2024-11-13T15:47:33-06:00 2023-12-31 990 2023-01-01 363699672 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND NEBR 4023544840 825 S 169TH STREET OMAHA NE 68118 JEFFREY E FRANCIS VP FINANCE & CFO 4023544000 2024-11-13 0 2023 2024-10-15 13:58:12Z JEFFREY E FRANCIS 825 S 169TH STREET OMAHA NE 68118 246509 0 X N/A X 1988 NE TO PROVIDE A FUND TO PAY CLAIMS FOR MEDICAL MALPRACTICE & OTHER GENERAL LIABILITY EXPENSES. 13 10 0 0 0 0 0 0 0 0 73551 45480 34714 0 108265 45480 0 0 0 0 0 0 0 0 0 22918 58351 22918 58351 85347 -12871 964698 888290 13330303 12734453 -12365605 -11846163 X THE NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND PROVIDES A POOLED FUND FROM CONTRIBUTIONS OF THE NEBRASKA METHODIST HEALTH SYSTEM AFFILIATES WHICH RESULTS IN A COST EFFECTIVE METHOD OF CONTROLLING, REDUCING AND PROTECTING RISKS OF LEGAL LIABILITY WHICH ARISE OUT OF THE RENDERING OF CARE TO THE SICK AND INJURED. 0 0 58351 THE TRUST FUND WAS ORGANIZED TO PROVIDE MEDICAL MALPRACTICE & GENERAL LIABILITY SELF-INSURANCE PROTECTION FOR NEBRASKA METHODIST HEALTH SYSTEM AND ITS AFFILIATES. THE TRUST POSTS FUNDS OF THE BENEFICIARIES TO SELF-INSURE EXPOSURE OF EMPLOYEES AND CERTAIN AGENTS. THESE EXPOSURES INCLUDE MALPRACTICE, PATIENT RELATED GENERAL LIABILITY, AND COMPREHENSIVE GENERAL LIABILITY. THIS POOLING OF FUNDS HELPS TO REDUCE INSURANCE EXPENSE RESULTING IN LOWER COST MEDICAL SERVICES TO THE COMMUNITY. 58351 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 6 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JEFFREY E FRANCIS 4023544840 825 S 169TH STREET OMAHA NE 68118 X STEPHEN L GOESER PRES & CEO NEBR METHODIST 1.00 39.00 X X 0 1250508 281592 LARRY V PEARSON CHAIRMAN 1.00 0.00 X X 0 0 0 ADAM YALE VICE CHAIRMAN 1.00 0.00 X X 0 0 0 DEB BASS TREASURER 1.00 0.00 X X 0 0 0 MONTY SELLON MD DIRECTOR 1.00 0.00 X 0 509652 45020 JODY HORNER DIRECTOR 1.00 0.00 X 0 0 0 RICHARD C HAHN DIRECTOR 1.00 0.00 X 0 0 0 CAROLEE V JONES MD DIRECTOR 1.00 0.00 X 0 798625 63735 DAN KINNEY PH D DIRECTOR 1.00 0.00 X 0 0 0 C L LANDEN DIRECTOR 1.00 0.00 X 0 0 0 SID DINSDALE DIRECTOR 1.00 0.00 X 0 0 0 JOHN NELSON DIRECTOR 1.00 0.00 X 0 0 0 BRET C GRIESS SECRETARY 1.00 0.00 X X 0 0 0 JEFFREY E FRANCIS CFO 1.00 39.00 X 0 659734 148176 0 3218519 538523 0 0 1 0 0 40157 40157 206352 201029 5323 5323 5323 45480 0 0 45480 X 1024 1024 11333 11333 CLAIMS SERVICE 45994 45994 58351 58351 0 0 42041 60390 2083 920574 827900 964698 888290 3260221 3188749 10070082 9545704 13330303 12734453 X -12365605 -11846163 -12365605 -11846163 964698 888290 X -12871 12872 519441 X 0 1 X 1 0 X X 4 JENNIE EDMUNDSON MEMORIAL HOSPITAL 420680355 3 1 0 250466 NEBRASKA METHODIST HOSPITAL 470376604 3 1 0 667498 PHYSICIANS CLINIC INC 470687317 10 1 0 995826 METHODIST FREMONT HEALTH 831362276 3 1 0 159798 4 0 2073588 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 X 1 0 0 CLAIMS RESERVES 8965210 DUE TO AFFILIATES 580494 9545704 X PART X, LINE 2: THE HEALTH SYSTEM 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. THERE WERE NO CHANGES MADE TO THE FINANCIAL STATEMENTS DUE TO FIN48. X 1 1 0 1 0 0 0 0 0 0 0 STEPHEN L GOESER PRES & CEO NEBR METHODIST 0 1032700 0 0 0 217808 0 256542 0 25672 0 1532722 0 179348 CAROLEE V JONES MD DIRECTOR 0 299166 0 69676 0 429783 0 45885 0 19490 0 864000 0 410595 JEFFREY E FRANCIS CFO 0 566292 0 15000 0 78442 0 115586 0 33212 0 808532 0 74249 MONTY SELLON MD DIRECTOR 0 418050 0 73456 0 18146 0 28724 0 17936 0 556312 0 0 PART I, LINE 3 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. METHODIST HEALTH SYSTEM 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. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NEBRASKA METHODIST HEALTH SYSTEM NONQUALIFIED PLAN DURING 2023 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: JEFFREY FRANCIS $90,836 ACCRUAL; PLAN DISTRIBUTION $74,249 STEPHEN GOESER $226,842 ACCRUAL; $179,348 PLAN DISTRIBUTION CAROLEE V. JONES MD $12,885 ACCRUAL; $410,595 DISTRIBUTION MONTY SELLON MD $8,145 ACCRUAL FORM 990, PART VI, SECTION A, LINE 7B NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NOT-FOR-PROFIT, HAS THE RIGHT TO APPROVE ALL AMENDMENTS TO THE TRUST AGREEMENT OF THE NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND AND TO APPROVE ANY DISSOLUTION, CONSOLIDATION, OR MERGER OF THE TRUST. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING THE FORM 990, A COPY OF THE FORM 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW THROUGH A SECURE INTERNET PORTAL. THE BOARD OF DIRECTORS IS 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 AND COMPLIANCE DEPARTMENTS. THE RETURN GETS A DETAIL TIE-OUT AND SYSTEM CONTROLLER REVIEW. IT 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 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 A 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 THE DIRECTORS NOT INVOLVED IN THE CONFLICT, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTEREST OF THE NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND AND/OR THE NEBRASKA METHODIST 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 EFFORT UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. METHODIST HEALTH SYSTEM 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. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO MEMBERS OF THE BOARD OF DIRECTORS AND EMPLOYEES. FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC THROUGH THE IRS FORM 990. FORM 990, PART VII STEPHEN GOESER, PRESIDENT AND CEO OF THE NEBRASKA METHODIST HEALTH SYSTEM, AND JEFFREY FRANCIS, VICE PRESIDENT OF FINANCE AND CFO FOR THE NEBRASKA METHODIST HEALTH SYSTEM, ARE FULLTIME EMPLOYEES OF NEBRASKA METHODIST HEALTH SYSTEM. THEIR AVERAGE HOURS PER WEEK ARE ALLOCATED AMONG THE ENTITIES THAT COMPRISE THE NEBRASKA METHODIST HEALTH SYSTEM. FORM 990, PART VII, SECTION A, COLUMN D & E INDIVIDUALS WHO HAVE COMPENSATION FROM THE ORGANIZATION OR A RELATED ORGANIZATION ARE EMPLOYEES OF THE RESPECTIVE ORGANIZATION. THESE INDIVIDUALS DO NOT RECEIVE COMPENSATION FOR SERVICES ON THE BOARD OF DIRECTORS. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 11,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 11,333. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES EQUITY TRANSFERS FROM AFFILIATES 519,441. NEBRASKA METHODIST HEALTH SYSTEM INC 8511 W DODGE ROAD OMAHA NE 68114 470639839 ADMINISTRATIVE SUPPORT NE 501(C)(3) L12: III-FI N/A 0 NEBRASKA METHODIST HOSPITAL 8511 W DODGE ROAD OMAHA NE 68114 470376604 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL 933 E PIERCE COUNCIL BLUFFS IA 51503 420680355 LICENSED HOSPITAL IA 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM 0 PHYSICIANS CLINIC INC 8511 W DODGE ROAD OMAHA NE 68114 470687317 CLINICAL HEALTH CARE NE 501(C)(3) L10 NEBRASKA METHODIST HEALTH SYSTEM 0 NEBRASKA METHODIST COLLEGE OF NURSING & ALLIED HEALTH 8511 W DODGE ROAD OMAHA NE 68114 470724387 NURSING & HEALTH EDUCATION FACILITY NE 501(C)(3) L2 NEBRASKA METHODIST HOSPITAL 0 NEBRASKA METHODIST HOSPITAL FOUNDATION 8511 W DODGE ROAD OMAHA NE 68114 470595345 SUPPORT OF NEBRASKA METHODIST HOSPITAL NE 501(C)(3) L7 NEBRASKA METHODIST HEALTH SYSTEM 0 REAL ESTATE HOLDINGS INC 8511 W DODGE ROAD OMAHA NE 68114 470649790 PROPERTY MANAGEMENT NE 501(C)(2) NEBRASKA METHODIST HEALTH SYSTEM 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 933 E PIERCE COUNCIL BLUFFS IA 51503 421439454 SUPPORT OF JENNIE EDMUNDSON MEM. HOSPITAL IA 501(C)(3) L7 JENNIE EDMUNDSON MEMORIAL HOSPITAL 0 SHARED SERVICE SYSTEMS INC 8511 W DODGE ROAD OMAHA NE 68114 470649534 MEDICAL SUPPLY DISTRIBUTION & LAUNDRY NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 METHODIST HEALTH PARTNERS 8511 W DODGE ROAD OMAHA NE 68114 470797563 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0