2023-11-14T18:03:41-06:00 2022-12-31 135565207 KPMG LLP 1212 NORTH 96TH STREET SUITE 300 OMAHA NE 68114 990 2022-01-01 470689372 CHILDREN'S PHYSICIANS CHIL 4029556262 8200 DODGE STREET OMAHA NE 68114 AMY HATCHER CFO 4029556262 2023-11-14 1 AMY HATCHER XXX-XX-XXXX 0 HOLLY MOEN P01800653 6123055000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DENNIS BIERLE 8200 DODGE STREET OMAHA NE 68114 55082574 0 X WWW.CHILDRENSOMAHA.ORG X 1996 NE CHILDREN'S PHYSICIANS IS THE LEADING PEDIATRIC PRIMARY CARE PRACTICE DEDICATED TO CARING FOR ALL CHILDREN IN OMAHA AND THE SURROUNDING AREAS, WHILE SUPPORTING EDUCATION AND RESEARCH. 9 4 0 0 0 0 1649124 44652 50920152 53725402 2202 4791 1187486 1307729 53758964 55082574 0 0 0 0 35796478 38433326 0 0 0 19659966 20714037 55456444 59147363 -1697480 -4064789 24211934 17679835 20220559 17753249 3991375 -73414 CHILDREN'S PHYSICIANS DELIVERS THE HIGHEST QUALITY PEDIATRIC PRIMARY CARE WHILE SUPPORTING EDUCATION AND RESEARCH. 0 0 51691865 0 55033131 CHILDREN'S PHYSICIANS IS A PEDIATRIC HEALTH CARE PROVIDER ORGANIZATION FOR OMAHA AND SURROUNDING COMMUNITIES THAT OWNS AND OPERATES PEDIATRIC PRIMARY CARE CLINICS. THE CLINICS ALSO SERVE AS RESIDENT TRAINING SITES FOR PEDIATRIC RESIDENTS. AS OF DECEMBER 31, 2022, CHILDREN'S PHYSICIANS OPERATES TWELVE CLINIC SITES AND MANAGES THREE OFFICES, PLATTSMOUTH GENERAL PEDS, UNMC GENERAL PEDS, AND KEARNEY. SEE HTTPS://WWW.CHILDRENSNEBRASKA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-BENEFIT/ FOR THE COMMUNITY BENEFIT REPORT. 51691865 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 18 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 9 4 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X AMY HATCHER 4029556262 8200 DODGE STREET OMAHA NE 68114 MALINDA BENDER MD VICE CHAIR 0.00 40.00 X X 0 428241 20559 MICHAEL MOORE MD DIRECTOR THRU DEC 2022 0.00 40.00 X 0 372210 62203 KATIE VOLLMUTH MD SECRETARY/TREASURER 0.00 40.00 X X 0 242954 15686 CHANDA CHACON PRESIDENT & CEO 0.00 40.00 X X 0 1358205 221995 CHRISTOPHER MALONEY MD EVP & PHYS IN CHIEF 0.00 40.00 X 0 1154777 127943 RICHARD ANDREL DIRECTOR 1.00 0.00 X 0 0 0 JO GILES DIRECTOR 1.00 0.00 X 0 0 0 CHERYL LOGAN DIRECTOR 1.00 0.00 X 0 0 0 TERRANCE ZACH CHAIRMAN 1.00 0.00 X X 0 0 0 AMY HATCHER EVP & CFO 1.00 39.00 X 0 830258 112014 0 4386645 560400 0 0 1 0 A AND K MARKETING 5243 N 129TH ST OMAHA NE 68164 MARKETING SERVICES 332255 ST ELIZABETH REGIONAL MEDICAL CENTER 12809 WEST DODGE ROAD OMAHA NE 68154 AFTER HOURS CALL SERVICE 234795 SWISTAK ENTERPRISES LLC 4624 CREST RIDGE LOOP BLAIR NE 68008 GROUNDS MAINTENANCE 153507 CYRACOM INTERNATIONAL INC PO BOX 74008076 CHICAGO IL 60674 PHONE INTERPRETER 144718 4 44652 44652 PATIENT SERVICES REV 621110 50982708 50982708 CAPITATION PAYMENTS 621110 1487442 1487442 DEPARTMENT SERVICES 621110 1255252 1255252 53725402 4791 4791 MANAGEMENT FEE INCOME 900099 694279 694279 SCHOOL RN PROGRAM 900099 313387 313387 ADMINISTRATIVE REVENUE 900099 161148 161148 138915 138915 1307729 55082574 55033131 0 4791 31625121 29439975 2185146 756486 687287 69199 4197892 3556354 641538 1853827 1695681 158146 2372632 2372632 3357222 3194020 163202 447247 5793 441454 9948031 9866235 81796 654573 654573 2011203 1989385 21818 9458 2056 7402 23184 23184 615303 615303 385048 385048 REPAIRS/MAINTENANCE 421827 421613 214 SALES & USE TAX 172036 1809 170227 PROFESSIONAL BUSINESS E 115199 103615 11584 PROF DUES & SUBS 82363 66370 15993 98711 23185 75526 59147363 51691865 7455498 0 9425041 5204056 0 0 0 0 4150500 3278510 0 0 0 0 37120 16339 1423917 1406955 0 26115 9420036 6341963 3215315 3078073 0 0 0 0 0 0 4137945 3536249 1822096 1133538 24211934 17679835 1031881 1044495 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19188678 16708754 20220559 17753249 X 3991375 -73414 0 0 3991375 -73414 24211934 17679835 X -4064789 0 X 0 1 X 1 0 X 31971 28659 22837 1649124 44652 1777243 47652509 49812237 48730695 52107638 55033131 253336210 47684480 49840896 48753532 53756762 55077783 255113453 0 0 0 255113453 961 3797 1476 2202 4791 13227 961 3797 1476 2202 4791 13227 47685441 49844693 48755008 53758964 55082574 255126680 0.99990 1.00000 0.00010 0.00000 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 343811 180398 163413 4871893 2970609 1901284 3552188 2538812 1013376 652144 652144 0 3078073 ACCOUNTS RECEIVABLE-AFFILIATES 431735 OTHER RECEIVABLES 701803 1133538 ACCOUNTS PAYABLE - AFFILIATES 12644351 LEASE OBLIGATION 3354526 CURRENT PORTION OF LEASE PAYMENT 604976 OTHER PAYABLES 104901 16708754 X PART X, LINE 2: FIN 48 FOOTNOTE THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. DURING 2022 OR 2021, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES. 0 1 0 0 0 0 0 0 0 CHANDA CHACON PRESIDENT & CEO 0 941443 0 362412 0 54350 0 207850 0 14145 0 1580200 0 0 CHRISTOPHER MALONEY MD EVP & PHYS IN CHIEF 0 726471 0 287253 0 141053 0 127319 0 624 0 1282720 0 0 AMY HATCHER EVP & CFO 0 530543 0 196180 0 103535 0 100868 0 11146 0 942272 0 0 MALINDA BENDER MD VICE CHAIR 0 396081 0 29750 0 2410 0 18023 0 2536 0 448800 0 0 MICHAEL MOORE MD DIRECTOR THRU DEC 2022 0 341073 0 28000 0 3137 0 38800 0 23403 0 434413 0 0 KATIE VOLLMUTH MD SECRETARY/TREASURER 0 222955 0 18000 0 1999 0 13664 0 2022 0 258640 0 0 PART I, LINE 3 SEE SCHEDULE O FORM 900, PART VI, LINE 15 NARRATIVE REGARDING METHODS USED BY RELATED ORGANIZATIONS TO ESTABLISH COMPENSATION OF THE EXECUTIVES AND PHYSICIANS. PART-I LINE-4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN DURING 2022. THE AMOUNTS OF DEFERRED COMPENSATION DISTRIBUTED AND ACCRUED FOR EACH OF THE INDIVIDUALS DURING 2021 ARE AS FOLLOWS: CHANDA CHACON $190,000 ACCRUAL, $0 PLAN DISTRIBUTION CHIRSTOPHER MALONEY $109,470 ACCRUAL, $0 PLAN DISTRIBUTION AMY HATCHER $83,018 ACCRUAL, $0 PLAN DISTRIBUTION FORM 990, PART VI, SECTION A, LINE 6 CHILDREN'S PHYSICIANS' HAS A SINGLE CORPORATE MEMBER, CHILDREN'S HOSPITAL & MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A CHILDREN'S PHYSICIANS' HAS A SINGLE CORPORATE MEMBER, CHILDREN'S HOSPITAL & MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7B RESERVED POWERS OF MEMBER. NOTWITHSTANDING ANYTHING IN THE BYLAWS TO THE CONTRARY, THE CONSENT OF THE MEMBER, ACTING THROUGH THE HOSPITAL DESIGNEE, SHALL BE REQUIRED TO APPROVE THE FOLLOWING ACTIONS: I. ELECTION AND REMOVAL OF DIRECTORS. IN ACCORDANCE WITH THESE BYLAWS, THE MEMBER SHALL HAVE THE POWER TO APPOINT CERTAIN DIRECTORS OF THE CORPORATION UNDER ARTICLE IV, SECTION 1, AND REMOVE CERTAIN DIRECTORS OF THE CORPORATION UNDER ARTICLE IV, SECTION 11. THE MEMBER SHALL ALSO HAVE THE RIGHT TO APPROVE THE PERSON CREIGHTON UNIVERSITY WISHES TO APPOINT TO THE BOARD AS THE CREIGHTON APPOINTED DIRECTOR. II. APPOINTMENT AND REMOVAL OF CORPORATION ADMINISTRATIVE LEADER. IN ACCORDANCE WITH THE BYLAWS, THE HOSPITAL DESIGNEE SHALL HAVE THE POWER TO APPOINT AND REMOVE THE PERSON DESIGNATED AS THE ADMINISTRATIVE LEADER OF THE CORPORATION. III. APPROVAL OF CERTAIN ACTIONS. THE FOLLOWING ACTIONS OF THE CORPORATION MUST BE APPROVED BY THE HOSPITAL DESIGNEE: (1) ADOPTION AND ADJUSTMENT OF THE CORPORATION'S ANNUAL BUDGET, CAPITAL EXPENDITURES BUDGET, MISSION STATEMENT, OPERATING PLAN, AND LONG-RANGE PLAN; (2) INCURRENCE OR ASSUMPTION OF DEBT (OTHER THAN TRADE PAYABLES); (3) ADOPTION OF COMPENSATION PLANS; (4) ANY DISTRIBUTIONS OF CAPITAL OR NET EARNINGS OF THE CORPORATION; (5) CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS; (6) ANY ACTION REQUIRED TO BE SUBMITTED TO AND APPROVED BY THE VOTING MEMBERS OF A NONPROFIT CORPORATION PURSUANT TO THE NEBRASKA NONPROFIT CORPORATION ACT; (7) REORGANIZATION AND TRANSFER OF ASSETS OUTSIDE OF THE ORDINARY COURSE OF BUSINESS; (8) ESTABLISHMENT OF A SUBSIDIARY OR PARTICIPATION AS A SHAREHOLDER, PARTNER, OR MEMBER OF ANY OTHER ENTITY; AND (9) ADMISSION OF NEW MEMBERS. FORM 990, PART VI, SECTION B, LINE 11B A COMPLETE COPY OF THE FORM 990, EXCLUDING PART VII AND SCHEDULE J - COMPENSATION INFORMATION, IS MADE AVAILABLE TO THE HOSPITAL BOARD OF DIRECTORS VIA THE DIRECTORS DESK BOARD PORTAL PRIOR TO FILING WITH THE IRS. A COPY OF THE FORM 990, INCLUDING PART VII AND SCHEDULE J - COMPENSATION INFORMATION, IS REVIEWED WITH THE COMPENSATION & HUMAN RESOURCES COMMITTEE OF THE HOSPITAL'S BOARD OF DIRECTORS AT ITS NOVEMBER MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT 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 CONFLICT OF INTEREST QUESTIONNAIRE AND HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST PROMPTLY. EACH INTERESTED PERSON SIGNS ANNUALLY AN ACKNOWLEDGMENT 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 PHYSICIANS IS A NOT-FOR-PROFIT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES; AGREES TO REPORT TO THE GENERAL COUNSEL OR THE BOARD CHAIR ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICT OF INTEREST QUESTIONNAIRE; STATES THAT THE INFORMATION PROVIDED IN THE CONFLICT OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF. THE GENERAL COUNSEL REVIEWS EACH COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE TO DETERMINE IF INVESTIGATION OF ANY POTENTIAL CONFLICT 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 OF INTEREST 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 PHYSICIANS AND FOR CHILDREN'S PHYSICIANS OWN BENEFIT. THE INTERESTED PERSON MAY BE 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, SECTION B, LINE 15 EACH YEAR, AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF COMPENSATION, TO SUBSTANTIATE THE COMPENSATION OF EXECUTIVE AND PHYSICIAN COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. THE INDEPENDENT COMPANY ISSUES AN ANNUAL REASONABLENESS OPINION LETTER REGARDING THE APPORPRIATENESS OF EXECUTIVE AND PHYSICIAN PAY LEVELS. THE HOSPITAL BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. CHILDREN'S HOSPITAL & MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED IN ADMINISTRATION. FORM 990, PART XI, LINE 10: CHILDREN'S PHYSICIANS IS SUPPORTED BY CAPITAL TRANSFERS FROM ITS PARENT CHILDREN'S HOSPITAL & MEDICAL CENTER AS IT IS AN INTEGRAL PART OF THE ORGANIZATION. THE NEGATIVE FUND BALANCE AT YEAR-END WAS BASED UPON AN ESTIMATE OF REQUIRED FUNDING. CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 470379754 PEDIATRICS NE 501(C)(3) LINE 3 N/A 0 CHILDREN'S HOSPITAL & MEDICAL CENTER FDN 8200 DODGE STREET OMAHA NE 68114 476105603 FUNDRAISING NE 501(C)(3) LINE 7 CHMC 0 CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA NE 68114 363967578 HEALTH NETWORK NE CHMC C 0 KENT INC 8200 DODGE STREET OMAHA NE 68114 470527928 REAL ESTATE NE CHMC C 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0