2012-11-06T08:31:37-06:00 2011-12-31 135565207 KPMG LLP 2 CENTRAL PARK PLAZA SUITE 1501 OMAHA NE 68102 990 2011-01-01 363699672 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND NEBR 4023544840 8511 WEST DODGE ROAD OMAHA NE 68114 LINDA BURT 4023544000 2012-11-06 1 P00223617 4023481450 2011 2016-02-25 16:41:14Z LINDA BURT 8511 WEST DODGE ROAD OMAHA NE 68114 6824485 0 X N/A X 1988 NE TO PROVIDE A FUND TO PAY CLAIMS FOR MEDICAL MALPRACTICE & OTHER GENERAL LIABILITY EXPENSES. 19 14 0 0 0 0 0 0 2526027 2527345 187443 350841 0 0 2713470 2878186 0 0 0 0 0 0 0 0 0 3798909 2209315 3798909 2209315 -1085439 668871 13290485 12943648 8931331 8129314 4359154 4814334 X THE NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND PROVIDES A POOLED FUND FROM CONTRIBUTIONS OF THE NEBRASKA METHODIST HEALTH SYSTEM AFFILIATES WHICH RESULTS IN A COST EFFECTIVE METHOD OF CONTROLLING, REDUCING AND PROTECTING RISKS OF LEGAL LIABILITY WHICH ARISE OUT OF THE RENDERING OF CARE TO THE SICK AND INJURED. 0 0 2209315 0 2527345 THE TRUST FUND WAS ORGANIZED TO PROVIDE MEDICAL MALPRACTICE & GENERAL LIABILITY SELF-INSURANCE PROTECTION FOR NEBR. METHODIST HEALTH SYSTEM AND ITS AFFILIATES. THE TRUST POSTS FUNDS OF THE BENEFICIARIES TO SELF INSURE EXPOSURE OF EMPLOYEES AND CERTAIN AGENTS. THESE EXPOSURES INCLUDE MALPRACTICE, PATIENT RELATED GENERAL LIABILITY, AND COMPREHENSIVE GENERAL LIABILITY. THIS POOLING OF FUNDS HELPS TO REDUCE INSURANCE EXPENSE RESULTING IN LOWER COST MEDICAL SERVICES TO THE COMMUNITY. 2209315 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 30 0 0 0 0 0 0 0 0 0 0 0 0 X 19 14 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X LINDA BURT 4023544840 8511 W DODGE ROAD OMAHA NE 68114 X SPENCER STEVENS 1.00 X X 0 0 0 LARRY V PEARSON 1.00 X X 0 0 0 ART N BURTSCHER 1.00 X X 0 0 0 ADAM YALE 1.00 X X 0 0 0 STEVEN T BAILEY MD 1.00 X 0 268710 69273 LARRY DEROIN 1.00 X 0 0 0 HARRIS A FRANKEL MD 1.00 X 0 0 0 JOHN M FRASER 1.00 X X 0 602762 171191 RICHARD C HAHN 1.00 X 0 0 0 KRISTEN HOFFMAN MD 1.00 X 0 393647 83546 DAN KINNEY PHD 1.00 X 0 0 0 C L LANDEN 1.00 X 0 0 0 JOHN LOHRBERG MD 1.00 X 0 175781 34508 DANIEL D LYDIATT MD DDS 1.00 X 0 227149 20610 DIANNE SEEMAN LOZIER 1.00 X 0 0 0 JAMES L MOUNCE 1.00 X 0 0 0 JOHN P NELSON 1.00 X 0 0 0 L B RED THOMAS 1.00 X 0 0 0 CONSTANCE M RYAN 1.00 X 0 0 0 LINDA K BURT 1.00 X 0 471507 95632 0 2139556 474760 0 0 1 0 RONALD J PALAGI PC 3131 SOUTH 72 STREET OMAHA NE 68124 LEGAL/CLAIMS 700000 FRASER STRYKER PC LLO 409 SOUTH 17 STREET OMAHA NE 68102 LEGAL/CLAIMS 450000 SODORO DALY & SODORO 7000 SPRING STREET OMAHA NE 68106 CONSULTING/CLAIMS 335749 RICHARD SCHICKER 11920 BURT STREET 145 OMAHA NE 68154 LEGAL/CLAIMS 250000 CULLAN & CULLAN LLC 1113 HARNEY STREET OMAHA NE 68102 LEGAL/CLAIMS 200000 8 SELF INS. PREM REV 524298 2527345 2527345 2527345 299618 299618 3997522 3946299 51223 51223 51223 2878186 2527345 0 350841 21962 21962 59150 59150 CLAIMS SERVICE 2128203 2128203 2209315 2209315 0 0 46749 70906 13044177 12626390 199559 246352 13290485 12943648 8931331 0 8129314 8931331 8129314 X 4359154 4814334 4359154 4814334 13290485 12943648 X 668871 -213691 X 0 1 1 X 0 X X X 0 0 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL 420680355 3 1 1 1 36224 NEBRASKA METHODIST HOSPITAL 470376604 3 1 1 1 1599584 PHYSICIANS CLINIC INC 470687317 9 1 1 1 492395 NEBR METH COLLEGE OF NURSING AND ALLIED HEALTH 470724387 2 1 1 1 0 NEBR METHODIST FOUNDATION 470595345 7 1 1 1 0 5 2128203 0 CLAIMS RESERVES 8129314 8129314 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: PART X, LINE 2: THE HEALTH SYSTEM 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. 0 1 0 0 0 0 0 0 0 STEVEN T BAILEY MD 0 226606 0 40916 0 1188 0 57472 0 15535 0 341717 0 0 JOHN M FRASER 0 570354 0 0 0 32408 0 159357 0 13449 0 775568 0 0 KRISTEN HOFFMAN MD 0 288874 0 100638 0 4135 0 67190 0 16623 0 477460 0 0 JOHN LOHRBERG MD 0 134183 0 25528 0 16070 0 34389 0 2939 0 213109 0 0 DANIEL D LYDIATT MD DDS 0 222723 0 65 0 4361 0 20610 0 268 0 248027 0 0 LINDA K BURT 0 345340 0 0 0 126167 0 82134 0 14751 0 568392 0 105240 PART I, LINE 3 SEE SCHEDULE O, PART VI, SECTION B, LINE 15 EXPLANATION REGARDING THE METHODS USED BY A RELATED ORGANIZATION TO ESTABLISH COMPENSATION. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NEBRASKA METHODIST HEALTH SYSTEM NONQUALIFIED PLAN DURING 2011 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: STEVEN BAILEY, MD $9,485 ACCRUAL JOHN FRASER, $111,396 ACCRUAL LINDA BURT $65,226 ACCRUAL; PLAN DISTRIBUTION $105,240 KRISTEN HOFFMAN MD $21,501 ACCRUAL JOHN LOHRBERG MD $6,562 ACCRUAL FORM 990, PART VI, SECTION B, LINE 11 A COPY OF THE FORM 990 WAS PROVIDED TO MEMBERS OF THE NEBRASKA METHODIST HEALTH SYSTEM AUDIT COMMITTEE WHO REVIEWED IT IN DETAIL. THE AUDIT COMMITTEE REPORTED TO THE BOARD OF DIRECTORS ON THEIR REVIEW OF THE FORM 990 AT A REGULARLY SCHEDULED MEETING. A COPY OF THE FORM 990 WAS MADE AVAILABLE TO ALL MEMBERS ELECTRONICALLY THROUGH A SECURE PORTAL. INFORMATION FOR THE FORM 990 IS GATHERED FROM APPROPRIATE, RESPONSIBLE PARTIES THROUGHOUT THE NEBRASKA METHODIST HEALTH SYSTEM ORGANIZATION INCLUDING THE FINANCE, HUMAN RESOURCE AND COMPLIANCE DEPARTMENTS; IS REVIEWED BY EXTERNAL TAX ADVISORS AND HAS A FINAL REVIEW BY THE CHIEF EXECUTIVE OFFICER AND CHIEF FINANCIAL OFFICER FOR NEBRASKA METHODIST HEALTH SYSTEM. FORM 990, PART VI, SECTION B, LINE 12C AN 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 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 THE DIRECTORS FOR WHOM NO CONFLICT EXISTS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTERESTS OF THE NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND AND/OR THE NEBRASKA 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 EFFORT UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. 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. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NON-PROFIT CORPORATION. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO MEMBERS OF THE BOARD OF DIRECTORS AND EMPLOYEES. FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC THROUGH THE IRS FORM 990. HOURS WORKED FOR RELATED ORGANIZATION FORM 990, PART VII, COLUMN B JOHN FRASER, PRESIDENT AND CEO OF NEBRASKA METHODIST HEALTH SYSTEM, IS A FULLTIME EMPLOYEE OF NEBRASKA METHODIST HEALTH SYSTEM INC. HIS AVERAGE HOURS PER WEEK HAVE BEEN ALLOCATED AMONG THE ENTITIES THAT COMPRISE THE NEBRASKA METHODIST HEALTH SYSTEM. LINDA BURT, VICE PRESIDENT OF FINANCE AND CFO OF NEBRASKA METHODIST HEALTH SYSTEM IS A FULLTIME EMPLOYEE OF NEBRASKA METHODIST HEALTH SYSTEM INC. HER AVERAGE HOURS PER WEEK HAVE BEEN ALLOCATED AMONG THE ENTITIES THAT COMPRISE THE NEBRASKA METHODIST HEALTH SYSTEM. DIRECTORS STEVEN BAILEY MD, KRISTEN HOFFMAN MD AND JOHN LOHRBERG MD ARE EMPLOYEES OF PHYSICIANS CLINIC INC. DIRECTOR DANIEL LYDIATT MD IS AN EMPLOYEE OF NEBRASKA METHODIST HOSPITAL. THESE INDIVIDUALS ARE FULLTIME EMPLOYEES WITH AN AVERAGE OF 40 HOURS PER WEEK. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -213,691. NEBRASKA METHODIST HEALTH SYSTEM INC 8511 W DODGE ROAD OMAHA NE 68114 470639839 ADMINISTRATIVE SUPPORT NE 501(C)(3) L11 F-III N/A 0 NEBRASKA METHODIST HOSPITAL 8511 W DODGE ROAD OMAHA NE 68114 470376604 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL 933 E PIERCE COUNCIL BLUFFS IA 51503 420680355 LICENSED HOSPITAL IA 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 PHYSICIANS CLINIC INC 8511 W DODGE ROAD OMAHA NE 68114 470687317 CLINICAL HEALTH CARE NE 501(C)(3) L9 NEBRASKA METHODIST HEALTH SYSTEM 0 NEBRASKA METHODIST COLLEGE OF NURSING & ALLIED HEALTH 8511 W DODGE ROAD OMAHA NE 68114 470724387 NURSING & HEALTH EDUCATION FACILITY NE 501(C)(3) L2 NEBRASKA METHODIST HOSPITAL 0 NEBRASKA METHODIST HOSPITAL FOUNDATION 8511 W DODGE ROAD OMAHA NE 68114 470595345 SUPPORT OF NEBRASKA METHODIST HOSPITAL NE 501(C)(3) L7 NEBRASKA METHODIST HEALTH SYSTEM 0 REAL ESTATE HOLDINGS INC 8511 W DODGE ROAD OMAHA NE 68114 470649790 PROPERTY MANAGEMENT NE 501(C)(2) NEBRASKA METHODIST HEALTH SYSTEM 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 933 E PIERCE COUNCIL BLUFFS IA 51503 421439454 SUPPORT OF JENNIE EDMUNDSON MEM. HOSPITAL IA 501(C)(3) L11, I JENNIE EDMUNDSON MEMORIAL HOSPITAL 0 HEALTHCARE PARTNERS OF WESTERN IOWA 933 E PIERCE STREET COUNCIL BLUFFS IA 51503 421411452 MANAGED CARE CONTRACTING IA JENNIE EDMUNDSON MEMORIAL HOSPITAL C SHARED SERVICE SYSTEMS INC 8511 W DODGE ROAD OMAHA NE 68114 470649534 MEDICAL SUPPLY DISTRIBUTION & LAUNDRY NE NEBRASKA METHODIST HEALTH SYSTEM INC C METHODIST HEALTH PARTNERS 8511 W DODGE ROAD OMAHA NE 68114 470797563 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0