2023-11-14T17:54:55-06:00 2022-12-31 135565207 KPMG LLP 1212 NORTH 96TH STREET SUITE 300 OMAHA NE 68114 990 2022-01-01 470379754 CHILDREN'S HOSPITAL & MEDICAL CENTER CHIL 4029556262 8200 DODGE STREET OMAHA NE 68114 AMY HATCHER CFO 4029556262 2023-11-14 1 AMY HATCHER 999009999 0 HOLLY K MOEN P01800653 4023481450 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHANDA CHACON 8200 DODGE STREET OMAHA NE 68114 634968556 0 X WWW.CHILDRENSNEBRASKA.ORG X 1948 NE CHILDREN'S HOSPITAL & MEDICAL CENTER DELIVERS EXTRAORDINARY CARE TO CHILDREN, EDUCATES HEALTH CARE PROFESSIONALS, AND PROMOTES PEDIATRIC RESEARCH. 16 12 3894 125 706682 53547 52012177 9403889 492873084 550385169 215381 5502664 15051567 15828482 560152209 581120204 11882407 15823508 0 0 254198016 288844775 0 0 62 215989404 248552910 482069827 553221193 78082382 27899011 914047518 1273488401 388882674 360866441 525164844 912621960 X TO IMPROVE THE LIFE OF EVERY CHILD - THROUGH EXCEPTIONAL CARE, ADVOCACY, RESEARCH AND EDUCATION. 0 0 447336213 15823508 564967202 THE HOSPITAL OPERATES A 225 LICENSED-BED PEDIATRIC HOSPITAL, WHICH INCLUDES 13 ACTIVE SURGICAL SUITES, TWO HYBRID HEART CATHETERIZATION LABS, AN OUTPATIENT SURGERY CENTER INCLUDING 4 SURGICAL SUITES, AND A FETAL CARE CENTER THAT FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. CHILDREN'S HAS ACHIEVED THE MAGNET DESIGNATION FOR NURSING EXCELLENCE, AND ITS PEDIATRIC AND NEONATAL INTENSIVE CARE UNITS HAVE EARNED A BEACON AWARD FOR EXCELLENCE FROM THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES, WHICH RECOGNIZES CRITICAL CARE UNITS WITH EXCELLENT PATIENT OUTCOMES THAT EXCEED NATIONAL BENCHMARKS. THE HOSPITAL WAS RECOGNIZED BY U.S. NEWS AND WORLD REPORT IN TWO SPECIALTIES, INCLUDING PULMONOLOGY & LUNG SURGERY AND UROLOGY. CHILDREN'S SPECIALTY PEDIATRIC CENTER OFFERS MORE THAN 100 OUTPATIENT SPECIALTY AND SUB-SPECIALTY CLINICS, PROVIDING DIAGNOSTICS, TREATMENT, AND THERAPY. IN ADDITION, THE HOSPITAL PROVIDES OUTPATIENT BEHAVIORAL HEALTH AND A FULL ARRAY OF PEDIATRIC HOME HEALTHCARE SERVICES TO CHILDREN AND ADOLESCENTS WHO HAVE IMMEDIATE OR LONG-TERM HEALTHCARE NEEDS. THE HOSPITAL IS HOME TO THE REGION'S ONLY LEVEL IV NEONATAL INTENSIVE CARE UNIT AND THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT WITH LEVEL II PEDIATRIC TRAUMA CERTIFICATION. THE HOSPITAL ALSO PROVIDES SPECIALTY PEDIATRIC CARE SERVICES IN COMMUNITIES ACROSS THREE STATES. 447336213 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 1 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 295 0 1 3894 1 1 1 0 0 0 0 0 0 0 0 0 1 0 X 16 12 0 0 1 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 GA NE X AMY HATCHER 4029556262 8200 DODGE STREET OMAHA NE 68114 CHANDA CHACON PRESIDENT & CEO 40.00 0.00 X X 1358205 0 221995 MARGARET HERSHISER CHAIR 1.00 0.00 X X 0 0 0 STACY SCHOLTZ VICE CHAIR 1.00 0.00 X X 0 0 0 SAMANTHA MOSSER SECRETARY 1.00 0.00 X X 0 0 0 AMY RYAN TREASURER 1.00 0.00 X X 0 0 0 BRADLEY BRITIGAN MD MEMBER 1.00 0.00 X 0 0 0 DAVE DIAMOND MEMBER 1.00 0.00 X 0 0 0 ROBERT DUNLAY MD MEMBER 1.00 0.00 X 0 0 0 DIANE DUREN MEMBER 1.00 0.00 X 0 0 0 CINDY HEIDER MEMBER 1.00 0.00 X 0 0 0 JOHN JENKINS MEMBER 1.00 0.00 X 0 0 0 STEVE LINDSAY MEMBER 1.00 0.00 X 0 0 0 MICHAEL ROBINO MEMBER 1.00 0.00 X 0 0 0 KENNY ROCKER MEMBER 1.00 0.00 X 0 0 0 SHEILAH SNYDER MD MEMBER 1.00 0.00 X 0 0 0 JAYESH THAKKER MD MEMBER 1.00 0.00 X 0 0 0 JONATHAN WEGNER MEMBER 1.00 0.00 X 0 0 0 AMY HATCHER EVP & CFO 39.00 1.00 X 830258 0 112014 KATHY ENGLISH EVP COO & CNO 40.00 0.00 X 950207 0 38588 DAVID FETT-JONES VP CLINICAL AND ANCILLARY SERVICES 40.00 0.00 X 395248 0 60230 CHRISTOPHER MALONEY MD EVP CHIEF CLINICAL OFFICER & PHYS IN CHIEF 40.00 0.00 X 1154777 0 127943 AMY BONES SVP & GENERAL COUNSEL 40.00 0.00 X 604184 0 78042 JEROLD VUCHAK SVP CHIEF INFO OFFICER 40.00 0.00 X 661476 0 76695 JANEL ALLEN SVP & CHIEF PEOPLE OFFICER 40.00 0.00 X 595359 0 78551 ERIN WILLIS-LOUCKS MD PHYSICIAN 40.00 0.00 X 860414 0 45592 7410128 0 839650 379 0 1 0 PROLINK HEALTHCARE LLC 4600 MONTGOMERY RD STE 300 CINCINNATI OH 45212 STAFFING SERVICES 2791403 UNMC PHYSICIANS 983135 NEBRASKA MEDICAL CENTER OMAHA NE 68198 PATHOLOGY SERVICES 1499629 CHOICE SOLUTIONS LLC 7015 COLLEGE BLVD STE 300 OVERLAND PARK KS 66211 IT SERVICES 1412711 NODDLE VP1 LLC 2285 S 67TH ST STE 250 OMAHA NE 68106 FACILITIES SERVICES 1044365 CHARTIS GROUP LLC 220 WEST KINZIE STREET THIRD FLOOR CHICAGO IL 60654 CONSULTING SERVICES 823204 45 8042813 1338826 22250 9403889 NET PATIENT REVENUE 622110 550385169 550385169 550385169 6084910 64123 6020787 603890 0 603890 603890 603890 51843042 1423064 52723831 1124521 -880789 298543 -582246 -582246 MANAGEMENT FEE INCOME 541610 8154454 8154454 CAFETERIA INCOME 900099 2118534 2118534 OTHER DEPARTMENTAL REV 900099 1531178 1531178 3420426 2777867 642559 15224592 581120204 564967202 706682 6042431 2975124 2975124 12848384 12848384 4072349 4072349 231501981 197253936 34248045 11939446 10206670 1732776 26775819 22777586 3998233 14555180 12376790 2178390 723153 690852 32301 443202 443202 71561 71561 44213430 28178152 16035278 2347837 1260 2346577 74425875 72885125 1540688 62 18569850 18146273 423577 8382706 2325766 6056940 660125 503645 156480 9882098 9882098 35100148 36415112 -1314964 39171313 17277278 21894035 2362050 12578 2349472 BUILDING & GROUND MAINT 4039200 163926 3875274 EQUIPMENT MAINTENANCE 3058587 959205 2099382 BANK & SERVICE FEES 1491295 128013 1363282 COMMUNITY SERVICES 978346 382574 595772 2632134 945866 1686268 553221193 447336213 105884918 62 12465391 7093146 56831028 49356032 1687264 0 108164031 106223455 0 0 0 0 0 0 7551899 9204286 11494604 12817449 916107548 276514046 627056819 639593502 0 0 38954331 397630295 0 0 0 0 49842151 51570236 914047518 1273488401 97325050 83088072 0 0 63015 40694 251697075 246580710 0 0 0 0 3724917 0 0 0 36072617 31156965 388882674 360866441 X 523477580 912621960 1687264 0 525164844 912621960 914047518 1273488401 X 27899011 7323854 352234251 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 71561 71561 553149632 553221193 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 84126 85016 88360 71561 329063 250000 250000 250000 250000 1000000 1500000 67055688 13279795 488673 55090 17783545 62985521 99960929 12775597 1571110 150207 47101741 67055688 92781994 8659064 650201 133073 1997257 99960929 88066716 5785740 768122 1838583 0 92781995 80139900 8481002 127409 681595 0 0 88066716 0.46500 0.15300 0.38200 0 1 1 37044712 37044712 632453355 160357081 472096274 18317379 13139402 5177977 177034915 102660768 74374147 51257187 356795 50900392 639593502 LIMITED PARTNERSHIP INVESTMENT 361858979 F PEDIATRIC ENRICHMENT FUND 13611111 F OTHER - BOARD DESIGNATED FUND 21600000 F DEBT SERVICE RESERVE FUNDS 560205 F 397630295 LEASE OBLIGATION - OPERATING 12148153 LEASE OBLIGATION - FINANCING 5142696 DEFERRED COMPENSATION LIABILITY 5974296 INTERCOMPANY PAYABLE 3417027 SWAP LIABILITY 1073982 CURRENT PORTION OF LEASE PAYMENTS - OPERATING 2638339 CURRENT PORTION OF LEASE PAYMENTS - FINANCING 762472 31156965 X PART V, LINE 4: THESE FUNDS ARE ADMINISTERED BY THE CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION ON BEHALF OF AND FOR THE BENEFIT OF CHILDREN'S HOSPITAL & MEDICAL CENTER. THE FUNDS ARE USED TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, AND OPERATIONS OF THE HOSPITAL. 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. CENTRAL AMERICA AND THE CARIBBEAN INVESTMENTS 35992471 EUROPE (INCLUDING ICELAND AND GREENLAND) INVESTMENTS 11917520 0 0 0 0 0 0 47909991 0 47909991 1 0 0 1 1 0 PART III ACCOUNTING METHOD: 1 1 X 1 X 1 X 1 1 1 0 1 1 5562698 5562698 0.01010 231170975 150276109 80894866 0.14620 236733673 150276109 86457564 0.15630 6440235 2322558 4117677 0.00740 23813663 1338826 22474837 0.04060 8331321 6688825 1642496 0.00300 164669589 103913479 60756110 0.10980 203254808 114263688 88991120 0.16080 439988481 264539797 175448684 0.31710 16000 16000 0.00000 16000 16000 0.00000 1 1931218 0 226645 1171185 -944540 X 1 1 1 1 CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA NE 68114 WWW.CHILDRENSNEBRASKA.ORG 260005 X X X X X CHILDREN'S HOSPITAL & MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE PART V, SECTION C X 1 22 1 SEE PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X X 1 X 0 X X X 1 X 0 0 CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 5: AS PART OF THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY CONDUCTED ON BEHALF OF CHILDREN'S HOSPITAL & MEDICAL CENTER, BOYS TOWN NATIONAL RESEARCH HOSPITAL AND BUILDING HEALTHY FUTURES, KEY INFORMANTS (INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY) WERE CONTACTED BY EMAIL, INTRODUCED TO THE COMMUNITY HEALTH NEEDS ASSESSMENT KEY INFORMANT SURVEY AND PROVIDED A LINK TO TAKE THE SURVEY ONLINE. THE SURVEY COLLECTED RESPONSES IN APRIL AND MAY OF 2021, AND REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. SUPPORTING ORGANIZATIONS FOR THE CHNA INCLUDED: CHARLES DREW HEALTH CENTER, INC., DOUGLAS COUNTY HEALTH DEPARTMENT, THE LOZIER FOUNDATION, ONE WORLD COMMUNITY HEALTH CENTERS, INC., AND THE WELLBEING PARTNERS.THESE POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS AMONG THE FAMILIES AND CHILDREN/ADOLESCENTS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. IN ALL, 143 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY, REPRESENTING COMMUNITY/BUSINESS LEADERS, PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, SOCIAL SERVICE PROVIDERS AND OTHER HEALTH CARE PROVIDERS. THESE KEY INFORMANTS REPRESENT ORGANIZATIONS THAT WORK WITH LOW-INCOME POPULATIONS, POPULATIONS OF COLOR, MEDICALLY UNDERSERVED POPULATIONS, AND INDIVIDUALS WITH SPECIAL HEALTH CONDITIONS. CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 6A: BOYS TOWN NATIONAL RESEARCH HOSPITAL CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 6B: BUILDING HEALTHY FUTURES, CHARLES DREW HEALTH CENTER, INC., DOUGLAS COUNTY HEALTH DEPARTMENT, THE LOZIER FOUNDATION, ONE WORLD COMMUNITY HEALTH CENTERS, INC., AND THE WELLBEING PARTNERS. CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 11: ON NOVEMBER 17, 2021, THE BOARD OF DIRECTORS OF CHILDREN'S HOSPITAL & MEDICAL CENTER (CHILDREN'S), WHICH INCLUDES REPRESENTATIVES FROM THROUGHOUT THE COMMUNITY, MET TO DISCUSS THIS PLAN AND THE INTERNAL AND EXTERNAL PRIORITIZATION INPUT FOR ADDRESSING THE COMMUNITY HEALTH PRIORITIES IDENTIFIED THROUGH THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). UPON REVIEW, THE BOARD OF DIRECTORS APPROVED AND ADOPTED THIS CHNA AND INSTRUCTED CHILDREN'S COMMUNITY HEALTH & ADVOCACY TEAM TO DEVELOP A NEW IMPLEMENTATION STRATEGY PLAN FOR 2022-2024 TO UNDERTAKE MEASURES TO MEET THE HEALTH NEEDS OF THE COMMUNITY.IMPLEMENTATION STRATEGY PLAN APPROVALON APRIL 26, 2022, THE QUALITY & PATIENT SAFETY COMMITTEE OF THE BOARD OF DIRECTORS OF CHILDREN'S HOSPITAL & MEDICAL CENTER, WHICH INCLUDES REPRESENTATIVES FROM THROUGHOUT THE COMMUNITY, MET TO DISCUSS THIS PLAN FOR ADDRESSING THE COMMUNITY HEALTH PRIORITIES IDENTIFIED THROUGH THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT. THE QUALITY AND PATIENT SAFETY COMMITTEE OF THE BOARD HAS BEEN DELEGATED THE AUTHORITY TO APPROVE THIS PLAN. UPON REVIEW, THE QUALITY & PATIENT SAFETY COMMITTEE OF THE BOARD OF DIRECTORS APPROVED AND ADOPTED THIS IMPLEMENTATION STRATEGY PLAN TO UNDERTAKE THESE MEASURES TO MEET THE HEALTH NEEDS OF THE COMMUNITY.AS A RESULT OF THE INTERNAL AND EXTERNAL PLANNING CONVERSATIONS UTILIZING THE CHNA DATA, ALIGNMENT WITH CHILDREN'S 2025 STRATEGIC PLAN, AND THE DESIRE TO ADDRESS STRATEGIES FOR WHICH HEALTH EQUITY IS NEEDED, THE FOLLOWING IMPACT AREAS WERE IDENTIFIED AS PRIORITIES FOR THE 2022-2024 IMPLEMENTATION STRATEGY PLAN (ISP):- PEDIATRIC MENTAL WELLNESS- HEALTHY HOUSING- FINANCIAL STABILITY- FOOD SECURITYIN ADDITION TO THE IMPACT AREAS, A FOCUS ON UNDERREPRESENTED POPULATIONS AS DEFINED BY NATIONAL INSTITUTES OF HEALTH (NIH), USING EARLY CHILDHOOD SETTINGS AND SCHOOLS AS ACCESS POINTS FOR INTERVENTIONS AND SERVICE DELIVERY, AND UTILIZATION OF CHILDREN'S ACCESS TO CARE FRAMEWORK ADOPTED DURING THE 2019-2021 ISP ARE KEY COMPONENTS OF A SUCCESSFUL 2022-2024 IMPLEMENTATION STRATEGY PLAN.THREE OF THE FOUR IMPACT AREAS IDENTIFIED BY THE CHNA, AND THE PRIORITIZATION PROCESS ARE NEW AREAS OF FOCUS FOR CHILDREN'S. TO ENSURE BEST FIT INTERVENTIONS AND ACTIVITIES ARE SELECTED AND IMPLEMENTED, THE FIRST 12-18 MONTHS OF THE 2022-2024 ACTION ISP CONCENTRATE ON: - DISCOVERY & RESEARCH: COLLECTING DATA REGARDING POPULATIONS IMPACTED, CONDUCTING AN INVENTORY OF CURRENT POLICIES, PRACTICES AND WORKFLOWS THAT SUPPORT RELATED WORK INTERNALLY AND, IN THE COMMUNITY, AND UNDERSTANDING THE LOCAL AND NATIONAL LANDSCAPE TO IDENTIFY BEST AND EMERGING PRACTICES. - ADVOCACY: ASSESSING CURRENT AND PROPOSED POLICIES AND LEGISLATION EFFECTING EACH IMPACT AREA AND IDENTIFYING KEY PARTNERS AND CHAMPIONS FOR THE WORK. - EDUCATION & TRAINING: EVALUATING STAFF AWARENESS, KNOWLEDGE AND SENSITIVITY TO EACH IMPACT AREA, AND IDENTIFYING EDUCATION AND TRAINING OPPORTUNITIES AND MODES FOR DELIVERY.IN LATE 2021, CROSS-DEPARTMENTAL ISP ACTION TEAMS WERE FORMED AROUND EACH OF THE FOUR IMPACT AREAS. THE TEAMS ARE CURRENTLY MADE UP OF CHILDREN'S STAFF MEMBERS WITH EXPERIENCE AND EXPERTISE IN THEIR ASSIGNED AREA. THE TEAMS EXPLORING THE LANDSCAPE TO BROADEN EACH ACTION PLAN TO INCLUDE STRATEGIES AIMED AT: - INTERVENTIONS THAT BEST FIT THE NEEDS OF THE COMMUNITIES AND POPULATIONS IMPACTED, REFLECT BEST PRACTICE AND BUILD UPON THE ASSETS THE ORGANIZATION CAN BRING TO THE WORK. - COMMUNITY PARTNERS REPRESENTING THE INTERESTS OF THOSE AFFECTED AND POSITIONED TO MAKE REAL IMPACT. - BEST METHODS TO COORDINATE WORK INTERNALLY AND WITHIN THE COMMUNITY. - APPLYING A HEALTH EQUITY LENS TO EACH IMPACT AREA, AND THE ACTION TEAMS' SUBSEQUENT RECOMMENDATIONS.IN 2022, QUARTERLY MEETINGS WERE ESTABLISHED FOR EACH OF THE FOUR ISP ACTION TEAMS. THE TEAMS MET TO EXPLORE INTERVENTIONS AND BEST PRACTICES. THREE OF THE FOUR ACTION TEAMS, FINANCIAL STABILITY, FOOD SECURITY AND HEALTHY HOUSING, HAVE FOLLOWED A SIMILAR PATH AND EXPLORATION PROCESS THAT INCLUDED COMPLETION OF A "HEALTH EQUITY PRIMER" TO LEVEL-SET MEMBER KNOWLEDGE AND COMFORT WITH CONCEPTS RELATED TO HEALTH EQUITY. TWO NEW PROGRAM COORDINATOR ROLES WERE ADDED IN FALL 2022, ONE .75 FTE TO FOCUS ON FOOD SECURITY, AND ONE FTE TO FOCUS ON FINANCIAL STABILITY AND HEALTHY HOUSING.IN FALL 2022, CHILDREN'S HOSTED FOUR DAYS OF COMMUNITY EXPLORATION WHERE ISP ACTION TEAM MEMBERS, CHILDREN'S COMMUNITY HEALTH & ADVOCACY STAFF AND INTERESTED EXECUTIVE LEADERS TRAVELED TO A NUMBER OF NON-PROFIT ORGANIZATIONS SERVING THE OMAHA AREA TO INTERVIEW AND TOUR PROGRAMS THAT SERVE TARGET CHILD AND FAMILY POPULATIONS WITH ONE OR MORE SERVICES IN THE IMPACT AREAS OF FINANCIAL STABILITY, FOOD SECURITY, HEALTHY HOUSING AND PEDIATRIC MENTAL WELLNESS. FOLLOWING THE TOUR DAYS, ATTENDEES WERE SURVEYED ON THEIR KNOWLEDGE, INTEREST AND EXPERIENCE FOR EACH OF THE FOUR AREAS.THE PROGRAM COORDINATORS FOR THE ACTION TEAMS USED THE TOUR EXPERIENCES, SURVEY FEEDBACK AND EXPLORATION OF PEER HOSPITAL PROGRAMMING TO DEVELOP A LIST OF "PROMISING OPTIONS" FOR PROGRAMMING AND PARTNERSHIP SPECIFIC TO EACH PRIORITY TO BE FURTHER DEVELOPED AND EXPLORED IN 2023, WITH THE GOAL OF IDENTIFYING 1-3 PROMISING OPTIONS FROM EACH OF THE THREE IMPACT AREAS TO BUILD OUT AND BEGIN TO IMPLEMENT IN LATE 2023 AND THROUGHOUT 2024, THE FINAL YEAR OF THE CURRENT ISP CYCLE.THE FOURTH IMPACT AREA, FOCUSED ON PEDIATRIC MENTAL WELLNESS, WAS DEFINED IN THE PREVIOUS ISP CYCLE, 2019-2021. DUE DILIGENCE HAD LARGELY BEEN COMPLETED AND INITIAL PROGRAMMING HAD BEEN IDENTIFIED. IN EARLY 2022, CHILDREN'S WAS AWARDED A $100K ZERO SUICIDE GRANT FROM CARDINAL HEALTH FOUNDATION NATIONAL COLLABORATIVE. THIS FUNDING WILL SUPPORT TRAINING CHILDREN'S STAFF AND IMPLEMENTATION OF THE ZERO SUICIDE MODEL IN 2023. ADDITIONALLY, CHILDREN'S DEVELOPED A STRATEGIC WORKFORCE PIPELINE WORKGROUP, IN PARTNERSHIP WITH OMAHA PUBLIC SCHOOLS, THE LARGEST SCHOOL DISTRICT IN NEBRASKA, TO SUPPORT MENTAL HEALTH CAREER PATHWAYS FOR STUDENTS. THE FIRST EVENT, A TEACHER IN-SERVICE DAY, WAS HELD IN SEPTEMBER 2022. CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 13B: CHILDREN'S RECOGNIZES THAT SOME PATIENTS WILL BE UNRESPONSIVE TO THE FINANCIAL ASSISTANCE APPLICATION PROCESS DUE TO A VARIETY OF REASONS INCLUDING BUT NOT LIMITED TO:1. LACK OF DOCUMENTATION REQUIRED TO COMPLY WITH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION REQUIREMENTS.2. LACK OF THE EDUCATIONAL LEVEL TO UNDERSTAND AND COMPLETE THE FINANCIAL ASSISTANCE APPLICATION.3. FEAR THAT INFORMATION GATHERED DURING THE APPLICATION PROCESS WILL BE USED IN THE COLLECTION PROCESS IN THE EVENT THAT THE APPLICATION IS DENIED.4. OUT OF STATE PATIENTS THAT DO NOT RESPOND TO COMPLETION OF A MEDICAIDAPPLICATION OR FINANCIAL ASSISTANCE APPLICATION.IN THE ABSENCE OF INFORMATION PROVIDED BY THE PATIENT OR IN CASES WHERE THE INFORMATION PROVIDED BY THE PATIENT IS INCOMPLETE, AN ASSESSMENT PROCESS UTILIZING A PREDICTIVE MODEL WILL BE DEPLOYED TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. THE PREDICTIVE MODEL INCORPORATES INCOME AND HOUSEHOLD SIZE ESTIMATES, A SOCIO-ECONOMIC NEED FACTOR (WIC, SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM, HUD PROGRAMS), CENSUS BLOCK DATA, AS WELL AS INFORMATION ON HOME OWNERSHIP.THE APPLICATION OF THE PREDICTIVE SCORING PROCESS AND PRESUMPTIVE FINANCIAL ASSISTANCE WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT FOR ALL PATIENTS THAT HAVE NOT APPLIED FOR CHARITY CARE. CHILDREN'S IS NOT OBLIGATED TO NOTIFY THE PATIENT THAT THEY HAVE RECEIVED PRESUMPTIVE FINANCIAL ASSISTANCE. CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 16J: THE POLICY IS PROVIDED TO THE PUBLIC IN SUMMARY AND THEY ARE DIRECTED TO VISIT THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE FOR THE FULL POLICY. CHILDREN'S HOSPITAL & MEDICAL CENTER PART V, SECTION B, LINE 24: AT CHILDREN'S, COMMERCIAL INSURERS, GOVERNMENT PAYORS AND SELF-PAY BILLING PARTIES ARE ALL BILLED THE SAME GROSS CHARGE RATE FOR EACH SPECIFIC PROCEDURE PERFORMED. GROSS CHARGES ON AN FAP-PATIENT BILL ARE THEN DISCOUNTED ACCORDING TO THEIR FPG ELIGIBILITY WHICH REDUCES OR ELIMINATES THE AMOUNT THE PATIENT IS REQUIRED TO PAY. PART V, SECTION B, LINE 7A HTTPS://WWW.CHILDRENSNEBRASKA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-BENEFIT/ PART V, SECTION B, LINE 10A HTTPS://WWW.CHILDRENSNEBRASKA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-BENEFIT/ PART V, SECTION B, LINE 16A HTTPS://WWW.CHILDRENSNEBRASKA.ORG/HOSPITAL-EXPERIENCE/BILLING-INSURANCE-MEDICAL-RECORDS/FINANCIAL-ASSISTANCE/ PART V, SECTION B, LINE 16B HTTPS://WWW.CHILDRENSNEBRASKA.ORG/HOSPITAL-EXPERIENCE/BILLING-INSURANCE-MEDICAL-RECORDS/FINANCIAL-ASSISTANCE/ PART V, SECTION B, LINE 16C HTTPS://WWW.CHILDRENSNEBRASKA.ORG/HOSPITAL-EXPERIENCE/BILLING-INSURANCE-MEDICAL-RECORDS/FINANCIAL-ASSISTANCE/ 2 1 - LINCOLN CLINIC 5930 VANDERVOORT DR STE A LINCOLN NE 68516 PEDIATRIC CLINIC 2 - CAROLYN SCOTT RAINBOW HOUSE 7825 FARNAM DRIVE OMAHA NE 68114 NO-COST ACCOMMODATIONS FOR FAMILIES OF PATIENTS PART I, LINE 3C: 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 SERVICES. 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 WILL BE CONSIDERED FOR FREE OR REDUCED ASSISTANCE BASED ON 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. PRESUMPTIVE ELIGIBILITY IS AVAILABLE IN A VARIETY OF CIRCUMSTANCES INCLUDING THE ABSENCE OF DOCUMENTATION REQUIRED TO COMPLY WITH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION REQUIREMENTS. THE PREDICTIVE MODEL 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 2022 COMMUNITY BENEFIT REPORT INCLUDE $5.6 MILLION IN FINANCIAL ASSISTANCE. PART I, LINE 7: EXPLANATION OF THE COSTING METHODOLOGY USED TO CALCULATE SUBSIDIZED HEALTH SERVICES: SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING A COMBINATION OF CHILDREN'S HOSPITAL & MEDICAL CENTER'S COST ACCOUNTING SYSTEM AND A COST TO CHARGE RATIO CALCULATION SIMILAR TO WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. THE REPORTED SUBSIDIZED LOSS REPRESENTS THE DIFFERENCE IN NET REVENUE RECEIVED FROM ALL PAYORS 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 BENEFITIS EXCLUDED FROM THE OPERATING EXPENSE TOTAL AS ARE BAD DEBT AND NON-PATIENT 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 SCHEDULE H AS A COMMUNITY BENEFIT.PART I, LINE 7I:THE ORGANIZATION DID NOT INCLUDE COSTS ATTRIBUTABLE TO PRIMARY CARE PHYSICIAN CLINICS AS CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT. PART III, LINE 2: DESCRIBE THE METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2& 3:BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE 2022 MEDICARECOST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST VALUE.BAD DEBT EXPENSE AT 100% CHARGE VALUE $4,460,610MEDICARE COST TO CHARGE RATIO X .4329BAD DEBT EXPENSE AT COST $1,931,218 PART III, LINE 3: ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY: THIS PROCESS INCLUDES IDENTIFYING 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 2022 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 II CHILDREN'S HOSPITAL & MEDICAL CENTER SUPPORTED ECONOMIC DEVELOPMENT IN ITS SPONSORSHIP DONATIONS TO ORGANIZATIONS SUCH AS THE GREATER OMAHA CHAMBER OF COMMERCE AND PARTICIPATED IN COALITION BUILDING ACTIVITIES SUCH AS THE NATIONAL ASSOCIATION OF CHILDREN'S HOSPITALS AND RELATED INSTITUTIONS' COMMUNITY HEALTH AFFINITY GROUP. PART III, LINE 4: FOR UNINSURED PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE, THE ORGANIZATION DETERMINES THE TRANSACTION PRICE ASSOCIATED WITH SERVICES ON THE BASIS OF CHARGES REDUCED BY IMPLICIT PRICE CONCESSIONS. IMPLICIT PRICE CONCESSIONS INCLUDED IN THE ESTIMATE OF THE TRANSACTION PRICE ARE BASED ON HISTORICAL COLLECTION EXPERIENCE FOR APPLICABLE PATIENT PORTFOLIOS. PATIENTS WHO MEET THE COMPANY'S CRITERIA FOR FREE "CHARITY" CARE ARE PROVIDED WITHOUT CHARGE; SUCH AMOUNTS ARE NOT REPORTED AS REVENUE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. SETTLEMENTS WITH THIRD-PARTY PAYORS FOR RETROACTIVE ADJUSTMENTS DUE TO AUDITS, REVIEWS, OR INVESTIGATIONS ARE CONSIDERED VARIABLE CONSIDERATION AND ARE INCLUDED IN THE DETERMINATION OF THE ESTIMATED TRANSACTION PRICE FOR PROVIDING PATIENT CARE USING THE MOST LIKELY OUTCOME METHOD. THESE SETTLEMENTS ARE ESTIMATED BASED ON THE TERMS OF THE PAYMENT AGREEMENTS WITH THE PAYOR, CORRESPONDENCE FROM THE PAYOR, AND HISTORICAL SETTLEMENT ACTIVITY, INCLUDING AN ASSESSMENT TO ENSURE THAT IT IS PROBABLE THAT A SIGNIFICANT REVERSAL IN THE AMOUNT OF CUMULATIVE REVENUE RECOGNIZED WILL NOT OCCUR WHEN THE UNCERTAINTY ASSOCIATED WITH THE RETROACTIVE ADJUSTMENT IS SUBSEQUENTLY RESOLVED. ESTIMATED SETTLEMENTS ARE ADJUSTED IN FUTURE PERIODS AS NEW INFORMATION BECOMES AVAILABLE OR AS YEARS ARE SETTLED OR ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, AND INVESTIGATIONS. PART III, LINE 8: MEDICARE2022 MEDICARE CHARGES REPORTED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS) IN THE PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM FOR PROVIDER FYE 12/31 WERE MULTIPLIED BY THE 2022 COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST OF CARE RELATED TO THE REIMBURSEMENT PAYMENTS REPORTED ON SCHEDULE H, PART III, LINE 5. PART III, LINE 9B: COLLECTION PRACTICESSELF-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 CENTER'S FINANCIAL ASSISTANCE PROGRAM. ALL CORRESPONDENCE, INCLUDING STATEMENTS AND COLLECTION LETTERS STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. PART VI, LINE 2: CHILDREN'S HOSPITAL & MEDICAL CENTER (CHILDREN'S) USES NUMEROUS RESOURCES TO BENCHMARK, ALIGN AND CONDUCT ASSESSMENTS OF THE HEALTH CARE NEEDS OF CHILDREN IN THE COMMUNITIES WE SERVE. THESE RESOURCES INCLUDE FOCUSED STAKEHOLDER INPUT AND PRIORITIZATION, NATIONAL PUBLIC HEALTH (HEALTHY PEOPLE 2030) AND PEDIATRIC CARE STANDARDS. WE ALSO REVIEW DATA FROM THE AMERICAN ACADEMY OF PEDIATRICS, OUR 2021 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) REPORT, AND TRENDS AS IDENTIFIED BY CHILDREN'S HOSPITAL ASSOCIATION (CHA).TO SUPPORT THE ORGANIZATION'S HEALTH EQUITY EFFORTS, CHILDREN'S BEGAN DEVELOPING A SOCIAL DETERMINANTS OF HEALTH (SDOH) AND EQUITY DASHBOARD. ONCE COMPLETED, THE DASHBOARD WILL ALLOW PATIENT-FACING STAFF, MANAGEMENT AND LEADERSHIP TO PULL REAL-TIME DATA REGARDING KEY PEDIATRIC HEALTH INDICATORS AND MONITOR FOR DISPARITIES ACROSS MULTIPLE FACTORS. DEPLOYMENT OF THE DASHBOARD IS ANTICIPATED FOR LATE 2023. PART VI, LINE 3: 3-PATIENT EDUCATION OF ELIGIBILITYFINANCIALLY 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 ACCESS CENTER PATIENT ADVOCATES, CENTRAL BILLING OFFICE 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 ANDOUTPATIENTS PRESENTING THROUGH CARES AND FOR THOSE PATIENTS SCHEDULED INTHE SPECIALTY PEDIATRIC CENTER CLINICS.ELIGIBILITY OF THE INSURED IS VALIDATED ELECTRONICALLY. THE BENEFIT DETAIL INCLUDING DEDUCTIBLE, COPAYMENT AND COINSURANCE AMOUNTS ARE DISCUSSED WITH THE FAMILY. ALL INDIVIDUALS WHO ARE FINANCIALLY UNABLE TO PAY ARE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGHGOVERNMENT 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 ACCESS CENTER PATIENT ADVOCATES WHO ARE AVAILABLE MONDAY THROUGH FRIDAY. ALL SELF-PAY FAMILIES ARE ENCOURAGED TO SPEAK TO AN ACCESS CENTER PATIENT ADVOCATE. CARE ESTIMATES OR QUESTIONS REGARDING ESTIMATE OF COST FOR UPCOMING TESTING ARE DIRECTED TO THE PATIENT ADVOCATES AND THESE SERVICES ARE AGAIN OFFERED PRIOR TO ENDING THE CONVERSATION. FINANCIAL ASSISTANCE INFORMATION IS ALSO LOCATED IN THE PATIENT HANDBOOKS. PATIENTSTATEMENTS AND ALL 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 THEY ARE UNINSURED OR HAVE LIMITED INCOME, THEY 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, THEY MAY THEN APPLY FOR THE CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. CONTACT NUMBERS FOR THE PATIENT ADVOCATES AND HOURS OF SERVICE ARE PROVIDED. THE WEBSITE INCLUDES COPIES OF CHILDREN'S FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM AND THE PLAIN LANGUAGE SUMMARY IN ENGLISH, ARABIC, CHINESE, FRENCH, PERSIAN, SPANISH, AND VIETNAMESE. THE WEBSITE ALSO INCLUDES AMOUNTS GENERALLY BILLED IN ENGLISH. ALL OTHER BILLING, PAYMENT, AND FINANCIAL RESPONSIBILITY RELATED LINKS ON CHILDREN'S WEBSITE STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE.THE FINANCIAL ASSISTANCE POLICY IS CURRENTLY AVAILABLE ON THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. HTTPS://WWW.CHILDRENSNEBRASKA.ORG/HOSPITAL-EXPERIENCE/BILLING-INSURANCE-MEDICAL-RECORDS/FINANCIAL-ASSISTANCE/ PART VI, LINE 4: 4-COMMUNITY INFORMATIONTHE HOSPITAL'S 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 889,016. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA.FOR THE YEAR ENDED DECEMBER 31, 2022, 51.8% OF THE HOSPITAL'S INPATIENT DISCHARGES WERE FROM PATIENTS RESIDING IN THE THREE-COUNTY PRIMARY SERVICE AREA. PATIENTS RESIDING IN THE SEVENTEEN-COUNTY SECONDARY SERVICE AREA ACCOUNTED FOR 17.9% OF TOTAL HOSPITAL INPATIENT DISCHARGES DURING THIS SAME TIME PERIOD. THE REMAINING 30.3% OF TOTAL DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE THE PRIMARY AND SECONDARY SERVICE AREAS.2020 DEMOGRAPHIC SUMMARYOMAHA METRO MARKET AREA: DOUGLAS, SARPY AND POTTAWATTAMIE COUNTIES SOURCES: ESRI (BASED ON US CENSUS BUREAU), UNITED STATES CENSUS BUREAU AND CHILDREN'S HOSPITAL AND MEDICAL CENTER PATIENT ENCOUNTER DATABASE.COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 12TOTAL POPULATION 889,016PEDIATRIC POPULATION 220,128AVERAGE HOUSEHOLD INCOME $101,468PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVELTOTAL POPULATION 10.4%UNDER AGE 18 12.0%PERCENT OF RESIDENTS ON MEDICAID 11.0%AGE POPULATION %OF TOTAL LESS THAN 18 220,128 24.8%18 TO 24 80,420 9.0%25 TO 44 254,759 28.7%45 TO 64 204,917 23.0%65+ 128,792 14.5%TOTAL 889,016 100.0%RACE POPULATION %OF TOTALWHITE 621,814 69.9%HISPANIC 111,061 12.5%BLACK 74,468 8.4%ASIAN/PACIFIC ISLANDER 34,589 3.9%OTHER/2+ RACES 43,404 4.9%AM. IND/ALASKA NAT 3,680 0.4%TOTAL 889,016 100.0%FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREASAPPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS: 13.7%COUNTY # OF CENSUS TRACTS* TOTAL CENSUS TRACTS % OF TOTALDOUGLAS 36 156 23.1%SARPY 12 43 27.9%POTTAWATTAMIE 3 30 10.0%TOTAL 51 229 22.2%*CENSUS TRACT IS A GEOGRAPHICAL DIVISION OF 500 TO 3,000 HOUSEHOLDS PART VI, LINE 5: PROUDLY SERVING CHILDREN SINCE 1948, CHILDREN'S HOSPITAL & MEDICAL CENTER (CHILDREN'S) MISSION IS TO IMPROVE THE LIFE OF EVERY CHILD THROUGH DEDICATION TO EXCEPTIONAL CARE, ADVOCACY, RESEARCH, AND EDUCATION. CHILDREN'S CENTER FOR THE CHILD & COMMUNITY IS A STATEWIDE COMMUNITY OUTREACH HUB OF CHILDREN'S. THE CHILDREN'S CENTER FOR THE CHILD & COMMUNITY WAS LAUNCHED IN 2016 TO SERVE AS THE INFRASTRUCTURE FOR COMMUNITY HEALTH IMPROVEMENT, LEADING BOTH INTERNAL AND EXTERNAL PARTNERSHIPS AROUND PEDIATRICS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PLANNING AND IMPLEMENTATION.A LEADER IN PEDIATRIC HEALTH CARE, CHILDREN'S CONDUCTED MORE THAN 470,000 VISITS IN 2022. CHILDREN'S OFFERS UNIQUE RESOURCES TO CHILDREN ACROSS A THREE-STATE REGION AND BEYOND, AND IS THE ONLY FULL-SERVICE, PEDIATRIC HEALTH CARE CENTER IN NEBRASKA. IN ADDITION TO TRADITIONAL HOSPITAL-BASEDSERVICES, SOME OF THE OTHER PROGRAMS AND SERVICES CHILDREN'S OFFERS TO PATIENTS ARE BEHAVIORAL HEALTH, REHAB SERVICES, HOME HEALTH, URGENT CARE, WEIGHT & WELLNESS, AND SPECIALTY CARE CLINICS. IN ADDITION, CHILDREN'S OFFERS PALLIATIVE CARE, FAMILY RESOURCES, CHILD LIFE SPECIALISTS, PASTORAL CARE, SOCIAL WORKERS, NURSE CASE MANAGERS, INTERPRETERS, FINANCIAL COUNSELORS, PATIENT ADVOCATES, AND OTHER PROGRAMS TO ENHANCE THE PATIENT EXPERIENCE.CHILDREN'S HAS ACHIEVED THE MAGNET DESIGNATION FOR NURSING EXCELLENCE, AND ITS PEDIATRIC AND NEONATAL INTENSIVE CARE UNITS HAVE EARNED A BEACON AWARD FOR EXCELLENCE FROM THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES, WHICH RECOGNIZES CRITICAL CARE UNITS WITH EXCELLENT PATIENT OUTCOMES THAT EXCEED NATIONAL BENCHMARKS. CHILDREN'S HAS BEEN NAMED BY U.S. NEWS & WORLD REPORT AS ONE OF THE NATION'S BEST CHILDREN'S HOSPITALS, NATIONALLY RANKED IN PULMONOLOGY & LUNG SURGERY AND UROLOGY. U.S. NEWS RECOGNIZES HOSPITALS WITH EXCELLENT SURVIVAL RATES, PATIENT SAFETY, SPECIALIZED STAFF, AND HOSPITAL REPUTATION. 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 SERVES AS THE PRIMARY ACADEMIC MEDICAL TRAINING LOCATION FOR THE UNMC DEPARTMENT OF PEDIATRICS.IN 2022, CHILDREN'S PROVIDED MORE THAN $175 MILLION IN COMMUNITY BENEFITS, REPRESENTING 32% OF THE HOSPITAL'S OPERATING EXPENSES. TOTAL COMMUNITY BENEFITS PROVIDED IN 2022 INCLUDED THE FOLLOWING:- PROVIDED $5.6 MILLION IN FINANCIAL ASSISTANCE TO FAMILIES UNABLE TO PAY. WITH 46% OF PATIENT CARE REVENUES DEVOTED TO THE CARE OF LOW-INCOME CHILDREN ASSISTED BY MEDICAID, THE FY 2022 SHORTFALL BETWEEN MEDICAID REIMBURSEMENT AND THE COST OF PROVIDING CARE WAS $80.9 MILLION.- CONTRIBUTED $4.1 MILLION TOWARDS COMMUNITY HEALTH IMPROVEMENT AND COMMUNITY BENEFIT OPERATIONS AIMED AT PROMOTING HEALTH AND PREVENTING ILLNESS AND INJURY MADE AVAILABLE THROUGH INJURY PREVENTION, OBESITY PREVENTION, PARENTING U EDUCATION CLASSES, OUTREACH EDUCATIONAL CLASSES, HEALTH FAIRS, JUST KIDS MAGAZINE, AND THE CONSUMER WEBSITE. CHILDREN'S GIVES BACK TO THE COMMUNITY THROUGH ADVOCACY SERVICES WHICH ARE AVAILABLE TO ANYONE SUSPECTING CHILD ABUSE OR NEGLECT, AND LODGING FOR FAMILIES OF OUT-OF-TOWN PATIENTS IS OFFERED AT THE CAROLYN SCOTT RAINBOW HOUSE AT NO COST.- CONTRIBUTED $22.5 MILLION IN PEDIATRIC HEALTH CARE EDUCATION COSTS TO EDUCATE TOMORROW'S HEALERS.- PROVIDED $60.8 MILLION IN CASH AND IN-KIND DONATIONS/SPONSORSHIPS TO BENEFIT THE BROADER COMMUNITY. PART VI, LINE 6: CHILDREN'S HOSPITAL & MEDICAL CENTER IS NOT AFFILIATED WITH A GREATER HEALTH CARE SYSTEM, BUT IS ITS OWN HEALTH CARE SYSTEM WHICH THE HOSPITAL OPERATES THE FOLLOWING RELATED ORGANIZATIONS:- CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION- CHILDREN'S PHYSICIANS- CHILDREN'S HEALTH NETWORK- BRIGHT FOUNDRY PART VI, LINE 7 THE CHILDREN'S HOSPITAL & MEDICAL CENTER COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF NEBRASKA THROUGH THE NEBRASKA HOSPITAL ASSOCIATION, AND IS AVAILABLE TO THE PUBLIC ON THE WEBSITE AT: HTTPS://WWW.CHILDRENSNEBRASKA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-BENEFIT/ 1 NE PEDIATRIC PRACTICE 8200 DODGE STREET OMAHA NE 68114 263064869 501(C)(3) 10105 0 PEDIATRIC RESEARCH UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 985520 NE MED CTR OMAHA NE 68198 470049123 501(C)(3) 2865019 0 SUPPORT FOR MEDICAL SCHOOL CEDARS YOUTH SERVICES INC 6601 PIONEERS BLVD LINCOLN NE 68506 470551975 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY CHICANO AWARENESS CENTER INC 4821 S 24TH ST OMAHA NE 68107 237208431 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY COMPLETELY KIDS 2566 ST MARYS AVE OMAHA NE 68105 275111197 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY EDUCARE OF LINCOLN INC 3435 N 14TH ST LINCOLN NE 68521 460568146 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY FOUNDATION FOR LINCOLN PUBLIC SCHOOLS 5905 O ST LINCOLN NE 68501 363490560 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY GIRLS INCORPORATED OF OMAHA 2811 N 45TH ST OMAHA NE 68104 470562184 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY HASTINGS FAMILY YMCA 1430 W 14TH ST HASTINGS NE 68901 470376607 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY NEBRASKA APPLESEED CENTER PO BOX 83613 LINCOLN NE 68501 470798343 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY ONEWORLD COMMUNITY HEALTH CENTERS INC 4920 S 30TH ST OMAHA NE 68107 470548990 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY YMCA OF GREATER OMAHA 430 S 20TH ST OMAHA NE 68102 470376586 501(C)(3) 10000 0 PREVENTION OF CHILDHOOD OBESITY 12 0 FINANCIAL ASSISTANCE TO PATIENTS IN NEED 7236 12848384 BOOK WRITEOFF PATIENT ACCOUNTS PART I, LINE 2: CHILDREN'S HOSPITAL & MEDICAL CENTER HAS A WRITTEN FINANCIAL ASSISTANCE/CHARITY CARE POLICY. THE AMOUNT OF FINANCIAL ASSISTANCE AN INDIVIDUAL CAN RECEIVE IS BASED ON THE ANNUAL GROSS INCOME THRESHOLDS USING THE CURRENT FEDERAL POVERTY LEVEL GUIDELINES. GRANTS TO ORGANIZATIONS ARE ONLY DISTRIBUTED TO 501(C)(3) OR GOVERNMENT ORGANIZATIONS BASED ON THE HOSPITAL'S EVALUATION CRITERIA. X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 CHANDA CHACON PRESIDENT & CEO 941443 0 362412 0 54350 0 207850 0 14145 0 1580200 0 0 0 CHRISTOPHER MALONEY MD EVP CHIEF CLINICAL OFFICER & PHYS IN 726471 0 287253 0 141053 0 127319 0 624 0 1282720 0 0 0 KATHY ENGLISH EVP COO & CNO 571664 0 190283 0 188260 0 26550 0 12038 0 988795 0 86360 0 AMY HATCHER EVP & CFO 530543 0 196180 0 103535 0 100868 0 11146 0 942272 0 0 0 ERIN WILLIS-LOUCKS MD PHYSICIAN 827548 0 30060 0 2806 0 23650 0 21942 0 906006 0 0 0 JEROLD VUCHAK SVP CHIEF INFO OFFICER 405961 0 166549 0 88966 0 68499 0 8196 0 738171 0 0 0 AMY BONES SVP & GENERAL COUNSEL 387916 0 141629 0 74639 0 69870 0 8172 0 682226 0 0 0 JANEL ALLEN SVP & CHIEF PEOPLE OFFICER 366626 0 152589 0 76144 0 65048 0 18503 0 678910 0 0 0 DAVID FETT-JONES VP CLINICAL AND ANCILLARY SERVICES 266085 0 81121 0 48042 0 39562 0 20668 0 455478 0 0 0 PART I, LINE 1A CHANDA CHACON'S SOCIAL CLUB DUES WERE PAID FOR BY THE ORGANIZATION TO BE USED FOR BUSINESS PURPOSES. 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: CHANDA CHACON - $190,000 ACCRUAL, $0 PLAN DISTRIBUTION CHRISTOPHER MALONEY - $109,470 ACCRUAL, $0 PLAN DISTRIBUTION KATHY ENGLISH - $86,133 ACCRUAL, $86,360 PLAN DISTRIBUTION AMY HATCHER - $83,018 ACCRUAL, $0 PLAN DISTRIBUTION AMY BONES - $49,120 ACCRUAL, $0 PLAN DISTRIBUTION JEROLD VUCHAK - $51,516 ACCRUAL, $0 PLAN DISTRIBUTION JANEL ALLEN - $47,198 ACCRUAL, $0 PLAN DISTRIBUTION DAVID FETT-JONES - $21,883 ACCRUAL, $0 PLAN DISTRIBUTION A HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230KT6 2008-08-12 100881609 REFUND BONDS (6/8/2007) 1 0 0 B HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230NJ5 2017-03-14 101075067 USED TO CONSTRUCT HUBBARD CENTER FOR CHILDREN 0 0 0 C HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230KT6 2017-11-28 26885000 REFUND BONDS (8/12/2008) 0 0 0 D HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE 521440796 259230PJ3 2020-05-28 109497288 HUBBARD / REFUND BONDS (9/10/2014) 0 0 0 A 71185000 100892290 751783 24826 2755000 97360681 2008 1 0 1 1 B 104280765 1064167 103216598 2021 0 0 1 1 C 12750000 26885000 305601 26579399 2008 1 0 1 1 D 2600000 109498595 10089 1132344 90024355 18331807 2021 1 0 1 1 A 0 1 1 1 1 1 0.00200 0.00200 0 0 1 B 0 0 0 0 0.00000 0.00000 0 0 1 C 0 1 1 1 1 1 0.00200 0.00200 0 0 1 D 0 0 0 0 0.00000 0.00000 0 0 1 A 0 0 1 1 1 1 MORGAN STANLEY 25.000000000000 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 1 1 0 0 0 0 1 D 0 0 1 1 0 0 0 0 1 A 1 B 1 C 1 D 1 PART-II LINE-3 THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS. PART-IV LINE-2C DATE THE REBATE COMPUTATION WAS PERFORMED: 10/02/2017 (2008 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 02/28/2020 (2017 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 05/28/2018 (2017B BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 04/30/2021 (2020A&B BONDS) FORM 990, PART VI, SECTION A, LINE 4 SYNOPSIS OF CHANGES TO THE CHILDREN'S HOSPITAL & MEDICAL CENTER BYLAWS: 1. REMOVE NUMBER OF COMMITTEE MEMBERS. ARTICLE. VIII, SECTION 1B HAS THE GENERAL REQUIREMENT THAT EACH COMMITTEE MUST HAVE AT LEAST 2 DIRECTORS. 2. REMOVE HOW MANY TIMES A YEAR THE COMMITTEE MUST MEET. THE ONLY EXCEPTION IS QUALITY & PATIENT SAFETY COMMITTEE (QPSC) ARTICLE VIII, SECTION 4 STILL STATES THE QPSC MUST MEET MONTHLY. 3. REMOVE REFERENCE TO PAST CHAIR COUNCIL AND COMMUNITY ADVISORY COMMITTEE. 4. ARTICLE VIII, SECTION I - REVISE REFERENCES TO NON-DIRECTORS SERVING ON COMMITTEES, EXCEPT FOR THE GENERAL REFERENCE IN ART. VIII, SECTION 1 H 5. ARTICLE XVIII REVISE REQUIREMENT FOR APPROVAL OF BYLAW AMENDMENTS FROM 2/3 VOTE TO MAJORITY VOTE OF THE BOARD. 6. ARTICLE VIII, SECTION 1 (H) - IN ACCORDANCE WITH SECTION 21-1968(C) OF THE NEBRASKA NONPROFIT CORPORATION ACT, THE BOARD OF DIRECTORS MAY SET FORTH IN THESE BYLAWS THE AUTHORIZATION TO PERMIT A NON-BOARD MEMBER TO SERVE ON CERTAIN BOARD COMMITTEES AND AS PART OF THAT COMMITTEE, TO EXERCISE SOME OF THE POWERS WHICH WOULD OTHERWISE BE EXERCISED BY THE BOARD. TO THE EXTENT SO AUTHORIZED, ANY PERSON OR PERSONS SHALL HAVE THE DUTIES AND RESPONSIBILITIES OF THE DIRECTORS, AND THE DIRECTORS SHALL BE RELIEVED FROM SUCH DUTIES AND RESPONSIBILITIES. THE FINANCE, AUDIT AND COMPLIANCE COMMITTEE WILL HAVE A CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION MEMBER ON IT, AS SPECIFIED IN SECTION 6 OF THIS ARTICLE. THE INVESTMENT COMMITTEE MAY HAVE OTHER NON-DIRECTOR MEMBERS ON THAT COMMITTEE AS WELL, IF APPROVED BY THE CHAIR OF THE BOARD. THE STRATEGY COMMITTEE MAY HAVE OTHER NON-DIRECTOR MEMBERS ON THAT COMMITTEE AS WELL, IF APPROVED BY THE CHAIR OF THE BOARD. THE QUALITY & PATIENT SAFETY COMMITTEE WILL HAVE THE PARENT OF A CHILD WHO HAS RECENTLY BEEN TREATED WITHIN THE CHILDREN'S SYSTEM ON THAT COMMITTEE. ANY NON-DIRECTORS SERVING ON BOARD COMMITTEES WILL BE SUBJECT TO THE SAME DUTIES OF CARE, LOYALTY AND CONFIDENTIALITY IN FAVOR OF THE CORPORATION AS DIRECTORS ARE. FORM 990, PART VI, SECTION B, LINE 11B GOVERNANCE, MANAGEMENT, AND DISCLOSURE 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 COMPLETE 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 POLICIES 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 OR A BOARD COMMITTEE FOR APPROVAL (COVERED PERSON). COVERED PERSON INCLUDES (BUT IS NOT LIMITED TO) ANY DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWER, OR KEY EMPLOYEE/STAFF. ALL COVERED PERSONS MUST ANNUALLY SUBMIT A COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE IN THE FORMAT PRESCRIBED BY THE GOVERNANCE COMMITTEE FROM TIME TO TIME. EACH COVERED PERSON SHALL ANNUALLY ACKNOWLEDGE IN WRITING THAT HE OR SHE (A) HAS RECEIVED A COPY OF THE 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 PROMPTLY REPORT TO THE CHAIR OF THE GOVERNANCE COMMITTEE, AND CHILDREN'S GENERAL COUNSEL ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICT OF INTEREST QUESTIONNAIRE; AND (G) STATES THAT THE INFORMATION HE OR SHE WILL PROVIDE IN THE CONFLICT OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF. A COVERED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST OR ANY SITUATIONS THAT COULD CREATE AN APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES OR WHENEVER IT INVOLVES A MATTER OF BOARD/COMMITTEE ACTION. DISCLOSURE MEANS PROMPTLY PROVIDING THE MATERIAL FACTS OF AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDREN'S GENERAL COUNSEL (IN WRITING IF TIME ALLOWS) OR TO THE BOARD OR BOARD COMMITTEE REVIEWING THE CONTRACT, TRANSACTION OR ARRANGEMENT. THE GOVERNANCE COMMITTEE WILL BE CONVENED TO CONSIDER THE DISCLOSURE. CERTAIN CIRCUMSTANCES, IN ADDITION TO FINANCIAL INTERESTS, COULD GIVE RISE TO A POTENTIAL CONFLICT OF INTEREST, INCLUDING INSTANCES WHERE THE ACTIONS OR ACTIVITIES OF AN INDIVIDUAL ON BEHALF OF CHILDREN'S ALSO INVOLVE OBTAINING A PERSONAL GAIN OR ADVANTAGE, OR COULD HAVE AN ADVERSE EFFECT ON CHILDREN'S INTERESTS. A COVERED PERSON MUST ALSO MAKE A DISCLOSURE WHENEVER HE OR SHE HAS A PERSONAL, NON-FAMILIAL RELATIONSHIP THAT COULD IMPACT, OR APPEAR TO IMPACT, THE BOARD MEMBER'S ABILITY TO EXERCISE THEIR INDEPENDENT JUDGMENT IN CARRYING OUT THE DIRECTOR'S FIDUCIARY RESPONSIBILITIES. ALSO, DISCLOSING OR USING INFORMATION RELATING TO CHILDREN'S BUSINESS FOR THE PERSONAL PROFIT OR ADVANTAGE OF AN INDIVIDUAL OR HIS OR HER FAMILY, OR OTHER COLLEAGUES OF THE DIRECTOR, OR DISCLOSING MATTERS DISCUSSED DURING BOARD OR COMMITTEE MEETINGS, COULD GIVE RISE TO A CLAIM OF CONFLICT AND MUST NOT OCCUR. A POTENTIAL CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST, DOES NOT NECESSARILY RISE TO THE LEVEL OF AN ACTUAL CONFLICT OF INTEREST, BUT ONCE RECOGNIZED, IT MUST IN EVERY CASE BE DISCLOSED AND EVALUATED. THE GOVERNANCE COMMITTEE WILL CONSIDER THE FOLLOWING FACTORS, AMONG OTHER RELEVANT FACTS, WHEN DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS: (I) THE PROXIMITY OF THE COVERED PERSON TO THE DECISION-MAKING AUTHORITY OF THE OTHER ENTITY INVOLVED IN THE TRANSACTION OR BUSINESS ARRANGEMENT; (II) THE MAGNITUDE OF THE FINANCIAL INTEREST OR PERSONAL INTEREST; (III) THE DEGREE TO WHICH THE COVERED PERSON MIGHT BENEFIT PERSONALLY IF A PARTICULAR TRANSACTION OR BUSINESS ARRANGEMENT WERE APPROVED; (IV) THE ABILITY OF THE COVERED PERSON TO MAKE AN INDEPENDENT DECISION BASED ONLY ON THE BEST INTEREST OF CHILDREN'S; AND (V) SUCH OTHER FACTORS THAT MAY BE RELEVANT TO THE PARTICULAR MATTER. THE GOVERNANCE COMMITTEE SHALL REVIEW EACH COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE AND MAY MAKE SUCH FURTHER INVESTIGATION OF POTENTIAL CONFLICTS AS IT MAY DETERMINE APPROPRIATE. THE GOVERNANCE COMMITTEE SHALL MAKE APPROPRIATE REPORTS TO THE BOARD CONCERNING ITS REVIEW, ANY FURTHER INVESTIGATION, AND ITS RECOMMENDATIONS TO THE BOARD REGARDING ANY POTENTIAL OR ACTUAL CONFLICT OF INTEREST, OR ANY APPEARANCE OF A CONFLICT OF INTEREST. WHENEVER A COVERED PERSON (OR A PERSON OTHER THAN THE COVERED PERSON) VOLUNTARILY IDENTIFIES OR DISCLOSES A POTENTIAL CONFLICT OF INTEREST, THE GOVERNANCE COMMITTEE SHALL FOLLOW THE SAME PROCEDURE OUTLINED ABOVE. TRANSACTIONS OR BUSINESS ARRANGEMENTS WITH COVERED PERSONS WITH CONFLICTS OF INTEREST MUST BE APPROVED IN ADVANCE BY A MAJORITY OF INDEPENDENT DIRECTORS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN CHILDREN' S BEST INTEREST, IS FAIR AND REASONABLE TO CHILDREN'S AND THAT, AFTER REASONABLE INVESTIGATION, THE INDEPENDENT DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. THE CONFLICTED DIRECTOR WILL RECUSE HIMSELF/HERSELF. IN CASES IN WHICH A COVERED PERSON HAS AN INTEREST OR A RELATIONSHIP THAT CALLS INTO QUESTION THE ABILITY OF THE COVERED PERSON TO ACT SOLELY IN CHILDREN'S BEST INTERESTS, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN, AT THE DISCRETION OF THE BOARD OR THE GOVERNANCE COMMITTEE: (A) THE COVERED PERSON WILL BE REQUIRED TO LEAVE THE MEETING FOR THE GENERAL DISCUSSION OF THE MATTER AND THE BOARD VOTE; (B) THE GOVERNANCE COMMITTEE CAN RECOMMEND TO THE BOARD THAT 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 BE INCOMPATIBLE WITH CHILDREN'S BEST INTERESTS TO HAVE SUCH AN INDIVIDUAL ON ITS BOARD/COMMITTEE. IF THE BOARD/COMMITTEE BELIEVES A COVERED PERSON HAS FAILED TO COMPLY WITH THIS POLICY, THE BOARD SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND GIVE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE. AFTER HEARING THE RESPONSE AND CONDUCTING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD/COMMITTEE SHALL DETERMINE WHETHER SUCH PERSON HAS, IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THE 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. AT ANY BOARD/COMMITTEE MEETING AT WHICH A CONFLICT-OF-INTEREST ISSUE IS ADDRESSED, THE MINUTES OF THE BOARD/COMMITTEE MEETING SHALL REFLECT THE PROCESS THAT WAS FOLLOWED, AND THE ACTIONS TAKEN BY THE BOARD/COMMITTEE. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A AND 15B POLICIES EACH YEAR AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF EXECUTIVE COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPANY 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 RANGES FOR ALL EXECUTIVES, INCLUDING THE CHIEF EXECUTIVE OFFICER, ALL EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS. THE BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. FORM 990, PART VI, SECTION C, 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 9: CAPITAL TRANSFERS FROM THE FOUNDATION 354,360,133. CHANGE IN VALUE OF SPLIT INTEREST -1,687,264. CAPITAL TRANSFERS TO CHILDREN'S HEALTH NETWORK -438,618. FORM 990, PART XII, LINE 3A SINGLE AUDITS FOR TAX YEARS 2020 AND 2021 WILL BE CONDUCTED IN TAX YEARS 2022 AND 2023, RESPECTIVELY. 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