Attach to Form 990 or Form 990-EZ.
See separate instructions.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 monetary support | |||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| (A)
JENNIE EDMUNDSON HOSP |
420680355 | 3 | No | Yes | Yes | 0 | |||
| (B)
PHYSICIANS CLINIC INC |
470687317 | 9 | No | Yes | Yes | 3,653,717 | |||
| (C)
NEBR METH HOSP FNDN |
470595345 | 7 | No | Yes | Yes | 2,130,884 | |||
| (D)
NEBR METH HOSPITAL |
470376604 | 3 | Yes | Yes | Yes | 0 | |||
| Total | 5,784,601 | ||||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.).. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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.).. | ||||||




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART V, LINE 2B | NEBRASKA METHODIST HEALTH SYSTEM INC. IS A COMMON PAYMASTER FOR ITSELF AND CERTAIN RELATED AFFILIATES. ALL W-2 FORMS FOR THESE AFFILIATES ARE ISSUED UNDER THE TAX IDENTIFICATION NUMBER OF NEBRASKA METHODIST HEALTH SYSTEM. ALL REQUIRED FEDERAL EMPLOYMENT TAX RETURNS WERE FILED BY NEBRASKA METHODIST HEALTH SYSTEM INC. WAGES AND BENEFITS SHOWN IN THIS FORM 990 ARE ACTUAL WAGES ASSOCIATED WITH ONLY NEBRASKA METHODIST HEALTH SYSTEM INC. |
| FORM 990, PART VI, SECTION B, LINE 11 | PRIOR TO FILING THE FORM 990, A COPY IS PROVIDED TO THE AUDIT COMMITTEE OF NEBRASKA METHODIST HEALTH SYSTEM. THE COMMITTEE IS GIVEN AN OPPORTUNITY TO ASK QUESTIONS OR REQUEST MORE INFORMATION AT A SUBSEQUENT MEETING. THE FORM 990 IS ALSO POSTED ON A SECURE BOARD PORTAL; BOARD MEMBERS ARE GIVEN NOTICE OF THE DOCUMENT IN THE PORTAL SO THEY MAY REVIEW AND ASK QUESTIONS PRIOR TO FILING. INFORMATION FOR THE FORM 990 IS GATHERED FROM APPROPRIATE RESPONSIBLE PARTIES THROUGHOUT THE ORGANIZATION, INCLUDING THE ORGANIZATION'S HUMAN RESOURCES, FINANCE AND COMPLIANCE DEPARTMENTS. THE RETURN GETS A DETAIL TIE-OUT AND DIRECTOR OF ACCOUNTING REVIEW. IT IS REVIEWED BY EXTERNAL TAX ADVISORS AND HAS A FINAL REVIEW BY THE CHIEF FINANCIAL OFFICER FOR NEBRASKA METHODIST HEALTH SYSTEM AND THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 12C | AN ANNUAL QUESTIONNAIRE IS SENT TO ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES PURSUANT TO THE METHODIST HEALTH SYSTEM CONFLICT OF INTEREST POLICY WHICH REQUIRES THE DISCLOSURE OF RELATIONSHIPS, NOT JUST FINANCIAL, THAT COULD GIVE RISE TO CONFLICTS WITH THE ORGANIZATION. A BOARD COMMITTEE MEETS ANNUALLY TO REVIEW ALL POTENTIAL CONFLICTS IDENTIFIED THROUGH THE SURVEYS. SHOULD A DECISION COME TO THE BOARD WITH AN IDENTIFIED CONFLICT, THE OFFICER, DIRECTOR, OR KEY EMPLOYEE IS NOT PERMITTED TO VOTE OR USE PERSONAL INFLUENCE ON THE MATTER AND IS NOT COUNTED IN DETERMINING A QUORUM FOR A MEETING AT WHICH THE MATTER IS DISCUSSED. A POTENTIAL CONFLICT OF INTEREST, ONCE IDENTIFIED, MUST BE EVALUATED ON A CASE BY CASE BASIS. IN ORDER TO APPROVE THE TRANSACTION WHICH INVOLVES A DIRECT CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DIRECTORS FOR WHOM NO CONFLICT EXISTS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTERESTS OF NEBRASKA METHODIST HEALTH SYSTEM AND/OR ITS AFFILIATES, IS FAIR AND REASONABLE, AND AFTER INVESTIGATION, THE DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORT UNDER THE CIRCUMSTANCES. |
| FORM 990, PART VI, SECTION B, LINE 15 | METHODIST HEALTH SYSTEM RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED, AND COMPENSATION RANGES ARE SET. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF THE NEBRASKA METHODIST HEALTH SYSTEM, A NEBRASKA NON-PROFIT CORPORATION. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE FORM 1023 WAS FILED PRIOR TO 7/15/87 AND NEED NOT BE MADE PUBLICLY AVAILABLE. A COPY OF THE IRS LETTER 947 WILL BE PROVIDED UPON WRITTEN REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. HOWEVER, THE AMENDED ARTICLES OF INCORPORATION ARE AVAILABLE THROUGH THE NEBRASKA SECRETARY OF STATE'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND EMPLOYEES. FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC THROUGH THE IRS FORM 990 AND FORM 990-T. THE ORGANIZATION ALSO CONTRIBUTES INFORMATION REGARDING COMMUNITY BENEFITS IT PROVIDES AS PART OF THE ANNUAL COMMUNITY BENEFIT REPORT. THIS REPORT IS AVAILABLE TO THE PUBLIC ON THE WEBSITE WWW.METHODISTCHART.ORG. |
| FORM 990, PART VII, SECTION A | TODD GRAGES, CYNTHIA PEACOCK AND STEVE BAUMERT ARE KEY EMPLOYEES FOR THE NEBRASKA METHODIST HEALTH SYSTEM. THESE INDIVIDUALS HAVE ASSIGNED LEADERSHIP ROLES WITH PHYSICIANS CLINIC, NEBRASKA METHODIST HOSPITAL FOUNDATION AND JENNIE EDMUNDSON MEMORIAL HOSPITAL RESPECTIVELY. THESE INDIVIDUALS ARE PAID BY NEBRASKA METHODIST HEALTH SYSTEM THROUGH A COMMON PAYMASTER ARRANGEMENT AND REPORT TO THE PRESIDENT OF THE NEBRASKA METHODIST HEALTH SYSTEM. FOR THIS REASON, THEY ARE REPORTED ON THE NEBRASKA HEALTH SYSTEM FORM 990 AS KEY EMPLOYEES. LINDA BURT IS THE CFO FOR THE ENTIRE GROUP OF NEBRASKA HEALTH SYSTEM ENTITIES. HER HOURS HAVE BEEN ALLOCATED ACROSS THE ORGANIZATION. |
| FORM 990, PART IX, LINE 11G | CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 4,241,980. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,241,980. BILLING SERVICE FEES: PROGRAM SERVICE EXPENSES 238,674. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 238,674. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 32,377. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 32,377. |
| FORM 990, PART XI, LINE 9: | MINIMUM PENSION LIABILITY ADJUSTMENT 62,337,048. TRANSFERS TO AFFILIATES -2,137,358. BENEFICIAL INTEREST IN NET ASSETS OF THE FOUNDATION 89,265,593. |
| FORM 990, PART X, LINE 20 | BOND LIABILITIES SHOWN ON THE NEBRASKA METHODIST HEALTH SYSTEM BOOKS AND RECORDS WERE INCLUDED AS PART OF THE REFUNDING PORTION OF THE HOSPITAL AUTHORITY NO. 3 OF DOUGLAS COUNTY, NEBRASKA ISSUE DATED 5/20/2008. THIS BOND ISSUE IS REPORTED ON SCHEDULE K OF THE NEBRASKA METHODIST HOSPITAL FORM 990. |
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Affiliated Group Business Name:
NEBRASKA METHODIST HOSPITAL Address. Either US or Foreign Type:
8511 W DODGE ROAD
OMAHA,
NE
68114
EIN:
47-0376604 Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
23,245
Total Lobbying Expenditures:
23,245
Other Exempt Purpose Expenditures:
428,666,028
Total Exempt Purpose Expenditures:
428,689,273
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|
|
Affiliated Group Business Name:
NEBRASKA METHODIST HEALTH SYSTEM Address. Either US or Foreign Type:
8511 W DODGE ROAD
OMAHA,
NE
68114
EIN:
47-0639839 Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
48,000
Total Lobbying Expenditures:
48,000
Other Exempt Purpose Expenditures:
44,445,835
Total Exempt Purpose Expenditures:
44,493,835
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
|