2011-02-10T13:28:08-06:00 2010-06-30 KPMG LLP Two Central Park Plaza Suite 1501 Omaha NE 681021626 990 2009-07-01 470785575 UNMC Physicians UNMC 4025599789 988101 NEBRASKA MEDICAL CENTER OMAHA NE 681988101 TROY K WILHELM 4025597990 2011-02-03 true 4023481450 2009 2016-02-24 21:20:13Z MR TROY K WILHELM 988101 NEBRASKA MEDICAL CENTER OMAHA NE 681988101 203880432 false X WWW.UNMCPHYSICIANS.COM X 1995 NE SUPPORT THE MISSION OF UNIVERSITY OF NEBRASKA MEDICAL CENTER, IMPROVE HEALTH OF NEBRASKA THROUGH EDUCATION, RESEARCH, THE HIGHEST QUALITY PATIENT CARE, AND OUTREACH TO UNDERSERVED POPULATIONS. 20 0 1410 0 0 0 442860 186192306 203767140 506601 403495 1068908 -733063 187767815 203880432 20996949 37224110 0 0 113141592 112913065 0 0 0 47325212 52011757 181463753 202148932 6304062 1731500 115279150 117107955 41874375 38573920 73404775 78534035 SUPPORT THE MISSION OF THE UNIVERSITY OF NEBRASKA MEDICAL CENTER, AND ALSO TO IMPROVE THE HEALTH OF NEBRASKA THROUGH PREMIER EDUCATIONAL PROGRAMS, INNOVATIVE RESEARCH, THE HIGHEST QUALITY PATIENT CARE, AND OUTREACH TO UNDERSERVED POPULATIONS. false false 196928066 37224110 204777880 UNMC PHYSICIANS DIRECTS ITS RESOURCES TOWARD GIVING LEADING PHYSICIANS THE RESOURCES TO PROVIDE EXCELLENT HEALTHCARE TO PATIENTS ACROSS NEBRASKA AND BEYOND. UNMC PHYSICIANS CONTINUES TO LEAD THE REGION THROUGH A FOCUSED MISSION INCLUDING EXCEPTIONAL PATIENT CARE, EDUCATION THAT EMPOWERS, CUTTING-EDGE RESEARCH AND AN EMPHASIS ON GIVING BACK TO THE COMMUNITY. WITH MORE THAN 50 SPECIALTIES AND SUB-SPECIALTIES, UNMC PHYSICIANS PROVIDES SPECIALIZED SERVICES AND THE LATEST IN TREATMENT OPTIONS TO ITS PATIENTS. OUR PHYSICIANS NOT ONLY TREAT PATIENTS, BUT THEY EDUCATE FUTURE PHYSICIANS. MANY OF OUR DOCTORS TRAINED AND NOW TEACH AT THE UNIVERSITY OF NEBRASKA MEDICAL CENTER. THEY, ALONG WITH EXPERIENCED NURSES, ALLIED HEALTH PROFESSIONALS AND BUSINESS SUPPORT PERSONNEL ARE DEDICATED TO SERVING THE HEALTHCARE NEEDS OF OUR COMMUNITY. CHARITABLE CARE IS A HIGH PRIORITY, AND WE MAKE TREATMENT AVAILABLE TO ALL PERSONS WHO PRESENT THEMSELVES FOR CARE, REGARDLESS OF RACE, CREED, LIFESTYLE, OR ABILITY TO PAY. DURING FISCAL 2009, UNMC PHYSICIANS SERVED MORE THAN 390 THOUSAND PATIENTS IN ITS CLINICS AND OVER 260 THOUSAND PATIENTS THROUGH INPATIENT AND OTHER ANCILLARY SERVICE LINES. IN ADDITION, UNMC PHYSICIANS SUPPORTS MANY COMMUNITY BASED HEALTH PROGRAMS SERVING THE POOR THROUGH DONATED FUNDS, SUPPLIES, PHYSICIAN TIME AND NURSE TIME. UNMC PHYSICIANS PROVIDED MORE THAN 2.5 MILLION DOLLARS, AT COST, IN CHARITABLE CARE TO THE UNDERSERVED AND THOSE UNABLE TO PAY FOR MEDICALLY NECESSARY HEALTHCARE SERVICES. IN ADDITION, OVER 29 PERCENT OF UNMC PHYSICIANS NET PATIENT SERVICE REVENUE CAME FROM GOVERNMENT FUNDED HEALTH INSURANCE PROGRAMS, SUCH AS MEDICAID, MEDICARE AND TRICARE. WHILE THESE GOVERNMENT PROGRAMS DO NOT COVER THE FULL COST OF THE HEALTH SERVICES PROVIDED, UNMC PHYSICIANS TRANSFERRED OVER 31 MILLION DOLLARS TO THE COLLEGE OF MEDICINE AT THE UNIVERSITY OF NEBRASKA MEDICAL CENTER IN SUPPORT OF ITS CLINICAL, EDUCATION AND RESEARCH MISSION. PLEASE SEE THE COMMUNITY BENEFIT REPORT FOR ADDITIONAL DETAILS AT WWW. UNMCPHYSICIANS.COM 196928066 true true false false false false false false false true true false false false false false false false false false true true true true false false false false false false false false false false false false false true false false false true 75 0 true 1410 true false false false false false false false false false 20 0 false false false false true true true true true false false true true true true true true true true true false X MR TROY K WILHELM 4025597990 988101 NEBRASKA MEDICAL CENTER OMAHA NE 681988101 CHARLES A ENKE 40.0 X 298865 218007 34030 KEVIN L GARVIN 40.0 X 340822 205708 33477 JOHN L GOLLAN 40.0 X 152808 288781 24077 DONALD A LEOPOLD 40.0 X 262821 203847 38198 CARL V SMITH 40.0 X X 213592 219005 27337 CRAIG W WALKER 40.0 X 375996 221400 38679 STEVEN WENGEL 40.0 X 40000 221850 24199 JAMES WISECARVER 40.0 X 246087 114283 43840 Lynell Klassen 40.0 X 47716 263870 26922 GERALD GROGGEL 40.0 X 204423 106615 19222 ROBERT MUELLEMAN 40.0 X X 211222 166582 44135 RODNEY S MARKIN 40.0 X X 336091 193565 36862 MICHAEL SITORIUS 40.0 X 58800 227922 27844 PIERRE FAYAD 40.0 X 139505 209906 20783 MARK MAILLIARD 40.0 X 180105 108668 18274 JOHN SPARKS 40.0 X 144400 206073 19507 DEBRA ROMBERGER 40.0 X 210678 31948 7471 THOMAS HEJKAL 40.0 X 262627 116197 24798 STEVE HINRICHS 40.0 X 218000 211615 38314 KEN FOLLETT 40.0 X 446808 130822 43659 SHIELA ELLIS 40.0 X 271320 103276 30134 DAVID W MERCER 40.0 X 166650 86061 46738 CORY D SHAW 40.0 X 200444 154080 25180 TROY WILHELM 40.0 X 251135 0 19026 DENNIS BIERLE 40.0 X 225647 0 20501 CARIN BORG 40.0 X 75699 102525 21998 HAROLD MAURER 40.0 X 89077 512593 42607 LISA RUNCO 40.0 X 79838 86788 24436 BRYAN SCHWAHN 40.0 X 103193 75282 29458 DAVID MELLIGER 40.0 X 70640 82715 21234 JEAN BOTHA 40.0 X 633121 70881 44533 ALAN LANGAS 40.0 X 819049 95179 43106 WENDY JEAN WARD 40.0 X 633308 70807 44401 TRACY DORHEIM 40.0 X 434298 112567 44736 WILLIAM THORELL 40.0 X 463764 73994 44570 8908549 5293412 1094286 37 false true false KIEWIT BUILDING GROUP INC 3921 MASON STREET OMAHA NE 681051840 GENERAL CONTRACTOR 4524529 NEBRASKA MEDICAL CENTER 988145 NEBRASKA MEDICAL CENTER OMAHA NE 681988145 MEDICAL CALL CENTER 383344 GOLDNER COOPER COTTON SUNDELL 8901 W DODGE RD SUITE 210 OMAHA NE 68114 Physician Svcs. 200000 ADP PO BOX 78415 PHOENIX AZ 85062 PAYROLL SERVICE 190050 RELAYHEALTH PO BOX 403421 ATLANTA GA 30384 STMT PRINTING & MAIL 183170 9 442860 442860 PATIENT SVC REVENUE 621400 196781195 196781195 MISC. CLINICAL SUPPORT REVENUE 900099 2106464 2106464 THE NEBRASKA MEDICAL CENTER - CLINIC SUPPORT 900099 4879481 4879481 203767140 403495 403495 0 0 0 0 0 0 DEPARTMENTAL MISC. DEPOSITS 561000 1010740 1010740 LOSSES IN JOINT VENTURE 900099 -1743803 -1743803 -733063 203880432 204777880 -1340308 31619635 31619635 5604475 5604475 0 0 11488744 11488744 0 80760049 80760049 10444412 10444412 6190522 6190522 4029338 4029338 0 79864 79864 108951 108951 0 0 0 0 466191 466191 1398149 1398149 0 0 3043709 3043709 292387 292387 0 107930 107930 0 0 1498059 1498059 402889 402889 DEAN & DEPT DEVELOPMENT FUND 9450170 9450170 CONTRACTED PHYSICIAN SVC 9341824 9341824 PROVISION FOR BAD DEBT EXPENSE 8256269 8256269 MEDICAL SUPPLIES/EQUIPMENT 4136734 4136734 MEDICAL MALPRACTICE EXPENSE 3097220 3097220 10331411 5702249 4629162 202148932 196928066 5220866 0 25771012 14881197 2459892 2470322 31229942 33061316 236751 392868 77892 522565 33247123 11684998 16786819 21562125 31434141 35552760 2340142 462251 4942559 8202551 115279150 117107955 23889457 23551686 17984918 15022234 41874375 38573920 X 73404775 78534035 73404775 78534035 115279150 117107955 X false true true X false X 442860 442860 145982067 157535782 179803474 187261214 204777880 875360417 145982067 157535782 179803474 187261214 205220740 875803277 12299303 14737271 17833743 25842227 25069283 95781827 12299303 14737271 17833743 25842227 25069283 95781827 780021450 833226 985619 901909 506601 403495 3630850 207897 207897 833226 985619 1109806 506601 403495 3838747 -1743803 -1743803 146815293 158521401 180913280 187767815 203880432 877898221 0.88851 0.89530 0.00437 0.00460 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2358686 2358686 4416180 192596 4223584 6604066 1497994 5106072 14299343 9994408 4304935 5568848 0 5568848 21562125 LAND HELD FOR FUTURE EXPANSION 3043800 DUE FROM UNMC 2802534 DUE FROM OUTSIDE CONTRACTS 1869427 COLLEGE OF NURSING 0 DUE FROM WVP MED BLDG LLC 486790 8202551 0 FEES PAYABLE TO UNMC 7193239 RESERVE FOR SELF INSURANCE 4883373 EDUCATION BUILDING COMMITMENT 2000000 UNMC PAYABLE - NPPI 945622 15022234 203880432 202148932 1731500 3397760 3397760 5129260 193417448 3397760 -13860744 -10462984 203880432 203880432 188288188 188288188 13860744 13860744 202148932 Part XII, Line 2D 8,256,269 Bad Debt Expense Reclass 5,604,475 CHARITY CARE RECLASS ---------- 13,860,744 EXPLANATION TO THE ORGANIZATION'S FINANCIAL STATEMENTS (FIN 48) PART X FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES (FIN 48) IS NOT APPLICABLE TO UNMC PHYSICIANS AS THEY ARE CONSIDERED A GOVERNMENTAL ENTITY FOR ACCOUNTING PURPOSES. Part XIII, Line 4B 8,256,269 Bad Debt Expense Reclass true true X true X true X true true false true true 2382536 2382536 0.01210 20169576 17350959 2818618 0.01430 1791 421 1370 22553903 17351380 5202524 0.02640 168495 168495 0.00090 4995592 4995592 0.02530 36074213 36074213 0.18290 41238300 41238300 0.20910 63792203 17351380 46440824 0.23550 true 3559421 1150585 21746122 41489993 -19743871 X true true BELLEVUE MEDICAL CENTER LLC

2500 medical center drive BELLEVUE NE 68123

X X X BELLEVUE MEDICAL CENTER IS STRUCTURED AS AN LLC AND IS A HOSPITAL. UNMC PHYSICIANS IS NOT A HOSPITAL, BUT ITS INFORMATION IS BEING REPORTED AS REQUIRED due to its ownership held in the llc. Per the instructions, unmc physicians has answered part I line 3 based on the joint venture charity care policy OF The Bellevue Medical Center, which is a hospital; and not on the charity care policy of UNMC Physicians, which is not a hospital. However, unmc physician's policy is determined by the fpg level of 150% for part I line 3a and 350% for part I line 3b. The UNMC Physicians community benefit report can be accessed at: www.unmcphysicians.com/v2/default.asp?id=13 Bellevue Medical Center was opening the new hospital during the fiscal year and had a little over a month of activity. Therefore, a community benefit report has not been completed. BOTH UNMC PHYSICIANS AND BELLEVUE MEDICAL CENTER USED THE COST TO CHARGE RATIO FOR FIGURES REPORTED IN THE TABLE. THIS COST TO CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 OF THE INSTRUCTIONS. The organization does not have information that indicates that services are provided despite a financial loss to the organization. Bellevue Medical Center did not engage in subsidized services during the fiscal year. The amount used to calculate the table 7 percentages is $197,196,609. This amount is derived from part ix line 25 in the amount of $202,148,932, less bad debt of $8,256,269 for unmc physicians. Per the instructions, then the proportionate share of total expenses of the Bellevue medical center joint venture of $3,337,826, less bad debt of $33,880 was added to the unmc physicians' amount. Patient Service Revenue may qualify for financial assistance. The Patient is obligated to complete financial assistance forms and to submit supporting documentation to qualify. Services to patients who provide this information and qualify for assistance are not considered bad debt. Bad Debt is reported for services rendered to those unwilling to pay and /or work with the organization to provide financial assistance if available. This is only after the organization has exhausted all reasonable efforts to collect outstanding balances from the patient. If an account is determined to meet the criteria of a bad debt, the remaining balance will be written off to bad debt expense. As the organization does not have a cost accounting system, the COST OF THE BAD DEBT WAS ESTIMATED USING THE COST TO CHARGE RATIO. THERE IS NO SPECIFIC FOOTNOTE IN THE AUDITED FINANCIAL STATEMENTS FOR BAD DEBT, HOWEVER, A DISCUSSION ON NET PATIENT SERVICE REVENUE STATES, "UNMC Physicians has agreements with third party payers that provide payment to UNMC Physicians at amounts different from its established rates. Net patient service revenue is reported at the net realizable amounts from patients, third-party payers and others for services rendered." As a part of our mission, we will provide treatment to any patient who needs it. We have a disproportionate share of Medicare patients in the community where we provide care below our cost. This produces a loss and is considered a community benefit. Our costing methodology is the cost to charge ratio. We are not a hospital and do not have a hospital cost accounting system to produce detailed cost information at the service level. We do not have or prepare Medicare cost reports, therefore we use the cost to charge ratio. UNMC Physicians provides financial assistance to qualified uninsured or underinsured patients requiring non-elective medically necessary treatment. Patients known to qualify for financial assistance (after completing all paperwork and receiving approval) are identified accordingly in the financial systems to ensure financial assistance is used to cover services rendered by UNMC Physicians. Financial assistance can result in 100% assistance sliding to 20%. Consideration is given to medically necessary current charges and can extend for a period up to six months. Patients can renew every six months. A reevaluation of the patient's financial situation may be performed if the patient is unable to comply with the financial assistance arrangements. Patients receive a statement from the organization as long as they have a balance due. Patients of the Bellevue Medical Center known to qualify for financial assistance (once all paperwork is received and approved) are flagged in the system and monitored accordingly to ensure financial assistance is "posted" to the patient account. When the 12 month approval expires, patients are contacted if services have been rendered within the last six months to discuss submittal of new information for continuation of assistance. If patients no longer qualify, other payments options are discussed per organizational policy. Reports are utilized for follow up purposes. Patients who qualify for 100% assistance do not receive guarantor statements (bills) from the organization. Patients who qualify for an 80% or 60% discount work with customer service or collection staff to outline payment arrangements according to set policy. UNMC PHYSICIANS SUPPORTS THE MISSION OF THE UNIVERSITY OF NEBRASKA MEDICAL CENTER, TO IMPROVE THE HEALTH OF NEBRASKA THROUGH PREMIER EDUCATIONAL PROGRAMS, INNOVATIVE RESEARCH, THE HIGHEST QUALITY PATIENT CARE, AND OUTREACH TO UNDERSERVED POPULATIONS. UNMC PHYSICIANS IS NOT A HSOPITAL, HOWVEVER, UNMC PHYSICIANS OWNS 19% OF BELLEVUE MEDICAL CENTER, LLC, WHICH IS A HOSPITAL. THEREFORE, per the instructions, SCHEDULE H INCLUDES ALL CLINICAL ACTIVITIES OF UNMC PHYSICIANS, PLUS 19% OF HOSPITAL ACTIVITY OF BELLEVUE MEDICAL CENTER, LLC. UNMC Physicians uses disease incidence and prevalence data, leading causes of death, community health status research and supply and demand analysis to assess the health care needs of the communities it serves. Bellevue Medical Center is majority owned by The Nebraska Medical Center. UNMC Physicians HAS A MINORITY OWNERSHIP. both OF THESE ORGANIZATIONS are 501(c)(3) organizations. It was determined that the community had a need for medical services that was not currently being fulfilled. Between the two organizations they own over 80% of Bellevue Medical Center. UNMC PHYSICIANS employs financial counselors and customer service staff, all of whom are trained in assisting our patients with resolution of the patients' liability. Depending on individual patient needs, payment arrangements or financial assistance may be offered to assist our patients with resolution of their balances. Patients are educated about the requirements and eligibility for patient assistance by financial counselors onsite at clinic locations, through brochures and pamphlets, and through the unmc physicians' website. Bellevue Medical Center employs Financial Counselors, Customer Service Staff and Collection Staff, all of whom are trained in assisting our patients with resolution of patient liability. Depending upon individual patient needs, payment arrangements or financial assistance may be offered to assist our customers with resolution of patient balances. Additionally, the organization contracts with a company to work with our self pay population to pursue coverage through state, federal or local programs. The contract organization provides this patient population with financial assistance applications to complete as well, therefore, if the patient does not meet requirements for state, federal or local coverage, a financial assistance application can be utilized. Our mission is to further the University of Nebraska Medical Center's mission by giving leading physicians the resources necessary to provide high quality health care to patients from across Nebraska and beyond. In addition, we support the missions of, and provide services to, The Nebraska Medical Center, Children's Hospital, and the Omaha VA Medical Center. We generally serve the local area of Omaha, but provide service to patients throughout the state of Nebraska. In addition, given our close proximity to Iowa, we serve many patients from that state as well. patients from the Omaha Metro area served by UNMC Physicians are predominately White-Non Hispanic with over 70% in this category. Black Non-Hispanic make up 13% of the population; 7.5% is Hispanic - White. The remaining 9% includes Asian, Native American, and Unknown classifications. UNMC Physicians continues to lead the region through a focused mission including exceptional patient care, education that empowers, cutting-edge research and an emphasis on giving back to the community. At UNMC Physicians, we recognize an individual's right to quality healthcare regardless of age, sex, race, religion, national origin, or ability to pay. In addition to providing free or reduced healthcare to low income patients, UNMC Physicians supports the community through employee volunteer hours, donations to many charities and extensive financial support of the University of Nebraska Medical Center. Because of the continued dedication of our talented physicians, we are able to significantly impact the community through leadership in many medical fields. UNMC Physicians grants credit without collateral to its patients, most of whom are local residents and are insured under third party payor arrangements. The mix of our receivables from patients as of June 30, 2010 was Medicare - 19%, Medicaid -10%, Commercial Payors -41%, Self-Pay 18% and Other 12%. Bellevue Medical Center is located in Bellevue, Nebraska. Statistics of the population served is not yet available since the hospital was only open for a month during this fiscal year. The organization does not currently participate in these types of community building activities. the organization is a physician practice focused on its mission of providing exceptional patient care, education of future medical professionals for the region, and research, while supporting the community. Bellevue Medical Center did not have any community building activities in FY10 as the hospital was only operational 45 days of the fiscal year. However, Bellevue Medical Center plans to partake in community building activities once the hospital has had a chance to develop. PART VI, LINE 6 Unmc physicians is not a hospital and therefore this question is not applicable. Bellevue medical center is a hospital, however, it is not a tax exempt organization, and therefore this question is not applicable. part i, line 2: for further clarification of part i, line 2, both unmc physicians, which is not a hospital and bellevue medical center, which is a hospital through a joint venture, have separate and distinct charity care policies. therefore the "generally tailored to individual hospitals" has been checked. UNMC Physicians is a not for profit corporation committed to supporting the mission of the University of Nebraska Medical Center ("UNMC"). It was established by UNMC to provide a vehicle for the faculty of the College of Medicine to develop an integrated practice for management of clinical activities. The mission of the University of Nebraska Medical Center is to improve the health of Nebraska through premier education programs, innovative research, the highest quality patient care, and outreach to underserved populations. Bellevue Medical Center is not part of a affiliated group. PART VI LINE 8 Unmc physicians is not required to file its community benefit report with any state, however Unmc physicians does make it available to the public via the web link provided above. Bellevue medical center is also not required to file a community benefit report with any state. true AMERICAN HEART ASSOCIATION HEARTLAND AFFILIATE 10100 J STREET SUITE A OMAHA NE 68127 135613797 501(C)(3) 25000 FURTHER EXEMPT PURP. AMERICAN DIABETES ASSOCIATION 14216 DAYTON CIR STE 6 OMAHA NE 68137 131623888 501(C)(3) 10000 FURTHER EXEMPT PURP. NATIONAL MULTIPLE SCLEROSIS SOCIETY 328 south 72nd street OMAHA NE 68114 470439079 501(C)(3) 10000 FURTHER EXEMPT PURP. UNIVERSITY OF NEBRASKA MEDICAL CENTER 986800 NE MED CTR OMAHA NE 68198 470049123 GOVT 31171955 EDUC. SUPPORT UNIVERSITY HOSPITAL AUXILIARY 987509 NE MED CTR OMAHA NE 68198 470591991 501(C)(3) 21000 FURTHER EXEMPT PURP. UNIVERSITY OF NEBRASKA FOUNDATION 8712 W DODGE RD STE 100 OMAHA NE 68114 470379839 501(C)(3) 174000 FURTHER EXEMPT PURP. UNMC COLLEGE OF NURSING 985330 NE MED CTR OMAHA NE 68198 470049123 501(C)(3) 76750 FURTHER EXEMPT PURP. THE DURHAM MUSEUM 801 SOUTH 10TH STREET OMAHA NE 68108 470556061 501(C)(3) 16875 FURTHER EXEMPT PURP. AMERICAN COLLEGE OF PHYSICIANS NEBRASKA CHAPTER 4904 S SWEETBRIAR DR SIOUX FALLS SD 57108 510253459 501(C)(3) 7500 FURTHER EXEMPT PURP. Metro Omaha Medical Society 7906 DAVENPORT STREET OMAHA NE 68114 470258950 501(C)(6) 35000 FURTHER EXEMPT PURP. OMAHA PERFORMING ARTS SOCIETY 1200 DOUGLAS ST OMAHA NE 68102 470832480 501(C)(3) 33333 FURTHER EXEMPT PURP. 10 1 CHARITY CARE 4585 5604475 BOOK PATIENT FIN'L ASSIST PART I, LINE 2 CHARITABLE GIVING IS PRIORITIZED AS FOLLOWS: 1) HEALTH AND WELLNESS 2) HUMAN SERVICES 3) MEDICAL EDUCATION AND RESEARCH PROCEDURES FOR MONITORING THE USE OF THE GRANT FUNDS IN THE U.S.: DONATIONS WILL BE BUDGETED AT THE DEPARTMENT OR COST CENTER LEVEL. FURTHERMORE, ALL DONATION REQUESTS MUST BE SUBMITTED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. THE CFO MAY ALSO REQUEST ADDITIONAL INFORMATION, AND/OR MAKE THE APPROVAL CONTINGENT UPON THE ORGANIZATION PROVIDING ONE OR MORE REPORTS DURING OR AT THE CONCLUSION OF THE PROJECT SHOWING HOW THE GRANT FUNDS WERE SPENT. ANY SINGLE DONATION REQUEST, OR DONATIONS IN THE AGGREGATE TO ANY ONE CHARITY IN A FISCAL YEAR OF $10,000, SHALL REQUIRE THE APPROVAL OF THE UNMC PHYSICIANS BOARD OF DIRECTORS. PART III UNMC PHYSICIANS HAS A WRITTEN FINANCIAL ASSISTANCE/CHARITY CARE POLICY. X X X X false false false false false false false false false CHARLES A ENKE 263514 218007 35351 0 0 0 7042 18098 3 8977 305910 245082 0 0 KEVIN L GARVIN 305000 205708 35822 0 0 0 17001 16476 3 408 357826 222592 0 0 JOHN L GOLLAN 130997 266781 21811 0 0 22000 0 18571 3 5506 152811 312858 0 0 DONALD A LEOPOLD 233702 181847 29119 0 0 22000 16732 16634 3 4832 279556 225313 0 0 CARL V SMITH 208730 197005 4862 0 0 22000 10135 14370 3 2832 223730 236207 0 0 CRAIG W WALKER 278496 221400 97500 0 0 0 14119 18170 3 6485 390118 246055 0 0 STEVEN WENGEL 40000 221850 0 0 0 0 0 18175 3 6090 40003 246115 0 0 JAMES WISECARVER 216087 114283 30000 0 0 0 28811 9523 3 5506 274901 129312 0 0 Lynell Klassen 37933 263870 9783 0 0 0 0 21484 3 5438 47719 290792 0 0 GERALD GROGGEL 179423 84615 25000 0 0 22000 8750 8617 3 1855 213176 117087 0 0 ROBERT MUELLEMAN 196222 166582 15000 0 0 0 21248 13997 3 8890 232473 189469 0 0 RODNEY S MARKIN 326091 171565 10000 0 0 22000 18353 15677 3 3156 354447 212398 0 0 MICHAEL SITORIUS 37800 227922 21000 0 0 0 0 18954 3 9178 58803 256054 0 0 PIERRE FAYAD 112977 209906 26528 0 0 0 0 17032 3 3751 139508 230689 0 0 CORY D SHAW 152088 137580 48356 0 0 16500 5162 12846 3 7244 205609 174170 0 0 TROY WILHELM 207245 0 31864 0 12026 0 14386 0 4643 0 270164 0 0 0 MARK MAILLIARD 175105 108668 5000 0 0 0 8574 8721 3 1099 188682 118488 0 0 JOHN SPARKS 104400 184073 40000 0 0 22000 76 15225 3 4530 144479 225828 0 0 DEBRA ROMBERGER 195384 31948 15294 0 0 0 1352 2764 3 3355 212033 38067 0 0 THOMAS HEJKAL 129043 116197 133584 0 0 0 9870 9696 3 5484 272500 131377 0 0 STEVE HINRICHS 188000 211615 30000 0 0 0 16144 17280 3 5142 234147 234037 0 0 KEN FOLLETT 359613 130822 87195 0 0 0 26461 10908 3 6290 473272 148020 0 0 SHIELA ELLIS 241320 103276 30000 0 0 0 17967 8495 3 3672 289290 115443 0 0 DENNIS BIERLE 198115 0 27532 0 0 0 16923 0 3581 0 246151 0 0 0 JEAN BOTHA 383292 54381 249829 0 0 16500 34950 5911 3 3768 668074 80560 0 0 ALAN LANGAS 568220 95179 250829 0 0 0 31669 7841 3 3596 850721 106616 0 0 WENDY JEAN WARD 383479 54307 249829 0 0 16500 34977 5896 3 3648 668288 80351 0 0 CARIN BORG 75699 102525 0 0 0 0 9940 8452 3 3606 85642 114583 0 0 HAROLD MAURER 89077 512593 0 0 0 0 0 39775 3 4185 89080 556553 0 0 LISA RUNCO 79838 86788 0 0 0 0 11753 7314 3 5393 91594 99495 0 0 BRYAN SCHWAHN 86193 75282 17000 0 0 0 18896 5390 3 5172 122092 85844 0 0 TRACY DORHEIM 434298 112567 0 0 0 0 33325 7521 3 3890 467626 123978 0 0 DAVID MELLIGER 43140 82715 27500 0 0 0 11980 6777 3 2477 82623 91969 0 0 DAVID W MERCER 166650 86061 0 0 0 0 45000 17 3 1771 211653 87849 0 0 WILLIAM THORELL 412141 60794 51623 0 0 13200 34510 6170 3 3890 498277 84054 0 0 GOVERNANCE, MANAGEMENT, AND DISCLOSURE - CONFLICTS OF INTEREST PART VI, SECTION B, QUESTION 12C All Covered Persons are required to complete, on an annual basis (at a minimum), a Conflict of Interest Questionnaire and Attestation of Compliance. Any Covered Person considering activity that could create an actual or potential Conflict of Interest must immediately disclose the nature of the Conflict of Interest including all material facts within the Conflict of Interest Questionnaire and Attestation of Compliance. During the time period between annual attestations, Covered Persons are encouraged to seek counsel and advice from the Chairman of the Board of Directors (Chairman) or Chief Executive Officer (CEO) should any questions arise as to whether or not personal activity or proposed activity would be considered a Conflict of Interest. Whenever there is reason to believe that an actual or potential Conflict of Interest exists between UNMC Physicians and a Covered Person, the following procedures for reviewing a potential Conflict of Interest shall be undertaken: 1.Conflicts involving Board members or Members of Board Committees The Chairman shall serve as the Designated Reviewing Official and shall have responsibility (except when he/she is a Covered Person) to promptly bring the actual or potential Conflict of Interest to the attention of the Board for action at the next regular meeting of the Board, or during a special meeting called specifically to review the potential conflict of interest. When the Chairman has an actual or potential Conflict of Interest, the CEO shall serve as the Designated Reviewing Official. 2.Conflicts involving CEO, CFO or COO The Chairman shall serve as the Designated Reviewing Official and shall have responsibility to promptly bring the actual or potential Conflict of Interest to the attention of the Board for action at the next regular meeting of the Board, or during a special meeting called specifically to review the actual or potential Conflict of Interest. 3.Conflicts involving all other Covered Persons The CEO shall serve as the Designated Reviewing Official and shall be responsible for reviewing the actual or potential Conflict of Interest. UNMC Physicians shall refrain from acting upon any transaction involving an actual or potential Conflict of Interest until such time as the actual or potential Conflict of Interest has been reviewed and final resolution (i.e., approved, denied, and/or proposed an alternative arrangement) has been determined through the applicable process described below: 1.Conflicts involving Board members or Members of Board Committees A) The Covered Person shall have an opportunity and must be available to provide factual information about the actual or potential Conflict of Interest. B) The Covered Person shall not participate in any way in, or be present during, the deliberations and decision-making vote with respect to such actual or potential Conflict of Interest. C) The disinterested members of the Board shall consider whether the terms of the actual or potential Conflict of Interest are fair and reasonable to UNMC Physicians and shall vote to determine final resolution. D)Final resolution of the arrangement by the disinterested members of the Board shall be by vote of a majority of directors in attendance at a meeting at which a quorum is present. A Covered Person shall not be counted for purposes of determining whether a quorum is present, nor for purposes of determining what constitutes a majority vote of Board members in attendance. 2.Conflicts involving CEO, CFO, COO A)The Covered Person shall have an opportunity and must be available to provide factual information about the actual or potential Conflict of Interest. B)The Covered Person shall not participate in any way in, or be present during, the deliberations and decision-making vote with respect to the actual or potential Conflict of Interest. C)The Chairman shall bring actual or potential Conflicts of Interest to the attention of the Board for action. Members of the Board shall consider whether the terms of the actual or potential Conflict of Interest are fair and reasonable to UNMC Physicians and shall vote to determine final resolution. D)Final resolution of the actual or potential Conflict of Interest by the disinterested members of the Board shall be by vote of a majority of directors in attendance at a meeting at which a quorum is present. 3.Conflicts involving all other Covered Persons A) The Covered Person shall have an opportunity and must be available to provide factual information about the actual or potential Conflict of Interest. B) The Covered Person shall not participate in any way in, or be present during, the deliberations and decision-making vote with respect to such actual or potential Conflict of Interest. C) The CEO shall be responsible for reviewing and determining final resolution of actual or potential Conflicts of Interest. All results shall be reported to the Chairman who may then determine whether any further board review or action is necessary. POLICIES - COMPENSATION PART VI, SECTION B, QUESTION 15 The Compensation Committee for accepting/revising/rejecting executive compensation is comprised of: 1. the Chair of the Board of Directors of UNMC Physicians ("Board"); 2. Vice Chancellor for Business and Finance of the University of Nebraska Medical Center (UNMC) who shall serve as the Committee Chair (Committee Chair); 3. two (2) members who are not employees of UNMC Physicians. These two (2) members shall be appointed by the Committee Chair and are subject to approval of Board; and 4. three (3) Board members, who are chairs of clinical departments. The Compensation Committee reviews all proposed compensation. All compensation submitted for review must be supported by appropriate documentation, including but not limited to comparability data (i.e., Association of American Medical Colleges (AAMC)) relevant for the occupation and Corporation position. The Compensation Committee shall ensure, when reviewing and approving all compensation (subject to the Compensation Committee Policy and Procedure) that its review and approval qualifies for the rebuttable presumption of reasonableness under the Intermediate Sanctions regulations (26 C.F.R. 53.4958-6, as amended). To ensure such compliance, the Compensation Committee shall: 1. ensure that no conflict of interest is present with Compensation Committee members present; 2. receive and rely upon appropriate data as to comparability from internal or external resources prior to making its determination; and 3. document the basis for its determination of reasonableness concurrently with making that determination. Such documentation shall include: a) the terms of the arrangement that was approved and the date it was approved; b) the members of the Compensation Committee who were present and those who voted on it (Quorum is required for any approval); c) the comparability data obtained and relied upon by the Compensation Committee and how such material was obtained; and d) the action(s) taken by the Compensation Committee. GOVERNANCE, MANAGEMENT, AND DISCLOSURE Form 990, Part VI, Line 19 Governing documents, Conflict of Interest policy, and audited financial statements are available to the public upon request in the administration offices. GOVERNANCE, MANAGEMENT, AND DISCLOSURE PART VI, LINE 11 The Form 990 is initially reviewed in detail by the Finance Committee of the Board of Directors, with executive management and independent tax specialists present to assist with the review. The Finance Committee's role is to thoroughly understand the Form 990 contents and to report to the full board of directors the results of its review. The review with the full Board of Directors is conducted prior to the filing of the Form 990 with the IRS. The Form 990 is sent to each Director of the Board one week prior to the Board Meeting at which the Form 990 will be reviewed and reported upon by the Finance Committee. IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS SCHEDULE R, PART II UNIVERSITY OF NEBRASKA MEDICAL CENTER IS A PART OF THE UNIVERSITY OF NEBRASKA GOVERNED BY THE BOARD OF REGENTS. GOVERNANCE, MANAGEMENT, AND DISCLOSURE PART VI, SECTION A, LINE 6 The Corporation's Bylaws and Articles of Incorporation provide that all full time, part time and volunteer faculty members of the University of Nebraska College of Medicine who provide professional clinical healthcare services and have a separate employment arrangement with Corporation are deemed members of the Corporation. Each full time member is entitled to one vote on any matter submitted to a vote of the members. GOVERNANCE, MANAGEMENT, AND DISCLOSURE PART VI, SECTION A, LINE 7A Four director seats on the board of directors shall be filled by and elected by the full time members of the corporation. GOVERNANCE, MANAGEMENT, AND DISCLOSURE PART VI, SECTION A, LINE 7B The Board of Regents of the University of Nebraska (Board of Regents), is a public corporate body organized and existing under the Constitution and laws of the State of Nebraska. The Corporation exists under the provisions of the medical service plan as adopted by the Board of Regents. Therefore, certain actions taken by the Corporation require approval by the Board of RegentS. In addition, certain matters taken up by the Corporation's Board of Directors may require member approval. IRS FILINGS AND TAX COMPLIANCE 990 PART V LINE 2A The number of employees reported on the w-3 return is different than the number reported on Line 2a of the form 990. This is due to a clerical error in the filing of the w-2 returns that generated blank w-2s. UNIVERSITY OF NEBRASKA MEDICAL CENTER 986800 NEBRASKA MEDICAL CENTER OMAHA NE 68198 470049123 EDUCATION NE GOVT N/A NA false true false false false false false false true true false true true true true true true false