2012-08-15T11:27:20-05:00 2011-12-31 KPMG LLP Two Central Park Plaza Suite 1501 Omaha NE 681021626 990 2011-01-01 470379754 CHILDREN'S HOSPITAL & MEDICAL CENTER % MICHAEL J BROWN CHIL 4029554116 8200 DODGE STREET OMAHA NE 68114 MICHAEL J BROWN 4029554116 2012-06-27 true 4023481450 2011 2016-02-24 21:20:13Z GARY A PERKINS 8200 DODGE STREET OMAHA NE 68114 224375585 false X www.CHILDRENSOMAHA.ORG X 1948 NE A FAMILY-CENTERED REGIONAL PROVIDER DEDICATED TO COST-EFFECTIVE, QUALITY HEALTHCARE Services & ADVOCACY FOR CHILDREN, INFANTS THROUGH ADOLESCENTS, WHILE ACTIVELY PROMOTING HEALTHCARE EDUCATION & Research. 20 18 1998 297 0 0 6856976 4284969 200133005 211631952 653743 -204156 8057766 8394992 215701490 224107757 3584092 3711498 0 0 98984678 103961568 0 0 0 98472270 102288591 201041040 209961657 14660450 14146100 257508374 280529833 140536958 150153513 116971416 130376320 X SO THAT ALL CHILDREN MAY HAVE A BETTER CHANCE TO LIVE....CHILDREN'S HOSPITAL & MEDICAL CENTER DELIVERS EXTRAORDINARY CARE TO CHILDREN, EDUCATES HEALTH CARE PROFESSIONALS, AND PROMOTES PEDIATRIC RESEARCH. false false 196617970 3711498 219893906 THE HOSPITAL OPERATES A 145-BED PEDIATRIC HOSPITAL, WHICH INCLUDES SEVEN SURGICAL SUITES, A HYBRID HEART CATHETERIZATION LAB, 30 OUTPATIENT SPECIALTY CLINICS, AND A 33-BED OUTPATIENT "DAY HOSPITAL" KNOWN AS CHILDREN'S AMBULATORY RECOVERY AND EXPRESS STAY (CARES) UNIT, 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, CENTER BASED PRIVATE DUTY NURSING AT CHILDREN'S HOME HEALTHCARE'S WORLD, AND HOME INFUSION THERAPY SERVICES. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT IN THE REGION AND ALSO PROVIDES SPECIALTY PEDIATRIC SERVICES IN LINCOLN, NEBRASKA. 196617970 true true false true false false false false true true false false false true true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false false true true true false false true 43 0 true 1998 true false false false false false false false false false false X 20 18 false false false false false false false true true false false true true true true true true true true false X MICHAEL J BROWN 4029554116 8200 DODGE STREET OMAHA NE 68114 SUZANNE SCOTT 1.0 X 0 0 0 BARBARA SCHAEFER 1.0 X X 0 0 0 DEB PERRY MD 1.0 X X 0 0 0 GARY A PERKINS FACHE 40.0 X X 1118191 0 62401 ERIC BUTLER 1.0 X 0 0 0 JIM LANDEN 1.0 X 0 0 0 SUSAN WEIDNER 1.0 X 0 0 0 JOHN MOORE MD 40.0 X 225536 0 28301 DANA BRADFORD 1.0 X 0 0 0 SID DINSDALE 1.0 X 0 0 0 DAN HAMANN 1.0 X X 0 0 0 JIM SIMPSON 1.0 X X 0 0 0 ROWEN ZETTERMAN MD 1.0 X 0 0 0 RICH ANDERL 1.0 X 0 0 0 RODRIGO LOPEZ 1.0 X 0 0 0 MATTHEW MILLER 1.0 X 0 0 0 ELLEN WRIGHT 1.0 X 0 0 0 STEVE RAYNOR MD 1.0 X 0 0 0 LORRAINE CHANG 1.0 X 0 0 0 KATHY ENGLISH 40.0 X 423743 0 47555 MICHAEL BROWN 40.0 X 439423 0 29995 CARL GUMBINER MD 40.0 X 343836 0 12978 GEORGE E REYNOLDS MD 40.0 X 457428 0 48804 BETSY J STEPHENSON MD 40.0 X 310551 0 33857 JOHN ANDERSEN MD 40.0 X 374017 0 21295 MICHAEL WILCZEWSKI MD 40.0 X 300461 0 19793 DAWN GARY MD 40.0 X 292602 0 29287 4285788 0 334266 83 false true false KIEWIT BUILDING GROUP INC 3921 MASON STREET OMAHA NE 681051840 CONSTRUCTION 5914970 ELECTRIC COMPANY OF OMAHA 815 S 21ST STREET OMAHA NE 68103 ELECTRICAL CONTRACT. 707769 ALLSCRIPTS HEALTHCARE LLC PO BOX 8538-0133 PHILADELPHIA PA 19171 IT SUPPORT SERVICES 3356515 PYRAMID HEALTHCARE SOLUTION PO BOX 17389 CLEARWATER FL 337620389 MGMT STAFFING SVC. 877351 EPIC SYSTEMS CORP PO BOX 88314 MILWAUKEE WI 532880314 IT SUPPORT SERVICES 638944 19 3236964 1048005 4284969 NET PATIENT SERVICE REVENUE 621110 211631952 211631952 211631952 63672 63672 0 0 133038 133038 133038 133038 267828 -267828 -267828 -267828 0 0 0 MANAGEMENT FEE 541610 4293226 4293226 OTHER REVENUE 900099 3030315 3030315 METHODIST SERV INCOME 541900 938413 938413 8261954 224107757 219893906 -71118 479000 479000 3232498 3232498 0 0 3015612 3015612 0 83878110 83878110 4566597 4566597 6609536 6609536 5891713 5891713 0 192560 192560 157663 157663 21188 21188 0 0 16797547 10792298 6005249 2705023 2705023 30937516 30937516 5528991 5528991 0 6573754 6573754 433146 433146 0 0 5840770 5840770 10281706 10281706 17179673 17179673 1231819 1231819 COLLECTION EXPENSE 1430096 1430096 OPERATING LEASES 1010941 1010941 BUILDING MAINTENANCE 959436 959436 PROFESSIONAL DUES & SUBSCRIP. 385984 385984 620778 620778 209961657 196617970 13343687 0 4193063 4134523 15996973 31271941 1506000 1408000 32795432 37143949 0 0 0 0 0 0 2654723 2855497 1907180 1904593 300069679 126141918 175030197 173927761 0 0 10471372 13180949 3154554 4137356 374983 179340 9423897 10385924 257508374 280529833 26750591 31997654 0 0 37014 55627 100426669 100380922 0 0 0 0 7078768 6896147 0 0 6243916 10823163 140536958 150153513 X 115465416 128968320 1506000 1408000 0 0 116971416 130376320 257508374 280529833 X 14146100 -741196 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 21188 21188 209940469 209961657 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 7300 5371 20707 21188 54566 250000 250000 250000 250000 1000000 1500000 46369324 1889083 836292 2806131 46288568 47818091 734290 2140797 4323854 46369324 44226562 7371562 10645327 8254241 6171119 47818091 48753075 9675396 -13889726 312183 44226562 0.81000 0.07000 0.12000 false true true 11705265 11705265 175135722 47550334 127585388 11729407 6586569 5142838 98661456 71550090 27111366 2837829 454925 2382904 173927761 0 DEFERRED COMPENSATION LIAB 1352531 MINORITY INTEREST IN CP LIABIL 1379119 SWAP LIABILITY 8091513 10823163 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 2011 and 2010, the company did not record any amounts related to uncertain tax positions or any accrued interest and penalties. SCHEDULE D PART V, LINE 4 TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, AND OPERATIONS OF THE CHILDREN'S HOSPITAL & MEDICAL CENTER true true true X true X true true false true true 1718000 1718000 0.00800 79537000 57667000 21870000 0.10400 81255000 57667000 23588000 0.11200 1486000 69000 1417000 0.00700 7705000 965000 6740000 0.03200 76528000 44911000 31617000 0.15100 1239000 1239000 0.00600 747000 747000 0.00400 87705000 45945000 41760000 0.20000 168960000 103612000 65348000 0.31200 29000 29000 3000 3000 32000 32000 false 1869000 0 64110 197303 -133193 X true true 1 1 CHILDREN'S HOSPITAL & MEDICAL CENTER

8200 DODGE STREET OMAHA NE 681144113

X X X X X CHILDREN'S HOSPITAL & MEDICAL CENTER 1 true true 200. true 400. true X X X X true true X X X X X true false true X false false 6 W VILLAGE PTE URGENT CARE&AMBUL CLINICS

110 N 175TH STREET OMAHA NE 68118

UCC OPENS 6AM-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 6AM-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 2011 Community Benefit report include $1.8M in FINANCIAL ASSISTANCE and unreimbursed Medicaid costs associated with an affiliated sub, Children's Physicians. 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 PLUS any miscellaneous operating revenue reported by the department 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 and the Omaha Sports Commission. Children's Hospital and Medical Center goes beyond joint commission requirements to ensure community disaster readiness through our committee work involvement with the Omaha Medical Management Response team. PART III, Section A, Line 4 Bad Debt Expense New Accounting Standard Effective December 31, 2011, 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. 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 2011 Medicare Cost to Charge Ratio to arrive at an approximate cost value. Bad debt expense at 100% charge value $3,516,796 Medicare Cost to Charge Ratio x .5314 Bad debt expense at cost $1,869,000 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 2011 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. 2011 Medicare charges reported by CMS in the Provider Statistical and Reimbursement System for provider FYE 12/31 were multiplied by the 2011 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 Centers financial assistance program. All correspondence, including statements and collection letters state that Financial Assistance may be available. PART V, LINE 13g In regard to 13b, 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 19D 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 tradition charity care application requirements. 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 Child Health Corporation of America (CHCA) and the National Association of Children's Hospitals and Related Institutions (NACHRI). There are many local and state reports available for our use, including Vital Statistics, the Douglas County Health Department, United Way of the Midlands, Our Healthy Community Partnership (in which we are a member partner), and Kids Count in Nebraska. The hospital conducts consumer surveys, as well as medical staff and referring physician surveys, to help identify gaps in service(s). In addition to analyzing internal utilization of services, data is available to track utilization of services by all providers in the communities served by Children's. Other 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 2011, 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. Preofessional Research Consultants, Inc. (PRC) has been 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 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. Brochures which explain the billing process are available. 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 and is also available upon request. www.childrensomaha.org PART VI 4- COMMUNITY INFORMATION The Hospitals 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 777,000. The Hospitals secondary service area consists of eight surrounding counties in Nebraska and nine surrounding counties in Iowa. For year ended December 31, 2011, 57% of the Hospitals 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 24% of total discharges were from patients residing outside the primary and secondary service areas. 2011 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 777,230 Pediatric Population 203,625 Average Household Income $68,838 Percent of residents below federal poverty level Total Population 13.2% Under age 18 18.6% Percent of residents on Medicaid 12.3% Age Population % of Total Less than 18 203,625 26.2% 18 to 24 76,854 9.9% 25 to 44 220,454 28.4% 45 to 64 192,474 24.8% 65+ 83,823 10.7% Total 777,230 100.0% Race Population % of Total White 593,804 76.4% Black 65,287 8.4% Hispanic 79,277 10.2% Asian/Pacific Islander 17,876 2.3% Other 17,877 2.3% Am. Ind./Alaska Nat. 3,109 0.4% Total 777,230 100.0% Federally-Designated Medically Underserved Areas Approximate % of patients from medically underserved areas: 9.0% County # of Census Tracts* Total Census Tracts % of Total Douglas 36 156 23.1% Sarpy 1 43 2.3% Pottawattamie 3 30 10.0% Total 40 229 17.5% *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 and 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 dedicated pediatric emergency department 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. The team currently has the ability to transport these patients utilizing a dedicated ground ambulance or helicopter aircraft. Children's has achieved the Magnet designation for nursing excellence, is an InfoWorld 100 award winner for innovation in information technology and has received recognition in U.S. News and World Report's Best Children's Hospitals ranking 41 in Orthopedics and 47 in Cardiology and Heart Surgery. A pediatric affiliation established between Children's and the University of Nebraska Meedical 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 and 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 2011, our hospital: -Provided $3.5 million in services in the form of uncompensated care\charity care ($1.7 million) and bad debt write-offs(1.9 million) to families unable to pay the bills associated with their children's medical care. With 43 percent of patient care revenues devoted to the care of low-income children assisted by Medicaid, the Medicaid reimbursement shortfall for FY 2011 was $22 million less than the cost of the care provided. This amount has been steadily increasing and is expected to continue to rise with an uncertain national economic future. -Contributed $2.2 million towards community health education aimed at promoting health and preventing illness and injury made available through the Kohl's Keep Kids Safe Program, 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 $6.7 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 2011, 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 $31.6 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 2011, Children's Hospital and Medical Center contributed in total over $65 million in community benefits representing 31 percent of the hospital's operating expenses. PART VI 6-AFFILIATED HEALTH CARE SYSTEM Children's Hospital and 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 Foundation PART VI 7- STATE FILING OF COMMUNITY BENEFIT REPORT The Children's Hospital and 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. Internet Site: www.childrensomaha.org PART V, SECTION B, LINE 21 AT CHILDREN'S - COMMERCIAL INSURERS, GOVERNMENT PAYORS AND SELF-PAY BILLING PARTIES ARE ALL BILLED THE SAME GROSS CHARGE RATE FOR EACH SPECIFIC PROCEDURE PERFORMED. GROSS CHARGES ON AN FAP-PATIENT BILL ARE THEN DISCOUNTED ACCORDING TO THEIR FPG ELIGIBILITY WHICH REDUCES OR ELIMINATES THE AMOUNT THE PATIENT IS REQUIRED TO PAY. true Nebraska Pediatric Practice Inc 8200 Dodge St Omaha NE 68114 263064869 501(c)(3) 355000 Pediatrics University of NE College of Medicine 985520 NE Med Ctr Omaha NE 68198 470049123 501(c)(3) 124000 Ped. Research 2 CHARITY CARE ASSISTANCE TO THOSE PATIENTS IN NEED 2231 3232498 Book WRITE OFF PAT. ACCTS SCHEDULE I, PART I, LINE 2 SCHEDULE I - SUPPLEMENTAL INFORMATION 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 false false false false false false false false GARY A PERKINS FACHE 478848 0 240707 0 398636 0 53319 0 9082 0 1180592 0 0 0 KATHY ENGLISH 286090 0 98934 0 38719 0 38550 0 9005 0 471298 0 0 0 MICHAEL BROWN 275307 0 136945 0 27171 0 17150 0 12845 0 469418 0 0 0 JOHN MOORE MD 221290 0 0 4246 0 16279 0 12022 0 253837 0 0 0 CARL GUMBINER MD 299730 0 41332 0 2774 0 12250 0 728 0 356814 0 0 0 GEORGE E REYNOLDS MD 343917 0 110135 0 3376 0 36100 0 12704 0 506232 0 0 0 BETSY J STEPHENSON MD 306614 0 0 3937 0 33650 0 207 0 344408 0 0 0 JOHN ANDERSEN MD 370535 0 0 3482 0 13252 0 8043 0 395312 0 0 0 MICHAEL WILCZEWSKI MD 297279 0 0 3182 0 19600 0 193 0 320254 0 0 0 DAWN GARY MD 289197 0 0 3405 0 17150 0 12137 0 321889 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. HOSP AUTHORITY NO 2 OF DOUGLAS CO NE 521440796 259230KT6 2008-08-12 100881609 REFUND CHILD HOSP 2007 Series A&B false false false 0 0 100881843 5000176 0 0 751783 24826 0 2755000 92350000 0 true false true true false false false false 0.00000 0.00000 0.00000 true false true true MORGAN STANLEY 25. false false false 0 false true X PART II, LINE 3 0 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. 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 change for the top four executives (Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, and Chief Medical Officer) 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 12C POLICIES The Conflicts 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 of Directors or a Board committee for approval (interested person). This includes, but is not limited to, any director, officer, or member of a committee with board-designated powers. Each interested person has the obligation to annually submit a completed conflicts of interest questionnaire and has a continuing obligation to disclose any potential conflict of interest promptly. Each interested person signs annually an acknowledgement that states that the interested person has received, read and understands the conflict of interest policy, agrees to comply with the policy; understands that the policy applies to the board of directors and committees; understands that Children's Hospital & Medical Center is a not-for-profit organization that must engage primarily in exempt activities; agrees to report to the compliance Officer any change to matters previously disclosed on the Conflicts of Interest Questionnaire; states that the information provided in the conflicts of interest questionnaire is true and accurate to the best of his/her knowledge and belief. The governance committee reviews each completed conflicts of interest questionnaire to determine if any further investigation of potential conflicts is necessary. When a potential conflict is voluntarily identified by an interested person or through disclosure by another person, the remaining board/committee members review the matter and determine whether a conflict exists. Only disinterested board/committee members may vote to determine whether a conflict exists. The interested person in question cannot be present during the vote. If a conflict of interest exists, the disinterested board/committee members determine whether a more advantageous contract, transaction or arrangement should be obtained. When considering whether to enter into the proposed contract, transaction, or arrangement, only disinterested board/committee members can vote to determine if it is in the best interest of Children's and for Children's own benefit. The interested person may be required to leave the room when the matter is discussed and is required to leave the room when the matter is voted on. Only disinterested board/committee members may vote on the matter. Failure to comply with the conflict of interest policy may result in removal from the board. FORM 990, PART VI, LINE 11b GOVERNANCE, MANAGEMENT, AND DISCLOSURE The Form 990 will be available for all Board members through the Board Portal on the intranet and an overview will be presented to the Executive Committee prior to filing with the IRS. 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 5 Other Changes in Net Assets 1,776,689 Minority Interest in Children's Physicians (3,684,117) Change in Value of Swap 1,255 Capital Transfers Children's Health Network 1,164,977 Capital Transfers Chil. Hospital & Med. Ctr Fdn (741,196) Total Change in Net Assets 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 68144 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 CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA NE 68114 363967578 HEALTH NETWORK NE CHMC C corp 0 0 1.00000 false false true true false false false false true false true true true true false true false true CHILDREN'S HOSPITAL & MEDICAL CENTER FDN C 3236964 BOOK CHILDREN'S HOSPITAL & MEDICAL CENTER FDN IKLMN 2568312 BOOK CHILDREN'S PHYSICIANS D 1706105 BOOK CHILDREN'S HOSPITAL & MEDICAL CENTER FDN R 1164977 BOOK