PHYSICIANS CLINIC INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
PHYSICIANS CLINIC INC (EIN 47-0687317)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-13
IRS object ID
201343179349302374
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-13T10:48:52-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN135565207EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line12 CENTRAL PARK PLAZA SUITE 1501AddressLine1
CityOMAHACity
StateNEState
ZIP Code68102ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN470687317EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1PHYSICIANS CLINIC INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlPHYSNameControl
Phone4023544851Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line18511 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLINDA K BURTName
TitleVICE PRES-FINANCE, CFOTitle
Phone4023544000Phone
Date Signed2013-11-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
PTINP00223617PTIN
Phone4023481450Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1METHODIST PHYSICIANS CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonTODD D GRAGESNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line18511 W DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode
FieldValueIRS element (for citing)
Gross Receipts128854698GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BESTCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1985YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY, COST EFFECTIVE HEALTHCARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body8NbrVotingMembersGoverningBody
Nbr Independent Voting Members5NbrIndependentVotingMembers
Total Nbr Employees1207TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI359492TotalGrossUBI
Net Unrelated Business Txbl Income77532NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2855ContributionsGrantsPriorYear
Contributions Grants Current Year671ContributionsGrantsCurrentYear
Program Service Revenue Prior Year119523130ProgramServiceRevenuePriorYear
Program Service Revenue CY127482478ProgramServiceRevenueCY
Investment Income Prior Year-72889InvestmentIncomePriorYear
Investment Income Current Year3128InvestmentIncomeCurrentYear
Other Revenue Prior Year418950OtherRevenuePriorYear
Other Revenue Current Year347165OtherRevenueCurrentYear
Total Revenue Prior Year119872046TotalRevenuePriorYear
Total Revenue Current Year127833442TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year3053639GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY3452936GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year91729983SalariesEtcPriorYear
Salaries Etc Current Year98915146SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year34485317OtherExpensePriorYear
Other Expenses Current Year35208157OtherExpensesCurrentYear
Total Expenses Prior Year129268939TotalExpensesPriorYear
Total Expenses Current Year137576239TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-9396893RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-9742797RevenuesLessExpensesCY
Total Assets BOY60199602TotalAssetsBOY
Total Assets EOY55524860TotalAssetsEOY
Total Liabilities BOY36670008TotalLiabilitiesBOY
Total Liabilities EOY31463893TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY23529594NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY24060967NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionMETHODIST PHYSICIANS CLINIC PROVIDES ACCESSIBLE, QUALITY MEDICAL CARE THROUGH ITS INTEGRATED TEAM OF HEALTH PROFESSIONALS, INCLUDING SPECIALISTS IN FAMILY MEDICINE, INTERNAL MEDICINE, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, SURGERY, ORTHOPEDIC SURGERY, DERMATOLOGY, URGENT CARE, IMAGING, CARDIOLOGY AND INFECTIOUS DISEASE. METHODIST PHYSICIANS CLINIC IS DEDICATED TO MAINTAINING A COMPREHENSIVE DELIVERY SYSTEM AND A LIFE-LONG PARTNERSHIP WITH ITS PATIENTS, FAMILIES AND THE COMMUNITY.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense64440161Expense
Grants1595337Grants
Revenue58576313Revenue
DescriptionPHYSICIANS CLINIC PRIMARY CARE PROVIDERS SERVE AS THE PATIENT'S PERSONAL HEALTH ADVOCATE FOCUSING THEIR MEDICAL KNOWLEDGE AND EXPERTISE ON EACH PERSON'S UNIQUE HEALTH NEEDS. THEY OFFER COMPASSIONATE CARE AND PERSONAL ATTENTION - IN SICKNESS AND IN HEALTH.PRIMARY CARE MEDICINE PROVIDES CONTINUING AND COMPREHENSIVE HEALTH CARE FOR THE INDIVIDUAL AND FAMILY AND INCLUDES FAMILY MEDICINE, PEDIATRICS AND INTERNAL MEDICINE SPECIALTIES. PHYSICIANS CLINIC PHYSICIANS ARE KNOWLEDGEABLE IN THE BIOLOGICAL, CLINICAL AND BEHAVIORAL SCIENCES. THE SCOPE OF PRIMARY CARE MEDICINE ENCOMPASSES ALL AGES, BOTH GENDERS AND EACH ORGAN SYSTEM AND EVERY DISEASE ENTITY. PHYSICIANS CLINIC HOLDS PHYSICIANS TO THE HIGHEST QUALITY STANDARDS, REQUIRING BOARD CERTIFICATION OF ALL NEW FAMILY PHYSICIANS. PHYSICIANS CLINIC PHYSICIANS PROVIDE THE BEST IN HEALTH CARE FOR THE INDIVIDUAL AND THE INDIVIDUAL'S FAMILY MEMBERS FROM INFANCY TO THE GOLDEN YEARS.DURING 2012 THERE WERE 567,512 VISITS MADE TO THE VARIETY OF PHYSICIAN SPECIALITIES.PHYSICIANS CLINIC BEGAN ADOPTION OF A PATIENT-CENTERED MEDICAL HOME MODEL, ONE OF HEALTHCARE'S MOST IMPORTANT INNOVATIONS FOR IMPROVING PRIMARY CARE. PATIENT-CENTERED MEDICAL HOME IS A HEALTHCARE SETTING THAT FACILITATES PARTNERSHIPS BETWEEN INDIVIDUAL PATIENTS, THEIR PERSONAL PHYSICIANS AND, WHEN APPROPRIATE, THE PATIENT'S FAMILY. CARE IS FACILITATED BY REGISTRIES, INFORMATION TECHNOLOGY, HEALTH COACHES, DIABETIC EDUCATORS AND OTHER MEANS TO ASSURE THAT PATIENTS RECEIVE THE INDICATED CARE ON A TIMELY BASIS IN AN APPROPRIATE SETTING.PHYSICIANS CLINIC STARTED ADOPTING THE PATIENT-CENTERED MEDICAL HOME MODEL IN 2012 WITH THE GOAL OF BECOMING NCQA CERTIFIED. THE INITIAL FOCUS WAS ON DIABETES CHRONIC CARE WITH PLANS TO MOVE INTO HYPERTENSION AND STROKE CARE. BY THE END OF THE YEAR, THE RESULTS SHOWED A 60% IMPROVEMENT IN DIABETIC METRICS FOR THE EIGHT PRIMARY CARE SITES STARTED. PLANS ARE UNDERWAY TO ADD THE ADDITIONAL NINE PRIMARY CARE SITES IN 2013.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense10923952Expense
Grants336037Grants
Revenue8373084Revenue
DescriptionMETHODIST PHYSICIANS CLINIC PROVIDES SERVICES FROM ORTHOPEDIC PHYSICIANS WHO SPECIALIZE IN THE DIAGNOSIS AND TREATMENT OF DISEASES, INJURIES AND CONDITIONS OF THE MUSCULOSKELETAL SYSTEM. ORTHOPEDIC CONDITIONS INCLUDE ARTHRITIS, SPRAINS, FRACTURES, PULLED MUSCLES, BURSITIS, PULLED OR TORN LIGAMENTS AND TENDONS AS WELL AS SPORTS INJURIES.METHODIST PHYSICIANS CAREFULLY REVIEW THE PATIENTS' NEEDS TO DETERMINE THE BEST TREATMENT FOR ORTHOPEDIC CONDITIONS. IN MOST CASES, ORTHOPEDIC CONDITIONS CAN BE TREATED WITHOUT SURGERY. TREATMENT OPTIONS INCLUDE ANTI-INFLAMMATORY MEDICATIONS, INJECTIONS TO REDUCE INFLAMMATION AND PAIN, EXERCISE OR PHYSICAL THERAPY, BRACING OR SPLINTING AND IN SOME CASES SURGERY. PHYSICIANS CAN HELP THEIR PATIENTS PREVENT OR RECOVER FROM INJURIES ALLOWING PATIENTS TO MEET THEIR PERSONAL FITNESS AND HEALTH GOALS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense28284187Expense
Grants683932Grants
Revenue28731613Revenue
DescriptionOB-GYN SPECIALISTS AT PHYSICIANS CLINIC ARE FOCUSED ON THE HEALTH CARE NEEDS OF WOMEN TREAT AND THEM WITH THE SPECIAL CARE THEY DESERVE WHETHER FOR A ROUTINE OFFICE VISIT OR A HOSPITAL STAY. GYNECOLOGICAL SERVICES SPAN A SPECTRUM INCLUDING ANNUAL WELLNESS CHECKS, DIAGNOSTIC IMAGING, FAMILY PLANNING, HORMONAL DISORDERS, MENOPAUSAL MANAGEMENT, GYNECOLOGIC SURGERY AND LAPAROSCOPIC SURGERY. AT THE METHODIST PHYSICIANS CLINIC WOMEN'S CENTER, COMFORT AND CONVENIENCE FOR PATIENTS IS A MAIN CONCERN. PHYSICIANS CAN PERFORM MANY PROCEDURES IN STATE-OF-THE-ART EXAM ROOMS. EXPERIENCED OBSTETRICAL SPECIALISTS PROVIDE CARE IN ALL ASPECTS OF PREGNANCY FROM PRECONCEPTION TO POSTPARTUM CARE. PRENATAL VISITS INCLUDE EDUCATION TO PREPARE FOR PARENTHOOD. PHYSICIANS AND STAFF WORK WITH PATIENTS TO DEVELOP A BIRTH PLAN WITH THEIR PATIENTS.PATIENT VISITS IN THIS SPECIALTY FOR 2012 TOTALED 86,566.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense26441963Expense
Grants837630Grants
Revenue31801468Revenue
DescriptionMETHODIST PHYSICIANS CLINIC HAS TAKEN AN ACTIVE ROLE IN A NATIONAL CARDIOVASCULAR EDUCATION INITIATIVE KNOWN AS HEARTCARING. ONE OF MANY UNIQUE PROGRAM OFFERINGS AVAILABLE THROUGH THE SPIRIT HEALTH GROUP, HEARTCARING FOCUSES ON EDUCATING PRIMARY CARE PHYSICIANS ON GENDER DIFFERENTIATION IN CARDIOVASCULAR CARE. THESE PHYSICIANS, IN TURN, SHARE WITH WOMEN THROUGHOUT THE COMMUNITY THE KNOWLEDGE THEY HAVE GAINED WITH RESPECT TO THE UNIQUE RISK FACTORS, EARLY DETECTION AND APPROPRIATE TREATMENT OPTIONS ASSOCIATED WITH CARDIOVASCULAR DISEASE IN WOMEN. METHODIST PHYSICIANS CLINIC PRIMARY CARE PHYSICIANS PARTICIPATE ANNUALLY IN HEARTCARING TRAINING, THE INFORMATION FROM WHICH WAS SHARED AT COMMUNITY HEALTH FAIRS AND IN-CLINIC OPEN HOUSES.IN 2012 PHYSICIANS CLINIC PROVIDED CHARITY CARE OF $3,420,336 AND MEDICAID SERVICES PROVIDED AT REIMBURSEMENT LEVELS BELOW COST DEMONSTRATING ITS COMMITMENT TO HELP THOSE UNABLE TO AFFORD HEALTHCARE FOR A VARIETY OF REASONS. THERE WERE NEARLY 567,525 PATIENT VISITS AT 21 LOCATIONS IN OMAHA AND SURROUNDING COMMUNITIES IN THIS YEAR.PHYSICIANS CLINIC PROFESSIONALS GENEROUSLY GIVE OF THEIR TIME AND SERVICES TO SEVERAL AREA ORGANIZATIONS THAT PROVIDE CARE TO THE UNINSURED AND INDIGENT IN THE OMAHA AREA. TWO OF THESE ORGANIZATIONS - HOPE MEDICAL OUTREACH AND THE RENAISSANCE HEALTH CLINIC - CHARACTERIZE SUPPORT FROM METHODIST PHYSICIANS CLINIC PHYSICIANS AS OUTSTANDING, WITH MORE THAN 20 DIFFERENT CLINIC PHYSICIANS ROUTINELY ACCEPTING REFERRED PATIENTS FOR FURTHER TREATMENT.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp26441963TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt837630TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev31801468TotalOfOtherProgramServiceRev
Total Program Service Expense130090263TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With109638NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees1207NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members8NbrVotingGoverningBodyMembers
Number Independent Voting Members5NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1LINDA BURTBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4023544851TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18511 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (15 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
EDSON L BRIDGES II
CHAIRMAN1.000.00XX000
TERENCE COONEY MD
VICE CHAIRMAN40.000.00XX374623077851
STEVEN WILLIAMS MD
SECRETARY40.000.00XX223070060559
NP DODGE JR
TREASURER1.000.00XX000
ALLAN G LOZIER
DIRECTOR1.000.00X000
LARRY V PEARSON
DIRECTOR1.000.00X000
RICHARD C HAHN
DIRECTOR1.000.00X000
PATRICK MC CARVILLE
DIRECTOR40.000.00X272037071989
TODD D GRAGES
PRESIDENT39.001.00X035925884561
LINDA BURT
V-P FINANCE & CFO6.0034.00X044642389779
GEORGE DITTRICK
PHYSICIAN40.000.00648288047889X
KAYVON IZADI
PHYSICIAN40.000.00795868043562X
AJOY JANA
PHYSICIAN40.000.00671839061168X
DARREN KEISER
PHYSICIAN40.000.00958390061378X
SCOTT DEBATES
PHYSICIAN40.000.00755669060971X
FieldValueIRS element (for citing)
Total Reportable Comp From Org4699784TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs805681TotalReportableCompFrmRltdOrgs
Total Other Compensation659707TotalOtherCompensation
Number Individuals GT100 K172NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MCKESSON
P O BOX 98347CHICAGOIL60693PATIENT STATEMENT PREPARATION707343
EARLY OUT SERVICES INC
5807 NORTH 102 STREETOMAHANE68134SELF-PAY PRE-COLLECTION SVCS673137
MEYERS-CARLISLE-LEAPLEY
14124 INDUSTRIAL ROADOMAHANE68144CONSTRUCTION SERVICES350139
BROWNS MEDICAL IMAGING
14315 C CIRCLEOMAHANE68144MEDICAL MAINTENANCE CONTRACTS301591
GENERAL SERVICES BUREAU
5807 NORTH 102 STREETOMAHANE68134COLLECTION SERVICES227170
FieldValueIRS element (for citing)
Number Of Contractors GT100 K8NumberOfContractorsGT100K
Related Organizations671RelatedOrganizations
Total Contributions671TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionNET PATIENT SVC REVDescription
Business Code621110BusinessCode
Total Revenue Column127482478TotalRevenueColumn
Related Or Exempt Function Income127482478RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue127482478TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column914TotalRevenueColumn
Exclusion$914ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real919385Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real933963Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-14578Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-14578TotalRevenueColumn
Exclusion-$14,578ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other2214Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other2214Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column2214TotalRevenueColumn
Exclusion$2,214ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory89544GrossSalesOfInventory
Cost Of Goods Sold87293CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column2251TotalRevenueColumn
Exclusion$2,251ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnUnrelated Business RevenueUnrelatedBusinessRevenue
ON CALL SUPPORT SVCS541900204050204050
TECHNICAL SUPPORT SVCS5419008252682526
CONSULTING5416107291672916
FieldValueIRS element (for citing)
Total Other Revenue359492TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column127833442TotalRevenueColumn
Related Or Exempt Function Income127482478RelatedOrExemptFunctionIncome
Unrelated Business Revenue359492UnrelatedBusinessRevenue
Exclusion-$9,199ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total32600Total
Program Services32600ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total3420336Total
Program Services3420336ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total869730Total
Program Services869730ProgramServices

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total81172218Total
Program Services81172218ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total3229352Total
Program Services3229352ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total9471630Total
Program Services9471630ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total4172216Total
Program Services4172216ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total46995Total
Management And General46995ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total1850Total
Management And General1850ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total112362Total
Management And General112362ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3306335Total
Program Services3306335ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total330797Total
Program Services330797ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3355915Total
Program Services3355915ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total2357Total
Program Services2357ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total5824671Total
Program Services5824671ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total89176Total
Program Services89176ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total114473Total
Program Services114473ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2601478Total
Program Services2601478ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2093876Total
Program Services1069749ProgramServices
Management And General1024127ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
MEDICAL SUPPLIES80799818079981
ALLOCATIONS63006426300642
BILLING & COLLECTION SE13548031354803
MISCELLANEOUS952632952632

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total639814Total
Program Services639814ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total137576239Total
Program Services130090263ProgramServices
Management And General7485976ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY9109515BOY
EOY3011886EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY19459252BOY
EOY22607695EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY207192BOY
EOY218348EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1076076BOY
EOY1057150EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY720407BOY
EOY684401EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis68418702LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec40766745LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY29625972BOY
EOY27651957EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1188BOY
EOY293423EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY60199602BOY
EOY55524860EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY23125050BOY
EOY18085492EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY4908439BOY
EOY5010756EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2603036BOY
EOY2421521EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6033483BOY
EOY5946124EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY36670008BOY
EOY31463893EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23529594BOY
EOY24060967EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23529594BOY
EOY24060967EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY60199602BOY
EOY55524860EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-9742797ReconcilationRevenueExpenses
Reconcilation Other Changes10274170ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2XPubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

FieldValueIRS element (for citing)
Current Tax Year Minus1 Year2855CurrentTaxYearMinus1Year
Current Tax Year671CurrentTaxYear
Total3526Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years97035586CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years100260130CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years108383451CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year119523130CurrentTaxYearMinus1Year
Current Tax Year127482478CurrentTaxYear
Total552684775Total

Total509 Total509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years97035586CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years100260130CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years108383451CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year119525985CurrentTaxYearMinus1Year
Current Tax Year127483149CurrentTaxYear
Total552688301Total

Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Amts From Subst Contributors AmtsFromSubstContributors

FieldValueIRS element (for citing)
Total0Total

Support From DQ Ps Etc SupportFromDQPsEtc

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Total509552688301PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years324764CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years262367CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years558118CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year975090CurrentTaxYearMinus1Year
Current Tax Year920299CurrentTaxYear
Total3040638Total

Investment Income And UBTI InvestmentIncomeAndUBTI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years324764CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years262367CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years558118CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year975090CurrentTaxYearMinus1Year
Current Tax Year920299CurrentTaxYear
Total3040638Total

Net Income From Other UBI NetIncomeFromOtherUBI

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years2924CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years3796CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years70394CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year85928CurrentTaxYearMinus1Year
Current Tax Year78532CurrentTaxYear
Total241574Total

Total Support Total TotalSupportTotal

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years97363274CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years100526293CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years109011963CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year120587003CurrentTaxYearMinus1Year
Current Tax Year128481980CurrentTaxYear
Total555970513Total
FieldValueIRS element (for citing)
Public Support Percentage5090.99410PublicSupportPercentage509
Prior Year Support Percentage0.99490PriorYearSupportPercentage
Investment Income Percentage0.00550InvestmentIncomePercentage
Prior Yr Invest Income Percentage0.00480PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509XThirtyThreePercntTestsCY509

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$1,850GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB1850TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1:ReturnReference
ExplanationA PORTION OF THE ANNUAL DUES PAID TO THE AMERICAN MEDICAL GROUP ASSOCIATION IS ATTRIBUTABLE TO LOBBYING ACTIVITIES.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3876290OtherCostOrOtherBasis
Book Value3876290BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis41892657OtherCostOrOtherBasis
Depreciation22723863Depreciation
Book Value19168794BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis22649755OtherCostOrOtherBasis
Depreciation18042882Depreciation
Book Value4606873BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings27651957TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionLIABILITY FOR OBRA (PHYS RET)Description
Amount$5,946,124Amount
FieldValueIRS element (for citing)
Total Of Amounts5946124TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X, LINE 2:ReturnReference
ExplanationPHYSICIANS CLINIC INC. 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. MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained0RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1NEBRASKA METHODIST HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line18511 W DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68114ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient470595345EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant25000AmountOfCashGrant
Purpose Of GrantIMPROVE HEALTH OF COMMUNITYPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantFINANCIAL ASSISTANCETypeOfGrant
Number Of Recipients15701NumberOfRecipients
Amount Of Non Cash Assistance3420336AmountOfNonCashAssistance
Method Of ValuationBOOKMethodOfValuation
Description Of Non Cash AssistanceUNINSURED/UNDERINSURED PATIENT FINANCIAL ASSISTANCEDescriptionOfNonCashAssistance

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
TERENCE COONEY MD
VICE CHAIRMAN33920603464307740601110200390454773000
STEVEN WILLIAMS MD
SECRETARY1850830187760192110476220131950283887000
PATRICK MC CARVILLE
DIRECTOR2468170143180109020500460222020344285086580
TODD D GRAGES
PRESIDENT030941600049842068465017173044489600
LINDA BURT
V-P FINANCE & CFO0351687000947360760990147570537279072560
GEORGE DITTRICK
PHYSICIAN5521750765850195280305780175700696436000
KAYVON IZADI
PHYSICIAN7946620102801780309360149250841729000
AJOY JANA
PHYSICIAN653631010280171800448570186100735306000
DARREN KEISER
PHYSICIAN9416820102801568004356902010801022067000
SCOTT DEBATES
PHYSICIAN67345708195102610431620201080818939000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE FOLLOWING INDIVIDUALS PARTICIPATED IN A NONQUALIFIED PLAN DURING 2012 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: TERENCE COONEY, MD $18,760 ACCRUAL PATRICK MCCARVILLE MD $7,383 ACCRUAL; $8,658 PLAN DISTRIBUTION TODD GRAGES, $45,080 ACCRUAL LINDA BURT, $58,333 ACCRUAL; $72,560 PLAN DISTRIBUTION SCOTT DEBATES, MD $18,257 ACCRUAL GEORGE DITTRICK MD $12,578 ACCRUAL KAYVON IZADI MD $13,255 ACCRUAL AJOY JANA MD $19,064 ACCRUAL DARREN KEISER, MD $18,553 ACCRUAL
PART I, LINE 6BONUSES ARE PAID TO PHYSICIANS BASED ON TWO SEPARATE CRITERIA. THE FIRST IS BASED ON SUBGROUPS WHICH IDENTIFY AND PAY BONUSES BASED ON THE BOTTOMLINE RESULTS AS COMPARED TO PRESET TARGETS FOR THESE SUBGROUPS AND DISTRIBUTED EQUALLY OR ON PERSONAL PRODUCTION TO THE PHYSICIANS OF THAT SUBGROUP. THE SECOND IS BASED ON THE OVERALL CLINIC RESULTS AS COMPARED TO THE OVERALL CLINIC BUDGET WHICH IS DISTRIBUTED TO EACH PHYSICIAN EQUALLY.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART V, LINE 2BTHE PAYROLL SYSTEM FOR PHYSICIANS CLINIC IS BEING HANDLED BY A COMMON PAYMASTER, NEBRASKA METHODIST HEALTH SYSTEM INC. ALL W-2 FORMS ARE ISSUED UNDER THE TAX IDENTIFICATION NUMBER OF NEBRASKA METHODIST HEALTH SYSTEM. ALL REQUIRED FEDERAL EMPLOYMENT TAX RETURNS WERE FILED BY NEBRASKA METHODIST HEALTH SYSTEM. WAGES AND BENEFITS SHOWN IN THE FORM 990 ARE ACTUAL WAGES ASSOCIATED WITH PHYSICIANS CLINIC PERSONNEL.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE MEMBER OF PHYSICIANS CLINIC INC. IS NEBRASKA METHODIST HEALTH SYSTEM, INC., A NEBRASKA NOT-FOR-PROFIT CORPORATION.
FORM 990, PART VI, SECTION A, LINE 7ANEBRASKA METHODIST HEALTH SYSTEM, INC., THE MEMBER, HAS THE POWER TO ELECT AND REMOVE THE DIRECTORS OF THE CORPORATION. THE NEBRASKA METHODIST HEALTH SYSTEM ALSO HAS THE POWER TO APPOINT AND REMOVE THE PERSON DESIGNATED AS THE CORPORATION'S PRESIDENT BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7BNEBRASKA METHODIST HEALTH SYSTEM, INC., THE MEMBER, HAS THE POWER TO APPROVE OR REFUSE TO APPROVE ANY AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THE BYLAWS OR ANY ACTION REQUIRED TO BE SUBMITTED TO AND APPROVED BY THE VOTING MEMBERS OF A NONPROFIT CORPORATION UNDER THE NEBRASKA NONPROFIT CORPORATION ACT. METHODIST HEALTH SYSTEM ALSO HAS APPROVAL AUTHORITY WITH REGARD TO THE ANNUAL BUDGET, CAPITAL EXPENDITURES IN EXCESS OF ESTABLISHED THRESHOLDS, THE MISSION STATEMENT, LONG-RANGE PLAN, INCURRENCE OF DEBT AND ESTABLISHMENT OF A SUBSIDIARY OR PARTICIPATION AS A SHAREHOLDER, PARTNER OR EQUITY MEMBER OF ANY OTHER ENTITY.
FORM 990, PART VI, SECTION B, LINE 11PHYSICIANS CLINIC INC. IS AN AFFILIATE ORGANIZATION OF NEBRASKA METHODIST HEALTH SYSTEM, INC. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. PRIOR TO FILING THE FORM 990, A COPY IS PROVIDED TO THE AUDIT COMMITTEE OF NEBRASKA METHODIST HEALTH SYSTEM. THE COMMITTEE IS GIVEN AN OPPORTUNITY TO ASK QUESTIONS OR REQUEST MORE INFORMATION AT A SUBSEQUENT MEETING. INFORMATION FOR THE FORM 990 IS GATHERED FROM APPROPRIATE RESPONSIBLE PARTIES THROUGHOUT THE ORGANIZATION, INCLUDING THE ORGANIZATION'S HUMAN RESOURCES, FINANCE AND COMPLIANCE DEPARTMENTS. THE RETURN GETS A DETAIL TIE-OUT AND DIRECTOR OF ACCOUNTING REVIEW. IT IS REVIEWED BY EXTERNAL TAX ADVISORS AND HAS A FINAL REVIEW BY THE CHIEF FINANCIAL OFFICER FOR NEBRASKA METHODIST HEALTH SYSTEM AND THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER.
FORM 990, PART VI, SECTION B, LINE 12CAN ANNUAL QUESTIONNAIRE IS SENT TO ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES PURSUANT TO THE METHODIST HEALTH SYSTEM CONFLICTS OF INTEREST POLICY WHICH REQUIRES THE DISCLOSURE OF ALL CONFLICTS OF INTEREST, NOT JUST FINANCIAL, THAT COULD GIVE RISE TO CONFLICTS WITH THE ORGANIZATION. SHOULD A CONFLICT OF INTEREST BE IDENTIFIED, THE OFFICER, DIRECTOR OR KEY EMPLOYEE IS NOT PERMITTED TO VOTE OR USE PERSONAL INFLUENCE ON THE MATTER AND IS NOT COUNTED IN DETERMINING A QUORUM FOR A MEETING AT WHICH THE MATTER IS DISCUSSED. A POTENTIAL CONFLICT OF INTEREST, ONCE IDENTIFIED, MUST BE EVALUATED ON A CASE BY CASE BASIS. IN ORDER TO APPROVE THE TRANSACTION WHICH INVOLVES A DIRECT CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DIRECTORS FOR WHOM NO CONFLICT EXISTS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTEREST OF PHYSICIANS CLINIC AND/OR METHODIST HEALTH SYSTEM AFFILIATES, IS FAIR AND REASONABLE, AND AFTER INVESTIGATION, THE DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES.
FORM 990, PART VI, SECTION B, LINE 15PHYSICIANS CLINIC IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. METHODIST HEALTH SYSTEM RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED AND COMPENSATION RANGES ARE SET. THIS INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF THE NEBRASKA METHODIST HEALTH SYSTEM INC. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. PHYSICIANS CLINIC(PCI) ADMINISTRATION MAINTAINS A WRITTEN PHYSICIAN COMPENSATION PLAN THAT HAS BEEN REVIEWED BY OUTSIDE COUNSEL AND APPROVED BY PCI ADMINISTRATION AND THE PCI BOARD OF DIRECTORS. THE PLAN DEFINES THE METHODOLOGY FOR DETERMINING PHYSICIAN COMPENSATION AND SITE FINANCIAL ACCOUNTABILITY BONUS. THE PLAN ALSO ADDRESSES THE PAYMENT OF A MONTHLY DRAW TO PHYSICIANS, SALARY GUARANTEES AND TIME-OFF PROVISIONS. INDEPENDENT MARKET REVIEWS AND INTERNAL ANALYSIS OF PHYSICIAN COMPENSATION ARE REGULARLY PERFORMED. THE COMPENSATION CONSULTING FIRM OF SULLIVAN COTTER & ASSOCIATES HAS BEEN ENGAGED BY PHYSICIANS CLINIC ADMINISTRATION TO PERFORM MARKET REVIEWS ON A REGULAR BASIS.
FORM 990, PART VI, SECTION C, LINE 18THE FORM 1023 WAS FILED PRIOR TO 7/15/87 AND NEED NOT BE MADE PUBLICLY AVAILABLE. A COPY OF THE IRS DETERMINATION LETTER WILL BE PROVIDED UPON WRITTEN REQUEST.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. HOWEVER, THE AMENDED ARTICLES OF INCORPORATION OF THE ORGANIZATION ARE AVAILABLE THROUGH THE NEBRASKA SECRETARY OF STATE'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND EMPLOYEES. FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC THROUGH THE IRS FORM 990 AND FORM 990-T. THE ORGANIZATION ALSO CONTRIBUTES INFORMATION REGARDING COMMUNITY BENEFITS IT PROVIDES AS PART OF THE METHODIST HEALTH SYSTEM'S ANNUAL COMMUNITY BENEFIT REPORT. THE REPORT IS AVAILABLE TO THE PUBLIC ON THE WEBSITE, WWW.METHODISTCHART.ORG.
FORM 990, PART VIILINDA BURT, VICE PRESIDENT OF FINANCE AND CFO FOR THE NEBRASKA METHODIST HEALTH SYSTEM, IS A FULLTIME EMPLOYEE OF NEBRASKA METHODIST HEALTH SYSTEM. HER AVERAGE HOURS PER WEEK ARE ALLOCATED AMONG THE ENTITIES THAT COMPRISE THE NEBRASKA METHODIST HEALTH SYSTEM.AVERAGE HOURS FOR RELATED ORGANIATIONS
FORM 990, PART VIITODD GRAGES IS A KEY EMPLOYEE OF NEBRASKA METHODIST HEALTH SYSTEM AND IS ASSIGNED FULLTIME DUTIES AS PRESIDENT OF PHYSICIANS CLINIC INC. SALARY AND BENEFITS ARE INCLUDED IN ALLOCATIONS.AVERAGE HOURS FOR RELATED ORGANIZATIONS
FORM 990, PART VII, SECTION A, COLUMN D & EINDIVIDUALS WHO HAVE COMPENSATION FROM THE ORGANIZATION OR A RELATED ORGANIZATION ARE EMPLOYEES OF THE RESPECTIVE ORGANIZATION. THESE INDIVIDUALS DO NOT RECEIVE COMPENSATION FOR SERVICES ON THE BOARD OF DIRECTORS.COMPENSATION BY ORGANIZATION OR RELATED ORGANIZATIONS
FORM 990, PART XI, LINE 9:TRANSFERS FROM AFFILIATES 10,274,170.CHANGES IN NET ASSETS OR FUND BALANCES:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
NEBRASKA METHODIST HEALTH SYSTEM INC
8511 W DODGE ROADOMAHANE68114470639839ADMINISTRATIVE SUPPORTNE501(C)(3)L11: III-FIN/A0
NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND
8511 W DODGE ROADOMAHANE68114363699672INSURANCENE501(C)(3)L11: III-FI0NEBRASKA METHODIST HEALTH SYSTEM
NEBRASKA METHODIST HOSPITAL
8511 W DODGE ROADOMAHANE68114470376604LICENSED HOSPITALNE501(C)(3)L30NEBRASKA METHODIST HEALTH SYSTEM
REAL ESTATE HOLDINGS
8511 W DODGE ROADOMAHANE68114470649790PROPERTY MANAGEMENTNE501(C)(2)0NEBRASKA METHODIST HEALTH SYSTEM
NEBRASKA METHODIST HOSPITAL FOUNDATION
8511 W DODGE ROADOMAHANE68114470595345SUPPORT OF NEBRASKA METHODIST HOSPITALNE501(C)(3)L70NEBRASKA METHODIST HEALTH SYSTEM
NEBRASKA METHODIST COLLEGE OF NURSING & ALLIED HEALTH
8511 W DODGE ROADOMAHANE68114470724387NURSING & HEALTH EDUCATION FACILITYNE501(C)(3)L20NEBRASKA METHODIST HOSPITAL
JENNIE EDMUNDSON MEMORIAL HOSPITAL
933 E PIERCE STREETCOUNCIL BLUFFSIA51503420680355LICENSED HOSPITALIA501(C)(3)L30NEBRASKA METHODIST HEALTH SYSTEM
JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION
933 E PIERCE STREETCOUNCIL BLUFFSIA51503421439454SUPPORT OF JENNIE EDMUNDSON MEMORIAL HOSPITALIA501(C)(3)L11, I0JENNIE EDMUNDSON MEMORIAL HOSPITAL

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityControlled OrgControlledOrg
SHARED SERVICE SYSTEMS INC
8511 W DODGE ROADOMAHANE68114470649534MEDICAL SUPPLY DISTRIBUTION & LAUNDRYNENEBRASKA METHODIST HEALTH SYSTEMC0
METHODIST HEALTH PARTNERS
8511 W DODGE ROADOMAHANE68114470797563MANAGED CARE CONTRACTINGNENEBRASKA METHODIST HEALTH SYSTEMC0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org1LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets1ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

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