2011-08-12T14:36:27-05:00 2010-12-31 KPMG LLP Two Central Park Plaza Suite 1501 Omaha NE 681021626 990 2010-01-01 470379754 CHILDREN'S HOSPITAL & MEDICAL CENTER CHIL 4029554116 8200 DODGE STREET OMAHA NE 68114 MICHAEL J BROWN 4029554116 2011-08-12 true 4023481450 2010 2016-02-24 21:20:13Z GARY A PERKINS 8200 DODGE STREET OMAHA NE 68114 215701490 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 2007 280 0 0 8595750 6856976 219858126 200133005 323194 653743 10400016 8057766 239177086 215701490 1843545 3584092 0 0 118519608 98984678 0 0 0 99449352 98472270 219812505 201041040 19364581 14660450 256015840 257508374 143037700 140536958 112978140 116971416 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 190600348 3584092 215701490 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. 190600348 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 2007 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 JOHN GOLLAN MD 1.0 X 0 0 0 STEVEN W SELINE 1.0 X 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 967704 0 56835 ERIC BUTLER 1.0 X 0 0 0 JIM LANDEN 1.0 X X 0 0 0 SUSAN WEIDNER 1.0 X 0 0 0 JOHN MOORE MD 40.0 X 200568 0 25967 DANA BRADFORD 1.0 X 0 0 0 SID DINSDALE 1.0 X 0 0 0 DAN HAMANN 1.0 X 0 0 0 JIM SIMPSON 1.0 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 CARL GUMBINER MD 40.0 X X 117661 0 2549 STEPHEN RAYNOR MD 1.0 X 0 0 0 KATHY ENGLISH 40.0 X 371961 0 46320 MICHAEL BROWN 40.0 X 393728 0 28263 DAVID M CHRISTENSEN MD 40.0 X 147652 0 2943 GEORGE E REYNOLDS MD 40.0 X 399511 0 44858 BETSY J STEPHENSON MD 40.0 X 268799 0 33244 CHANDRIKA RIZAL MD 40.0 X 255147 0 33868 RACHEL L MCMANN MD 40.0 X 252248 0 15299 JOHN C ANDRESEN MD 40.0 X 273943 0 20113 3648922 0 310259 100 false true false KIEWIT BUILDING GROUP INC 3921 MASON STREET OMAHA NE 681051840 CONSTRUCTION SRVCS 20777932 ECLIPSYS SOLUTIONS CORP PO BOX 8538-0133 LOCKBOX 077133 PHILADELPHIA PA 19117 IT SUPPORT SERVICES 2966643 PLACZEK STUDIOS INC-MATTHEW PLACZE 3716 LEAVENWORTH STREET OMAHA NE 68105 SCULPTOR/CONSTRUCT. 1689286 ELECTRIC COMPANY OF OMAHA 815 S 21ST STREET OMAHA NE 68103 ELECTRICAL CONTRACT. 1242848 HDR INC PO BOX 3480 OMAHA NE 681030480 BUILDING CONSULTANTS 931142 23 5409667 1447309 6856976 NET PATIENT SERVICE REVENUE 621110 200133005 200133005 200133005 634349 634349 0 0 71775 71775 71775 71775 19394 19394 19394 19394 0 0 0 MANAGEMENT FEE 541610 4131279 4131279 OTHER REVENUE 900099 2707929 2707929 METHODIST SERV INCOME 541900 1146783 1146783 7985991 215701490 208118996 725518 1035801 1035801 2548291 2548291 0 0 2241941 2241941 0 79475436 79475436 4211671 4211671 7582010 7582010 5473620 5473620 0 542585 542585 176219 176219 20707 20707 0 0 14964353 11292389 3671964 2898576 142 2898434 28810321 28810321 5426857 5426857 0 6255136 6255136 340127 340127 0 0 4857812 4857812 11761264 11761264 15684331 15684331 1194782 1194782 PROVISION FOR BAD DEBTS 2077972 2077972 COLLECTION EXPENSE 976047 976047 OPERATING LEASES 975582 975582 BUILDING MAINTENANCE 589241 589241 PROFESSIONAL DUES & SUBSCRIP. 433571 433571 486787 486787 201041040 190600348 10440692 0 860904 4193063 41674519 15996973 1507000 1506000 31665743 32795432 2820484 2654723 849630 1907180 290568930 115538733 154717624 175030197 8830841 10471372 3099771 3154554 570626 374983 9418698 9423897 256015840 257508374 30308755 26750591 61781 37014 100470257 100426669 7245040 7078768 4951867 6243916 143037700 140536958 X 111471140 115465416 1507000 1506000 112978140 116971416 256015840 257508374 X 14660450 -10667174 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 20707 20707 201020333 201041040 1000000 250000 1000000 1000000 1000000 1000000 4000000 6000000 8661 7300 5371 20707 42039 250000 250000 250000 250000 1000000 1500000 47818091 734290 2140797 4323854 46369324 44226562 7371562 10645327 8254241 6171119 47818091 48753075 9675396 -13889726 312183 44226562 0.82000 0.05000 0.13000 false true true 11641133 11641133 170022477 44528225 125494252 11327190 6101630 5225560 92153683 64473969 27679714 5424447 434909 4989538 175030197 0 DEFERRED COMPENSATION LIAB 1247749 MINORITY INTEREST IN CP LIABIL 490772 SWAP LIABILITY 4505395 6243916 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 2010 and 2009, 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 X true X true X true true true false true true 1455000 1455000 0.00730 76224000 55092000 21132000 0.10620 77679000 55092000 22587000 0.11350 1482000 62000 1420000 0.00710 8155000 1363000 6792000 0.03410 48109000 29839000 18270000 0.09180 5299000 5299000 0.02660 775000 775000 0.00390 63820000 31264000 32556000 0.16350 141499000 86356000 55143000 0.27700 33000 33000 3000 3000 36000 36000 false 1186000 0 29623 127846 -98223 X true true 1 1 CHILDREN'S HOSPITAL & MEDICAL CENTER

8200 DODGE STREET OMAHA NE 681144113

X X X X X X CHILDREN'S HOSPITAL & MEDICAL CENTER 1 7 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 HEALTHCARE 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 HARVEY OAKS URGENT CARE

14421 DUPONT CT OMAHA NE 68144

UCC OPENS 6AM-10PM CAROLYN SCOTT RAINBOW HOUSE

7815 HARNEY STREET OMAHA NE 68114

MINIMUM TO NO-COST ACCOMODATIONS FOR FAMILIES OF PATIENTS ENDOCRINOLOGY CLINIC

7831 CHICAGO CT OMAHA NE 68114

PEDIATRIC CLINIC-RELOCATED TO SPECIALTY PEDIATRIC CENTER AUGUST 2010 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 2010 Community Benefit report include $1.8M in FINANCIAL ASSISTANCE associated with an affiliated sub, Children's Physicians. PART I, LINE 7F $2,077,972 of Bad Debt included in functional expense Total Part IX, line 25 is not included in the Total Operating Expenses used to calculate the Table 7 percentages. 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 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 III, LINE 4 Bad Debt Expense Bad debt expense is identified on the consolidated statement of operations which is consistent with the reporting practice of other health care organizations, audited footnotes for Children's Hospital & Medical Center do not contain footnotes related to bad debt expense. 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 2010 Medicare Cost to Charge Ratio to arrive at an approximate cost value. Bad debt expense at 100% charge value $2,077,972 Medicare Cost to Charge Ratio x .5709 Bad debt expense at cost $1,186,000 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 2010 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, 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. 2010 Medicare charges reported by CMS in the Provider Statistical and Reimbursement System for provider FYE 12/31 were multiplied by the 2010 cost to charge ratio to arrive at an approximate cost of care related to the reimbursement payments reported on line 5. PART III, 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 VI, LINE 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. Children's is collaborating with Boys Town National Research Hospital in Omaha to conduct a comprehensive community needs assessment survey focuses solely on pediatrics. Planning for the survey will continue through 2011 and be conducted in early 2012. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE 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." PART VI, LINE 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 769,000. The Hospitals secondary service area consists of eight surrounding counties in Nebraska and nine surrounding counties in Iowa. For year ended December 31, 2010, 58% of the Hospitals discharges were from patients residing in the three-county primary service area. Patients residing in the seventeen-county secondary service area accounted for 18% of total hospital discharges during this same time period. Within this secondary service area, 13% of total discharges were from patients residing in the Nebraska counties,and 5% from patients residing in the Iowa counties. PART VI, Line 4 DEMOGRAPHICS 2010 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 769,108 Pediatric Population 202,920 Average Household Income $67,823 Percent of residents below federal poverty level 11.0% Percent of residents on Medicaid 12.3% Age Population % of Total Less than 18 202,920 26.4% 18 to 24 75,941 9.9% 25 to 44 218,351 28.4% 45 to 64 190,144 24.7% 65+ 81,752 10.6% Total 769,108 100.0% Race Population % of Total White 588,770 76.6% Black 66,511 8.7% Hispanic 75,524 9.8% Asian/Pacific Islander 17,971 2.3% Other 16,912 2.2% American Indian/ Alaska Native 3,420 0.4% Total 769,108 100.0% Federally-Designated Medically Underserved Areas Approximate % of patients from medically underserved areas: 11.8% County # of Census Tracts* Total Census Tracts % of Total Douglas 36 156 23.1% Sarpy 2 43 4.7% Pottawattamie 3 30 10.0% Total 41 229 17.9% *Census tract is a geographical division of 500 to 3,000 households. PART II ECONOMIC DEVELOPMENT Children's Hospital & Medical Center makes monetary donations to various organizations such as Nebraska Chamber of Commerce, Our Healthy Community Partner and Greater Omaha Chamber Foundation to support and enhance economic development throughout the state and Omaha metro area. COMMUNITY SUPPORT & COALITION BUILDING Children's Hospital & Medical Center goes beyond joint commission requirements to ensure community disaster readiness with our committee work involvement with the Omaha Medical Management Response team. Childrens has signed a Memorandum of Understanding and Resolution of the Omaha Metropolitan Area Hospitals and Support Facilities to participate in the Omaha Metropolitan Medical Response System (OMMRS). The OMMRS plan is for events involving weapons of mass destruction (WMD) that effect the Omaha metropolitan area and surrounding communities. Childrens will collaborate with OMMRS during a WMD event. In the event of a disaster affecting the community or surrounding areas, city officials will implement the Douglas County Emergency Operations Center (DCEOC) in downtown Omaha. A Childrens representative is assigned to report to DCEOC to maintain communication and to assist in management of the event. Cooperative planning among hospitals in the metropolitan area is achieved through participation in the medical table of the OMMRS which includes representation from all area hospitals. Communication and sharing of information essential elements of the command structure, names, roles and telephone numbers for individuals in the command structure, potentially shared resources and assets, and names of patients and deceased individuals brought to the hospital is coordinated through Douglas County Emergency Operations Center (DCEOC). The Childrens Incident Commander will make the decision when such information would be released. PART VI, LINE 5 and Part II Promotion of Community Health Information important in describing how the organization furthers its exempt purpose: Proudly serving children since 1948, Children's Hospital & Medical Center is the only full-service, pediatric health care center in Nebraska. Located in Omaha, it provides expertise in more than 30 pediatric specialty services to children and families across a five-state region and beyond. The 145 bed, non-profit hospital houses the only dedicated pediatric emergency department in the region and offers 24-hour, in-house services by pediatric critical care specialists. Children's has achieved the Magnet designation for nursing excellence, is an InfoWorld 100 award winner for innovation in information technology and for the first time received recognition in U.S. News and World Report's Best Children's Hospitals Ranking (ranked 41 in Orthopedics and 47 in Cardiology and Heart Surgery). A pediatric affiliation established between Children's and the University of Nebraska Medical Center College of Medicine (UNMC) supports enhancements in pediatric education, research and clinical care. Children's is also the primary teaching site for the family practice and joint pediatrics residency programs at Creighton University and UNMC. Children's Hospital & Medical Center is committed to ensuring that no child with a medical need is ever turned away due to a family's inability to pay for services. In 2010, our hospital: -Provided $2.7 million OF services in the form of uncompensated care or charity care ($1.5 million) and bad debt write-offs ($1.2 million) to families unable to pay the bills associated with their children's medical care. With 41 percent of patient care revenues devoted to the care of low-income children assisted by Medicaid, the Medicaid reimbursement shortfall for FY 2010 was $21 million less than the cost of the care we 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 Keeps 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 care, child life services, financial counseling and a variety of support groups. Children's gives back to the community through its 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 $6.8 million in pediatric health care education costs to educate tomorrow's healers and an additional $5.3 million to support pediatric education, research and clinical care that will in turn improve the health care of all children. In 2010, 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 $18.3 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 cost to the patient. In 2010, Children's Hospital & Medical Center contributed in total over $55 million in community benefits representing 27 percent of the hospital's operating expenses. PART VI, LINE 7 State Filing of Community Benefit Report The Children's Hospital & Medical Center's Community Benefit Report is filed in the State of Nebraska and is available to the public on the website www.childrensomaha.org. true Nebraska Pediatric Practice Inc 8200 Dodge St Omaha NE 68114 263064869 501(c)(3) 802200 Pediatrics University of NE College of Medicine 985520 NE Med Ctr Omaha NE 68198 470049123 501(c)(3) 233601 Ped. Research 2 0 CHARITY CARE ASSISTANCE TO THOSE PATIENTS IN NEED 1804 2548291 Book Write off pat. rec. 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 450992 0 224692 0 292020 0 48000 0 8835 0 1024539 0 0 0 KATHY ENGLISH 257405 0 77034 0 37522 0 37550 0 8770 0 418281 0 0 0 MICHAEL BROWN 250958 0 120704 0 22066 0 17150 0 11113 0 421991 0 0 0 DAVID M CHRISTENSEN MD 50173 0 97343 0 136 0 1928 0 1015 0 150595 0 0 0 JOHN MOORE MD 199253 0 0 0 1315 0 14460 0 11507 0 226535 0 0 0 GEORGE E REYNOLDS MD 336155 0 58988 0 4368 0 32650 0 12208 0 444369 0 0 0 BETSY J STEPHENSON MD 267632 0 0 0 1167 0 33009 0 235 0 302043 0 0 0 CHANDRIKA RIZAL MD 251750 0 0 0 3397 0 33650 0 218 0 289015 0 0 0 RACHEL L MCMANN MD 249252 0 0 0 2996 0 12250 0 3049 0 267547 0 0 0 JOHN C ANDRESEN MD 273432 0 0 0 511 0 12282 0 7831 0 294056 0 0 0 PART I, LINE 1A GARY PERKINS' SOCIAL CLUBS DUES ARE PAID FOR BY THE ORGANIZATION TO BE USED FOR BUSINESS PURPOSES. Hosp Authority No 2 of Douglas Co NE 521440796 259230KT6 2008-08-12 100881609 REFUND CHILDRENS HOSP SERIES A false false false 100881843 5000234 751783 24826 2755000 92350000 2008 true false true true false false false false true 0.00000 0.00000 0.00000 true false true true MORGAN STANLEY 25. false false false false true PART II, LINE 3 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 69,406 Minority Interest in Children's Physicians (1,354,930) Change in FV of Swap (14,916) Capital Transfers Children's Health Network (9,158,514) Capital Transfers Chil. Hospital & Med. Ctr Fdn (208,220) Equity in Losses of Children's Phsyicicans (10,667,174) Other Change in Net Assets FORM 990, PART VII BOARD MEMBERS During 2010, Carl Gumbiner, MD resigned from the board of directors and accepted the CMO position at Children's Hospital and Medical Center. Stephen Raynor, MD replaced him as a member on the board of directors. CHILDREN'S HOSPITAL & MEDICAL CENTER FDN 8200 DODGE STREET OMAHA NE 68114 476105603 FUNDRAISING NE 501(c)(3) LINE 7 NA CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA NE 68144 470689372 PED. CLINIC NE 501(c)(3) LINE 9 NA KENT INC 8200 DODGE STREET OMAHA NE 68114 470527928 REAL ESTATE NE NA C corp 0 219495 1.00000 CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA NE 68114 363967578 HEALTH NETWORK NE NA C corp 0 0 1.00000 false false true true false false false false true false true true true true false true true false CHILDREN'S HOSPITAL & MEDICAL CENTER FDN C 5409667 CHILDREN'S HOSPITAL & MEDICAL CENTER FDN IKLMN 2197436 CHILDREN'S PHYSICIANS D 1682239 CHILDREN'S HOSPITAL & MEDICAL CENTER FDN Q 9330524