEVEN C BURNHAM SVP 252000 0 82306 0 12817 0 32808 0 1291 0 381222 0 0 0 DEBRA ARNOW RN VP/CNO 226467 0 72189 0 5083 0 12750 0 5755 0 322244 0 0 0 MICHAEL WILCZEWSKI MD PHYSICIAN 273210 0 16962 0 571 0 20400 0 197 0 311340 0 0 0 PART I, LINE 1A GARY PERKINS' SOCIAL CLUBS DUES ARE PAID FOR BY THE ORGANIZATION TO BE USED FOR BUSINESS PURPOSES. PART II, COLUMN B (III) THE FIGURE FOR GARY A. PERKINS ITEMIZED AT PART II B (III) "OTHER REPORTABLE COMPENSATION" INCLUDES A PAYMENT OF THREE HUNDRED SEVENTY THOUSAND DOLLARS REPRESENTING A CONTRIBUTION TO A SUPPLEMENT EXECUTIVE RETIREMENT PLAN ("SERP") FOR MR. PERKINS IN HIS CAPACITY AS CHIEF EXECUTIVE OFFICER. THE SERP BENEFIT TARGET IS BASED ON MR. PERKINS 30 YEARS OF SERVICE AND WILL PROVIDE A MARKET COMPETITIVE BENEFIT IN THE OPINION OF THE HOSPITAL'S INDEPENDENT COMPENSATION CONSULTANT. PART I, LINE 4B The following individuals participated in a 457(f) plan during 2013. The amount of deferred compensation for each of the individuals during 2013 are as follows: Michael Brown $31,235 Kathy English $28,292 Carl Gumbiner, MD $29,048 Stephen C. Burnham $20,058 A Hospital Authority #2 of Douglas CO NE 521440796 259230KT6 2008-08-02 100881609 Refund Child Hosp 2007 Series A&B false false false A 3035000 0 100881788 5000179 0 0 751783 24826 0 2755000 92350000 0 true false true true A false false false false 0 false false false true A false false true true true true Morgan Stanley 25. false false false 0 false true A 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. Part IV, Line 2C Computation Date : July 31, 2013 FORM 990, PART III, LINE 4A THE HOSPITAL OPERATES A 145 BED PEDIATRIC HOSPITAL, WHICH INCLUDES 18 PICU AND 40 NICU BEDS. THE HOSPITAL HAS SEVEN SURGICAL SUITES, A HYBRID HEART CATHETERIZATION LAB, 40 OUTPATIENT SPECIALITY CLINICS, AND A 33 BED OUTPATIENT "DAY HOSPITAL" KNOWN AS THE CHILDREN'S AMBULATORY RECOVERY AND EXPRESS STAY(CARES) UNIT. THE CHILDREN'S SPECALITY PEDIATRIC CENTER PROVIDES OUTPATIENT DIAGNOSTICS, TREATMENT, AND THERAPY IN ADDITION TO OFFERING OUTPATIENT EATING DISORDER SERVICES AND PROVIDING A FULL ARRAY OF PEDIATRIC HOME HEALTH CARE SERVICES TO CHILDREN AND ADOLESCENTS WHO HAVE IMMEDIATE OR LONG TERM HEALTH CARE NEEDS, INCLUDING HOME MEDICAL EQUIPMENT RENTALS AND SALES, HOME HEALTH NURSING, IN HOME PRIVATE DUTY NURSING AND HOME INFUSION THERAPY SERVICES. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT IN THE REGION. IN 2013, CHILDREN'S HOSPITAL & MEDICAL CENTER RECEIVED LEVEL II PEDIATRIC TRAUMA VERIFICATION AND LAUNCHED A HEART TRANSPLANT PROGRAM FOR INFANTS AND CHILDREN. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE FIRST AND ONLY PEDIATRIC HOSPITAL IN NEBRASKA, AND THE ONLY PEDIATRIC HOSPITAL SERVING WESTERN IOWA AND NORTHWEST MISSOURI, TO RECEIVE PEDIATRIC TRAUMA VERIFICATION. THE FETAL CARE CENTER FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. CHILDREN'S HOSPITAL & MEDICAL CENTER ALSO PROVIDES SPECIALITY PEDIATRIC CARE SERVICES IN LINCOLN, KEARNEY, GRAND ISLAND, HASTINGS, NORTH PLATTE, COLUMBUS, NORFOLK, AND HOLDREGE, NEBRASKA; SIOUX FALLS AND RAPID CITY, SOUTH DAKOTA; AND SIOUX CITY,IOWA. FORM 990, PART VI, LINE 11b GOVERNANCE, MANAGEMENT, AND DISCLOSURE The form 990 will be available for all board members through the Director's Desk website and an overview will be presented to the Executive Committee of Children's Hospital & Medical Center prior to filing with the IRS. Form 990, Part VI, Line 12C POLICIES THE CONFLICT OF INTEREST POLICY APPLIES TO ANY PERSON IN A POSITION TO EXERCISE INFLUENCE IN CONNECTION WITH ANY CONTRACT, TRANSACTION OR ARRANGEMENT PRESENTED TO THE BOARD OR A BOARD COMMITTEE FOR APPROVAL (INTERESTED PERSON). INTERESTED PERSON INCLUDES BUT NOT LIMITED TO ANY DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWER, OR KEY EMPLOYEE. AN INTERESTED PERSON MUST ANNUALLY SUBMIT A COMPLETED CONFLICTS OF INTEREST QUESTIONNAIRE IN THE FORMAT BY THE GOVERNANCE COMMITTEE FROM TIME TO TIME. EACH INTERESTED PERSON SHALL ANNUALLY ACKNOWLEDGE IN WRITING THAT HE OR SHE (A) HAS RECEIVED A COPY OF THIS POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) AGREES TO COMPLY WITH THE POLICY; (D) UNDERSTANDS THAT THE POLICY APPLIES TO THE BOARD AND COMMITTEES; (E) UNDERSTANDS THAT CHILDRENS IS A NOT-FOR-PROFIT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES; (F) AGREES TO PROMPTLY REPORT TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDRENS GENERAL COUNSEL ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICTS OF INTEREST QUESTIONNAIRE; AND (G) STATES THAT THE INFORMATION PROVIDED IN THE CONFLICTS OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF. AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES OR WHENEVER IT INVOLVES A MATTER OF BOARD ACTION. DISCLOSURE MEANS PROMPTLY PROVIDING THE MATERIAL FACTS OF AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDRENS GENERAL COUNSEL (IN WRITING IF TIME ALLOWS) OR TO THE BOARD OR BOARD COMMITTEE REVIEWING THE CONTRACT, TRANSACTION OR ARRANGEMENT. CERTAIN CIRCUMSTANCES, IN ADDITION TO FINANCIAL INTERESTS, COULD GIVE RISE TO A POTENTIAL CONFLICT OF INTEREST, INCLUDING INSTANCES WHERE THE ACTIONS OR ACTIVITIES OF AN INDIVIDUAL ON BEHALF OF CHILDRENS ALSO INVOLVE OBTAINING A PERSONAL GAIN OR ADVANTAGE, OR COULD HAVE AN ADVERSE EFFECT ON CHILDRENS INTERESTS. ALSO, DISCLOSING OR USING INFORMATION RELATING TO CHILDRENS BUSINESS FOR THE PERSONAL PROFIT OR ADVANTAGE OF AN INDIVIDUAL OR HIS OR HER FAMILY WOULD GIVE RISE TO A CLAIM OF CONFLICT. FULL DISCLOSURE OF ANY SUCH SITUATION OR ANY OTHER CIRCUMSTANCES IN DOUBT SHOULD BE MADE. A POTENTIAL CONFLICT OF INTEREST DOES NOT NECESSARILY RISE TO THE LEVEL OF AN ACTUAL CONFLICT OF INTEREST, BUT ONCE RECOGNIZED, IT MUST IN EVERY CASE BE DISCLOSED AND EVALUATED. IN SOME INSTANCES, IT MAY BE SO SERIOUS THAT IT PREVENTS THE INDIVIDUAL FROM FURTHER PARTICIPATION IN CHILDRENS DELIBERATIONS WITH RESPECT TO A PARTICULAR TRANSACTION, OR COULD BE SO PERVASIVE THAT THE INDIVIDUAL MAY BE DISQUALIFIED FROM CONTINUED AFFILIATION WITH CHILDRENS. ON THE OTHER HAND, IT MAY BE OF LITTLE OR NO SIGNIFICANCE ONCE IT HAS BEEN DISCLOSED. THE GOVERNANCE COMMITTEE WILL CONSIDER THE FOLLOWING FACTORS, AMONG OTHER RELEVANT FACTS, WHEN DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS: (I) THE PROXIMITY OF THE INTERESTED PERSON TO THE DECISION-MAKING AUTHORITY OF THE OTHER ENTITY INVOLVED IN THE TRANSACTION OR BUSINESS ARRANGEMENT; (II) THE MAGNITUDE OF THE FINANCIAL INTEREST; (III) THE DEGREE TO WHICH THE INTERESTED PERSON MIGHT BENEFIT PERSONALLY IF A PARTICULAR TRANSACTION OR BUSINESS ARRANGEMENT WERE APPROVED; AND (IV) THE ABILITY OF THE INTERESTED PERSON TO MAKE AN INDEPENDENT DECISION BASED ONLY ON THE BEST INTERESTS OF CHILDRENS. THE GOVERNANCE COMMITTEE SHALL REVIEW EACH COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE, AND MAY MAKE SUCH FURTHER INVESTIGATION OF POTENTIAL CONFLICTS AS IT MAY DETERMINE APPROPRIATE. THE GOVERNANCE COMMITTEE SHALL MAKE APPROPRIATE REPORTS TO THE BOARD CONCERNING ITS REVIEW, ANY FURTHER INVESTIGATION, AND ITS RECOMMENDATIONS TO THE BOARD REGARDING ANY POTENTIAL CONFLICT OF INTEREST. WHENEVER AN INTERESTED PERSON (OR A PERSON OTHER THAN THE INTERESTED PERSON) VOLUNTARILY IDENTIFIES OR DISCLOSES A POTENTIAL CONFLICT OF INTEREST, THE REMAINING BOARD/COMMITTEE MEMBERS REVIEW AND DETERMINE WHETHER A CONFLICT EXISTS. ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS MAY VOTE TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS AND THE SUBJECT INTERESTED PERSON CANNOT BE PRESENT DURING THE VOTE. TRANSACTIONS OR BUSINESS ARRANGEMENTS WITH INTERESTED PERSONS WITH CONFLICTS OF INTEREST MUST BE APPROVED IN ADVANCE BY A MAJORITY OF DISINTERESTED DIRECTORS. IN ORDER TO APPROVE AN ARRANGEMENT OR TRANSACTION INVOLVING AN ACTUAL CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED DIRECTORS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN CHILDRENS BEST INTEREST, IS FAIR AND REASONABLE TO CHILDRENS AND THAT, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN CASES IN WHICH AN INTERESTED PERSON HAS A FINANCIAL INTEREST IN A PROPOSED ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN, AT THE DISCRETION OF THE BOARD: (A) THE INTERESTED PERSON MAY BE REQUIRED TO LEAVE THE MEETING FOR THE GENERAL DISCUSSION OF THE MATTER AND THE BOARD VOTE; AND/OR (B) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION. THE GOVERNANCE COMMITTEE CAN RECOMMEND TO THE BOARD THAT A DIRECTOR OR A MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS BE ASKED TO RESIGN IN THE EVENT A CONFLICT OF INTEREST IS SO SUBSTANTIAL THAT IT WOULD BE INCOMPATIBLE WITH CHILDRENS BEST INTERESTS TO HAVE SUCH AN INDIVIDUAL ON ITS BOARD/COMMITTEE. IF THE BOARD/COMMITTEE BELIEVES AN INTERESTED PERSON HAS FAILED TO COMPLY WITH THIS POLICY, THE BOARD SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND GIVE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE. AFTER HEARING THE RESPONSE AND CONDUCTING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD SHALL DETERMINE WHETHER SUCH PERSON HAS, IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THIS POLICY. IF THE BOARD DETERMINES THAT THERE HAS BEEN A VIOLATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION WHICH MAY INCLUDE REMOVAL FROM THE BOARD. Form 990, Part VI, Line 15 POLICIES EACH YEAR AN INDEPENDENT COMPANY (TOWERS WATSON) CONDUCTS A MARKET ANALYSIS OF THE EXECUTIVE COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE. EXECUTIVE BASE SALARIES ARE TARGETED FOR THE 50TH PERCENTILE OF THE MARKET. TOWERS WATSON ISSUES AN ANNUAL REASONABLENESS OPINION LETTER REGARDING THE APPROPRIATENESS OF THE EXECUTIVE PAY LEVELS. THE COMPENSATION COMMITTEE IS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE REVIEWS BASE PAY CHANGES FOR THE TOP FIVE EXECUTIVES (CHIEF EXECUTIVE OFFICER, CHIEF FINANCIAL OFFICER, CHIEF OPERATING OFFICER, CHIEF MEDICAL OFFICER AND SENIOR VP PHYSICIAN NETWORKS) AND VICE PRESIDENTS. THE BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING THE CEO'S PERFORMANCE WHICH AFFECTS HIS PAY RATE INDIRECTLY. 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 Other Changes in Net Assets MINORITY INTEREST IN CHILDREN'S PHYSICIANS 2,373,407 CHANGE IN VALUE OF SWAP 3,308,710 CHANGE IN VALUE OF SPLIT INTEREST 1,954,000 CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK 3,300 CAPITAL TRANSFERS CHILDREN'S HOSPITAL & MEDICAL CENTER FND (29,043,338) TOTAL CHANGES IN NET ASSETS (21,403,921) CHILDREN'S HOSPITAL & MEDICAL CENTER FDN 8200 DODGE STREET OMAHA NE 68114 476105603 FUNDRAISING NE 501(C)(3) LINE 7 CHMC true CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA NE 68114 470689372 PED. CLINIC NE 501(C)(3) LINE 9 CHMC true KENT INC 8200 DODGE STREET OMAHA NE 68114 470527928 REAL ESTATE NE CHMC C corp 0 219495 1.00000 true CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA NE 68114 363967578 HEALTH NETWORk NE CHMC C corp 0 0 1.00000 true false false true false false false false false false true false true true true true false true true true CHILDREN'S HOSPITAL & MEDICAL CENTER FND C 4195792 BOOK CHILDREN'S HOSPITAL & MEDICAL CENTER FND LMNOQ 571338 BOOK CHILDREN'S PHYSICIANS J 338260 BOOK CHILDREN'S HOSPITAL & MEDICAL CENTER FND R 28472000 BOOK