2023-11-14T17:57:48-06:00 2022-12-31 135565207 KPMG LLP 1212 NORTH 96TH STREET SUITE 300 OMAHA NE 68114 990 2022-01-01 476105603 CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION CHIL 4029556262 8200 DODGE STREET OMAHA NE 68114 AMY HATCHER CFO 4029556262 2022-11-13 1 AMY HATCHER XXX-XX-XXXX 0 HOLLY K MOEN P01800653 6123055000 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z AMY HATCHER 8200 DODGE STREET OMAHA NE 68114 281127970 0 X SEE SCHEDULE O X 1981 NE TO MANAGE AND DISTRIBUTE FUNDS, SOLICITED FROM THE PUBLIC, TO SUPPORT THE OBJECTIVE AND PURPOSE OF CHILDREN'S HOSPITAL & MEDICAL CENTER'S PREMIER PEDIATRIC SERVICES AND PROGRAMS. 19 19 0 274 -232102 0 14664816 15583616 0 0 12303047 14888398 581737 692790 27549600 31164804 47954667 8244075 0 0 0 0 321631 401745 3187133 2939124 3200900 51215422 11846720 -23665822 19318084 482957536 85931085 2124855 2599201 480832681 83331884 X CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION WAS CREATED IN 1981 TO RAISE AWARENESS AND MANAGE AND DISTRIBUTE FUNDS TO SUPPORT CHILDREN'S HOSPITAL & MEDICAL CENTER'S PREMIER PEDIATRIC SERVICES AND PROGRAMS. AS AN ADVOCATE FOR CHILDREN, MANY OF THE SERVICES THE HOSPITAL PROVIDES ARE NOT REIMBURSED. 0 0 8244075 8244075 0 THE FOUNDATION'S PURPOSE IS TO SOLICIT, RECEIVE, INVEST AND DISTRIBUTE GENERAL AND SPECIFIC, RESTRICTED AND UNRESTRICTED GIFTS FOR THE BENEFIT AND SUPPORT OF CHILDREN'S HOSPITAL & MEDICAL CENTER. GRANTS ARE APPROVED BY THE FOUNDATION'S BOARD OF DIRECTORS FOR THE BENEFIT OF CHILDREN'S HOSPITAL & MEDICAL CENTER AND AFFILIATES. SEE HTTPS://WWW.CHILDRENSNEBRASKA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-BENEFIT/ FOR THE COMMUNITY BENEFIT REPORT. 8244075 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 18 0 1 0 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 19 19 0 0 1 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 0 MI MA CA FL GA IN NE NM NY OK UT WI X AMY HATCHER 4029556262 8200 DODGE STREET OMAHA NE 68114 CINDY HEIDER CHAIR 1.00 0.00 X X 0 0 0 BARRETT KNUDSON VICE CHAIR 1.00 0.00 X X 0 0 0 ROBB PANTANO SECRETARY 1.00 0.00 X X 0 0 0 JAMIE WALKER TREASURER 1.00 0.00 X X 0 0 0 JODY CARSTENS DIRECTOR 1.00 0.00 X 0 0 0 DAVID DVORAK DIRECTOR 1.00 0.00 X 0 0 0 DAVE FREEMAN DIRECTOR 1.00 0.00 X 0 0 0 BRADY GIBSON DIRECTOR 1.00 0.00 X 0 0 0 KIM HAMMEES DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL JUNG DIRECTOR 1.00 0.00 X 0 0 0 ANDREW KENNY DIRECTOR 1.00 0.00 X 0 0 0 BECKI KERNS DIRECTOR 1.00 0.00 X 0 0 0 JOEL LINK DIRECTOR 1.00 0.00 X 0 0 0 MARILYN MECHAM DIRECTOR 1.00 0.00 X 0 0 0 LAUREN MILTENBERGER DIRECTOR 1.00 0.00 X 0 0 0 ANDY RUBACK DIRECTOR 1.00 0.00 X 0 0 0 JOEL RUSSELL DIRECTOR 1.00 0.00 X 0 0 0 DEBBIE WOOD DIRECTOR 1.00 0.00 X 0 0 0 RANDY WOOD DIRECTOR 1.00 0.00 X 0 0 0 AMY HATCHER EVP & CFO 1.00 39.00 X 0 830258 112014 BETH GREINER SVP & EXECUTIVE DIRECTOR 40.00 0.00 X 0 406162 38756 0 1236420 150770 0 0 1 0 0 503767 80758 14999091 686485 15583616 2815736 -232102 3047838 261284880 249212218 12072662 12072662 12072662 980890 503767 417065 563825 563825 462848 333883 128965 128965 31164804 0 -232102 15813290 8244075 8244075 275848 275848 401745 401745 415512 415512 33991 33991 58370 58370 76430 76430 1013 1013 3238 3238 2330 2330 5054 5054 74405 74405 SALARIES & WAGES 1624450 1624450 EMPLOYEE BENEFITS 375161 375161 DONOR RECOGNITION 78635 78635 BANK & CREDIT CARD FEES 52204 52204 124259 124259 11846720 8244075 415512 3187133 4571653 3969119 14934522 15637091 8704736 13650436 0 0 0 0 0 0 0 0 0 0 218021 245753 349276 337834 16495 11442 405578674 52417244 48933435 0 0 0 0 0 0 0 482957536 85931085 2039855 2556701 0 0 0 0 0 0 0 0 0 0 0 0 0 0 85000 42500 2124855 2599201 X 453577688 49579967 27254993 33751917 480832681 83331884 482957536 85931085 X 19318084 -63067041 -353751840 X X 0 1 X 1 1 0 X 11114858 7248226 10266662 14664816 15583616 58878178 11114858 7248226 10266662 14664816 15583616 58878178 7952176 50926002 -10812813 11345924 9495475 10597305 2815736 23441627 527710 474857 257101 352633 462848 2075149 84394954 3814822 0.60340 0.56810 X SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME GAMING ACTIVITIES 2018 AMOUNT: $ 15,960. 2019 AMOUNT: $ 16,840. 2020 AMOUNT: $ 0. 2021 AMOUNT: $ 0. 2022 AMOUNT: $ 0. INVENTORY SALES 2018 AMOUNT: $ 511,750. 2019 AMOUNT: $ 458,017. 2020 AMOUNT: $ 257,101. 2021 AMOUNT: $ 352,633. 2022 AMOUNT: $ 462,848. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 67055688 13279796 488673 55090 17783546 0 62985521 99960929 12775597 1571110 150207 47101741 0 67055688 92781994 8659064 650201 133073 1997257 99960929 88066716 5785740 768122 1838583 0 92781995 80139900 8481002 127409 681595 88066716 0.46500 0.15300 0.38200 0 0 28056 21771 6285 321220 316063 5157 11442 PLEDGE PMT (NU FDN CANCER CENTER COLLABORATION) 42500 42500 X PART V, LINE 4: TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS AND OPERATIONS OF CHILDREN'S HOSPITAL & MEDICAL CENTER. PART X, LINE 2: 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 AND 2021, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES. X X X X X X X 1 VIC GUTMAN & ASSOCIATES INC PO BOX 31134 OMAHA NE 68131 GRANT 0 6829387 14323 6815064 CHILDREN'S MIRACLE NETWORK 205 WEST 700 SOUTH SALT LAKE CITY UT 84101 FUNDRAISING 1 3127950 196671 2931279 WINE WOMEN & SHOES 1248 STOCKTON ST ST HELENA CA 94574 FUNDRAISING 0 278034 24272 253762 TRUE SENSE MARKETING 502 KEYSTONE DR WARRENDALE PA 15086 DIRECT MAIL 0 177089 156479 20610 LAURA SOLLA 173 WASHINTON ST FREEPORT PA 16229 FUNDRAISING 0 0 10000 -10000 10412460 401745 10010715 IA NE ANNUAL GALA 988602 361288 627314 0 536 36102 56828 92528 95831 WINE WMN SHOES 276164 66747 209417 0 0 7748 12004 0 41238 3 219891 75732 144159 0 0 46486 18564 0 9200 1484657 503767 980890 536 90336 87396 92528 146269 417065 563825 1 CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 470379754 501(C)(3) 8042813 0 NONE PROGRAM SUPPORT CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA NE 68114 470689372 501(C)(3) 44652 0 NONE PROGRAM SUPPORT NEBRASKA PEDIATRIC PRACTICE 8200 DODGE STREET OMAHA NE 68114 263064869 501(C)(3) 156610 0 NONE PROGRAM SUPPORT 3 0 PART I, LINE 2: MONIES ARE ONLY DISTRIBUTED TO RELATED ORGANIZATIONS AND AFFILIATES. 0 1 0 0 0 0 0 0 0 AMY HATCHER EVP & CFO 0 530543 0 196180 0 103535 0 100868 0 11146 0 942272 0 0 BETH GREINER SVP & EXECUTIVE DIRECTOR 0 278579 0 87547 0 40036 0 38409 0 347 0 444918 0 0 PART I, LINE 3 BETH GREINER IS THE SVP & EXECUTIVE DIRECTOR OF CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION. CHILDREN'S HOSPITAL & MEDICAL CENTER REVIEWS THE COMPENSATION OF THE EXECUTIVE DIRECTOR, AS REFERENCED IN SCHEDULE O, PART VI, LINE 15. 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 2022 ARE AS FOLLOWS: BETH GREINER $22,342 ACCRUAL, $0 PLAN DISTRIBUTION AMY HATCHER $83,018 ACCRUAL, $0 PLAN DISTRIBUTION X 10 517914 FMV X GALA AUCTION 46 168571 SELLING PRICE 0 1 1 PART I, LINE 32B: RBC WEALTH MANAGEMENT SELLS STOCK THAT IS RECEIVED. FORM 990, PART I, ITEM J HTTPS://WWW.CHILDRENSOMAHA.ORG/GET-INVOLVED/OUR-FOUNDATION/ FORM 990, PART VI, SECTION A, LINE 4 CHILDREN'S HOSPITAL & MEDICAL CENTER'S BOARD EXECUTIVE COMMITTEE MADE NECESSARY CHANGES TO THE HOSPITAL BYLAWS, WHICH LEAD TO CORRESPONDING CHANGES TO THE FOUNDATION BYLAWS, AMENDED ON FEBRUARY 22, 2022. THE CHANGES TO THE FOUNDATION'S BYLAWS WERE AS FOLLOWS: 1. THERE WILL BE ONE FOUNDATION BOARD MEMBER ON THE HOSPITAL FINANCE, AUDIT AND COMPLIANCE COMMITTEE. 2. THERE WILL NO LONGER BE A FOUNDATION BOARD MEMBER ON THE INVESTMENT COMMITTEE. 3. A MAJORITY OF THE FOUNDATION BOARD, RATHER THAN A 2/3 VOTE, WILL BE NEEDED TO RECOMMEND APPROVAL OF THE PROPOSED CHANGES. FORM 990, PART VI, SECTION A, LINE 7B CHILDREN'S HOSPITAL & MEDICAL CENTER BOARD REVIEWS DECISIONS MADE BY THE FOUNDATION BOARD. 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'S 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. A COMPLETE COPY OF THE FORM 990, INCLUDING PART VII AND SCHEDULE J - COMPENSATION INFORMATION, ALSO IS PROVIDED TO THE SVP & EXECUTIVE DIRECTOR OF THE FOUNDATION AND THE CHAIR OF THE BOARD FOR CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION. FORM 990, PART VI, SECTION B, LINE 12C THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO REQUIRE THAT ANY POTENTIAL CONFLICT OF INTEREST BE PROMPTLY AND FULLY DISCLOSED IN ORDER TO ASSURE THAT CHILDREN'S NOT ENGAGE IN ANY CONTRACT, TRANSACTION OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST. CHILDREN'S IS NOT PROHIBITED FROM DOING BUSINESS WITH AN ENTITY IN WHICH A MEMBER HAS A POTENTIAL CONFLICT OF INTEREST PROVIDED THE INTEREST HAS BEEN DISCLOSED AND THE INTERESTED PERSON IS NOT INVOLVED IN ANY DECISION MAKING REGARDING THE TRANSACTION. DEFINITIONS 1. CHILDREN'S. FOR PURPOSES OF THIS POLICY, CHILDREN'S REFERS TO CHILDREN'S HOSPITAL & MEDICAL CENTER AND CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION. 2. CONFLICT OF INTEREST. FOR PURPOSES OF THIS POLICY, A CONFLICT OF INTEREST EXISTS WHEN THE GOVERNANCE COMMITTEE, THE BOARD, OR THE COMMITTEE TO WHOM A POTENTIAL CONFLICT OF INTEREST IS REPORTED, HAS REVIEWED THE POTENTIAL CONFLICT OF INTEREST AND HAS DETERMINED THAT A CONFLICT OF INTEREST EXISTS. 3. FAMILY OR FAMILY MEMBER. FOR PURPOSES OF THIS POLICY AND THE ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRE, FAMILY OR FAMILY MEMBER SHALL INCLUDE THE INTERESTED PERSON'S: SPOUSE, PARENTS, IN-LAWS, BROTHERS OR SISTERS (BY WHOLE OR HALF-BLOOD), SPOUSES OF BROTHERS OR SISTERS, CHILDREN, GRANDCHILDREN, AND SPOUSES OF CHILDREN AND GRANDCHILDREN. 4. INTERESTED PERSON. AN INTERESTED PERSON SHALL MEAN ANY PERSON IN A POSITION TO EXERCISE INFLUENCE IN CONNECTION WITH ANY CONTRACT, TRANSACTION OR ARRANGEMENT PRESENTED TO THE BOARD OR A BOARD COMMITTEE FOR APPROVAL. "INTERESTED PERSON" INCLUDES (BUT IS NOT LIMITED TO) ANY DIRECTOR, OFFICER, OR MEMBER OF A COMMITTEE WITH BOARD- DELEGATED POWERS. 5. POTENTIAL CONFLICT OF INTEREST. AN INTERESTED PERSON HAS A POTENTIAL CONFLICT OF INTEREST WITH RESPECT TO A CONTRACT, TRANSACTION OR ARRANGEMENT INVOLVING CHILDREN'S IF THE PERSON HAS, DIRECTLY OR INDIRECTLY, THROUGH A BUSINESS, INVESTMENT, FAMILY OR OTHER RELATIONSHIP: I. AN OWNERSHIP OR INVESTMENT INTEREST IN ANY ENTITY INVOLVED IN SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; II. A COMPENSATION ARRANGEMENT WITH AN INDIVIDUAL OR ENTITY INVOLVED IN SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; III. A FIDUCIARY POSITION (E.G., MEMBER, OFFICER, DIRECTOR, COMMITTEE MEMBER) WITH RESPECT TO AN ENTITY INVOLVED IN SUCH CONTRACT, TRANSACTION OR ARRANGEMENT; IV. ANY RELATIONSHIP WITH AN INDIVIDUAL OR ENTITY THAT COULD RENDER THE DIRECTOR INCAPABLE OF MAKING A DECISION WITH ONLY THE BEST INTEREST OF CHILDREN'S IN MIND; OR V. ANY COMPENSATION ARRANGEMENT BETWEEN AN INTERESTED PERSON OR ANY FAMILY MEMBER AND CHILDREN'S. FOR PURPOSES OF THIS SECTION, COMPENSATION INCLUDES DIRECT AND INDIRECT REMUNERATION AS WELL AS GIFTS OR FAVORS THAT ARE SUBSTANTIAL IN NATURE. DUTY TO DISCLOSE I. AN INTERESTED PERSON HAS THE OBLIGATION TO ANNUALLY SUBMIT A COMPLETED CONFLICTS OF INTEREST QUESTIONNAIRE IN THE FORMAT APPROVED BY THE BOARD. II. AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF THE CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. III. DISCLOSURE REQUIRES 1) COMPLETING THE ANNUAL QUESTIONNAIRE AND 2) PROMPTLY PROVIDING THE MATERIAL FACTS OF AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST TO THE COMPLIANCE OFFICER (IN WRITING IF TIME ALLOWS) OR TO THE BOARD OR BOARD COMMITTEE REVIEWING THE CONTRACT, TRANSACTION OR ARRANGEMENT. DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. I. REVIEW OF QUESTIONNAIRES. THE GOVERNANCE COMMITTEE SHALL REVIEW EACH COMPLETED CONFLICTS OF INTEREST QUESTIONNAIRE. THE COMMITTEE MAY MAKE SUCH FURTHER INVESTIGATION OF POTENTIAL CONFLICTS AS IT MAY DETERMINE APPROPRIATE. ALL KNOWLEDGE AND INFORMATION ACQUIRED BY THE GOVERNANCE COMMITTEE SHALL BE PRIVATE AND CONFIDENTIAL. THE GOVERNANCE COMMITTEE SHALL MAKE APPROPRIATE REPORTS TO THE BOARD CONCERNING ITS REVIEW, ANY FURTHER INVESTIGATION, AND ITS RECOMMENDATIONS TO THE BOARD REGARDING ANY CONFLICTS OF INTEREST. II. RESIGNATION FROM BOARD. THE GOVERNANCE COMMITTEE CAN RECOMMEND A DIRECTOR OR A MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS BE ASKED TO RESIGN IN THE EVENT A CONFLICT OF INTEREST IS SO SUBSTANTIAL THAT IT WOULD NOT BE IN CHILDREN'S BEST INTERESTS TO HAVE SUCH AN INDIVIDUAL ON ITS BOARD/COMMITTEE. III. ONGOING DETERMINATIONS. WHENEVER A POTENTIAL CONFLICT IS VOLUNTARILY IDENTIFIED BY AN INTERESTED PERSON (OR THROUGH DISCLOSURE BY A PERSON OTHER THAN THE INTERESTED PERSON), THE REMAINING BOARD/COMMITTEE MEMBERS SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE INTERESTED PERSON MAY MAKE A PRESENTATION AND ANSWER ANY QUESTIONS BUT SHALL NOT BE PRESENT WHEN THE BOARD/COMMITTEE CONDUCTS ITS EVALUATION. THE BOARD/COMMITTEE MAY REQUEST ADDITIONAL INFORMATION FROM ALL REASONABLE SOURCES. ONCE THE BOARD/COMMITTEE HAS ALL NECESSARY INFORMATION, IT SHALL DETERMINE WHETHER A CONFLICT OF INTEREST INDEED EXISTS. ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS MAY VOTE TO DETERMINE WHETHER A CONFLICT EXISTS AND THE SUBJECT INTERESTED PERSON CANNOT BE PRESENT DURING THE VOTE. IV. IN THE EVENT THE BOARD OR A COMMITTEE HAS DETERMINED THAT A CONFLICT OF INTEREST EXISTS WITH RESPECT TO A PARTICULAR TRANSACTION OR ARRANGEMENT: A. THE DISINTERESTED BOARD/COMMITTEE MEMBERS SHALL EXERCISE DUE DILIGENCE TO DETERMINE WHETHER CHILDREN'S COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IF APPROPRIATE, THE BOARD/COMMITTEE SHALL APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT. B. IN CONSIDERING WHETHER TO ENTER INTO THE PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT, THE BOARD/COMMITTEE MAY APPROVE SUCH A CONTRACT, TRANSACTION OR ARRANGEMENT ONLY IF THE DISINTERESTED MEMBERS DETERMINE BY A MAJORITY VOTE THAT THE PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT IS IN CHILDREN'S BEST INTERESTS AND FOR CHILDREN'S OWN BENEFIT. C. THE DISINTERESTED MEMBERS OF THE BOARD/COMMITTEE MAY, IN THEIR DISCRETION, REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM WHILE THE PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT IS DISCUSSED. THE INTERESTED PERSON SHALL LEAVE THE ROOM WHILE THE MATTER IS VOTED ON; ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER TO APPROVE THE TRANSACTION OR ARRANGEMENT. V. IN DETERMINING WHETHER AND WHEN TO REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM DURING DISCUSSION OF THE PROPOSED CONTRACT, TRANSACTION OR ARRANGEMENT, THE DISINTERESTED DIRECTORS SHALL BALANCE THE NEED TO FACILITATE THE DISCUSSION BY HAVING SUCH PERSON ON HAND TO PROVIDE ADDITIONAL INFORMATION WITH THE NEED TO PRESERVE THE INDEPENDENCE OF THE DETERMINATION PROCESS. VIOLATIONS OF POLICY IF THE BOARD/COMMITTEE HAS REASON TO BELIEVE THAT AN INTERESTED PERSON HAS FAILED TO COMPLY WITH THIS POLICY, THE BOARD SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND PROVIDE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE. AFTER HEARING THE RESPONSE OF SUCH PERSON AND CONDUCTING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD SHALL DETERMINE WHETHER SUCH PERSON HAS, IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THIS POLICY. IF THE BOARD DETERMINES THAT THERE HAS BEEN A VIOLATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION WHICH MAY INCLUDE REMOVAL FROM THE BOARD. RECORD OF PROCEEDINGS AT ANY BOARD/COMMITTEE MEETING AT WHICH A CONFLICT OF INTEREST ISSUE WAS ADDRESSED, THE MINUTES OF THE BOARD /COMMITTEE MEETING SHALL INCLUDE A CONFLICT OF INTEREST PROCESSING RECORD IN THE FORM APPROVED BY THE BOARD. THE CONFLICT OF INTEREST PROCESSING RECORD SHOULD REFLECT THE ACTIONS TAKEN BY THE BOARD/ COMMITTEE. ANNUAL STATEMENTS EACH INTERESTED PERSON SHALL SIGN AN ANNUAL ACKNOWLEDGEMENT, IN THE FORMAT APPROVED BY THE BOARD, THAT THE INTERESTED PERSON (A) HAS RECEIVED A COPY OF THIS POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) AGREES TO COMPLY WITH THE POLICY; (D) UNDERSTANDS THAT THE POLICY APPLIES TO THE BOARD AND COMMITTEES; (E) UNDERSTANDS THAT CHILDREN'S IS A NOT-FOR-PROFIT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES; (F) AGREES TO REPORT TO COMPLIANCE OFFICER ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICTS OF INTEREST QUESTIONNAIRE; (G) STATES THAT THE INFORMATION PROVIDED IN THE CONFLICTS OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF. FORM 990, PART VI, SECTION B, LINE 15 EACH YEAR AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF EXECUTIVE 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 APPROPRIATENESS OF EXECUTIVE PAY LEVELS. THE COMPENSATION COMMITTEE APPROVES BASE PAY CHANGES FOR CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION'S EXECUTIVE DIRECTOR. 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. THE CHILDREN'S HOSPITAL & MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED THROUGH PUBLICLY AVAILABLE SOURCES SUCH AS EMMA.MSRB.ORG. FORM 990, PART XI, LINE 9: NET ASSET TRANSFERS TO HOSPITAL -354,401,576. OTHER CHANGES IN NET ASSETS W/ DONOR RESTRICTIONS 154,969. OTHER CHANGES IN NET ASSETS W/O DONOR RESTRICTIONS -137,688. CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -187,026. RESTRICTED INVESTMENT INCOME 819,481. FORM 990, PART XII, LINE 3B THE FOUNDATION WAS REQUIRED TO UNDERGO A SINGLE AUDIT, BUT THE AUDIT WILL NOT BE COMPLETED UNTIL 2023. CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 470379754 PEDIATRICS NE 501 (C) (3) LINE 3 N/A 0 CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA NE 68114 470689372 CLINICS NE 501 (C) (3) LINE 10 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 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0