2024-05-14T16:16:46-07:00 2023-06-30 990 2022-07-01 470439599 MADONNA REHABILITATION HOSPITAL MADO 4024133000 5401 South St Lincoln NE 68506 Michael Hedderman VP, FINANCE/ CFO 4024133000 2024-05-14 Michael Hedderman 999009999 1 0 11 0 AAL2 X 2022 2023-04-26 12:10:37Z MICHAEL HEDDERMAN 5401 SOUTH ST LINCOLN NE 68506 186066087 0 X WWW.MADONNA.ORG X 1967 NE Madonna Rehabilitation Hospitals is a Catholic organization that exists to provide medical and physical rehabilitation services to children and adults throughout the nation. We rehabilitate those who have sustained injuries or disabling conditions so they can fully participate in life; lead research to improve outcomes; and prevent physical disabilities and promote wellness through community programs. 19 18 2389 167 0 0 4459418 3844984 180184942 180866660 2927520 1354443 0 0 187571880 186066087 0 0 0 0 127027808 130781603 0 0 0 55815654 61812603 182843462 192594206 4728418 -6528119 294312557 289566166 91034746 87340715 203277811 202225451 Madonna Rehabilitation Hospitals is a Catholic organization that exists to provide medical and physical rehabilitation services to children and adults throughout the nation. We rehabilitate those who have sustained injuries or disabling conditions so they can fully participate in life; lead research to improve outcomes; and prevent physical disabilities and promote wellness through community programs. 0 0 115264470 0 130190048 Madonna fulfills this mission by delivering expert and comprehensive rehabilitation, treating each person as a unique individual. Madonna's hospitals integrate the physical, psychological, social, spiritual and vocational aspects of each patient's life. The hospitals' programs support the unmet needs of our community and region and are devoted to returning people to their homes, communities and jobs or school. In FY 2023 Madonna admitted 2,213 hospital inpatients from 20 states. The hospital received referrals from 904 physicians and 99 hospitals or health care facilities. In FY 2023, Madonna operated two inpatient rehabilitation facilities (IRFs): Madonna Rehabilitation Hospital Lincoln (MRH-L) and Acute Rehabilitation Omaha (AR-O) and two long-term care hospitals (LTCHs): Madonna Rehabilitation Specialty Hospital Lincoln (MRSH-L) and Madonna Rehabilitation Specialty Hospital Omaha (MRSH-O). MRH-L, AR-O, MRSH-L and MRSH-O offer comprehensive care to ensure continuity as patients' progress in their recovery or from one hospital to another. All hospitals employ an interdisciplinary team approach involving the patient and family, referring physician, rehabilitation physician, hospitalist, case manager, nutrition therapist, respiratory therapist, rehabilitation nurse, physical and occupational therapists, orthotic and prosthetic technician, psychologist, social workers, speech-language pathologists, therapeutic recreation specialists, vocational rehabilitation consultants and spiritual care counselors. Madonna's experienced staff treat thousands of individuals through inpatient and outpatient services every year, offering every patient the latest techniques and methods to produce the best results. As one of the largest, freestanding rehabilitation hospital systems in the United States, Madonna provides: * Intensive therapy programming * Programs with less intensive therapy, depending on the needs of the patient * 24-hour rehabilitation nursing and physician supervision * A continuum of services to ensure progress is maintained from inpatient to outpatient programs Our specialty rehabilitation programs focus on the needs of children and adults following traumatic injury and illness, including: brain injury, spinal cord injury, stroke, pulmonary conditions, neurological disorders and major multiple trauma. Madonna Rehabilitation Hospital has 20 separate program accreditations from the Commission on the Accreditation of Rehabilitation Facilities (CARF) in the area of medical rehabilitation. This includes: * Inpatient Rehabilitation Programs for the IRFs, LTCHs and Transitional Care Unit (TCU) * Brain Injury Program - Inpatient/Outpatient (adult and pediatric) * Cancer Specialty Program - Inpatient/Outpatient (adult and pediatric), Omaha Only * Spinal Cord Specialty Program - Inpatient/Outpatient (adult and pediatric), Lincoln Only * Stroke Specialty Program - Inpatient/Outpatient (adult) * Pediatric Specialty Program - Inpatient/Outpatient * Interdisciplinary Outpatient Medical Rehabilitation Programs - Multiple Service Madonna Rehabilitation Hospital Lincoln Patients at MRH-L rank in the top 3% nationally in terms of complexity, while discharging back to community settings at a higher rate according to industry benchmarks. Despite this complexity, 74% of patients discharged directly to a community setting, compared to eRehab benchmark of 73%. Additionally, the overall patient satisfaction rate for MRH-L was 90%. Acute Rehabilitation Omaha In October of 2023, Madonna will complete its seventh year of operating rehabilitation beds in Omaha. AR-O, overall, returned 77% of patients to a community destination rather than to an institution. Additionally, the overall patient satisfaction rate for AR-O was 95%. Madonna Rehabilitation Specialty Hospital Lincoln MRSH-L FY 2023 patient discharge to home or to an acute rehabilitation hospital to continue their recovery was 55% for the year. 69% of patients admitted on a mechanical ventilator weaned in an average of 15 days. Additionally, the overall patient satisfaction rate for MRSH-L was 85%. Madonna Rehabilitation Specialty Hospital Omaha MRSH-O FY 2023 patient discharge to home or to an acute rehabilitation hospital to continue their recovery was 56% for the year. 77% of patients admitted on a mechanical ventilator weaned in an average of 17 days. Additionally, the overall patient satisfaction rate for MRSH-O was 91%. 24539925 0 23710735 St. Jane de Chantal (St. Jane) is comprised of a 30-bed ventilator and special care unit (VAU/SN), a 30-bed Transitional Care Rehabilitation Unit (TCU) and a 66-bed nursing home. The expansion of TCU to include all private rooms to care for clinically complex patients has been completed. Patient/family satisfaction has increased. St. Jane received a three year CARF accreditation for our Inpatient Rehabilitation Programs - Skilled Nursing (Adults), effective July 2021 - July 2024. In FY 2023 St. Jane maintained a CMS 5-star rating and continues to be recognized as one of the Best Nursing Homes in Nebraska as published in U.S. News & World Report, 2022-2023. 11770254 0 11693651 Madonna TherapyPlus is committed to providing excellent care for patients who need outpatient rehabilitation. TherapyPlus offers a range of rehabilitation services for sports injuries, orthopedic sprains, strains and post-operative care to comprehensive rehabilitation for neurological conditions. TherapyPlus includes the Fit for Work program, which combines occupational health, wellness, safety and coordination of care for workers' compensation injuries with the expert services conveniently available from Madonna Rehabilitation Hospitals, Madonna TherapyPlus outpatient clinics and Madonna ProActive. In FY 2023, TherapyPlus had a 7.5% increase registrations and a 3.2% increase in visits compared to prior year, resulting in more patients served across all locations. TherapyPlus experienced growth in all areas including post-operative care, preventative care, and post-injury care, as well as those programmatic patients who were treated throughout the Madonna continuum of care. In FY2023, TherapyPlus continued to grow the new comprehensive Post-COVID Rehabilitation Clinic that launched the prior year. This clinic includes an interdisciplinary rehabilitation team including neuropsychology and physiatry. Focus through the clinic is to address the wide spectrum of rehabilitation needs for those who are experiencing lingering effects from COVID infection. The clinic provides an individualized approach for a safe return to life and work activities. 19879850 0 15272226 Madonna ProActive is a medically-based health, fitness and wellness facility and the first to be based on a rehabilitation model. Madonna ProActive provides medical, therapeutic and educational fitness and wellness expertise in addition to the latest technology. In FY 2023, ProActive exceeded annual membership goals by 8.7%, ending the year with 3,464 total members. A Shift away from home-based gym setups that were created in the initial phases of the pandemic as well as, community comfort and commitment in resuming prior activities, have been the key drivers for the volume increase. In addition, ProActive continues to expand essential medical and wellness programming in several key areas to further enhance the continuum of care that Madonna provides. 19879850 0 15272226 171454499 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 46 0 1 2389 1 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X MICHAEL HEDDERMAN 4024133000 5401 South St Lincoln NE 68506 PAUL A DONGILLI PRESIDENT AND CHIEF EXECUTIVE OFFICER 40 1 X X 655382 0 42637 ADAM T KAFKA PHYSICIAN MEDICAL DIRECTOR 40 X 641349 0 33562 JIAXIN J TRAN STAFF PHYSIATRIST 40 X 444480 0 26930 MORGAN T LAHOLT STAFF PHYSIATRIST 40 X 432704 0 30895 PAUL L KRABBENHOFT STAFF PHYSIATRIST 40 X 367585 0 33184 MATTHEW DRIEWER STAFF HOSPITALIST 40 X 364850 0 33906 MICHAEL J HEDDERMAN VICE PRESIDENT AND CHIEF FINANCIAL OFFICER 40 X 293675 0 27992 CHRISTOPHER A LEE VICE PRESIDENT AND CHIEF OPERATIONS OFFICER 40 X 290390 0 29476 LOU A MANSKE VICE PRESIDENT AND CHIEF HUMAN RESOURCES OFFICER 40 X 267739 0 24137 DANIEL GRIESS VP FACILITIES MANAGEMENT SYSTEM & ANCILLARY SERVICES 40 X 239010 0 24907 TERASA M FARLIN VICE PRESIDENT PATIENT CARE AND CNO 40 X 204751 0 34919 LYNN R HALLOWELL-GOTTSLEBEN VICE PRESIDENT REHABILITATION 40 X 195414 0 22261 JEFF GROMOWSKY VP & PHYSICIAN PRACTICE ADMINISTRATOR 40 X 187081 0 28761 LINDA S SUNDELL-SULLIVAN VICE PRESIDENT REFERRAL RELATIONS 40 X 186595 0 24090 RENAE M W FEILMEIER VICE PRESIDENT AND CHIEF HUMAN RESOURCES OFFICER 40 X 53360 0 7529 LAUREN PUGLIESE CHAIRPERSON 1 1 X X 0 0 0 TERRY ZACH MD VICE CHAIRPERSON 1 X X 0 0 0 JOHN SULLIVAN FR VICE PRESIDENT 1 X X 0 0 0 DAN VOKOUN SECRETARY 1 X X 0 0 0 WILL DOUGLAS TREASURER 1 X X 0 0 0 SCOTT BECKER CPA MEMBER 1 X 0 0 0 SCOTT CASSELS MEMBER 1 X 0 0 0 MARK FAHLESON JD MEMBER 1 X 0 0 0 DAVID GANNON MD MEMBER 1 X 0 0 0 KACEY LEMPKA MEMBER 1 X 0 0 0 BRAD NIETFELDT MEMBER 1 X 0 0 0 GARY PERKINS MEMBER 1 X 0 0 0 PATRICK SPETHMAN MEMBER 1 X 0 0 0 GREG VASEK MEMBER 1 X 0 0 0 SARAH WALKER PHD MEMBER 1 X 0 0 0 KEVIN WERTS MEMBER 1 X 0 0 0 NICK WILWERDING MEMBER 1 X 0 0 0 MARIA LIGHTHALL MEMBER 1 1 X 0 0 0 4824365 0 425186 138 0 1 0 RTG MEDICAL 1005 E 23RD ST STE 200 FREMONT NE 68025 MEDICAL SERVICES 7584189 NEBRASKA MEDICINE 4350 DEWEY AVE OMAHA NE 68105 MEDICAL SERVICES 2248537 UNMC 985045 NEBRASKA MEDICAL CENTER OMAHA NE 68198 MEDICAL EDUCATION 1745141 AUREUS RADIOLOGY LLC PO BOX 3037 OMAHA NE 68103 MEDICAL SERVICES 1201091 FUSION MEDICAL STAFFING LLC P O BOX 82674 LINCOLN NE 68501 STAFFING SERVICES 885061 35 0 0 0 2828065 0 1016919 64169 3844984 Patient Service Revenue (net) 900099 130190048 130190048 0 0 Long-Term Care 900099 23710735 23710735 0 0 Outpatient 900099 11693651 11693651 0 0 Physician Services 900099 9101547 9101547 0 0 6170679 6170679 0 0 180866660 1354443 0 0 1354443 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 186066087 180866660 0 1354443 X 0 0 0 0 0 0 0 0 2573397 0 2573397 0 0 0 0 0 103185611 92852134 10333477 0 2955512 2928512 27000 0 14602782 13313360 1289422 0 7464301 6916532 547769 0 0 0 0 0 176432 41282 135150 0 79270 0 79270 0 45229 0 45229 0 0 0 0 0 0 0 25108737 23786983 1321754 0 1208775 314197 894578 0 11449238 11150728 298510 0 2603493 1741261 862232 0 0 0 0 0 3279344 2329216 950128 0 605901 545866 60035 0 0 0 0 0 399135 357786 41349 0 2884180 2610846 273334 0 0 0 0 0 11915164 11054618 860546 0 1121016 1121016 0 0 MISCELLANEOUS 936689 390162 546527 0 0 0 0 0 192594206 171454499 21139707 0 21787362 14462488 38798982 45911884 1942901 1876702 2100539 1868981 296482157 128214546 166371797 168267611 62361448 56338911 949528 839589 294312557 289566166 24781949 22427630 61572445 59753585 4680352 5159500 91034746 87340715 X 203266296 200992014 11515 1233437 203277811 202225451 294312557 289566166 X -6528119 4253837 0 0 0 1221922 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 0 0 1 45229 45229 0 Schedule C, Part II-B, Line 1 Madonna Rehabilitation Hospital ("Madonna") has retained the lobbying services of a local lobbying firm to monitor legislation at the state level in Nebraska impacting Nebraska hospitals and long term care facilities generally, and Madonna specifically. Madonna is a member of the Nebraska Hospital Association ("NHA"). As part of its activities, the NHA provides lobbying services and monitors state legislation of concern to its members. On the national level, Madonna is a member of the American Rehabilitation Providers Association ("AMRPA") and the National Association of Long Term Hospitals ("NALTH"). Among other services provided to its members, AMRPA and NALTH lobby and monitor federal legislation on behalf of their members. 0 9282088 9282088 0 193899768 65264368 128635400 0 0 0 0 0 87626205 60316758 27309447 0 5674096 2633420 3040676 168267611 457 Plans 3312759 Lease Obligations 1196741 Current portion of Work Comp Reserve 650000 5159500 X 189098002 4253837 0 0 0 4253837 184844165 0 1221922 1221922 186066087 192594206 0 0 0 0 0 192594206 0 0 0 192594206 Schedule D, Part X, Line 2 Madonna is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code. Madonna has received a determination letter that it is exempt from federal income taxes on related income pursuant to Section 501(a) of the Internal Revenue Code. The Internal Revenue Service has established standards to be met to maintain tax exempt status. In general, such standards require Madonna to meet a community benefit standard and comply with various laws and regulations. Madonna accounts for uncertainties in accounting for income tax assets and liabilities using guidance included in FASB ASC Topic 740, Income Taxes. Madonna recognizes the effect of income tax positions only if those positions are more likely than not of being sustained. At June 30, 2023 and 2022, Madonna had no uncertain tax positions accrued. Schedule D, Part XI, Line 4b CHANGES IN TEMPORARILY RESTRICTED NET ASSETS. 1 1 X 1 X 3 0 1 1 0 1 1 2588074 2588074 0.0134 5225210 5225210 0.0271 0 0 7813284 0 7813284 0.0405 181691 181691 0.0009 2236503 2236503 0.0116 745437 745437 0.0039 962721 962721 0.005 423170 423170 0.0022 0 0 4549522 0 4549522 0.0236 0 0 12362806 0 12362806 0.0641 2 632717 1080 631637 0.0033 2 0 632717 1080 631637 0.0033 1 3613783 0 44487678 64129319 -19641641 X 1 1 3 1 MADONNA REHABILITAION HOSPITAL LINCOLN 5401 SOUTH ST LINCOLN NE 68506 WWW.MADONNA.ORG 500005 X ACUTE REHABILITATION HOSPITAL A 2 MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA 17500 BURKE STREET OMAHA NE 68118 WWW.MADONNA.ORG H000129 X LONG TERM CARE HOSPITAL A 3 MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN 5401 SOUTH STREET LINCOLN NE 68506 WWW.MADONNA.ORG 507001 X LONG TERM CARE HOSPITAL A A 0 0 1 X X X X X X X X 21 1 0 0 1 X SEE PART V SECTION C NARRATIVE FOR FULL WEB ADDRESS X 1 21 0 1 0 1 X 300 0 X X X X X 1 1 X X X 1 X https://www.madonna.org/patient-resources/patient-financial-services X https://www.madonna.org/patient-resources/patient-financial-services X https://www.madonna.org/patient-resources/patient-financial-services X X X X X 1 X 0 X X X X X 0 X X 0 0 Schedule H, Part V, Section B, Line 5-Group A * Madonna uses multiple avenues to collect data regarding the needs of its community, including patient satisfaction surveys, meeting minutes from local, state, regional and national organizations, capital campaign requests and other data sources. This is an ongoing process that is integrated into strategic planning and annual goal setting. A needs assessment questionnaire was distributed to the community and the results were collected and analyzed in fiscal year 2022 (tax year 2021). The results were discussed at Strategic Planning Committee meetings during the planning phases for fiscal year 2023. Hospital leadership regularly reviews and discusses community needs during weekly administrative team meetings. Many of these needs are addressed through capital item requests and programming updates and/or additions. Additionally, community needs are brought forth and discussed in numerous organizational and individual meetings at all levels. Madonna Rehabilitation Hospital executives, managers and clinicians are encouraged to meet with their counterparts in peer institutions and to pursue leadership positions in their areas of expertise. Each year, Madonna staff members are elected and/or are appointed to boards, special task forces and other leadership positions. In these positions, Madonna staff gets direct input from colleagues in affiliated organizations and with patients in the community served. Schedule H, Part V, Section B, Line 5-Group A MADONNA REHABILITAION HOSPITAL LINCOLN * Madonna uses multiple avenues to collect data regarding the needs of its community, including patient satisfaction surveys, meeting minutes from local, state, regional and national organizations, capital campaign requests and other data sources. This is an ongoing process that is integrated into strategic planning and annual goal setting. A needs assessment questionnaire was distributed to the community and the results were collected and analyzed in fiscal year 2022 (tax year 2021). The results were discussed at Strategic Planning Committee meetings during the planning phases for fiscal year 2023. Hospital leadership regularly reviews and discusses community needs during weekly administrative team meetings. Many of these needs are addressed through capital item requests and programming updates and/or additions. Additionally, community needs are brought forth and discussed in numerous organizational and individual meetings at all levels. Madonna Rehabilitation Hospital executives, managers and clinicians are encouraged to meet with their counterparts in peer institutions and to pursue leadership positions in their areas of expertise. Each year, Madonna staff members are elected and/or are appointed to boards, special task forces and other leadership positions. In these positions, Madonna staff gets direct input from colleagues in affiliated organizations and with patients in the community served. Schedule H, Part V, Section B, Line 11-Group A FACILITY 1 MADONNA REHABILITATION HOSPITAL FACILITY 2 MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN FACILITY 3 MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA Schedule H, Part V, Section B, Line 11-Group A MADONNA REHABILITAION HOSPITAL LINCOLN Purpose for the Plan This implementation strategy (Strategy) addresses the prioritized Community Health Care Needs Identified in the Community Health Needs Assessment (CHNA) conducted for the fiscal 2022 year and approved by the hospital's Board of Directors. The plan also meets the requirements for community benefit planning as set forth in Section 501(r) of the Internal Revenue Code (the "Code") as part of the Affordable Care Act. The CHNA for Madonna Rehabilitation Hospital may be reviewed in its entirety at https://www.madonna.org/about Areas of Focus As a result of the analysis, three areas were identified as the priorities on which Madonna will focus for the next three years. These three needs are: Lincoln Campus physical plant alignment with clinical needs, Lincoln campus clinical and ancillary services expansion, and the Nebraska Physiatrist Residency Program. Priority 1: Align the Lincoln Campus physical plant with space required to meet the clinical needs of a high-acuity, specialized patient population (Madonna's "community"). Strategy: Expand and construct physical space to support the specialized equipment, cutting edge technology and family involvement required for Physical Medicine and Rehabilitation programs. Priority 2: Expand Lincoln Campus on-site clinical and ancillary services required to meet the clinical needs of a high-acuity, specialized patient population (Madonna's "community"). Strategy: Implement/expand appropriate on-site diagnostic imaging, laboratory, telemetry, specialized physician services and nursing skills to improve patient quality and outcomes. Priority 3: Complete the implementation of the newly established Physical Medicine and Rehabilitation Graduate Medical Education Residency Training Program. Strategy: In collaboration with the University of Nebraska Medical Center College of Medicine (UNMC-COM), gradually increase the number of residents to the four year program capacity of 16 residents in 2022. Additionally, in collaboration with UNMC-COM, recruit and fill all required faculty positions. Next Steps This implementation strategy will be executed over the next three years. Periodic evaluation of objectives for each identified priority will be conducted to assure that Madonna is on track to complete the plan as described. At the end of fiscal year 2022 Madonna Rehabilitation Hospital will review the Implementation Strategy and report on the success experienced through the collaborative efforts of improving the health needs of the community. Schedule H, Part V, Section B, Line 13-Group A FPG is used to determine eligibility for financial assistance. If financial assistance is granted, it is for free care only. Schedule H, Part V, Section B, Line 16a-Group A https://www.madonna.org/patient-resources/patient-financial-services Schedule H, Part V, Section B, Line 16b-Group A https://www.madonna.org/patient-resources/patient-financial-services Schedule H, Part V, Section B, Line 16c-Group A https://www.madonna.org/patient-resources/patient-financial-services Schedule H, Part V, Section B, Line 20e-Group A Madonna Rehabilitation Hospital offers the following: Assistance with filling out applications for SSI, SSD, Medicaid and/or General Assistance Advocate for the patient with third party payers, government payers, and other entities that may restrict or deny benefits inappropriately Assist patient/families with billing/payment questions from prior stays to help escalate resolution and ensure that all appropriate documents have been returned to the payer for claims adjudication Extended payment plans Liability settlement pending without any other payer source Courtesy calls at time of final notice and prior to listing for collections Schedule H, Part V, Section B, Line 22d-Group A The amount of financial assistance is considered to be 100% of charges less the contractual adjustment for Amounts Generally Billed (AGB). AGB is the weighted average percentage as calculated by dividing the sum of commercial and Medicare contractual adjustments by the sum of commercial and Medicare gross charges. 4 ST JANE DE CHANTAL 2200 S 52ND STREET LINCOLN NE 68506 NURSING FACILITY (NF) MADONNA THERAPY PLUS 5401 SOUTH STREET LINCOLN NE 68506 OUTPATIENT CLINICS (4) MADONNA PROACTIVE HEALTH & FITNESS 7111 STEPHANIE LANE LINCOLN NE 68516 MEDICAL FITNESS CENTER REHABILITATION SPECIALISTS 5445 SOUTH STREET LINCOLN NE 68506 INPATIENT & OUTPATIENT PHYSICIAN CLINIC Schedule H, Part I, Line 3c If financial assistance is granted, it is for free care only. Schedule H, Part I, Line 6a The Community Benefit report is made available cost-free to the public at https://www.madonna.org/theindependent. Schedule H, Part I, Line 7 Medicare losses have increased significantly in recent years and no longer approximate the costs incurred to serve Medicare patients. This is due to reimbursement methodology changes that have resulted in decreasing payments despite inflationary growth in costs. Schedule H, Part II * Madonna's medically based health and fitness center (Madonna ProActive) is focused on improving the overall wellness of the community by reducing chronic risk factors through various health programs. * Madonna's Adaptive Sports program provides opportunities for children and adults with acquired physical disabilities to participate in recreational activities that are designed to promote physical health and wellness. The program is open to Madonna inpatients and outpatients as well as community members. Schedule H, Part II, Line 9 Madonna's medically based health and fitness center (Madonna ProActive) is focused on improving the overall wellness of the community by reducing chronic risk factors through various health programs. Madonna's Adaptive Sports program provides opportunities for children and adults with acquired physical disabilities to participate in recreational activities that are designed to promote physical health and wellness. The program is open to Madonna inpatients and outpatients as well as community members. Schedule H, Part III, Section A, Line 4 The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and assesses those accounts that will transition to self-pay patients based on analysis of payment history. Those transition accounts are considered in conjunction with self-pay patients (which include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill). The Hospital records a provision for bad debts in the period of service on the basis of its past experience, which indicates that certain patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. In many cases, the Hospital is able to negotiate payment subsequent to the initial determination of the collectability of the account. In these cases, the Hospital records additional contractual allowances and discounts. Upon consideration of the fact certain patient accounts that were previously allowed for are collected through negotiation and adjusted at the time of payment, the Hospital has determined the provision for bad debts is not significant to the financial statements and has combined with contractual allowances and discounts. Schedule H, Part III, Section B, Line 8 A cost accounting system is used by Madonna and it addresses all patient segments. None of the shortfall has been reported as community benefit. Schedule H, Part III, Section C, Line 9b All charges for patients found eligible for financial assistance are waived. Once this eligibility is confirmed, all collection activities are discontinued. Schedule H, Part VI, Line 2 The entire process of assessment is included in the description in Part V, Section B. Schedule H, Part VI, Line 3 The insurance status of all patients is assessed at the time of admission. The admissions process includes regular communication with patients and their families, and insurance status is a significant part of this process. Patients without insurance are assisted in their applications for Medicaid if it appears they may qualify. Patients whose Medicaid applications are pending are regularly admitted. Financial Assistance is granted to patients who are denied for Medicaid but are unable to pay, in accordance with the Financial Assistance Policy. Schedule H, Part VI, Line 4 The description of Madonna Rehabilitation Hospital's community in the 2022 CHNA: Madonna is one of the nation's largest specialized rehabilitation hospitals. Madonna treats children and adults with complex disabilities due to traumatic brain injury, spinal cord injury, stroke, neurological disorders, burns, pulmonary disease, and other disabling conditions. This is Madonna's "community" - the people who require inpatient post-acute physical rehabilitation to reduce or eliminate impairments, activity limitations, and participation restrictions. Unlike acute care hospitals, Madonna does not define "community served" as a geographic area, but rather by the priority population that requires these highly specialized services. This population includes people of all ages, gender, income level, and race from throughout the country. Schedule H, Part VI, Line 5 In an effort to meet the growing needs of the pediatric population, Madonna has expanded its designated area and features a pediatric therapy gym, allowing the youngest patients to receive age-appropriate rehabilitation services. Madonna has also renovated the Kit Scott Therapeutic Learning Center. The goal of the Learning Center is to help students successfully transition back to their home and school settings. Madonna also provides services to the community which would otherwise be unavailable or underserved, such as community medical transportation. Madonna physicians and therapists also present at numerous conferences throughout the year, providing recognized expertise to the community on rehabilitation and other relevant topics. In addition to our medical facilities (which include Lincoln's first medical fitness facility), Madonna provides volunteer and financial support to the community. Madonna employees donate hundreds of units of blood onsite each year and serve more than 1,000 meals each year at Matt Talbot Kitchen. Financial support include individual employee and organizational donations of money and supplies to patients and their families, area food banks, churches, missionaries, social services organizations, and health associations. In some cases, Madonna organizes fundraisers designed to benefit these organizations. Outside organizations are also allowed to use Madonna's meeting rooms at no charge. Schedule H, Part VI, Line 7 Nebraska is the only state in which Madonna Rehabilitation Hospital files a community benefit report. X X X X X 0 0 0 1 0 1 0 0 0 PAUL A DONGILLI PRESIDENT AND CHIEF EXECUTIVE OFFICER 655382 0 0 0 0 0 38600 0 4037 0 698019 0 0 0 ADAM T KAFKA PHYSICIAN MEDICAL DIRECTOR 641349 0 0 0 0 0 24100 0 9462 0 674911 0 0 0 JIAXIN J TRAN STAFF PHYSIATRIST 444480 0 0 0 0 0 24791 0 2139 0 471410 0 0 0 MORGAN T LAHOLT STAFF PHYSIATRIST 432704 0 0 0 0 0 24100 0 6795 0 463599 0 0 0 PAUL L KRABBENHOFT STAFF PHYSIATRIST 367585 0 0 0 0 0 24100 0 9084 0 400769 0 0 0 MATTHEW DRIEWER STAFF HOSPITALIST 364850 0 0 0 0 0 28720 0 5186 0 398756 0 0 0 MICHAEL J HEDDERMAN VICE PRESIDENT AND CHIEF FINANCIAL OFFICER 293675 0 0 0 0 0 25006 0 2986 0 321667 0 0 0 CHRISTOPHER A LEE VICE PRESIDENT AND CHIEF OPERATIONS OFFICER 290390 0 0 0 0 0 23687 0 5789 0 319866 0 0 0 LOU A MANSKE VICE PRESIDENT AND CHIEF HUMAN RESOURCES OFFICER 267739 0 0 0 0 0 24929 0 -792 0 291876 0 0 0 DANIEL GRIESS VP FACILITIES MANAGEMENT SYSTEM & ANCILLARY SERVICES 239010 0 0 0 0 0 22807 0 2100 0 263917 0 0 0 TERASA M FARLIN VICE PRESIDENT PATIENT CARE AND CNO 204751 0 0 0 0 0 28129 0 6790 0 239670 0 0 0 LYNN R HALLOWELL-GOTTSLEBEN VICE PRESIDENT REHABILITATION 195414 0 0 0 0 0 19205 0 3056 0 217675 0 0 0 JEFF GROMOWSKY VP & PHYSICIAN PRACTICE ADMINISTRATOR 187081 0 0 0 0 0 21117 0 7644 0 215842 0 0 0 LINDA S SUNDELL-SULLIVAN VICE PRESIDENT REFERRAL RELATIONS 186595 0 0 0 0 0 20617 0 3473 0 210685 0 0 0 Schedule J, Part I, Line 5 All hospital managers, approximately eighty, are eligible participants of the hospital's Management Incentive Compensation Plan. The Plan provides a structure for measuring the hospital's overall quality and financial performance. This plan allows for recognition and compensation when the hospital's performance exceeds baseline criteria. Upon achievement of an established quality benchmark, compensation is determined based upon a fixed formula encompassing revenues, earnings and participants' wages. The formula is applied equally to all participants. Schedule J, Part I, Line 6 See explanation for Line 5. A Hospital Authority No 2 of Douglas County NE 521440796 2014-09-25 86048946 construct, equip and furnish new hospital facility in Omaha, NE 0 0 0 A 21775000 0 86048946 0 5911150 0 989867 0 0 79147929 0 0 2016 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Schedule K, Part I, Column c-09/25/2014 86,048,946 Hospital Authority No 2 of Douglas County NE 25923P AA3, 25923P AB1, 25923P AC9, 25923P AD7, 25923P AE5, 25923P AF2, 25923P AS4, 25923P AG0, 25923P AH8, 25923P AJ4, 25923P AV7, 25923P AK1, 25923P AL9, 25923P AM7, 25923P AN5, 25923P AP0, 25923P AR6, 25923P AT2, 25923P AU9, 25923P AQ8 Schedule K, Part IV, Line 2c-09/25/2014 86,048,946 Hospital Authority No 2 of Douglas County NE Rebate computation performed May 15, 2018 X VARIOUS 146 64169 COST 0 0 1 1 Schedule M, Part I, Line 32b USE OF VARIOUS FINANCIAL INSTITUTIONS TO SELL STOCK GIFTS RECEIVED. Form 990, Part VI, Section A, Line 3 Food service operations are contracted with Aramark; an outside management corporation. No current or former officers, directors, trustees, key employees, or highest compensated employees were compensated by Aramark during the tax year. Form 990, Part VI, Section A, Line 6 The Diocesan Health Ministries, a Nebraska Nonprofit Corporation, is the sole member of Madonna Rehabilitation Hospital. Form 990, Part VI, Section A, Line 7a The Diocesan Health Ministries may designate one member of the organization's Board of Directors, as provided in the organization's articles of incorporation. Form 990, Part VI, Section A, Line 7b The Member, Diocesan Health Ministries, has final approval of: (1) Changes in philosophy and mission; (2) Matters involving sale, lease, transfer, exchange, disposition, pledge or alienation of real property in excess of five hundred thousand dollars ($500,000.00); (3) Matters involving purchase and/or encumbrance with debt, in any way, of real property in excess of five hundred thousand dollars ($500,000.00); (4) Community members nominated to serve on the Board of Directors; (5) Amendments, alterations or changes in the Articles of Incorporation or Bylaws; (6) The annual capital budget; (7) CEO selection; (8) Merger, consolidation, dissolution. The Board of Directors approves and forwards to the Member, for its review the annual report and the operating budget. Form 990, Part VI, Section B, Line 11b Prior to filing the organization's Form 990, the Chief Financial Officer presents the completed Form 990 and an executive overview of the Form 990 to the Finance and Audit Committee of the Board of Directors at a regularly scheduled meeting. The Finance and Audit Committee approves a motion to accept and forward to the Board of Directors the Form 990. Subsequently, the Finance and Audit Committee Board Chairperson (the organization's Board Treasurer) presents the Form 990 to the Board of Directors. Upon Board resolution to accept the Form 990 the Form 990 is filed with the Internal Revenue Service. Form 990, Part VI, Section B, Line 12c The organization annually distributes its Conflict of Interest Policy and Disclosure Form to Directors, Officers and key employees. The responses are reviewed by the Board of Directors and its counsel, and any appropriate action is taken, based upon those responses and the subsequent review. Form 990, Part VI, Section B, Line 15 Madonna Executive Compensation Plan The Executive Compensation Committee will make recommendations for the annual compensation of the Chief Executive Officer (CEO), and Chief Financial Officer (CFO). The Madonna Executive Compensation plan requires national salary benchmarks be used for the CEO and CFO positions. -Base Salary: the executive compensation committee annually determines the CEO's base salary by reviewing 990 data from nonprofit rehabilitation hospitals at a national level as well as other relevant data. Ideally, the data from nonprofit rehabilitation hospitals should be for hospitals within approximately plus or minus 50% of Madonna's gross revenues recognizing a need for a minimum of at least eight comparable sized institutions. The analysis includes reporting the salaries for benchmark firms (from 990 data) reported by the Vice President human resources. Other sources of information and data may be used as needed from third party salary surveys in addition to or in lieu of 990 data as deemed necessary from year to year. The annual compensation adjustment for the CEO and CFO is to represent both the market changes and the merit performance. Form 990, Part VI, Section C, Line 19 Summarized financial information is made available to the public on an annual basis through the publication of the Hospital's public annual report. In addition, the public annual report is available on the Hospital's website. The Hospital's governing documents and conflict of interest policy are not available to the public. Form 990, Part IX, Line 11g TOTAL PROGRAM MANAGEMENT FUNDRAISING CONTRACT LABOR 12,821,227 12,776,436 44,792 - MAINTENANCE CONTRACTS 6,958,882 6,240,782 718,100 - MEDICAL SERVICE FEES 4,154,434 4,154,434 - - MISCELLANEOUS OTHER 1,174,194 615,331 558,863 - TOTAL 11g 25,108,737 23,786,983 1,321,754 - Form 990, Part XI, Line 9 Change in temporarily restricted net assets. Form 990, Part XII, Line 2c The Finance Committee of the Board of Directors is responsible for the oversight of the audit and the selection of the independent auditor. The process has not changed from the prior year. MADONNA FOUNDATION 5401 SOUTH ST LINCOLN NE 68506 237159940 FUNDRAISING SUPPORT NE 501 (c)(3) 12b (Type II) MADONNA REHABILITATION HOSPITALS 1 MADONNA INC 5401 SOUTH ST LINCOLN NE 68506 363397284 5401 SOUTH ST NE 501 (c)(3) 12b (Type II) MADONNA REHABILITATION HOSPITALS 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 1 MADONNA FOUNDATION l 163000 FINANCIAL RECORD MADONNA FOUNDATION m 1370648 FINANCIAL RECORD MADONNA FOUNDATION p 431402 FINANCIAL RECORD MADONNA FOUNDATION s 2913650 FINANCIAL RECORD MADONNA INC s 22196 FINANCIAL RECORD