Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
MADONNA REHABILITATION HOSPITAL
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
5401 SOUTH STREET
 
Room/suite
City or town, state or country, and ZIP + 4
LINCOLN, NE685062134
D Employer identification number

47-0439599
E Telephone number

G Gross receipts $ 96,245,702
F Name and address of principal officer:
VICTOR WITKOWICZ
5401 SOUTH STREET
LINCOLN,NE685062134
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MADONNA.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1967
M State of legal domicile: NE
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: MADONNA REHABILITATION HOSPITAL 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.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 22
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 21
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 1,670
6 Total number of volunteers (estimate if necessary) .... 6 401
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 3,289,209 1,563,941
9 Program service revenue (Part VIII, line 2g) ......... 92,642,812 94,750,976
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,469,852 -69,215
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 0 0
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 99,401,873 96,245,702
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 0 0
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 64,247,266 66,138,454
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 23,383,409 24,209,516
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 87,630,675 90,347,970
19 Revenue less expenses. Subtract line 18 from line 12....... 11,771,198 5,897,732
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 104,590,243 108,788,293
21 Total liabilities (Part X, line 26)............. 20,792,242 19,101,612
22 Net assets or fund balances. Subtract line 21 from line 20..... 83,798,001 89,686,681
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: MADONNA REHABILITATION HOSPITAL 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 49,432,513 including grants of $   ) (Revenue $ 60,242,896 )
MADONNA REHABILITATION HOSPITAL FULFILLS THIS MISSION BY DELIVERING EXPERT AND COMPREHENSIVE REHABILITATION, TREATING EACH PERSON AS A UNIQUE INDIVIDUAL. MADONNA'S REHABILITATION PROGRAMS INTEGRATE THE PHYSICAL, PSYCHOLOGICAL, SOCIAL, SPIRITUAL AND VOCATIONAL ASPECTS OF EACH PATIENT'S LIFE. THE HOSPITAL'S 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 FY2012 MADONNA SERVED 5,709 PATIENTS FROM 32 U.S. STATES AND ONE U.S. TERRITORY IN ALL PROGRAMS.THE INPATIENT HOSPITAL PROGRAMS INCLUDE THE LONG TERM ACUTE CARE HOSPITAL (LTACH) AND ACUTE CARE REHABILITATION HOSPITAL. MADONNA OFFERS COMPREHENSIVE CARE THAT ENSURES CONTINUITY AS THE PATIENT PROGRESSES FROM ONE LEVEL TO THE NEXT. OUR INTERDISCIPLINARY TEAM APPROACH INVOLVES THE PATIENT AND FAMILY, REFERRING PHYSICIAN, REHABILITATION PHYSICIAN, CASE MANAGER, NUTRITION THERAPIST, RESPIRATORY THERAPIST, REHABILITATION NURSE, PHYSICAL AND OCCUPATIONAL THERAPISTS, ORTHOTIC AND PROSTHETIC (BRACES AND ARTIFICIAL LIMBS) TECHNICIAN, PSYCHOLOGIST, SOCIAL WORKERS, SPEECH-LANGUAGE PATHOLOGISTS, THERAPEUTIC RECREATION SPECIALISTS, VOCATIONAL REHABILITATION CONSULTANTS AND SPIRITUAL CARE COUNSELORS.THE VALUE OF MADONNA'S EXPERIENCED STAFF, WHO TREAT THOUSANDS OF PATIENTS EVERY YEAR, MEANS THAT EACH THERAPIST CAN OFFER THE LATEST TECHNIQUES AND METHODS TO PRODUCE THE BEST RESULTS FOR EVERY PATIENT.MADONNA'S INPATIENT HOSPITAL PROGRAM PROVIDES:-AN INTENSIVE THERAPY PROGRAM SEVEN DAYS A WEEK-PROGRAMS WITH LESS INTENSIVE THERAPY, DEPENDING ON THE NEEDS OF THE PATIENT-24-HOUR REHABILITATION NURSING AND PHYSICIAN SUPERVISION; AND-A CONTINUUM OF SERVICES TO ENSURE PROGRESS IS MAINTAINED FROM INPATIENT TO OUTPATIENT PROGRAMS. A SEVEN-MEMBER TEAM OF NATIONAL REHABILITATION EXPERTS REPRESENTING THE REHABILITATION COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF) COMPLETED MADONNA'S ACCREDITATION SURVEY IN MAY 2012. THE OUTCOMES WERE THE HIGHEST POSSIBLE - A THREE-YEAR ACCREDITATION IN SIX PROGRAM AREAS:-COMPREHENSIVE INTEGRATED INPATIENT REHABILITATION PROGRAM - ACUTE REHABILITATION, LONG TERM ACUTE CARE HOSPITAL AND TRANSITIONAL CARE OR SKILLED NURSING.-BRAIN INJURY PROGRAM - INPATIENT AND OUTPATIENT, ADULTS AND PEDIATRICS.-SPINAL CORD SYSTEM OF CARE - INPATIENT AND OUTPATIENT, ADULTS AND PEDIATRICS.-STROKE SPECIALTY PROGRAM - INPATIENT AND OUTPATIENT, ADULTS AND PEDIATRICS.-PEDIATRIC SPECIALTY PROGRAM - INPATIENT AND OUTPATIENT.-PERSON-CENTERED LONG-TERM CARE COMMUNITYTHE ACUTE REHABILITATION PROGRAM DISCHARGED 67 PERCENT OF ITS PATIENTS TO A NON-INSTITUTIONALIZED SETTING; THIS IS CONSISTENT WITH OR BETTER THAN INDUSTRY BENCHMARKS. THE BRAIN INJURY PROGRAM DISCHARGED 68 PERCENT OF ITS PATIENTS TO COMMUNITY SETTINGS, SURPASSING THE BENCHMARK. THE SPINAL CORD PROGRAM DISCHARGED 66 PERCENT OF ITS PATIENTS TO COMMUNITY SETTINGS, EXCEEDING THE BENCHMARK. THE STROKE PROGRAM DISCHARGED 65 PERCENT OF ITS PATIENTS TO COMMUNITY SETTINGS, EXCEEDING THE BENCHMARK.THE (LTACH) SERVES INDIVIDUALS WITH MEDICALLY COMPLEX DIAGNOSES, SUCH AS PULMONARY CONDITIONS, WOUNDS AND BURNS. IN FY 2012, THE LTACH PROGRAM DISCHARGED 29 PERCENT OF PATIENTS TO A NON-INSTITUTIONAL SETTING AND 21 PERCENT TO THE ACUTE REHABILITATION PROGRAM. REHABILITATION PATIENTS WITH DIAGNOSES, SUCH AS SPINAL CORD INJURY, BRAIN INJURY AND STROKE, COMPRISE THE MAJORITY OF THOSE WHO DISCHARGE TO THE ACUTE REHABILITATION PROGRAM. THIS COMBINED DISCHARGE RATE OF 50 PERCENT EXCEEDS THE NATIONAL BENCHMARK OF 41 PERCENT. TWO HUNDRED THIRTY-FOUR INDIVIDUALS, A MAJORITY OF WHOM HAD BRAIN INJURY, STROKE OR SPINAL CORD INJURY, WERE CONTACTED BY TELEPHONE SURVEY COMPLETED SIX MONTHS TO TWO YEARS AFTER DISCHARGE FROM MADONNA'S ACUTE REHABILITATION UNIT. FIFTY-SIX WERE CHILDREN OR ADOLESCENTS. NINETY-EIGHT PERCENT OF THOSE CONTACTED WERE STILL LIVING IN A COMMUNITY SETTING. FIFTEEN PERCENT REPORTED A RE-HOSPITALIZATION, WHICH IS SIGNIFICANTLY LESS THAN THE 22 PERCENT TO 34 PERCENT CITED IN THE LITERATURE. MOST OF THEM WERE RE-HOSPITALIZED FOR REASONS UNRELATED TO THEIR REHABILITATION STAY. OVERALL, 96 PERCENT OF THOSE CONTACTED REPORTED MAKING IMPROVEMENTS OR MAINTAINING GAINS ACROSS SIX FUNCTIONAL DOMAINS. NINETY-TWO PERCENT REPORTED SEEING THEIR PRIMARY CARE PHYSICIAN WITHIN THE LAST SIX MONTHS AND MORE THAN HALF WERE ACTIVELY PARTICIPATING IN SOME FORM OF ONGOING EXERCISE OR WELLNESS PROGRAM. THESE PERCENTAGES OF PEOPLE RETURNING TO THEIR LIFE ROLES ARE SIGNIFICANTLY HIGHER THAN THOSE CITED IN THE LITERATURE FOR THIS POPULATION. A COMPREHENSIVE SUPPORT SPACE REMODEL PROJECT CREATED DISTINCT PATIENT/FAMILY AND STAFF ZONES TO ENHANCE PATIENT AND FAMILY COMFORT. THE NEW DESIGN INCLUDES A LARGER NURSING STATION AND PATIENT CARE SUPPORT SPACE, EXPANDED THERAPY TREATMENT SPACE AND ADDITIONAL PATIENT DINING AND HOSPITALITY AREAS. THE CARF SURVEY TEAM NOTED THAT THE HOSPITAL SPACE REDESIGN AND RENOVATION PROJECT ENHANCED THE THERAPEUTIC USE OF SPACE, CREATED AN ENVIRONMENT OF HEALING AND MAXIMIZED INDEPENDENCE AND RETURN TO THE COMMUNITY.MADONNA EXPANDED IMPLEMENTATION OF ITS ELECTRONIC MEDICAL RECORD (EMR) SYSTEM WITH ADDITIONAL COMPONENTS FOR MEDICAL MANAGEMENT OF PATIENT CARE AND INTRODUCING THE INITIAL PORTIONS OF THE REHABILITATION MANAGEMENT MODULES. MADONNA PHYSICIANS ARE MEETING NATIONAL GOALS THROUGH THEIR COMPUTERIZED PHYSICIAN ORDER ENTRY. NURSING STAFF COMPLETE BAR CODE/ELECTRONIC MEDICATION ADMINISTRATION AND BEDSIDE CLINICAL CHARTING OF VITALS AND ASSESSMENTS. THE MADONNA TEAM DEVELOPED AND IMPLEMENTED STATE-OF-THE-ART REHABILITATION MANAGEMENT EMR MODULES TO DOCUMENT PATIENT TREATMENT GOALS, EDUCATION EVENTS AND PLAN OF CARE COMPOSITE REPORTS.
4b (Code:   ) (Expenses $ 19,174,015 including grants of $   ) (Revenue $ 21,339,124 )
ST. JANE DE CHANTAL IS THE HOSPITAL'S LONG TERM CARE DIVISION. IT INCLUDES TRADITIONAL INPATIENT NURSING HOME CARE, A TRANSITIONAL CARE UNIT, AND A SPECIAL NEEDS UNIT FOR THOSE WHO ARE VENTILATOR DEPENDENT OR HAVE OTHER COMPLEX MEDICAL CARE REQUIREMENTS. THE CHIP WOODS HOUSE ON MADONNA'S CAMPUS PROVIDES UP TO EIGHT YOUNG PERSONS AGES 19-59 WITH SEVERE DISABILITIES A COST-EFFECTIVE OPTION FOR INDEPENDENT LIVING IN THE COMMUNITY.RESIDENTS OF ST. JANE DE CHANTAL LONG TERM CARE PROGRAMS REPORT A HIGHER LEVEL OF OVERALL SATISFACTION THAN THE NATIONAL AVERAGE. THE NURSING HOME QUALITY INITIATIVE METHODS HELP ENSURE EXCELLENT IS RESIDENT CARE. ST. JANE EMBRACES A HOLISTIC APPROACH TO ELDER CARE EMPHASIZING THE MIND, BODY AND SPIRIT CONNECTION. THE ST. JANE CARE PHILOSOPHY IS FOCUSED ON TREATING ALL ASPECTS OF THE PERSON INCLUDING THEIR PHYSICAL, PSYCHOLOGICAL, SOCIAL, RECREATIONAL AND SPIRITUAL NEEDS.ST. JANE DE CHANTAL'S EXPERT INTERDISCIPLINARY TEAM INCLUDES REGISTERED NURSES, LICENSED PRACTICAL NURSES, CERTIFIED NURSING ASSISTANTS, NURSING ASSOCIATES, SOCIAL WORKERS, REGISTERED DIETITIANS, PHYSICAL, OCCUPATIONAL, SPEECH AND RECREATION THERAPISTS, PSYCHOLOGISTS, AN MDS COORDINATOR, RESTORATIVE AIDES AND SPIRITUAL CARE ADVISORS AS WELL AS MANY PEOPLE WHO SERVE IN SUPPORT ROLES.ST. JANE DE CHANTAL EARNED THREE-YEAR CARF ACCREDITATION FOR INPATIENT REHABILITATION, SKILLED NURSING. ST. JANE IS THE ONLY NURSING HOME FACILITY IN NEBRASKA TO HAVE EARNED THIS LEVEL OF ACCREDITATION.THE ST. JANE TEAM FOCUSED ON INCREASING NON PHARMACOLOGICAL APPROACHES TO MINIMIZE PAIN AND ANXIETY ASSOCIATED WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS. COMPONENTS INCLUDE AROMATHERAPY, HAND MASSAGE, COMFORT TOUCH, CHAIR YOGA, FAR INFRARED HEAT, DRUM CIRCLES, AND LIFE CELEBRATIONS. THESE APPROACHES ARE GROUNDED IN A CULTURE THAT VALUES THE RIGHTS, DIGNITY, AND EMPOWERMENT OF THE ELDERS MADONNA SERVES.EMPOWERING ACTIVITIES FOR ELDERS INCLUDED RAISING FUNDS FOR THE LINCOLN PUBLIC SCHOOLS' BACKPACK FOOD PROGRAM AND THE FOOD BANK DRIVE. RESIDENTS HAD THE OPPORTUNITY TO PARTICIPATE IN ART CLASSES FROM LUX ART CENTER INSTRUCTORS, LEARNING DRAWING, PAINTING AND CLAY TECHNIQUES. INPUT FROM YOUNGER RESIDENTS ON THE VENTILATOR ASSIST PROGRAM RESULTED IN MOVIE NIGHT AND FRIDAY AFTERNOON CLUB.ACCESS TO THE OUTDOORS IS ALSO PART OF HOLISTIC CARE. STAFF USED MEMORIAL FUNDS TO ENHANCE A COURTYARD NEAR THE RESIDENCES. STAFF INSTALLED A NEW FOUNTAIN AND ADDED PLANTS AND SHRUBS SIMILAR TO WHAT RESIDENTS MIGHT HAVE PLANTED IN THEIR OWN GARDENS. THE AREA OUTSIDE OF THE TRANSITIONAL CARE UNIT WAS ALSO LANDSCAPED WITH NEW PLANTINGS, PROVIDING AN ACCESSIBLE AND VISUALLY ATTRACTIVE AREA FOR PATIENTS AND FAMILIES.ST. JANE DE CHANTAL PROVIDES SPECIALIZED SERVICES UNDER CONTRACT FOR THE STATE OF NEBRASKA AND THE VETERANS ADMINISTRATION.
4c (Code:   ) (Expenses $ 7,097,586 including grants of $   ) (Revenue $ 7,601,237 )
MADONNA THERAPYPLUS IS COMMITTED TO PROVIDING EXCELLENT PATIENT CARE FOR OUTPATIENT REHABILITATION. WHETHER AN INJURY OR ILLNESS OCCURRED LAST WEEK OR YEARS AGO, THERAPYPLUS CAN HELP PEOPLE GET BACK TO DOING THE THINGS THEY WANT TO DO. WITH EXPERTISE IN AREAS RANGING FROM SINGLE SERVICE ORTHOPEDIC SPRAINS, STRAINS AND POST-OPERATIVE CARE TO COMPREHENSIVE REHABILITATION FOR NEUROLOGICAL CONDITIONS, THERAPYPLUS' GOAL IS TO HELP PATIENTS DECREASE THEIR PAIN, INCREASE THEIR FUNCTIONAL ABILITIES AND IMPROVE THEIR QUALITY OF LIFE. THERAPYPLUS OFFERS FOUR CONVENIENT LOCATIONS THROUGHOUT LINCOLN. EACH LOCATION OFFERS ONE-ON-ONE THERAPY APPOINTMENTS WITH A CLINICIAN, EXTENDED HOURS AND STATE-OF-THE-ART EQUIPMENT AND TECHNOLOGY. THERE ARE A VARIETY OF SERVICES AVAILABLE AT EACH LOCATION TO HELP INDIVIDUALS WITH ALL TYPES OF INJURY, INCLUDING WORKERS COMPENSATION CASES. THE MAIN CAMPUS LOCATION SPECIALIZES IN A COMPREHENSIVE, MULTIDISCIPLINARY APPROACH WITH TEAM MEMBERS INCLUDING PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SPEECH THERAPISTS, RECREATION THERAPISTS, NURSES, NEUROPSYCHOLOGISTS, CASE MANAGERS/SOCIAL WORKERS AND A NUTRITION THERAPIST. MADONNA'S COMPREHENSIVE OUTPATIENT SERVICES ARE ACCREDITED BY THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF). THIS IS THE PATIENT'S ASSURANCE THAT MADONNA'S PROGRAM MEETS THE HIGHEST INDUSTRY STANDARDS IN THE DELIVERY OF OUTPATIENT SERVICES. THERAPYPLUS INCLUDES THE MULTI-FACETED FIT FOR WORK PROGRAM, WHICH COMBINES OCCUPATIONAL HEALTH, WELLNESS, SAFETY AND COORDINATION OF WORKERS' COMPENSATION WITH THE EXPERT SERVICES CONVENIENTLY AVAILABLE FROM MADONNA REHABILITATION HOSPITAL, MADONNA THERAPYPLUS OUTPATIENT CLINICS AND MADONNA PROACTIVE.MADONNA THERAPYPLUS COMPLETED A VERY SUCCESSFUL YEAR WITH REFERRAL GROWTH, STRONG CLINICAL OUTCOMES, ADVANCED CLINICIAN TRAINING AND INCREDIBLE CUSTOMER SATISFACTION RATINGS. ACHIEVEMENTS INCLUDE:-VOTED NO. 1 FOR PHYSICAL THERAPY IN THE KFOR BEST OF LINCOLN PUBLIC SURVEY FOR THE SEVENTH YEAR SINCE 2004. VOTED NO. 1 IN PHYSICAL THERAPY IN THE FIRST LINCOLN JOURNAL STAR LINCOLN'S CHOICE AWARDS.-SECURED A NEW CONTRACT WITH CREIGHTON UNIVERSITY TO BE A TRAINING SITE FOR THE ORTHOPEDIC PHYSICAL THERAPIST RESIDENCY PROGRAM. -SERVED 182 PARTICIPANTS IN THE STRUCTURED INDEPENDENCE PROGRAM.
(Code:   ) (Expenses $ 5,785,893 including grants of $   ) (Revenue $ 5,567,719 )
OTHER PROGRAMS INCLUDE MADONNA PROACTIVE WHICH PROVIDES THE LINCOLN COMMUNITY AND SURROUNDING AREA WITH A HOLISTIC, MEDICALLY BASED APPROACH TO WELLNESS THROUGH CUSTOMIZED SERVICE, A SUPPORTIVE ENVIRONMENT, COMPREHENSIVE PROGRAMS, STATE-OF-THE-ART EQUIPMENT AND MEDICAL SUPERVISION. EDUCATION AND SUPPORT GROUPS CONTINUE TO UTILIZE THE EXPERTISE OF PROACTIVE STAFF AS PART OF OVERALL WELLNESS. MADONNA PROACTIVE EXTENDS MADONNA'S REHABILITATION EXPERTISE TO PEOPLE OF ALL ABILITIES IN THE COMMUNITY. MORE THAN 100 GROUP FITNESS CLASSES, ADVANCED EQUIPMENT AND EXPERT STAFF ENSURE THAT EACH PERSON RECEIVES THE SUPPORT THEY NEED TO ACHIEVE THEIR HEALTH AND WELLNESS GOALS.THE FACILITY WAS VOTED THE THIRD BEST HEALTH AND FITNESS CENTER IN KFOR'S "BEST IN LINCOLN" SURVEY.PROACTIVE PARTNERED WITH THE AMERICAN HEART ASSOCIATION AND NEBRASKA HEART INSTITUTE FOR THIS YEAR'S BETTER U CHALLENGE. A PROACTIVE TEAM SELECTED PARTNERS FROM THE COMMUNITY AND SUPPORTED THEM THROUGH A 12-WEEK WELLNESS PROGRAM, INCLUDING PERSONAL TRAINING, NUTRITION COUNSELING, WELLNESS COACHING AND WEEKLY EDUCATION SESSIONS.PROACTIVE INSTRUCTORS DEVELOPED NEW CLASSES FOR THOSE WITH SPECIAL NEEDS.
4d Other program services (Describe in Schedule O.)
(Expenses $ 5,785,893 including grants of $   ) (Revenue $ 5,567,719 )
4e Total program service expensesMediumBullet$ 81,490,007
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see attachment
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II..
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III.....
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
54
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
1,670
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
22
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
21
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
Yes
 
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
VICTOR WITKOWICZ
5401 SOUTH STREET
LINCOLN,NE685062134
(402) 413-3000
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JIM SCHULZ
CHAIRPERSON
 1.00 X   X       0 0 0
(2) RICH HERINK
VICE CHAIRPERSON
 1.00 X   X       0 0 0
(3) JOHN HANIGAN
TREASURER
 1.00 X   X       0 0 0
(4) DAN TOMES MD
SECRETARY
 1.00 X   X       0 0 0
(5) FR JOHN FOLDA
VICE PRESIDENT
 1.00 X   X       0 0 0
(6) RICH BAILEY
MEMBER
 1.00 X           0 0 0
(7) CAROL BERAN
MEMBER
 1.00 X           0 0 0
(8) JOHN BERGMEYER
MEMBER
 1.00 X           0 0 0
(9) JAN CONNOLLY
MEMBER
 1.00 X           0 0 0
(10) ANGIE MUHLEISEN
MEMBER
 1.00 X           0 0 0
(11) MATT HARRIS
MEMBER
 1.00 X           0 0 0
(12) DR BILL JOHNSON
MEMBER
 1.00 X           0 0 0
(13) DAVID LECHNER
MEMBER
 1.00 X           0 0 0
(14) LORI MCCLURG
MEMBER
 1.00 X           0 0 0
(15) MIKE MCCRORY
MEMBER
 1.00 X           0 0 0
(16) WILL SCOTT
MEMBER
 1.00 X           0 0 0
(17) DR ELIZABETH NOORDHOEK
MEMBER
 1.00 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) GARY PERKINS
MEMBER
 1.00 X           0 0 0
(19) TOM SMITH
MEMBER
 1.00 X           0 0 0
(20) MARK WHITEHEAD
MEMBER
 1.00 X           0 0 0
(21) DAVID SUNDBERG
MEMBER
 1.00 X           0 0 0
(22) MARSHA LOMMEL
PRESIDENT AND CEO
 40.00     X       676,528 0 46,732
(23) VICTOR WITKOWICZ
SR. VICE PRESIDENT-CFO
 40.00     X       324,976 0 30,368
(24) PAUL DONGILLI
EXECUTIVE VP-COO
 40.00     X       305,235 0 27,521
(25) DR THOMAS STALDER
VICE PRESIDENT-MEDICAL AFF
 40.00     X       164,531 0 15,716
(26) NATHENSON PAUL A
VP LTC SVS & BIOMEDICAL SU
 40.00     X       159,243 0 25,893
(27) ROLFE CHARLES DAVID
CHIEF INFORMATION OFFICER
 40.00     X       158,309 0 29,912
(28) KLANECKY SUSAN K
VP PATIENT CARE & CNO-HOSP
 40.00     X       144,187 0 10,915
(29) LEE CHRISTOPHER A
VICE PRESIDENT REHABILITAT
 40.00     X       142,048 0 24,330
(30) SULLIVAN LINDA S
VP BUS DEVELOPMENT & MARKE
 40.00     X       137,749 0 19,623
(31) SPEAR BARRY C
VICE PRESIDENT OF DEVELOPMENT
 20.00     X       28,172 28,172 424
(32) KAFKA ADAM T
STAFF PHYSIATRIST
 40.00         X   291,427 0 19,866
(33) KRABBENHOFT PAUL L
STAFF PHYSIATRIST
 40.00         X   285,580 0 47,216
(34) LAHOLT MORGAN L
STAFF PHYSIATRIST
 40.00         X   257,648 0 4,298
(35) JUDITH M BURNFIELD
DIR. INSTITUTE-REHAB SCIEN
 40.00         X   171,385 0 19,838
(36) ZENG WENJIA
STAFF PHYSIATRIST
 40.00         X   140,697 0 30,313
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 3,387,715 28,172 352,965
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet35
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
LINCOLN INTERNAL MEDICINE ASSOCIATES
3901 PINE LAKE STE 220
LINCOLN,NE68516 		PROFESSIONAL SERVICES 959,884
DIALYSIS CENTER OF LINCOLN
7910 O STREET
LINCOLN,NE685102500 		MEDICAL SERVICES 363,885
ST ELIZABETH REGIONAL MED
555 S 70TH ST
LINCOLN,NE68510 		MEDICAL SERVICES 306,109
BRYAN LGH EAST
1600 SOUTH 48TH STREET
LINCOLN,NE685061227 		MEDICAL SERVICES 275,504
COMPREHENSIVE PHARMACY SERVICES INC
P O BOX 116474
ATLANTA,GA303686474 		PHARMACY MANAGEMENT 274,656
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet9
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,539,648
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		24,293
g Noncash contributions included in lines 1a-1f:$ 32,456
h Total. Add lines 1a-1f.......MediumBullet 1,563,941
Program Service Revenue Business Code
2a PATIENT SERVICE REVENU 900,099 60,242,896 60,242,896    
b LONG-TERM CARE 900,099 21,339,124 21,339,124    
c OUTPATIENT 900,099 7,601,237 7,601,237    
d MEDICAL FITNESS CENTER 900,099 3,614,583 3,614,583    
e
f All other program service revenue . 1,953,136 1,953,136    
g Total. Add lines 2a–2f........MediumBullet 94,750,976
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet -69,215     -69,215
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet  
12 Total revenue. See Instructions....MediumBullet 96,245,702 94,750,976 0 -69,215
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21    
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 2,240,978   2,240,978  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 50,688,194 47,668,340 3,019,854  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,608,282 2,537,282 71,000  
9 Other employee benefits ....... 6,949,937 6,355,186 594,751  
10 Payroll taxes ........... 3,651,063 3,321,638 329,425  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 98,004 35,973 62,031  
c Accounting ........... 35,306   35,306  
d Lobbying ........... 40,307   40,307  
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 46,832   46,832  
g Other .......... 4,260,191 4,244,829 15,362  
12 Advertising and promotion .... 608,815 154,361 454,454  
13 Office expenses ....... 8,680,022 8,461,786 218,236  
14 Information technology ...... 739,001 279,059 459,942  
15 Royalties ..        
16 Occupancy ........... 1,961,811 1,902,358 59,453  
17 Travel ............ 263,271 231,775 31,496  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 264,785 264,172 613  
20 Interest ........... 290,003 290,003    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 4,891,398 3,878,416 1,012,982  
23 Insurance .............. 382,925 382,925    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MISCELLANEOUS 1,646,845 1,481,904 164,941  
b
c
d
e
f All other expenses        
25 Total functional expenses. Add lines 1 through 24f 90,347,970 81,490,007 8,857,963 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ..........   1  
2 Savings and temporary cash investments ....... 12,610,351 2 12,928,912
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 14,301,617 4 14,940,349
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 784,930 8 778,506
9 Prepaid expenses and deferred charges ............ 763,164 9 818,277
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 92,648,228
b Less: accumulated depreciation. ..... 10b 51,960,557 40,267,233 10c 40,687,671
11 Investments—publicly traded securities .......... 35,403,728 11 38,218,257
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 459,220 15 416,321
16 Total assets. Add lines 1 through 15 (must equal line 34)... 104,590,243 16 108,788,293
Liabilities 17 Accounts payable and accrued expenses . 11,483,281 17 11,872,583
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities .......... 7,790,759 20 5,535,825
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 1,518,202 25 1,693,204
26 Total liabilities. Add lines 17 through 25..... 20,792,242 26 19,101,612
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 83,772,832 27 89,652,996
28 Temporarily restricted net assets ..... 25,169 28 33,685
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 83,798,001 33 89,686,681
34 Total liabilities and net assets/fund balances ..... 104,590,243 34 108,788,293
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
96,245,702
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
90,347,970
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
5,897,732
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
83,798,001
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-9,052
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
89,686,681
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MADONNA REHABILITATION HOSPITAL
  		Employer identification number

47-0439599
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MADONNA REHABILITATION HOSPITAL
  		Employer identification number

47-0439599
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
MADONNA REHABILITATION HOSPITAL
  		Employer identification number

47-0439599
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
40,307
j
Total. Add lines 1c through 1i ...............................
40,307
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
EXPLANATION OF LOBBYING ACTIVITIES: 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. MADONNA IS ALSO A MEMBER OF FRIENDS OF NEBRASKA NONPROFIT HOSPITALS ("FONNH"). AS A PART OF ITS SERVICES PROVIDED TO MEMBERS, FONNH LOBBIES ON BEHALF OF ITS MEMBERS AND MONITORS STATE LEGISLATION OF CONCERN TO NONPROFIT HOSPITALS IN NEBRASKA. 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.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   2,954,562 2,954,562
b Buildings ................   46,538,582 23,340,096 23,198,486
c Leasehold improvements ............        
d Equipment ................   41,183,513 27,388,312 13,795,201
e Other .................   1,971,571 1,232,149 739,422
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 40,687,671
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  
NON-CURRENT PORTION OF WORK COMP 550,000
457 PLANS 719,564
CAPITAL LEASE OBLIGATIONS 423,640






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,693,204
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 96,245,702
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 90,347,970
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 5,897,732
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -9,052
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -9,052
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 5,888,680
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 95,264,188
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -981,514
e Add lines 2a through 2d ..................... 2e -981,514
3 Subtract line 2e from line 1..................... 3 96,245,702
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 96,245,702
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 90,347,970
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 90,347,970
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c 0
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 90,347,970
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: "THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2012 AND 2011, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED."
PART XI, LINE 8 - OTHER ADJUSTMENTS:   CHANGE IN TEMPORARILY RESTRICTED NET ASSETS AND OTHER. -9,052.
PART XII, LINE 2D - OTHER ADJUSTMENTS:   GRANTS AND BEQUESTS FOR PURCHASE OF PLANT AND EQUIPMENT AND OTHER
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
 
No
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    410,000   410,000 0.460 %
b Medicaid (from Worksheet 3, column a) .....     2,027,000   2,027,000 2.260 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     248,000   248,000 0.280 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    2,685,000   2,685,000 3.000 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    154,000   154,000 0.180 %
f Health professions education
(from Worksheet 5) .. 		    86,000   86,000 0.100 %
g Subsidized health services
(from Worksheet 6) .. 		    2,235,000   2,235,000 2.500 %
h Research (from Worksheet 7)     438,000   438,000 0.490 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....            
jTotal Other Benefits ...     2,913,000   2,913,000 3.270 %
kTotal. Add lines 7d and 7j. ..     5,598,000   5,598,000 6.270 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other 2   300,642   300,642 0.340 %
10 Total 2   300,642   300,642 0.340 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
813,965
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
23,408,844
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
26,137,832
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-2,728,988
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
11 MALP
  		YOUNG PEOPLE ASSISTED LIVING HOUSING 1.000 % 0 % 0 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?1
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 MADONNA REHABILITATION HOSPITAL
5401 SOUTH STREET
LINCOLN,NE685062134 		X               MADONNA REHABILITATION HOSPITAL
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MADONNA REHABILITATION HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 300.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18   No
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address Type of Facility (describe)
1 ST JANE DE CHANTAL
2200 S 52ND STREET
LINCOLN,NE685062134 		NURSING FACILITY (NF)
2 MADONNA THERAPY PLUS
5401 SOUTH STREET
LINCOLN,NE685062134 		OUTPATIENT CLINICS (4)
3 MADONNA REHABILITATION HOSPITAL
5401 SOUTH STREET
LINCOLN,NE685062134 		SKILLED NURSING FACILITY (SNF)
4 MADONNA PROACTIVE HEALTH & FITNESS
7111 STEPHANIE LANE
LINCOLN,NE68516 		MEDICAL FITNESS CENTER
5 REHABILITATION SPECIALISTS
5445 SOUTH STREET
LINCOLN,NE685062134 		INPATIENT & OUTPATIENT PHYSICIAN CLINIC
6
7
8
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
    PART I, LINE 7: A COST ACCOUNTING SYSTEM IS USED BY MADONNA AND IT ADDRESSES ALL PATIENT SEGMENTS. A COST TO CHARGE RATIO WAS NOT USED ON THIS TABLE.
    PART I, L7 COL(F): BAD DEBT EXPENSE SUBTRACTED IN COL F IS $813,965.
    PART II: MADONNA'S MEDICALLY BASED HEALTH AND FITNESS CENTER (PROACTIVE) IS FOCUSED ON IMPROVING THE OVERALL WELLNESS OF THE COMMUNITY THROUGH THE VARIOUS HEALTH PROGRAMS AND TO REDUCE CHRONIC RISK FACTORS.
    PART III, LINE 4: MANAGEMENT REVIEWS PATIENT RECEIVABLES INDIVIDUALLY AND BY PAYOR AND APPLIES PERCENTAGES RELATIVE TO ACCOUNT AGE AND HISTORICAL COLLECTION INFORMATION TO DETERMINE ADEQUACY OF THE BAD DEBT ALLOWANCE. A COST ACCOUNTING SYSTEM IS USED BY MADONNA AND IT ADDRESSES ALL PATIENT SEGMENTS. A COST TO CHARGE RATIO WAS NOT USED ON THIS TABLE.
    PART III, LINE 8: THE AMOUNT WAS DETERMINED USING INTERNAL PROGRAM FINANCIAL STATEMENTS WHICH USE DEPARTMENTALIZED COST TO CHARGE RATIOS AND OTHER ALLOCATION METHODS TO DETERMINE THE COST BASIS.
    PART III, LINE 9B: THE PATIENT MUST PROVIDE DOCUMENTATION OUTLINED IN THE APPLICATION WHICH WILL DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE (FA). IF IT IS DETERMINED THAT THE PATIENT QUALIFIES FOR 100% FA NO FURTHER COLLECTION EFFORTS ARE MADE.
MADONNA REHABILITATION HOSPITAL   PART V, SECTION B, LINE 11H: ALL PATIENTS ARE CHARGED THE SAME AMOUNT REGARDLESS OF PAYOR SOURCE OR ABILITY TO PAY. MADONNA FINANCIAL ASSISTANCE AND THE OPPORTUNITY TO SATISFY THE ACCOUNT FOR A REDUCED AMOUNT ARE AVAILABLE TO ALL PATIENTS.
MADONNA REHABILITATION HOSPITAL   PART V, SECTION B, LINE 17E: MADONNA REHABILITATION HOSPITAL OFFERS THE FOLLOWING:1. ASSISTANCE WITH FILLING OUT APPLICATIONS FOR SSI, SSD, MEDICAID AND/OR GENERAL ASSISTANCE2. ADVOCATE FOR THE PATIENT WITH THIRD PARTY PAYERS, GOVERNMENT PAYERS, AND OTHER ENTITIES THAT MAY RESTRICT OR DENY BENEFITS IN APPROPRIATELY3. ASSIST PATIENTS/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 ADJUDICATION4. EXTENDED PAYMENT PLANS5. LIABILITY SETTLEMENT PENDING WITHOUT ANY OTHER PAYER SOURCE6. COURTESY CALLS AT TIME OF 2ND STATEMENT TO OFFER PAYMENT PLAN IF UNABLE TO PAY BALANCE IN FULL7. REVIEW FOR FINANCIAL ASSISTANCE NEED AND SEND APPLICATION IF APPROPRIATE8. COURTESY CALLS AT TIME OF FINAL NOTICE AND PRIOR TO LISTING FOR COLLECTIONS
MADONNA REHABILITATION HOSPITAL   PART V, SECTION B, LINE 19D: FOR FAP-ELIGIBLE INDIVIDUALS THE HOSPITAL USED STANDARD RATES FOR SERVICE THAT ARE CHARGED TO ALL PATIENTS REGARDLESS OF INSURANCE OR PAYOR STATUS.
MADONNA REHABILITATION HOSPITAL   PART V, SECTION B, LINE 21: ALL PATIENTS ARE CHARGED THE SAME AMOUNT REGARDLESS OF PAYOR SOURCE OR ABILITY TO PAY. MADONNA FINANCIAL ASSISTANCE AND THE OPPORTUNITY TO SATISFY THE ACCOUNT FOR A REDUCED AMOUNT ARE AVAILABLE TO ALL PATIENTS.
    PART VI, LINE 2: MADONNA IDENTIFIES AREAS OF NEED THROUGH SEVERAL MECHANISMS OF THE HOSPITAL OPERATIONS. STRATEGIC PLANNING IDENTIFIES TRENDS AND FUTURE NEEDS OF THE COMMUNITY, AND HOW MADONNA CAN ADDRESS THESE NEEDS. THE ANNUAL BUDGET PROCESS LOOKS AT THE SHORT TERM FLUCTUATIONS AND BUILDS PROGRAMS AROUND THE CURRENT NEEDS OF THE COMMUNITY. THE BUDGET / NEEDS ASSESMENT IS PRESENTED TO THE BOARD OF DIRECTORS.
    PART VI, LINE 3: THE PATIENT EDUCATION OF ELIGIBILITY PROCESS STARTS WITH THE NURSE LIASONS, BUT ALSO INCLUDES SCHEDULING, REGISTRATION, CASE MANAGERS AND SOCIAL WORKERS. INFORMATION IS PROVIDED VERBALLY AS WELL AS IN WRITTEN FORM. MADONNA TAKES A TEAM APPROACH TO COMMUNICATE WITH THE PATIENT AND FAMILY. MADONNA PROVIDES SUPPORT THROUGH THE WEBSITE AT WWW.MADONNA.ORG.
    PART VI, LINE 4: MADONNA REHABILITATION HOSPITAL DEFINES THE COMMUNITY IT SERVES AS THOSE INDIVIDUALS WHO REQUIRE POST-ACUTE PHYSICAL REHABILIATION IN ORDER TO REDUCE OR ELIMINATE IMPAIRMENTS, ACTIVITY LIMITATIONS, AND PARTICIPATION RESTRICTIONS. THE GEOGRAPHICAL AREA PRIMARILY SERVED IS A REGIONAL AREA ENCOMPASSING NEBRASKA AS WELL AS THE SURROUNDING STATES OF SOUTH DAKOTA, IOWA, KANSAS AND MISSOURI. AS A NATIONALLY RECOGNIZED HOSPITAL FOR TOP QUALITY REHABILITATION SERVICES, MADONNA ALSO SERVES VETERANS AND PATIENTS FROM AROUND THE NATION WHO NEED EXPERTISE IN SUCH AREA'S AS TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY.
    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 LEARINING 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 REHABILITAITON AND OTHER REVELANT TOPICS.
REPORTS FILED WITH STATES PART VI, LINE 7 NE
Schedule H (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
Yes
 
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) MARSHA LOMMEL (i)
(ii)		 571,237
0 		105,291
0 		0
0 		40,500
0 		6,232
0 		723,260
0 		0
0
(2) VICTOR WITKOWICZ (i)
(ii)		 271,940
0 		53,036
0 		0
0 		24,000
0 		6,368
0 		355,344
0 		0
0
(3) PAUL DONGILLI (i)
(ii)		 255,809
0 		49,426
0 		0
0 		24,000
0 		3,521
0 		332,756
0 		0
0
(4) DR THOMAS STALDER (i)
(ii)		 137,531
0 		27,000
0 		0
0 		8,250
0 		7,466
0 		180,247
0 		0
0
(5) NATHENSON PAUL A (i)
(ii)		 132,036
0 		27,207
0 		0
0 		22,693
0 		3,200
0 		185,136
0 		0
0
(6) ROLFE CHARLES DAVID (i)
(ii)		 158,309
0 		0
0 		0
0 		27,434
0 		2,478
0 		188,221
0 		0
0
(7) KLANECKY SUSAN K (i)
(ii)		 119,701
0 		24,486
0 		0
0 		5,613
0 		5,302
0 		155,102
0 		0
0
(8) LEE CHRISTOPHER A (i)
(ii)		 117,562
0 		24,486
0 		0
0 		16,890
0 		7,440
0 		166,378
0 		0
0
(9) SULLIVAN LINDA S (i)
(ii)		 114,998
0 		22,751
0 		0
0 		18,190
0 		1,433
0 		157,372
0 		0
0
(10) KAFKA ADAM T (i)
(ii)		 291,427
0 		0
0 		0
0 		16,500
0 		3,366
0 		311,293
0 		0
0
(11) KRABBENHOFT PAUL L (i)
(ii)		 285,580
0 		0
0 		0
0 		40,500
0 		6,716
0 		332,796
0 		0
0
(12) LAHOLT MORGAN L (i)
(ii)		 257,648
0 		0
0 		0
0 		0
0 		4,298
0 		261,946
0 		0
0
(13) JUDITH M BURNFIELD (i)
(ii)		 171,385
0 		0
0 		0
0 		18,500
0 		1,338
0 		191,223
0 		0
0
(14) ZENG WENJIA (i)
(ii)		 140,697
0 		0
0 		0
0 		23,903
0 		6,410
0 		171,010
0 		0
0


Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
  PART I, LINE 5 ALL HOSPITAL MANAGERS, APPROXIMATELY SEVENTY, 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.
  PART I, LINE 6 SEE EXPLANATION FOR LINE 5.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number
47-0439599
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A HOSPITAL AUTHORITY NO 1 - OF LANCASTER COUNTY NE
  		47-0721900   09-13-2011 1,135,000 REFUND 2003 BONDS   X   X   X
B HOSPITAL AUTHORITY NO 1 - OF LANCASTER COUNTY NE
  		47-0721900   05-22-2009 6,848,483 REFUND 2004 BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 565,000 1,882,658    
2 Amount of bonds legally defeased . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . 1,135,000 6,848,483    
4 Gross proceeds in reserve funds . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . .        
6 Proceeds in refunding escrows . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . .        
8 Credit enhancement from proceeds . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . .        
11 Other spent proceeds . . . . . . . . . . . 1,135,000 6,848,483    
12 Other unspent proceeds . . . . . . . . . . .        
13 Year of substantial completion . . . . . . . . . . . 2004 2006
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X   X          
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X        
16 Has the final allocation of proceeds been made? . . . . . . X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X          
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .   X   X        
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X        
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet   %   %   %   %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet   %   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . .   %   %   %   %
7 Does the bond issue meet the private security or payment test? . . . X   X          
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X          
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X        
2 Is the bond issue a variable rate issue?   X   X        
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X        
b Name of provider . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X        
b Name of provider . . . . . .  
  		 
  		 
  		 
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X        
6 Did the bond issue qualify for an exception to rebate? . X   X          
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X   X          
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( EQUIPMENT ) X 4 22,456 COST/EXPERTS
26 Other Right pointing arrow large image ( SERVICES ) X 1 10,000 COST
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
 
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
Yes
 
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
THIRD PARTY USE: PART I, LINE 32B: MADONNA REHABILITATION HOSPITAL USES ITS SUPPORTING ORGANIZATION THE MADONNA FOUNDATION TO SOLICIT, PROCESS AND SELL NONCASH CONTRIBUTIONS. THE MADONNA FOUNDATION USES VARIOUS FINANCIAL INSTITUTIONS TO SELL STOCK GIFTS RECEIVED.
Schedule M (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Identifier Return Reference Explanation
  FORM 990, PART VI, SECTION A, LINE 3 FOOD SERVICE OPERATIONS ARE CONTRACTED WITH AN OUTSIDE MANAGEMENT CORPORATION.
  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) LAY 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 11 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 THE EXECUTIVE COMPENSATION COMMITTEE WILL MAKE RECOMMENDATIONS FOR THE ANNUAL COMPENSATION OF THE CHIEF EXECUTIVE OFFICER (CEO), CHIEF OPERATIONS OFFICER (COO), AND CHIEF FINANCIAL OFFICER (CFO). THE MADONNA EXECUTIVE COMPENSATION PLAN REQUIRES NATIONAL SALARY BENCHMARKS BE USED FOR THE CEO, COO AND CFO POSITIONS. 1. 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. 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 CALCULATING THE SALARIES FOR BENCHMARK FIRMS PROVIDED BY THE DIRECTOR HUMAN RESOURCES. SINCE THE DATA OFTEN LAGS THE YEAR IN REVIEW, THE AVERAGE AND MEDIAN CEO SALARY FOR THE BENCHMARK FIRMS WILL BE ADJUSTED TO THE CURRENT YEAR USING THE CONSUMER PRICE INDEX, THE GROWTH IN COMPENSATION AS DETERMINED BY A TREND ANALYSIS OR DATA FROM NATIONAL SURVEYS. THE ANNUAL COMPENSATION ADJUSTMENT FOR THE CEO IS TO REPRESENT BOTH THE MARKET CHANGES AND THE MERIT PERFORMANCE. 2. COMPARATIVE SALARIES FOR THE COO AND CFO WILL BE PROVIDED TO THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. THE PHILOSOPHY IS TO MATCH THE COMPENSATION OF OTHER NON-PROFIT REHABILITATION HOSPITALS, USING THE SAME GUIDELINES AS OUTLINED IN PARAGRAPH 1. ABOVE. 3. BENEFITS AND PERQUISITES: THE EXECUTIVE COMPENSATION COMMITTEE ANNUALLY DETERMINES THE PERCENTAGE OF BASE PAY PROVIDED TO THE CEO, COO, AND CFO.THE CURRENT PRACTICE IS TO SET BENEFITS AT TWENTY THREE PERCENT OF BASE SALARY REDUCED BY MADONNA'S SHARE OF THE COST OF HEALTH, DENTAL, LIFE, LONG-TERM DISABILITY PREMIUMS AND 403(B) PLAN MATCHING CONTRIBUTION. 4. RETIREMENT BENEFITS: THE EXECUTIVE COMPENSATION COMMITTEE ANNUALLY REVIEWS THE MATCHING OF RETIREMENT BENEFITS TO THE CEO, COO, AND CFO. THE CURRENT PRACTICE SHALL BE TO MATCH CONTRIBUTIONS MADE BY THE CEO, COO, AND CFO TO 403B AND 457B SUPPLEMENTAL RETIREMENT PLANS NOT TO EXCEED THE LIMIT SPECIFIED IN EACH INDIVIDUAL'S 457(F) AGREEMENT. THE 457(F) DEFERRED RETIREMENT PLAN IS FUNDED BY THE HOSPITAL PER THE TERMS OUTLINED. IN ADDITION, THE CEO, COO, AND CFO SHARE IN ANY CONTRIBUTION TO THE MADONNA REHABILITATION HOSPITAL RETIREMENT PLAN & TRUST, A PROFIT-SHARING PLAN. 5. MADONNA MANAGEMENT INCENTIVE COMPENSATION PLAN: THE CEO, COO, AND CFO PARTICIPATE IN THE MADONNA MANAGEMENT INCENTIVE COMPENSATION PLAN. 6. DISCRETIONARY BONUS: THE EXECUTIVE COMPENSATION COMMITTEE ANNUALLY WILL EVALUATE THE CEO BASED ON GOALS ESTABLISHED AT THE BEGINNING OF THE YEAR AS WELL AS THE FINANCIAL OUTCOME OF THE MANAGEMENT INCENTIVE COMPENSATION PLAN AND MAY AUTHORIZE A CEO DISCRETIONARY BONUS TO BE PAID PRIOR TO THE END OF THE FISCAL YEAR. THE DISCRETIONARY BONUS IS RESERVED FOR COMPENSATING THE CEO IN SITUATIONS WHERE THE CEO PERFORMED IN A CAPACITY THAT FAR EXCEEDS THE EXPECTATIONS OF THE POSITION.
  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.
CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: CHANGE IN TEMPORARILY RESTRICTED NET ASSETS AND OTHER. -9,052. TOTAL TO FORM 990, PART XI, LINE 5: -9,052.
  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 ACCOUNTANT. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) MADONNA FOUNDATION

5401 SOUTH STREET

LINCOLN,NE68506
23-7159940 		FUNDRAISING SUPPORT NE 501(C)(3) 11B (TYPE II) MADONNA REHABILITATION HOSPITAL
 
 
No
(2) MADONNA INC

5401 SOUTH STREET

LINCOLN,NE68506
36-3397284 		HEALTHCARE MANAGEMENT NE 501(C)(3) 11B (TYPE II) MADONNA REHABILITATION HOSPITAL
 
 
No










For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) MADONNA ASSISTED LIVING I LP

5401 SOUTH STREET
LINCOLN,NE68506
47-0825156 		RENTAL NE MADONNA REHABILITATION HOSPITAL
  		RELATED -17,568 416,321   No   Yes   1.000 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) MADONNA FOUNDATION

 K 28,842 FINANCIAL RECORD
(2) MADONNA FOUNDATION

 L 696,724 FINANCIAL RECORD
(3) MADONNA FOUNDATION

 M 19,400 FINANCIAL RECORD
(4) MADONNA FOUNDATION

 O 137,208 FINANCIAL RECORD
(5) MADONNA FOUNDATION

 R 1,539,648 FINANCIAL RECORD
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: