2023-11-13T16:54:50-06:00 2022-12-31 990 2022-01-01 470717207 FREMONT HEALTH CLINIC FREM 4023544000 825 S 169TH STREET OMAHA NE 68118 JEFFREY E FRANCIS VP FINANCE & CFO 4023544800 2023-11-13 JEFFREY FRANCIS 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z X BRETT RICHMOND 825 S 169TH STREET OMAHA NE 68118 0 0 X WWW.BESTCARE.ORG X 1988 NE THE ORGANIZATION PROVIDES HEALTHCARE TO PATIENTS IN FIVE SURROUNDING COUNTIES. X 3 1 0 0 0 0 0 0 12629847 0 46932 0 -233514 0 12443265 0 78782 32917 0 0 10643502 0 0 0 0 3197239 249638 13919523 282555 -1476258 -282555 10049975 0 19970206 0 -9920231 0 TO PROVIDE HEALTHCARE SERVICES. 0 0 282555 32917 FREMONT HEALTH CLINIC PROVIDES QUALITY HEALTH CARE TO RESIDENTS OF THE DODGE COUNTY AREA AND SURROUNDING COMMUNITIES INCLUDING LOCATIONS IN FREMONT, NORTH BEND, AND WATERLOO, NEBRASKA. 282555 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 1 X 4 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 1 0 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JEFFREY E FRANCIS 4023544800 825 S 168TH STREET OMAHA NE 68118 TODD GRAGES VICE CHAIRPERSON 1.00 39.00 X X 0 655045 115313 BRETT RICHMOND TREASURER & SECRETARY 1.00 39.00 X X 0 444289 92083 JODY HORNER CHAIRPERSON 1.00 X X 0 0 0 JEFFREY FRANCIS CFO 1.00 39.00 X 0 631955 130435 0 1731289 337831 0 0 1 0 TNT CLEANING SERVICES 2669 OLD HWY 8 FREMONT NE 68025 CLEANING SERVICES 138225 1 0 0 0 0 32917 32917 18796 18796 7299 7299 76924 76924 139213 139213 MEDICAL SUPPLIES 5035 5035 STAFF EDUCATION & DEVEL 2371 2371 282555 282555 0 0 2007958 0 0 0 1678243 0 0 0 241851 0 0 1378 0 0 6120545 0 0 0 0 0 0 10049975 0 19970206 19970206 0 X -9920231 0 -9920231 0 10049975 0 X -282555 10202786 X 0 1 X 1 0 X 128709 128709 3152410 8008013 11860403 12629847 0 35650673 3152410 8008013 11989112 12629847 35779382 0 0 0 35779382 182799 261403 588436 608871 0 1641509 182799 261403 588436 608871 1641509 381484 381484 3716693 8269416 12577548 13238718 37802375 0.94650 0.94980 0.04340 0.03830 X 0 X PART X, LINE 2: FREMONT HEALTH CLINIC 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. IN 2022 MANAGEMENT DETERMINED THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE FINANCIAL STATEMENTS. NO CHANGES WERE MADE TO THE FINANCIAL STATEMENTS DUE TO FIN 48. 0 FINANCIAL ASSISTANCE 398 32917 BOOK 0 1 0 0 0 0 0 0 0 TODD GRAGES VICE CHAIRPERSON 0 420416 0 28309 0 206320 0 91249 0 24686 0 770980 0 170396 JEFFREY FRANCIS CFO 0 520672 0 14154 0 97129 0 99231 0 31826 0 763012 0 93756 BRETT RICHMOND TREASURER & SECRETARY 0 354367 0 29209 0 60713 0 63305 0 29400 0 536994 0 38304 PART I, LINE 3 FREMONT HEALTH CLINIC IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. NEBRASKA METHODIST HEALTH SYSTEM, WITH WHICH FREMONT HEALTH CLINIC IS AFFILIATED, RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED AND COMPENSATION RANGES ARE SET. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NON-PROFIT CORPORATION AND THE CORPORATE PARENT OF THE ENTIRE HEALTH SYSTEM, OF WHICH FREMONT HEALTH CLINIC IS A MEMBER. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NONQUALIFIED PLAN DURING 2022 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: JEFFREY FRANCIS $77,881 ACCRUAL, $93,756 PLAN DISTRIBUTION TODD GRAGES $63,799 ACCRUAL, $170,396 PLAN DISTRIBUTION BRETT RICHMOND $38,905 ACCRUAL; $38,304 PLAN DISTRIBUTION 0 0 0 0 1 1 1 1 0 FORM 990, PART V, LINE 2B EFFECTIVE 01/01/2019, THE PAYROLL SYSTEM FOR FREMONT HEALTH CLINIC IS HANDLED BY A COMMON PAYMASTER, NEBRASKA METHODIST HEALTH SYSTEM, INC. ALL W-2 FORMS WERE ISSUED UNDER THE TAX IDENTIFICATION NUMBER OF NEBRASKA METHODIST HEALTH SYSTEM AND ALL REQUIRED EMPLOYMENT TAX RETURNS WERE FILED BY NEBRASKA METHODIST HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 4 METHODIST FREMONT HEALTH FILED ARTICLES OF DISSOLUTION WITH THE NEBRASKA ATTORNEY GENERAL'S OFFICE AND AND WAS LEGALLY DISSOLVED ON 06/13/2022. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF FREMONT HEALTH CLINIC INC. IS METHODIST FREMONT HEATLH, INC., A NEBRASKA NOT-FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A METHODIST FREMONT HEALTH, INC., THE MEMBER, HAS THE POWER TO ELECT AND REMOVE THE DIRECTORS OF THE CORPORATION. METHODIST FREMONT HEALTH ALSO HAS THE POWER TO APPOINT AND REMOVE THE PERSON DESIGNATED AS THE CORPORATION'S PRESIDENT BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B METHODIST FREMONT HEALTH, INC., THE MEMBER, HAS THE POWER TO APPROVE OR REFUSE TO APPROVE ANY AMENDMENT TO THE CORPORATION'S ARTICLES OF INCORPORATION OR THE BYLAWS OR ANY ACTION REQUIRED TO BE SUBMITTED TO AND APPROVED BY THE VOTING MEMBERS OF A NONPROFIT CORPORATION UNDER THE NEBRASKA NONPROFIT CORPORATION ACT. METHODIST FREMONT HEALTH ALSO HAS APPROVAL AUTHORITY WITH REGARD TO THE ANNUAL BUDGET, CAPITAL EXPENDITURES IN EXCESS OF ESTABLISHED THRESHOLDS, THE MISSION STATEMENT, LONG-RANGE PLAN, INCURRENCE OF DEBT AND ESTABLISHMENT OF A SUBSIDIARY OR PARTICIPATION AS A SHAREHOLDER, PARTNER OR EQUITY MEMBER OF ANY OTHER ENTITY. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, A COPY IS PROVIDED TO THE AUDIT AND COMPLIANCE COMMITTEE OF NEBRASKA METHODIST HEALTH SYSTEM AND THE FREMONT HEALTH CLINIC BOARD OF DIRECTORS. THEY ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS OR REQUEST MORE INFORMATION. INFORMATION FOR THE FORM 990 IS GATHERED FROM APPROPRIATE RESPONSIBLE PARTIES THROUGHOUT THE ORGANIZATION, INCLUDING THE ORGANIZATION'S HUMAN RESOURCES, FINANCE, COMPLIANCE, AND COMMUNITY BENEFITS DEPARTMENTS AND HAS A FINAL REVIEW BY THE CHIEF FINANCIAL OFFICER FOR NEBRASKA METHODIST HEALTH SYSTEM AND THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL QUESTIONNAIRE IS SENT TO ALL OFFICERS, DIRECTORS, COMMITTEE MEMBERS, MEDICAL DIRECTORS, AND KEY EMPLOYEES PURSUANT TO THE METHODIST HEALTH SYSTEM CONFLICTS OF INTEREST POLICY WHICH REQUIRES THE DISCLOSURE OF RELATIONSHIPS, NOT JUST FINANCIAL, THAT COULD GIVE RISE TO CONFLICTS WITH THE ORGANIZATION. A BOARD COMMITTEE MEETS ANNUALLY TO REVIEW ALL POTENTIAL CONFLICTS IDENTIFIED THROUGH THE SURVEYS. SHOULD A DECISION COME TO THE BOARD WITH AN IDENTIFIED CONFLICT, THE OFFICER, DIRECTOR OR KEY EMPLOYEE IS NOT PERMITTED TO VOTE OR USE PERSONAL INFLUENCE ON THE MATTER AND IS NOT COUNTED IN DETERMINING THE QUORUM FOR A MEETING AT WHICH THE MATTER IS DISCUSSED. A POTENTIAL CONFLICT OF INTEREST ONCE IDENTIFIED MUST BE EVALUATED ON A CASE BY CASE BASIS. IN ORDER TO APPROVE THE TRANSACTION WHICH INVOLVES A DIRECT CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DIRECTORS FOR WHOM NO CONFLICT EXISTS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTERESTS OF FREMONT HEALTH CLINIC AND/OR ITS HEALTH SYSTEM AFFILIATES, IS FAIR AND REASONABLE AND, AFTER INVESTIGATION, THE DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 FREMONT HEALTH CLINIC IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. NEBRASKA METHODIST HEALTH SYSTEM, WITH WHICH FREMONT HEALTH CLINIC IS AFFILIATED, RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED AND COMPENSATION RANGES ARE SET. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NON-PROFIT CORPORATION AND THE CORPORATE PARENT OF THE ENTIRE HEALTH SYSTEM, OF WHICH FREMONT HEALTH CLINIC IS A MEMBER. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. PHYSICIAN COMPENSATION IS COMPARED TO NATIONAL COMPENSATION SURVEY DATA FROM THE MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) AND THE AMERICAN MEDICAL GROUP ASSOCIATION (AMGA). THE POLICY ON "PHYSICIAN COMPENSATION" IS FOLLOWED WHEN CONTRACTING WITH PHYSICIANS TO ENSURE APPROPRIATE APPROVALS, INCLUDING APPROVAL BY THE BOARD OF DIRECTORS, ARE OBTAINED WHEN WARRANTED. OPINIONS OF FAIR MARKET VALUE REGARDING A PARTICULAR COMPENSATION ARRANGEMENT OR TRANSACTION MAY ALSO BE OBTAINED FROM REPUTABLE, INDEPENDENT VALUATION CONSULTANTS. FORM 990, PART VI, SECTION C, LINE 18 A COPY OF THE IRS LETTER 947 WILL BE PROVIDED UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. HOWEVER, ARTICLES OF INCORPORATION FOR THE ORGANIZATION ARE AVAILABLE THROUGH THE NEBRASKA SECRETARY OF STATE'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS. FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC THROUGH THE IRS FORM 990. FORM 990, PART XI, LINE 9: EQUITY MERGED INTO PARENT ORGANIZATION UPON DISSOLUTION 10,202,786. NEBRASKA METHODIST HOSPITAL 825 S 169TH STREET OMAHA NE 68118 470376604 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 NEBRASKA METHODIST HEALTH SYSTEM INC 825 S 169TH STREET OMAHA NE 68118 470639839 ADMINISTRATIVE SUPPORT NE 501(C)(3) L12: III-FI N/A 0 NEBRASKA METHODIST COLLEGE OF NURSING & ALLIED HEALTH 825 S 169TH STREET OMAHA NE 68118 470724387 NURSING AND HEALTH EDUCATION FACILITY NE 501(C)(3) L2 NEBRASKA METHODIST HOSPITAL 0 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST 825 S 169TH STREET OMAHA NE 68118 363699672 INSURANCE NE 501(C)(3) L12: III-FI NEBRASKA METHODIST HEALTH SYSTEM 0 REAL ESTATE HOLDINGS INC 825 S 169TH STREET OMAHA NE 68118 470649790 PROPERTY MANAGEMENT NE 501(C)(2) N/A NEBRASKA METHODIST HEALTH SYSTEM 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL 933 E PIERCE STREET COUNCIL BLUFFS IA 51503 420680355 LICENSED HOSPITAL IA 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 933 E PIERCE STREET COUNCIL BLUFFS IA 51503 421439454 SUPPORT OF JENNIE EDMUNDSON MEMORIAL HOSPITAL IA 501(C)(3) L7 JENNIE EDMUNDSON MEMORIAL HOSPITAL 0 NEBRASKA METHODIST HOSPITAL FOUNDATIOIN 825 S 169TH STREET OMAHA NE 68118 470595345 SUPPORT OF NEBRASKA METHODIST HOSPITAL NE 501(C)(3) L7 NEBRASKA METHODIST HEALTH SYSTEM 0 PHYSICIANS CLINIC INC 825 S 169TH STREET OMAHA NE 68118 470687317 CLINICAL HEALTH CARE NE 501(C)(3) L10 NEBRASKA METHODIST HEALTH SYSTEM 0 METHODIST FREMONT HEALTH 450 E 23RD STREET FREMONT NE 68025 831362276 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 SHARED SERVICE SYSTEMS INC & SUBSIDIARY 825 S 169TH STREET OMAHA NE 68118 470649534 MEDICAL SUPPLY DISTRIBUTION & LAUNDRY NE NEBRASKA METHODIST HEALTH SYSTEM C 0 METHODIST HEALTH PARTNERS 825 S 169TH STREET OMAHA NE 68118 470797563 MANAGAED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM C 0 FREMONT HEALTH PARTNERS 450 E 23RD STREET FREMONT NE 68025 460735043 MANAGAED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM C 0 HEALTH CHOICE OF NEBRASKA 450 E 23RD STREET FREMONT NE 68025 470783732 MANAGAED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM C 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0