Form990
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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 private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 07-01-2014 , and ending 06-30-2015
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 province, country, and ZIP or foreign postal code
LINCOLN, NE685062134
D Employer identification number

47-0439599
E Telephone number

G Gross receipts $ 110,951,098
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
subordinates?
H(b)
Are all subordinates
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 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 14
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 1,796
6 Total number of volunteers (estimate if necessary) ............. 6 352
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) ......... 1,000,659 1,023,990
9 Program service revenue (Part VIII, line 2g) ......... 106,209,751 109,088,431
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,544,569 838,677
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)................... 111,754,979 110,951,098
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) 70,227,794 73,481,184
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–24e).... 25,830,385 26,738,733
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 96,058,179 100,219,917
19 Revenue less expenses. Subtract line 18 from line 12....... 15,696,800 10,731,181
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 132,190,835 227,794,566
21 Total liabilities (Part X, line 26)............. 17,445,440 106,571,835
22 Net assets or fund balances. Subtract line 21 from line 20..... 114,745,395 121,222,731
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.
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Preparer's signature
Date
PTIN
Firm's name MediumBullet
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Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line 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 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 $ 53,271,139 including grants of $   ) (Revenue $ 70,641,691 )
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 FY2015 MADONNA SERVED 6,518 PATIENTS FROM 23 U.S. STATES. THE HOSPITAL RECEIVED REFERRALS FROM 1,154 PHYSICIANS AND 117 HOSPITALS.THE INPATIENT HOSPITAL PROGRAMS INCLUDE THE LONG TERM CARE HOSPITAL (MLTCH) NOW CALLED MADONNA REHABILITATION SPECIALTY HOSPITAL, (MRSH) AND ACUTE CARE REHABILITATION HOSPITAL (MRH). 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. MADONNA IS ACCREDITED BY CARF FOR THE MOST REHABILITATION PROGRAMS OF ANY HOSPITAL IN NEBRASKA. THESE PROGRAMS ARE:- 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 COMMUNITYMRH DISCHARGED 68 PERCENT OF ITS PATIENTS TO A NON-INSTITUTIONALIZED SETTING; THIS IS BETTER THAN INDUSTRY BENCHMARK OF 63 PERCENT. MRH SERVED AMONG THE MOST SEVERELY IMPAIRED PERSONS IN THE NATION (TOP 1 PERCENT). PATIENT SEVERITY, AS MEASURED BY CASE MIX INDEX, WAS IN THE 81ST PERCENTILE COMPARED TO THE NATIONAL NORM OF 49 PERCENT FOR OTHER REHABILITATION FACILITIES. OF THE PEOPLE SERVED BY MRSH, 42 PERCENT DISCHARGED TO A COMMUNITY SETTING OR ADVANCED TO ACUTE REHABILITATION. THIS SIGNIFICANTLY EXCEEDED THE INDUSTRY BENCHMARK OF 37 PERCENT.MRH LONG TERM OUTCOMESTO TRACK PATIENT GAINS, MADONNA STAFF SURVEYED 213 INDIVIDUALS WITHIN SIX MONTHS TO ONE YEAR AFTER DISCHARGE FROM MRH, A MAJORITY OF WHOM HAD BRAIN INJURY, STROKE OR SPINAL CORD INJURY. OF THESE, 100 PERCENT WERE STILL LIVING IN A COMMUNITY SETTING. SLIGHTLY LESS THAN 24 PERCENT REPORTED A RE-HOSPITALIZATION, WHICH IS CONSISTENT WITH NATIONAL TRENDS OF 22 TO 34 PERCENT. MOST INTERVIEWED WERE RE-HOSPITALIZED FOR REASONS UNRELATED TO THEIR REHABILITATION STAY; 43 PERCENT OF THE TOTAL WERE PLANNED HOSPITAL PROCEDURES. OVERALL, 95 PERCENT OF THOSE CONTACTED REPORTED MAKING IMPROVEMENTS OR MAINTAINING GAINS ACROSS SIX FUNCTIONAL DOMAINS, 92 PERCENT REPORTED SEEING THEIR PRIMARY CARE PHYSICIAN WITHIN THE LAST SIX MONTHS AND 99 PERCENT REPORTED BEING ACTIVELY INVOLVED IN SOME FORM OF ONGOING EXERCISE OR WELLNESS PROGRAM. THE PERCENTAGES OF PEOPLE WHO REPORTED RETURNING TO THEIR LIFE ROLES INCLUDING WORK, SCHOOL, DRIVING, HOMEMAKING AND OTHER ACTIVITIES WERE SIGNIFICANTLY HIGHER THAN NATIONAL TRENDS FOR THIS POPULATION. ONE OF THE WAYS MADONNA ACHIEVES EXCELLENT LONG-TERM OUTCOMES IS BY FOCUSING ON RETURN TO WORK WHEN APPROPRIATE. IN ADDITION TO PROVIDING INCOME, EMPLOYMENT HELPS TO FULFILL BASIC HUMAN NEEDS AND PROMOTES WELL-BEING BY PROVIDING A SENSE OF IDENTITY AND LIFE SATISFACTION. IN MADONNA'S WORK RE-ENTRY PROGRAM, INDIVIDUALS WITH STROKE, BRAIN INJURY, SPINAL CORD INJURY OR OTHER NEUROLOGICAL OR ORTHOPEDIC IMPAIRMENTS WORK TO MASTER THE PHYSICAL AND COGNITIVE SKILLS NEEDED FOR THEIR SPECIFIC JOB. THE PROGRAM PROGRESSES FROM A CLINICAL SETTING TO VOLUNTEER WORK TRIALS THAT RESEMBLE REAL JOBS. THIS PROCESS BEGINS EARLY IN A PATIENT'S TREATMENT PROGRAM AND CONTINUES THROUGH OUTPATIENT TREATMENT. INDIVIDUALS INVOLVED IN THE PROGRAM VOLUNTEER IN THE BEAUTY SHOP, PURCHASING, CENTRAL SUPPLY, THE CAFETERIA AND IN VARIOUS CLERICAL POSITIONS. AS A RESULT OF THIS PROGRAM, MANY INDIVIDUALS HAVE SUCCESSFULLY TRANSITIONED BACK TO WORK.HIGHLIGHTS- THE REHABILITATION HOSPITAL ACHIEVED EXCEPTIONAL CLINICAL OUTCOMES THIS YEAR. MRH SERVED AMONG THE MOST MEDICALLY COMPLEX PERSONS IN THE NATION (TOP 1 PERCENT). PATIENT SEVERITY, AS MEASURED BY CASE MIX INDEX, WAS IN THE 99TH PERCENTILE COMPARED TO THE NATIONAL AVERAGE FOR OTHER REHABILITATION FACILITIES. DESPITE THE MEDICAL COMPLEXITY OF PERSONS SERVED, 75 PERCENT OF PATIENTS DISCHARGED TO COMMUNITY SETTINGS, EXCEEDING THE INDUSTRY BENCHMARK OF 68 PERCENT. ALSO IMPRESSIVE, GIVEN THE EXTREME SEVERITY OF THE CASE MIX, MRH RANKED IN THE TOP FOUR PERCENT IN THE NATION AT PREVENTING RETURNS TO ACUTE CARE 30 DAYS POST DISCHARGE. - MRH CONTINUES TO MAKE STRIDES TOWARD A FULLY ELECTRONIC MEDICAL RECORD. INPATIENT AND OUTPATIENT THERAPY WORKGROUPS, INCLUDING ITS CLINICAL ANALYSTS, DESIGNED AND BUILT COMPONENTS OF ELECTRONIC ASSESSMENTS WITH GO LIVE FOR INPATIENT AND OUTPATIENT NEUROPSYCHOLOGY DEPARTMENTS, IN ADDITION TO INPATIENT RECREATION THERAPY.- MRH RECEIVED FULL, THREE-YEAR (THE BEST POSSIBLE) CERTIFICATIONS FROM COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF) INTERNATIONAL. CARF AWARDED EIGHT SEPARATE THREE-YEAR CERTIFICATIONS TO THE REHAB HOSPITAL WITH ANOTHER THIRTEEN CERTIFICATIONS GOING TO OTHER MADONNA BUSINESS LINES. - MRH BEGAN ROLLING OUT STUDER GROUP TOOLS AND PRINCIPLES. CONSISTENTLY EMPLOYING ALL THE PRINCIPLES IN THE PROGRAM IS GEARED TO INCREASE EMPLOYEE AND LEADER ACCOUNTABILITY, LEADING TO EVEN HIGHER QUALITY CARE AND CUSTOMER SERVICE. A NUMBER OF FRONT-LINE HOSPITAL STAFF MEMBERS AND HOSPITAL LEADERS ARE SERVING ON VARIOUS STUDER COMMITTEES THAT WERE LAUNCHED IN FY 2015. - THE NEURO-TECHNOLOGY CLINICAL INNOVATION TEAM, AS PART OF THE BRAIN TRUST INITIATIVE, LAUNCHED INITIATIVES TO MAXIMIZE USE AND BENEFITS OF CURRENT TECHNOLOGY AND TO BRING NEW TECHNOLOGY, WITH EMPHASIS ON NEUROPLASTICITY, TO MADONNA. THE GROUP CREATED A GAIT TECHNOLOGY PROGRESSION PROTOCOL AND BEGAN WORK ON CREATING UPPER EXTREMITY ROBOTIC TECHNOLOGY PROGRESSION PROTOCOLS WITH COGNITIVE TECHNOLOGY PROGRESSIONS EXPECTED TO FOLLOW.
4b (Code:   ) (Expenses $ 21,203,646 including grants of $   ) (Revenue $ 22,900,845 )
ST. JANE DE CHANTAL (ST. JANE) COMPRISES A 38-BED VENTILATOR AND SPECIAL CARE UNIT (VAU/SN), A 21-BED TRANSITIONAL CARE REHABILITATION UNIT (TCU) AND A 66-BED NURSING HOME. IN ADDITION, THERE IS AN EIGHT-BED ASSISTED LIVING UNIT FOR YOUNG ADULTS WITH HIGH ACUITY SPECIAL CARE NEEDS. THE FACILITY PROVIDES SPECIALIZED SERVICES UNDER CONTRACT FOR THE STATE OF NEBRASKA AND THE VETERANS ADMINISTRATION. ST. JANE OFFERS A HOLISTIC APPROACH TO CARE, EMPHASIZING THE MIND, BODY AND SPIRIT IN A WELCOMING, CARING ENVIRONMENT FOCUSED ON IMPROVING OR MAINTAINING THE HEALTH AND WELL-BEING OF ITS RESIDENTS. FY 2015 CONTINUED TO FOCUS ON RESIDENT-CENTERED CARE WITH A REMODELING PROJECT AND THE COMPLETION OF NEW FURNITURE AND TELEVISIONS FOR THE RESIDENT ROOMS. ST. JANE CONTINUES TO OFFER AROMATHERAPY AND A "QUIET ZONE" THAT CONTRIBUTES TO DECREASED STIMULATION FOR STAFF AND RESIDENTS. BOTH BATHING AREAS FEATURE A NEW RESIDENT BATHING SYSTEM INCLUDING A TELEVISION FOR CALMING VIDEOS AND MUSIC THERAPY DURING BATHS.HIGHLIGHTS- THE ORGANIZATION ENCOURAGES THE RESIDENTS TO PARTICIPATE IN COMMUNITY EVENTS AND HAS BEEN INNOVATIVE IN RECENTLY ASSISTING THE RESIDENTS TO GO FISHING, ATTEND MOVIE OPENINGS, AND ATTEND A ROLLER DERBY. THE ORGANIZATION HAS BEEN CREATIVE WITH PROGRAMMING REGARDING THE EMPLOYEE AWARDS DINNER BY INCLUDING THE RESIDENTS IN PARTICIPATION AND PLANNING INTEGRATED PROGRAMS, SUCH AS SPA DAY, IN ADVANCE OF THE CEREMONY." -QUOTE FROM MADONNA'S 2015 CARF SURVEY REPORT- IN APRIL OF FY 2015, ST. JANE EARNED A THREE-YEAR CARF ACCREDITATION FOR INPATIENT REHABILITATION FOR TCU AND PERSON-CENTERED LONG TERM CARE COMMUNITY FOR THE NURSING HOME. ST. JANE REMAINS THE ONLY NURSING FACILITY IN NEBRASKA TO HAVE EARNED THIS LEVEL OF ACCREDITATION. - THE ST. JANE TEAM CONTINUES TO FOCUS ON INCREASING NON-PHARMACOLOGIC APPROACHES TO MINIMIZE PAIN AND ANXIETY ASSOCIATED WITH AGING AND GERIATRIC MEDICAL ISSUES. COMPONENTS INCLUDE AROMATHERAPY, HAND MASSAGE, COMFORT TOUCH , CHAIR YOGA, FAR INFRARED HEAT, DRUM CIRCLES, WEIGHTED BLANKETS AND LIFE CELEBRATIONS. MADONNA USES THESE APPROACHES IN A CULTURE THAT VALUES THE RIGHTS, DIGNITY AND EMPOWERMENT OF ELDERS. STAFF TRAINING CONTINUED ON THE TECHNIQUES OF PROVIDING COMFORT TOUCH TO RESIDENTS IN ALL PROGRAMS. A HOLISTIC INTERVENTION STATION CONTINUED TO BE A PART OF THE NURSE AIDE COMPETENCY TRAINING IN JUNE 2015, PROVIDING EDUCATION TO MORE THAN 150 NURSES, NURSE AIDES AND MEDICATION AIDES ON THE USE OF NON PHARMACOLOGIC INTERVENTIONS. - ACCESS TO THE OUTDOORS CONTINUED TO BE PART OF HOLISTIC CARE. STAFF VOLUNTEERS PLANTED A BUTTERFLY GARDEN WITH PERENNIALS AND FLOWERING SHRUBS OUTSIDE OF THE VAU/SN UNIT, PROVIDING AN ATTRACTIVE VIEW FROM RESIDENT WINDOWS AND THE LOUNGE. RESIDENTS HELPED WATER AND CARE FOR THE RAISED PORTION OF THE GARDEN. RESIDENTS AGREED THAT THE FACILITY MET ITS GOAL TO IMPROVE VISUAL QUALITY OF THE VAU. - STAFF AT ST. JANE REMAINED INVOLVED WITH GREAT PLAINS QUALITY CARE COLLABORATIVE (GPQCC) AND IS HIGHLY RESPECTED BY OTHER LONG TERM CARE FACILITIES THROUGHOUT THE STATE OF NEBRASKA. STAFF MEMBERS PRESENTED "HOLISTIC INTERVENTIONS IN LONG TERM CARE" AT THE NEBRASKA HEALTHCARE QUALITY FORUM IN MAY 2015. STAFF MEMBERS ALSO PREPARED A STORYBOARD ON THE TOPIC OF "CULTURE OF SAFETY" AT THE GREAT PLAINS QUALITY INNOVATION NETWORK, IN JUNE 2015. CMS QUALITY INITIATIVES ON MARCH 29, 2012, CMS (CENTERS FOR MEDICARE AND MEDICAID SERVICES) LAUNCHED A NEW INITIATIVE AIMED AT IMPROVING BEHAVIORAL HEALTH AND SAFEGUARDING NURSING HOME RESIDENTS FROM UNNECESSARY ANTIPSYCHOTIC DRUG USE. AS PART OF THE INITIATIVE, CMS DEVELOPED A NATIONAL ACTION PLAN REQUIRING USE OF A MULTIDIMENSIONAL APPROACH, INCLUDING PUBLIC REPORTING, RAISING PUBLIC AWARENESS, REGULATORY OVERSIGHT, TECHNICAL ASSISTANCE/TRAINING AND RESEARCH. THE ACTION PLAN STRIVES TO ENHANCE PERSON-CENTERED CARE FOR NURSING HOME RESIDENTS, PARTICULARLY THOSE WITH DEMENTIA-RELATED BEHAVIORS. INSTEAD OF SETTING A TARGET RATE, CMS SET A GOAL OF REDUCING ANTIPSYCHOTIC DRUG UTILIZATION. IN RESPONSE, ST. JANE ESTABLISHED A COMMITTEE TO MONITOR AND ANALYZE ANTIPSYCHOTIC DRUG UTILIZATION TO MEET OR EXCEED THIS GOAL. THE COMMITTEE SET A GOAL OF REDUCING ANTIPSYCHOTIC DRUG USE TO 12 PERCENT OR LOWER FOR THE ST. JANE PATIENT POPULATION. THE GOAL WAS MET ALL FOUR QUARTERS WITH THE YTD AVERAGE OF 11 PERCENT. THE COMMITTEE CONTINUES TO MEET EACH MONTH TO REVIEW EACH RESIDENT AND IDENTIFY OPPORTUNITIES TO REDUCE EVEN FURTHER THAN THE TARGETED GOAL.CMS ALSO LAUNCHED PROGRAMS TO SUPPORT THE PARTNERSHIP FOR PATIENTS' GOAL OF REDUCING HOSPITAL READMISSION RATES. TO REDUCE HOSPITAL READMISSIONS FROM THE FACILITY, ST. JANE PARTICIPATED IN A PROGRAM TO REDUCE RETURNS TO ACUTE CARE. THIS QUALITY IMPROVEMENT PROGRAM FOCUSED ON THE MANAGEMENT OF ACUTE CHANGE IN RESIDENT CONDITION. IT INCLUDED CLINICAL AND EDUCATIONAL TOOLS AND STRATEGIES FOR USE IN EVERYDAY PRACTICE IN LONG-TERM CARE FACILITIES. DURING FY 2015, TCU'S UNPLANNED RETURN TO ACUTE CARE (RTAC) RATE TOTALED 8 PERCENT. THE RATES FOR ST. JANE ARE FAR BELOW THE AVERAGE RTAC FOR NEBRASKA, WHICH RANGES FROM 18 PERCENT TO 21 PERCENT. THE LOWER RETURN RATE IS DUE TO A FOCUSED PROGRAM, HIGHER NURSE STAFFING LEVELS AND COLLABORATION WITH MADONNA'S PHARMACISTS AND MEDICAL STAFF.
4c (Code:   ) (Expenses $ 7,612,013 including grants of $   ) (Revenue $ 7,378,394 )
MADONNA THERAPYPLUS IS COMMITTED TO PROVIDING EXCELLENT PATIENT CARE FOR OUTPATIENT REHABILITATION. THERAPYPLUS OFFERS A RANGE OF REHABILITATION SERVICES FROM SPORTS INJURIES AND SINGLE SERVICE ORTHOPEDIC SPRAINS, STRAINS AND POST-OPERATIVE CARE TO COMPREHENSIVE REHABILITATION FOR NEUROLOGICAL CONDITIONS.THERAPYPLUS INCLUDES THE FIT FOR WORK PROGRAM, WHICH COMBINES OCCUPATIONAL HEALTH, WELLNESS, SAFETY AND COORDINATION OF WORKERS' COMPENSATION WITH THE EXPERT SERVICES CONVENIENTLY AVAILABLE FROM MADONNA REHABILITATION HOSPITAL, MADONNA THERAPYPLUS OUTPATIENT CLINICS AND MADONNA PROACTIVE.HIGHLIGHTSMADONNA THERAPYPLUS COMPLETED A SUCCESSFUL YEAR WITH REFERRAL GROWTH, STRONG CLINICAL OUTCOMES, ADVANCED CLINICIAN TRAINING AND EXCELLENT CUSTOMER SATISFACTION RATINGS. ACHIEVEMENTS INCLUDE:- VOTED NUMBER ONE FOR PHYSICAL THERAPY IN THE KFOR BEST OF LINCOLN PUBLIC SURVEY FOR THE 10TH YEAR SINCE 2004. VOTED NUMBER ONE IN PHYSICAL THERAPY IN THE LINCOLN JOURNAL STAR LINCOLN'S CHOICE AWARDS FOR THE SECOND YEAR SINCE 2014.- SERVED 222 PARTICIPANTS IN THE STRUCTURED INDEPENDENCE PROGRAM. FORTY-TWO PERCENT OF THE PARTICIPANTS JOINED PROACTIVE AFTER COMPLETING THIS PROGRAM.- A SUCCESSFUL CARF SURVEY IN APRIL RESULTED IN NO DEFICIENCIES OR RECOMMENDATIONS IN THE COMPREHENSIVE OUTPATIENT STANDARDS. - FIT FOR WORK SUCCESSFULLY INCREASED CORPORATE CLIENTS AND PROACTIVE MEMBERSHIPS. HIGHLIGHTS INCLUDE: - GAINED 355 NEW PROACTIVE CORPORATE MEMBERS, 23 INJURY CLIENTS AND 16 WELLNESS COMPANIES. - MADE 75 REFERRALS FOR PHYSICAL THERAPY AND RESPONDED TO 515 CALLS REGARDING INJURIES THROUGH THE CORPORATE SERVICE HOTLINE. - EXPANDED OPPORTUNITIES TO ENABLE EMPLOYERS TO BETTER USE THEIR PREVENTATIVE SERVICE BENEFITS BY SUBMITTING MEDICAL CLAIMS FOR FLU VACCINES AND LAB PROFILES INCLUDING VITAMIN D SCREENING. THERAPYPLUS CLINICIANS DID AN EXCELLENT JOB OF PROVIDING QUALITY PATIENT CARE TO MAXIMIZE OUTCOMES DESPITE THE DECREASED VISIT UTILIZATION ALLOWANCE FOR MEDICARE AND TIGHTER AUTHORIZATION REQUIREMENTS BY MANY INSURANCE PAYORS. CHANGES IN OUTPATIENT INSURANCE BENEFITS, INCLUDING INCREASING CONTRACTUAL ADJUSTMENTS, VISIT LIMITATIONS AND THE EXTENSION OF THE MEDICARE THERAPY CAPS, AFFECTED OUTCOMES AND FINANCIAL SUCCESS. PATIENTS ALSO SELF-LIMITED SERVICES DUE TO HIGH CO-PAYS AND DEDUCTIBLES. GROWTH IN NET REVENUE IS ATTRIBUTED TO THE 6 PERCENT INCREASE IN PATIENTS SERVED.COMPLETED THROUGH THE PATIENT ASSESSMENT, THE FUNCTIONAL ASSESSMENT MEASURE (FAM) TOOL DETERMINES CLINICAL OUTCOMES IN VARIOUS FUNCTIONAL AREAS FOR PATIENTS WITH NEUROLOGICAL DIAGNOSES. RESULTS DECREASED BY 1.0 COMPARED TO FY 2014. THE LIMITED SENSITIVITY OF THE FAM TOOL CONTRIBUTED TO A CEILING EFFECT IN FY 2015 WITH ADMISSION SCORES 1.27 POINTS HIGHER AND DISCHARGE SCORES 1.16 POINTS HIGHER COMPARED TO THE PREVIOUS FISCAL YEAR. THIS PROVIDED LESS POTENTIAL FOR IMPROVEMENT AS MEASURED ON THE FAM.
(Code:   ) (Expenses $ 7,528,247 including grants of $   ) (Revenue $ 8,167,501 )
OTHER PROGRAMS INCLUDE MADONNA PROACTIVE WHICH IS LINCOLN'S FIRST MEDICALLY BASED HEALTH, FITNESS AND WELLNESS FACILITY AND THE FIRST TO BE BASED ON A REHABILITATION MODEL. PROACTIVE PROVIDES MEDICAL, THERAPEUTIC AND EDUCATIONAL FITNESS AND WELLNESS EXPERTISE IN ADDITION TO THE LATEST RESEARCH AND TECHNOLOGY.THE GOAL OF PROACTIVE IS TO MEET PEOPLE WHERE THEY ARE REGARDLESS OF AGE OR ABILITY AND HELP THEM TO BECOME THE VERY BEST THAT THEY CAN BE.HIGHLIGHTS- A COMBINATION OF CARDIO AND AQUATIC THERAPY HELPS TO MOVE MY MUSCLES AND STRETCH THEM TO LESSEN THE SPASMS AND INVOLUNTARY MOVEMENTS. IT IS CONVENIENT TO HAVE SOTERIA MASSAGE ADJACENT TO THERAPYPLUS WITHIN PROACTIVE. ALL THREE OFFER A WELCOMING ENVIRONMENT. THE FACILITIES ARE CLEAN AND WELL MAINTAINED AND THE STAFF TRULY CARES ABOUT ITS CLIENTELE." - SANDY DANEK, PROACTIVE MEMBER AND CLIENT OF THERAPYPLUS AND SOTERIA.- PROACTIVE'S ANNUAL TOTAL MEMBERSHIP ACHIEVED NEW SUCCESS OPERATING WITH MORE THAN 4,000 PARTICIPANTS. RETENTION EFFORTS ALONG WITH NEW MEMBER GROWTH SUPPORTED THIS ACHIEVEMENT.- A NEW MEDICAL MEMBERSHIP AT PROACTIVE ENCOURAGED THERAPYPLUS PATIENTS TO STAY ACTIVE WITH THEIR MEMBERSHIP WHILE ACTIVELY INVOLVED IN REHABILITATION.- PROACTIVE PARTNERED WITH THE AMERICAN HEART ASSOCIATION AND THE CHI HEALTH NEBRASKA HEART FOR THE BETTER U CHALLENGE. A PROACTIVE TEAM SELECTED FOUR FEMALE PARTNERS FROM THE COMMUNITY AND SUPPORTED THEM THROUGH A 12-WEEK WELLNESS PROGRAM INCLUDING PERSONAL TRAINING, NUTRITION COUNSELING, WELLNESS COACHING AND WEEKLY EDUCATION SESSIONS. PARTICIPANTS LOST A GROUP TOTAL OF 78 POUNDS.- THE LIFE BALANCE FOR HEART/CARDIAC REHAB PROGRAM GRADUATED 81 AND COMPLETED 1,793 VISITS, AN 11 PERCENT INCREASE FROM 1,620 LAST YEAR. IN ADDITION, CARDIAC REHAB BEGAN SERVING PATIENTS WHO RECEIVED A LEFT VENTRICULAR SUPPORT DEVICE. - INTEGRATIVE MEDICINE CLASSES INCLUDED PERSONAL CONSULTATION SESSIONS AND CLASSES FOR SPECIFIC MEDICAL CONDITIONS. PROACTIVE OFFERED A VARIETY OF MEDITATION AND STRESS MANAGEMENT CLASSES TO COMPLEMENT A DIVERSIFIED YOGA PROGRAM. A TOTAL OF 168 NUTRITIONAL COUNSELING SESSIONS, CONDUCTED BY PROACTIVE'S DIETITIAN, PROVIDED NUTRITIONAL GUIDANCE FOR INDIVIDUALS WITH A WIDE RANGE OF HEALTH AND WELLNESS CONCERNS.- FOUR INDIVIDUALS ENROLLED IN THE COMPREHENSIVE WEIGHT MANAGEMENT CLASS "HEALTHIER WEIGH." PARTICIPANTS LOST A TOTAL 36.2 POUNDS. MANY OF THE PARTICIPANTS ALSO SAW DECREASED BLOOD PRESSURE AND TOTAL CHOLESTEROL IMPROVEMENTS.- PROACTIVE FITNESS TRAINERS AND DIETITIANS PROVIDED 222 MEDICAL FITNESS AND NUTRITION EVALUATIONS/SESSIONS FOR PRE-BARIATRIC SURGERY PATIENTS TO ENSURE THEY HAD THE NECESSARY KNOWLEDGE AND PLANNING TO MAINTAIN WEIGHT LOSS POST-SURGERY.- PROACTIVE GROUP FITNESS EXPANDED OFFERINGS TO REACH MEDICAL NEEDS OF CLIENTS. NEW CLASSES INCLUDED: TAI CHI FOR PARKINSON'S, QI GONG, YOGA ON THE HILL AND BIG GRAD CLASS. IN ADDITION, SEVERAL SPECIAL WORKSHOPS INCLUDED YOGA, TAI CHI FOR BALANCE AND HALF-MARATHON TRAINING. - SOTERIA STAFF PROVIDED 4,009 MASSAGES AT PROACTIVE, THE MAIN CAMPUS HOSPITAL AND OFFSITE CLINIC LOCATIONS. SOTERIA ALSO COLLABORATED WITH THE INTEGRATIVE HEALTH GROUP MEMBERS TO PROMOTE AND EDUCATE ON THE BENEFITS OF MASSAGE TO NURSING STAFF AND THE GENERAL PUBLIC. - PROACTIVE FITNESS STAFF PROVIDED 9,256 PERSONAL TRAINING SESSIONS TO 596 MEMBERS. THE FITNESS STAFF IMPLEMENTED A NEW SMALL GROUP TRAINING FORMAT WITH POSITIVE INITIAL SUCCESS.- CHASE DANCE AT PROACTIVE IMPLEMENTED WORKSHOPS WITH ADAPTIVE DANCERS FROM AGES 8-19 THROUGHOUT THE DANCE SEASON ALONGSIDE THE CONTINUATION OF DANCE CLASSES FOR ALL AGES AND ABILITIES. THE SEASON OFFERED PERFORMANCE OPPORTUNITIES FOR THE ADAPTIVE DANCERS. - THE SPRING DANCE RECITAL ACHIEVED RECORD HIGH REVENUE FOR TICKET SALES. IN ADDITION TO THE DANCE CLASS STUDENTS, THE ADAPTIVE DANCERS AND THE SENIOR MEMBER TAP GROUPS PERFORMED.- PROACTIVE SPORTS PERFORMANCE SERVED 379 ATHLETES AND DELIVERED 4,725 SESSIONS. MULTIPLE HIGH SCHOOL-AGED PROACTIVE SPORTS PERFORMANCE ATHLETES ACCEPTED SPORTS SCHOLARSHIP OFFERS FROM NCAA DIVISION I, II AND III COLLEGES AND NAIA COLLEGIATE SPORTS PROGRAMS.SPORTS PERFORMANCE IMPLEMENTED A NEW SERVICE OF RUNNING EVALUATIONS FOR MEMBERS, COMMUNITY MEMBERS AND ATHLETES.
4d Other program services (Describe in Schedule O.)
(Expenses $ 7,528,247 including grants of $   ) (Revenue $ 8,167,501 )
4e Total program service expensesMediumBullet89,615,045
Form 990 (2014)
Form 990 (2014)
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 (see instructions)? 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, or have a section 501(h) election in effect during the tax year? 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 for escrow or custodial account liability; 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, line 10?
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 VIIClick 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 VIIIClick 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 IXClick 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 XClick 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 XClick 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 and XII 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 and XII 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, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions) ....
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 hospital facilities? 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 statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government 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 or other assistance to or for domestic individuals 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, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................ 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), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I.... Click to see attachment
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................... Click to see attachment
25b
 
No
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes," complete Schedule L, Part II................ Click to see attachment
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......... Click to see attachment
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 .......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If "Yes,"
complete Schedule L, Part IV..................... Click to see attachment
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 direct or indirect owner? If "Yes," complete Schedule L, Part IV... Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..Click to see attachment
29
 
No
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, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
68
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
1,796
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” to line 3b, 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, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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 as charitable contributions?...
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
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 or note to any line 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 .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
14
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 this 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, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletVICTOR WITKOWICZ

5401 SOUTH STREET
LINCOLN,NE685062134 (402) 413-3000
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) LYNN ROPER........................................................................
CHAIRPERSON
 1.00
.......................   		X   X       0 0 0
(2) TOM SMITH........................................................................
VICE CHAIRPERSON
 1.00
.......................   		X   X       0 0 0
(3) DAN TOMES MD........................................................................
SECRETARY
 1.00
.......................   		X   X       0 0 0
(4) FR JOHN SULLIVAN........................................................................
VICE PRESIDENT
 1.00
.......................   		X   X       0 0 0
(5) RICH HERINK........................................................................
TREASURER
 1.00
.......................   		X   X       0 0 0
(6) CAROL BERAN........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(7) JOHN BERGMEYER........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(8) MARK FAHLESON........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(9) JIM SCHULZ........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(10) DR WILLIAM THORELL........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(11) DR ELIZABETH NOORDHOEK........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(12) LISA SMITH........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(13) MIKE MCCRORY........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(14) WILL SCOTT........................................................................
MEMBER
 1.00
.......................   		X           0 0 0
(15) MARSHA LOMMEL........................................................................
PRESIDENT AND CEO
 40.00
.......................   		X   X       732,434 0 46,198
(16) VICTOR WITKOWICZ........................................................................
SR. VICE PRESIDENT-CFO
 40.00
.......................   		    X       406,454 0 38,507
(17) PAUL DONGILLI........................................................................
EXECUTIVE VP-COO
 40.00
.......................   		    X       410,872 0 36,025
Form 990 (2014)
Form 990 (2014)
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 (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) DR THOMAS STALDER........................................................................
VP OF MEDICAL AFFAIRS/CHIEF MEDICAL OFFICER
 20.00
.......................   		    X       189,687 0 9,916
(19) CHARLES DAVID ROLFE........................................................................
CHIEF INFORMATION OFFICER
 40.00
.......................   		    X       184,471 0 13,064
(20) SUSAN K KLANECKY........................................................................
VP PATIENT CARE
 40.00
.......................   		    X       171,193 0 13,867
(21) CHRISTOPHER A LEE........................................................................
VICE PRESIDENT REHABILITATION
 40.00
.......................   		    X       170,899 0 13,801
(22) LINDA S SULLIVAN........................................................................
VICE PRESIDENT REFERRAL RE
 40.00
.......................   		    X       159,933 0 7,768
(23) LYNN R HALLOWELL-GOTTSLEBEN........................................................................
VICE PRESIDENT THERAPY PLU
 40.00
.......................   		    X       171,729 0 14,761
(24) MORGAN L LAHOLT........................................................................
STAFF PHYSIATRIST
 40.00
.......................   		        X   403,951 0 7,867
(25) ADAM T KAFKA........................................................................
STAFF PHYSIATRIST
 40.00
.......................   		        X   383,367 0 7,635
(26) PAUL L KRABBENHOFT........................................................................
STAFF PHYSIATRIST
 40.00
.......................   		        X   285,181 0 10,495
(27) ANA DELGADO........................................................................
STAFF NEUROLOGIST
 40.00
.......................   		        X   208,421 0 4,543
(28) JIAXIN TRAN........................................................................
STAFF PHYSIATRIST
 40.00
.......................   		        X   185,202 0 3,043




1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,063,794 0 227,490
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet47
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 1,034,129
DLR GROUP

6457 FRANCES ST STE 200
OMAHA,NE68106 		ARCHITECT SERVICES 801,831
DIALYSIS CENTER OF LINCOLN

7910 O STREET
OMAHA,NE685102500 		MEDICAL SERVICES 466,591
BRYAN LGH EAST

1600 SOUTH 48TH STREET
LINCOLN,NE685061299 		MEDICAL SERVICES 382,523
WORK USA LINCOLN

140 S 27TH ST STE C
LINCOLN,NE68510 		STAFFING SERVICES 328,361
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet14
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 881,533
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		142,457
g Noncash contributions included in lines
1a-1f:$ 		18,452
h Total. Add lines 1a-1f.......MediumBullet 1,023,990
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE, NET 900099 70,641,691 70,641,691    
b LONG-TERM CARE 900099 22,900,845 22,900,845    
c OUTPATIENT 900099 7,378,394 7,378,394    
d MEDICAL FITNESS CENTER 900099 3,911,021 3,911,021    
e
f All other program service revenue . 4,256,480 4,256,480    
g Total. Add lines 2a–2f........MediumBullet 109,088,431
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 838,677     838,677
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 110,951,098 109,088,431 0 838,677
Form 990 (2014)
Form 990 (2014)
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).Check if Schedule O contains a response or note to any line 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 domestic organizations and domestic governments. See Part IV, line 21 ....    
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ....    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............    
4 Benefits paid to or for members ....    
5 Compensation of current officers, directors, trustees, and key employees .... 2,597,672   2,597,672  
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 .... 57,857,975 54,273,170 3,584,805  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 2,971,132 2,899,937 71,195  
9 Other employee benefits ....... 5,975,274 5,393,073 582,201  
10 Payroll taxes ........... 4,079,131 3,698,567 380,564  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 145,148 48,724 96,424  
c Accounting ........... 59,150   59,150  
d Lobbying ........... 38,535   38,535  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 88,563   88,563  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 5,268,127 5,221,033 47,094  
12 Advertising and promotion .... 907,750 187,925 719,825  
13 Office expenses ....... 9,706,148 9,475,012 231,136  
14 Information technology ...... 989,197 379,930 609,267  
15 Royalties ..        
16 Occupancy ........... 2,031,984 1,945,101 86,883  
17 Travel ............ 311,865 271,412 40,453  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 240,450 234,823 5,627  
20 Interest ........... 53,217 53,217    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 5,512,839 4,252,191 1,260,648  
23 Insurance .............. 513,049 513,049    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MISCELLANEOUS 872,711 767,881 104,830  
b
c
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 100,219,917 89,615,045 10,604,872 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 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing .............   1  
2 Savings and temporary cash investments ......... 12,196,917 2 18,983,669
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 20,099,284 4 26,124,072
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 750,517 8 854,822
9 Prepaid expenses and deferred charges .......... 875,720 9 836,899
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 134,505,615
b Less: accumulated depreciation ..... 10b 65,239,136 44,323,003 10c 69,266,479
11 Investments—publicly traded securities .......... 45,160,544 11 110,407,256
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 ........... 8,784,850 15 1,321,369
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 132,190,835 16 227,794,566
Liabilities 17 Accounts payable and accrued expenses ......... 14,605,848 17 19,476,542
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities ............. 1,406,105 20 85,597,230
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other 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.................... 1,433,487 25 1,498,063
26 Total liabilities. Add lines 17 through 25......... 17,445,440 26 106,571,835
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 114,705,606 27 121,217,797
28 Temporarily restricted net assets ........... 39,789 28 4,934
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 114,745,395 33 121,222,731
34 Total liabilities and net assets/fund balances ........ 132,190,835 34 227,794,566
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
110,951,098
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
100,219,917
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
10,731,181
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
114,745,395
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-4,253,845
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
121,222,731
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(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 listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.)..            
11 Total support Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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 VI.) ..            
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) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2014 		(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2015. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the 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 its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
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


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
MADONNA REHABILITATION HOSPITAL
  		Employer identification number

47-0439599
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

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 Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), 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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) Total
2a Lobbying nontaxable 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) 2014


Schedule C (Form 990 or 990-EZ) 2014
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)
No
Yes
(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
 
66,442
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
38,585
j
Total. Add lines 1c through 1i ...............................
105,027
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
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
PART II-B, LINE 1: MADONNA REHABILITATION HOSPITAL ("MADONNA") HAS RETAINED THE LOBBYING SERVICES OF A LOCAL LOBBYING FIRM TO MONITOR LEGISLATION AT THE STATE LEVEL IN NEBRASKA IMPACTING NEBRASKA HOSPITALS AND LONG TERM CARE FACILITIES GENERALLY, AND MADONNA SPECIFICALLY. MADONNA IS A MEMBER OF THE NEBRASKA HOSPITAL ASSOCIATION ("NHA"). AS PART OF ITS ACTIVITIES, THE NHA PROVIDES LOBBYING SERVICES AND MONITORS STATE LEGISLATION OF CONCERN TO ITS MEMBERS. ON THE NATIONAL LEVEL, MADONNA IS A MEMBER OF THE AMERICAN REHABILITATION PROVIDERS ASSOCIATION ("AMRPA") AND THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS ("NALTH"). AMONG OTHER SERVICES PROVIDED TO ITS MEMBERS, AMRPA AND NALTH LOBBY AND MONITOR FEDERAL LEGISLATION ON BEHALF OF THEIR MEMBERS. ADDITIONALLY, MADONNA HAS UTILIZED THE SERVICES OF HEARTLAND STRATEGY GROUP, LLC, FOR CERTAIN LOBBYING SERVICES AT THE FEDERAL LEVEL IMPACTING MADONNA'S INTERESTS.
Schedule C (Form 990 or 990EZ) 2014

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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 value of contributions to (during year)    
3 Aggregate value of 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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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)
Revenue 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
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (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 current year end balance (line 1g, column (a)) 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 XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 .................   8,794,448 8,794,448
b Buildings ................   74,342,960 30,010,472 44,332,488
c Leasehold improvements ............        
d Equipment ................   49,255,773 33,729,558 15,526,215
e Other .................   2,112,434 1,499,106 613,328
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 69,266,479
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
457 PLANS 914,402
NON-CURRENT PORTION OF WORK COMP 400,000
INVESTMENT IN AFFILIATE 183,661






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,498,063
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 106,281,730
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d -4,669,368
e Add lines 2a through 2d ..................... 2e -4,669,368
3 Subtract line 2e from line 1..................... 3 110,951,098
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 XIII.) ........... 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.) ...... 5 110,951,098
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 100,219,917
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 XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e 0
3 Subtract line 2e from line 1..................... 3 100,219,917
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 XIII.) ............ 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.) ...... 5 100,219,917
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC TOPIC 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, 2015 AND 2014, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED.
PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON INVEST IN AFFILIATE, GRANTS/BEQUESTS FOR PURCHASE OF PLANT & EQUIP -4,669,368.
Schedule D (Form 990) 2014

Additional Data


Software ID:  
Software Version:  




SCHEDULE H (Form 990)
Department of the TreasuryInternal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining 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) .. 		    853,000   853,000 0.850 %
b Medicaid (from Worksheet 3,
column a) .... 		    1,387,000   1,387,000 1.380 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    410,000   410,000 0.410 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		    2,650,000   2,650,000 2.640 %
Other Benefits
     237,000   237,000 0.240 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    154,000   154,000 0.150 %
g Subsidized health services
(from Worksheet 6) .. 		    2,334,000   2,334,000 2.330 %
h Research (from Worksheet 7)     417,000   417,000 0.420 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		           
j Total. Other Benefits ..     3,142,000   3,142,000 3.140 %
k Total. Add lines 7d and 7j .     5,792,000   5,792,000 5.780 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
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 3   143,369   143,369 0.140 %
10 Total 3   143,369   143,369 0.140 %
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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
 
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
21,015,000
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
22,984,000
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-1,969,000
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(owned 10% or more by officers, directors, trustees, key employees, and physicians—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) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?2
Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 MADONNA REHABILITATION HOSPITAL
5401 SOUTH STREET
LINCOLN,NE685062134
WWW.MADONNA.ORG
500005 		X               ACUTE REHABILITATION HOSPITAL A
2 MADONNA LONG TERM CARE HOSPITAL
5401 SOUTH STREET
LINCOLN,NE685062134
WWW.MADONNA.ORG
507001 		X               LONG TERM CARE HOSPITAL A
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		 
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?....................... 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C.......... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12.................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................ 6a   No
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b   No
7 Did the hospital facility make its CHNA report widely available to the public? .............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14
10 Is the hospital facility's most recently adopted implementation strategy posted on a website? ........ 10   No
a If "Yes" (list url):  
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b Yes  
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 12a   No
b If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 12b    
c If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
Financial Assistance Policy (FAP)
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Included measures to publicize the policy within the community served by the hospital facility?....... 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
h
i
Billing and Collections
17 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 all of the actions the hospital facility or other authorized party may take upon non-payment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group  
Yes No
19 Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?......... 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?................ 21   No
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
22 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
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ................................ 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
PART V, SECTION B FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: MADONNA REHABILITATION HOSPITAL, - FACILITY 2: MADONNA LONG TERM CARE HOSPITAL
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: MADONNA USES MULTIPLE AVENUES TO COLLECT DATA REGARDING THE NEEDS OF ITS COMMUNITY, INCLUDING PATIENT SATISFACTION SURVEYS, MEETING MINUTES FROM LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS, CAPITAL CAMPAIGN REQUESTS AND OTHER DATA SOURCES. THIS IS AN ONGOING PROCESS THAT IS INTEGRATED INTO STRATEGIC PLANNING AND ANNUAL GOAL SETTING. A NEEDS ASSESSMENT QUESTIONNAIRE WAS DISTRIBUTED TO THE COMMUNITY AND THE RESULTS WERE COLLECTED AND ANALYZED IN FISCAL YEAR 2013. THE RESULTS WERE DISCUSSED AT STRATEGIC PLANNING COMMITTEE MEETINGS DURING THE PLANNING PHASES FOR FISCAL YEARS 2014 AND 2015. HOSPITAL LEADERSHIP REGULARLY REVIEWS AND DISCUSSES COMMUNITY NEEDS DURING WEEKLY ADMINISTRATIVE TEAM MEETINGS. MANY OF THESE NEEDS ARE ADDRESSED THROUGH CAPITAL ITEM REQUESTS AND PROGRAMMING UPDATES AND/OR ADDITIONS. ADDITIONALLY, COMMUNITY NEEDS ARE BROUGHT FORTH AND DISCUSSED IN NUMEROUS ORGANIZATIONAL AND INDIVIDUAL MEETINGS AT ALL LEVELS. MADONNA REHABILITATION HOSPITAL EXECUTIVES, MANAGERS AND CLINICIANS ARE ENCOURAGED TO MEET WITH THEIR COUNTERPARTS IN PEER INSTITUTIONS AND TO PURSUE LEADERSHIP POSITIONS IN THEIR AREAS OF EXPERTISE. EACH YEAR, MADONNA STAFF MEMBERS ARE ELECTED AND/OR ARE APPOINTED TO BOARDS, SPECIAL TASK FORCES AND OTHER LEADERSHIP POSITIONS. IN THESE POSITIONS, MADONNA STAFF GETS DIRECT INPUT FROM COLLEAGUES IN AFFILIATED ORGANIZATIONS AND WITH PATIENTS IN THE COMMUNITY SERVED.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11: PURPOSE FOR THE PLANTHIS IMPLEMENTATION STRATEGY (STRATEGY) ADDRESSES THE PRIORITIZED COMMUNITY HEALTH CARE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED FOR THE FISCAL 2013 YEAR AND APPROVED BY THE HOSPITAL'S BOARD OF DIRECTORS. THE PLAN ALSO MEETS THE REQUIREMENTS FOR COMMUNITY BENEFIT PLANNING AS SET FORTH IN SECTION 501(R) OF THE INTERNAL REVENUE CODE (THE "CODE") AS PART OF THE AFFORDABLE CARE ACT. THE CHNA FOR MADONNA REHABILITATION HOSPITAL MAY BE REVIEWED IN ITS ENTIRETY AT WWW.MADONNA.ORG/MY-MADONNA/CHNA.HTML. AREAS OF FOCUSAS A RESULT OF THE ANALYSIS, THREE AREAS WERE IDENTIFIED AS THE PRIORITIES ON WHICH MADONNA WILL FOCUS FOR THE NEXT THREE YEARS. THESE THREE NEEDS ARE: OMAHA INPATIENT POST-ACUTE HOSPITAL SERVICES, NEBRASKA PHYSIATRY RESIDENCY PROGRAM, AND ADVANCEMENTS IN AFFORDABLE TECHNOLOGY.PRIORITY #1: OMAHA INPATIENT POST-ACUTE HOSPITAL SERVICES.OBJECTIVE: ESTABLISH AN INPATIENT POST-ACUTE HOSPITAL IN OMAHA, NEBRASKA.STRATEGY: MADONNA CONTRACTED WITH HDR ARCHITECTURE TO CONDUCT INDEPENDENT HEALTHCARE MARKET DEMAND AND CAPACITY ANALYSIS FOR INPATIENT POST-ACUTE HOSPITAL NEEDS IN OMAHA, NEBRASKA AND THE SURROUNDING REGION. THE HDR ANALYSIS SHOWED THAT OMAHA IS UNDERSERVED IN THE USAGE OF INPATIENT REHABILITATION AND LONG-TERM ACUTE CARE SERVICES.MADONNA'S BOARD OF DIRECTORS APPROVED PURSUING THE ESTABLISHMENT OF A REHABILITATION HOSPITAL IN OMAHA. FINANCING OPTIONS, SITE PLANS AND PURSUIT OF PHILANTHROPIC DOLLARS ARE BEING INITIATED. DUE TO REGULATORY CHANGES, THE LONG-TERM CARE HOSPITAL OPENED IN SPACE LEASED FROM ANOTHER HOSPITAL IN APRIL 2014. CONSTRUCTION BEGAN ON A NEW BUILDING THAT WILL HOST BOTH THE LONG-TERM CARE HOSPITAL AND INPATIENT REHABILITATION HOSPITAL IN SEPTEMBER 2014. THE ANTICIPATED OPENING OF THE NEW BUILDING IS FISCAL 2017. THE IMPACT OF HAVING AN OMAHA FACILITY WILL EXPAND MADONNA'S RESEARCH CAPABILITY AS WELL AS GRANT PATIENTS GREATER ACCESS TO SPECIALIZED SERVICES.PRIORITY #2: NEBRASKA PHYSIATRY RESIDENCY PROGRAMOBJECTIVE: ESTABLISH A PHYSICAL MEDICINE AND REHABILITATION (PM&R) GRADUATE MEDICAL EDUCATION RESIDENCY TRAINING PROGRAM.STRATEGY: IT IS UNDERSTOOD THAT A MAJORITY OF PHYSICIANS PRACTICE WITHIN THE VICINITY OF WHERE THEY WENT TO SCHOOL. MADONNA WILL WORK WITH THE UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE, THE NEBRASKA MEDICAL CENTER, UNIVERSITY OF NEBRASKA PHYSICIANS AND OTHERS TO DEVELOP AN ACADEMIC AFFILIATION AGREEMENT TO GUIDE THE ESTABLISHMENT OF A PM&R GRADUATE MEDICAL EDUCATION RESIDENCY TRAINING PROGRAM AT THE OMAHA SITE. A FORMAL AGREEMENT TO THIS END WAS SIGNED IN NOVEMBER 2014.PRIORITY #3: ADVANCEMENTS IN AFFORDABLE TECHNOLOGY.OBJECTIVE: IN PARTNERSHIP WITH OTHERS, DEVELOP AFFORDABLE TECHNOLOGY TO AID PATIENTS IN THEIR RECOVERIES.STRATEGY A: COLLABORATE WITH NEBRASKA GLOBAL TO REFINE THE FIRST HOPE INITIATIVE AND/OR DEVELOP OTHER INITIATIVES. COMPLETION OF THE FIRST HOPE INITIATIVE WILL RESULT IN AFFORDABLE, INTEGRATED TECHNOLOGY PACKAGES THAT GIVE PATIENTS COMPLETE CONTROL OF THEIR ENVIRONMENT FROM THE FIRST DAY OF ADMISSION AND ALLOW THEM TO ENGAGE IN THERAPEUTICALLY MEANINGFUL ACTIVITIES 24-HOURS-A-DAY, SEVEN-DAYS-A-WEEK WHILE IN THE HOSPITAL AND AS THEY TRANSITION BACK TO THEIR COMMUNITIES AND HOMES.STRATEGY B: INCREASE THE USE OF ICARES THROUGH SPORTSART FITNESS. MORE ICARES IN THE MARKETPLACE WILL SUPPLY MORE PATIENTS WITH AN AFFORDABLE WAY TO HELP ACCELERATE GAIT AND CARDIOVASCULAR IMPROVEMENT.NEXT STEPSTHIS IMPLEMENTATION STRATEGY HAS CONTINUED TO BE ROLLED OUT IN THE YEARS SUBSEQUENT TO THE CHNA CONDUCTED IN FISCAL 2013 (TAX YEAR 2012). PERIODIC EVALUATION OF OBJECTIVES FOR EACH IDENTIFIED PRIORITY IS CONDUCTED TO ASSURE THAT MADONNA IS ON TRACK TO COMPLETE THE PLAN AS DESCRIBED. AT THE END OF FISCAL YEAR 2016, MADONNA REHABILITATION HOSPITAL WILL REVIEW THE IMPLEMENTATION STRATEGY AND REPORT ON THE SUCCESS EXPERIENCED THROUGH THE COLLABORATIVE EFFORTS OF IMPROVING THE HEALTH NEEDS OF THE COMMUNITY.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13B: FPG IS USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF FINANCIAL ASSISTANCE IS GRANTED, IT IS FOR FREE CARE ONLY.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 16A WEBSITE: HTTP://WWW.MADONNA.ORG/MY-MADONNA/SERVICES.HTML
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.MADONNA.ORG/MY-MADONNA/SERVICES.HTML
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 20E: 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 INAPPROPRIATELY3. 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
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 22D: THE AMOUNT OF FINANCIAL ASSISTANCE IS CONSIDERED TO BE 100% OF CHARGES.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 24: 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.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2014
Schedule H (Form 990) 2014
Page
Part VFacility Information (continued)

Section D. 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) 2014
Schedule H (Form 990) 2014
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference 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 II, COMMUNITY BUILDING ACTIVITIES: MADONNA'S MEDICALLY BASED HEALTH AND FITNESS CENTER (MADONNA PROACTIVE) IS FOCUSED ON IMPROVING THE OVERALL WELLNESS OF THE COMMUNITY BY REDUCING CHRONIC RISK FACTORS THROUGH VARIOUS HEALTH PROGRAMS.
PART III, LINE 4: MADONNA REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, MADONNA ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, MADONNA ANALYZES CONTRACTUALLY DUE AMOUNTS AND ASSESSES THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON ANALYSIS OF PAYMENT HISTORY. THOSE TRANSITION ACCOUNTS ARE CONSIDERED IN CONJUNCTION WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). MADONNA RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT CERTAIN PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN MANY CASES, MADONNA IS ABLE TO NEGOTIATE PAYMENT SUBSEQUENT TO THE INITIAL DETERMINATION OF THE COLLECTABILITY OF THE ACCOUNT. IN THESE CASES, MADONNA RECORDS ADDITIONAL CONTRACTUAL ALLOWANCES AND DISCOUNTS. UPON CONSIDERATION OF THE FACT CERTAIN PATIENT ACCOUNTS THAT WERE PREVIOUSLY ALLOWED FOR ARE COLLECTED THROUGH NEGOTIATION AND ADJUSTED AT THE TIME OF PAYMENT, MADONNA HAS DETERMINED THE PROVISION FOR BAD DEBTS IS NOT SIGNIFICANT TO THE CONSOLIDATED FINANCIAL STATEMENTS AND HAS COMBINED WITH CONTRACTUAL ALLOWANCES AND DISCOUNTS.
PART III, LINE 8: A COST ACCOUNTING SYSTEM IS USED BY MADONNA AND IT ADDRESSES ALL PATIENT SEGMENTS. NO COST TO CHARGE RATIO WAS USED. NONE OF THE SHORTFALL HAS BEEN REPORTED AS COMMUNITY BENEFIT.
PART III, LINE 9B: ALL CHARGES FOR PATIENTS FOUND ELIGIBLE FOR FINANCIAL ASSISTANCE ARE WAIVED. ONCE THIS ELIGIBILITY IS CONFIRMED, ALL COLLECTION ACTIVITIES ARE DISCONTINUED.
PART VI, LINE 2: MADONNA USES MULTIPLE AVENUES TO COLLECT DATA REGARDING THE NEEDS OF ITS COMMUNITY, INCLUDING PATIENT SATISFACTION SURVEYS, MEETING MINUTES FROM LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS, CAPITAL CAMPAIGN REQUESTS AND OTHER DATA SOURCES. THIS IS AN ONGOING PROCESS THAT IS INTEGRATED INTO STRATEGIC PLANNING AND ANNUAL GOAL SETTING. A NEEDS ASSESSMENT QUESTIONNAIRE WAS DISTRIBUTED TO THE COMMUNITY AND THE RESULTS WERE COLLECTED AND ANALYZED IN FISCAL YEAR 2013. THE RESULTS WERE DISCUSSED AT STRATEGIC PLANNING COMMITTEE MEETINGS DURING THE PLANNING PHASES FOR FISCAL YEARS 2014 AND 2015. HOSPITAL LEADERSHIP REGULARLY REVIEWS AND DISCUSSES COMMUNITY NEEDS DURING WEEKLY ADMINISTRATIVE TEAM MEETINGS. MANY OF THESE NEEDS ARE ADDRESSED THROUGH CAPITAL ITEM REQUESTS AND PROGRAMMING UPDATES AND/OR ADDITIONS. ADDITIONALLY, COMMUNITY NEEDS ARE BROUGHT FORTH AND DISCUSSED IN NUMEROUS ORGANIZATIONAL AND INDIVIDUAL MEETINGS AT ALL LEVELS. MADONNA REHABILITATION HOSPITAL EXECUTIVES, MANAGERS AND CLINICIANS ARE ENCOURAGED TO MEET WITH THEIR COUNTERPARTS IN PEER INSTITUTIONS AND TO PURSUE LEADERSHIP POSITIONS IN THEIR AREAS OF EXPERTISE. EACH YEAR, MADONNA STAFF MEMBERS ARE ELECTED AND/OR ARE APPOINTED TO BOARDS, SPECIAL TASK FORCES AND OTHER LEADERSHIP POSITIONS. IN THESE POSITIONS, MADONNA STAFF GETS DIRECT INPUT FROM COLLEAGUES IN AFFILIATED ORGANIZATIONS AND WITH PATIENTS IN THE COMMUNITY SERVED.
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: THE DESCRIPTION OF MADONNA REHABILITATION HOSPITAL'S COMMUNITY IN THE 2013 CHNA:MADONNA REHABILITATION HOSPITAL IS ONE OF THE NATION'S LARGEST SPECIALIZED REHABILITATION HOSPITALS. WE TREAT CHILDREN AND ADULTS WITH COMPLEX AND SEVERE DIAGNOSES FOR TRAUMATIC BRAIN INJURY, SPINAL CORD INJURY, STROKE, NEUROLOGICAL DISORDERS, BURNS, PULMONARY DISEASE AND OTHER DISABLING CONDITIONS. THIS IS OUR "COMMUNITY" - THE PEOPLE WHO REQUIRE INPATIENT POST-ACUTE PHYSICAL REHABILITATION TO REDUCE OR ELIMINATE IMPAIRMENTS, ACTIVITY LIMITATIONS AND PARTICIPATION RESTRICTIONS. UNLIKE ACUTE CARE HOSPITALS, WE DO NOT DEFINE OUR COMMUNITY SERVED AS A GEOGRAPHIC AREA, BUT RATHER BY THE POPULATION THAT REQUIRES THESE HIGHLY SPECIALIZED SERVICES.
PART VI, LINE 5: IN AN EFFORT TO MEET THE GROWING NEEDS OF THE PEDIATRIC POPULATION, MADONNA HAS EXPANDED ITS DESIGNATED AREA AND FEATURES A PEDIATRIC THERAPY GYM, ALLOWING THE YOUNGEST PATIENTS TO RECEIVE AGE-APPROPRIATE REHABILITATION SERVICES. MADONNA HAS ALSO RENOVATED THE KIT SCOTT THERAPEUTIC LEARNING CENTER. THE GOAL OF THE LEARNING CENTER IS TO HELP STUDENTS SUCCESSFULLY TRANSITION BACK TO THEIR HOME AND SCHOOL SETTINGS. MADONNA ALSO PROVIDES SERVICES TO THE COMMUNITY WHICH WOULD OTHERWISE BE UNAVAILABLE OR UNDERSERVED, SUCH AS COMMUNITY MEDICAL TRANSPORTATIONS. MADONNA PHYSICIANS AND THERAPISTS ALSO PRESENT AT NUMEROUS CONFERENCES THROUGHOUT THE YEAR, PROVIDING RECOGNIZED EXPERTISE TO THE COMMUNITY ON REHABILITATION AND OTHER RELEVANT TOPICS. IN ADDITION TO OUR MEDICAL FACILITIES (WHICH INCLUDE LINCOLN'S FIRST MEDICAL FITNESS FACILITY), MADONNA PROVIDES VOLUNTEER AND FINANCIAL SUPPORT TO THE COMMUNITY. MADONNA EMPLOYEES DONATE HUNDREDS OF UNITS OF BLOOD ONSITE EACH YEAR AND SERVE MORE THAN 1,000 MEALS EACH YEAR AT MATT TALBOT KITCHEN. FINANCIAL SUPPORT INCLUDE INDIVIDUAL EMPLOYEE AND ORGANIZATIONAL DONATIONS OF MONEY AND SUPPLIES TO PATIENTS AND THEIR FAMILIES, AREA FOOD BANKS, CHURCHES, MISSIONARIES, SOCIAL SERVICES ORGANIZATIONS, AND HEALTH ASSOCIATIONS. IN SOME CASES, MADONNA ORGANIZES FUNDRAISERS DESIGNED TO BENEFIT THESE ORGANIZATIONS.OUTSIDE ORGANIZATIONS ARE ALSO ALLOWED TO USE MADONNA'S MEETING ROOMS AT NO CHARGE.
PART VI, LINE 6: MADONNA IS AFFILIATED WITH A NEW LONG-TERM CARE HOSPITAL IN THE OMAHA METROPOLITAN AREA. THIS HOSPITAL WAS STARTED BECAUSE THE ORGANIZATION DETERMINED THE OMAHA AREA WAS UNDERSERVED IN THIS TYPE OF CARE.
PART VI, LINE 7, REPORTS FILED WITH STATES NE
Schedule H (Form 990) 2014
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, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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 of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used 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), 501(c)(4), and 501(c)(29) organizations 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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 (E) amounts for that individual.
(A) Name and Title (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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1MARSHA LOMMELPRESIDENT AND CEO (i)
(ii)		 490,902
...............................
0 		241,532
...............................
0 		0
...............................
0 		42,694
...............................
0 		3,504
...............................
0 		778,632
...............................
0 		0
...............................
0
2VICTOR WITKOWICZSR. VICE PRESIDENT-CFO (i)
(ii)		 272,683
...............................
0 		133,771
...............................
0 		0
...............................
0 		31,279
...............................
0 		7,228
...............................
0 		444,961
...............................
0 		0
...............................
0
3PAUL DONGILLIEXECUTIVE VP-COO (i)
(ii)		 278,894
...............................
0 		131,978
...............................
0 		0
...............................
0 		30,002
...............................
0 		6,023
...............................
0 		446,897
...............................
0 		0
...............................
0
4DR THOMAS STALDERVP OF MEDICAL AFFAIRS/CHIEF MEDICAL (i)
(ii)		 138,753
...............................
0 		50,934
...............................
0 		0
...............................
0 		2,000
...............................
0 		7,916
...............................
0 		199,603
...............................
0 		0
...............................
0
5CHARLES DAVID ROLFECHIEF INFORMATION OFFICER (i)
(ii)		 137,329
...............................
0 		47,142
...............................
0 		0
...............................
0 		7,076
...............................
0 		5,988
...............................
0 		197,535
...............................
0 		0
...............................
0
6SUSAN K KLANECKYVP PATIENT CARE (i)
(ii)		 135,413
...............................
0 		35,780
...............................
0 		0
...............................
0 		8,624
...............................
0 		5,243
...............................
0 		185,060
...............................
0 		0
...............................
0
7CHRISTOPHER A LEEVICE PRESIDENT REHABILITATION (i)
(ii)		 134,999
...............................
0 		35,900
...............................
0 		0
...............................
0 		8,145
...............................
0 		5,656
...............................
0 		184,700
...............................
0 		0
...............................
0
8LINDA S SULLIVANVICE PRESIDENT REFERRAL RE (i)
(ii)		 123,030
...............................
0 		36,903
...............................
0 		0
...............................
0 		6,809
...............................
0 		959
...............................
0 		167,701
...............................
0 		0
...............................
0
9LYNN R HALLOWELL-GOTTSLEBENVICE PRESIDENT THERAPY PLU (i)
(ii)		 119,253
...............................
0 		52,476
...............................
0 		0
...............................
0 		7,563
...............................
0 		7,198
...............................
0 		186,490
...............................
0 		0
...............................
0
10MORGAN L LAHOLTSTAFF PHYSIATRIST (i)
(ii)		 125,633
...............................
0 		278,318
...............................
0 		0
...............................
0 		2,000
...............................
0 		5,867
...............................
0 		411,818
...............................
0 		0
...............................
0
11ADAM T KAFKASTAFF PHYSIATRIST (i)
(ii)		 125,865
...............................
0 		257,502
...............................
0 		0
...............................
0 		2,000
...............................
0 		5,635
...............................
0 		391,002
...............................
0 		0
...............................
0
12PAUL L KRABBENHOFTSTAFF PHYSIATRIST (i)
(ii)		 178,656
...............................
0 		106,525
...............................
0 		0
...............................
0 		2,000
...............................
0 		8,495
...............................
0 		295,676
...............................
0 		0
...............................
0
13ANA DELGADOSTAFF NEUROLOGIST (i)
(ii)		 37,917
...............................
0 		170,504
...............................
0 		0
...............................
0 		2,000
...............................
0 		2,543
...............................
0 		212,964
...............................
0 		0
...............................
0
14JIAXIN TRANSTAFF PHYSIATRIST (i)
(ii)		 79,898
...............................
0 		105,304
...............................
0 		0
...............................
0 		2,000
...............................
0 		1,043
...............................
0 		188,245
...............................
0 		0
...............................
0
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
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) 2014

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.
SchKMediumBulletInformation about Schedule K (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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 2 - OF DOUGLAS COUNTY NE
  		52-1440796 SUPPLINFO 09-25-2014 86,048,946 CONSTRUCT, EQUIP, AND FURNISH NEW HOSPITAL FACILITY IN OMAHA, NE.   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . .        
2 Amount of bonds legally defeased . . . . . . . . . . .        
3 Total proceeds of issue . . . . . . . . . . . . . . 86,048,946      
4 Gross proceeds in reserve funds . . . . . . . . . . . .        
5 Capitalized interest from proceeds . . . . . . . . . . . 2,363,486      
6 Proceeds in refunding escrows . . . . . . . . . . . .        
7 Issuance costs from proceeds . . . . . . . . . . . . 911,512      
8 Credit enhancement from proceeds . . . . . . . . . . .        
9 Working capital expenditures from proceeds . . . . . . . . .        
10 Capital expenditures from proceeds . . . . . . . . . . . 31,933,500      
11 Other spent proceeds . . . . . . . . . . . . . .        
12 Other unspent proceeds . . . . . . . . . . . . . . 50,840,449      
13 Year of substantial completion . . . . . . . . . . . . 2016
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . .   X            
15 Were the bonds issued as part of an advance refunding issue? . . . . .   X            
16 Has the final allocation of proceeds been made? . . . . . . . .   X            
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . . 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            
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .   X            
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
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            
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            
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            
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .   X            
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .                
9 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              
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .   X            
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . . X              
b Exception to rebate? . . . . . . . .   X            
c No rebate due? . . . . . . . .   X            
If "Yes" to line 2c, provide in Part VI the date the rebate
computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .   X            
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X            
b Name of provider . . . . . . . . .  
  		 
  		 
  		 
 
c Term of hedge . . . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was the hedge terminated? . . . . . .                
Schedule K (Form 990) 2014
Schedule K (Form 990) 2014
Page 3
Part IV
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .   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? . . . . .                
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .   X            
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X              
Part V
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
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? X              
Part VI
Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).
Return Reference Explanation
SCHEDULE K SUPPLENTAL INFORMATION CUSIP NUMBERS INCLUDE THE FOLLOWING: 25923P AA3 25923P AB1 25923P AC9 25923P AD7 25923P AE5 25923P AF2 25923P AS4 25923P AG0 25923P AH8 25923P AJ4 25923P AV7 25923P AK1 25923P AL9 25923P AM7 25923P AN5 25923P AP0 25923P AR6 25923P AT2 25923P AU9 25923P AQ8 PART IV, LINE 2C: PER THE TAX REGULATORY AGREEMENT, THE FIRST REBATE COMPUTATION IS TO OCCUR AS OF THE END OF THE FIFTH BOND YEAR SUBSEQUENT TO THE BOND ISSUANCE DATE. SUCH COMPUTATION WILL OCCUR ON AUGUST 31, 2019.
Schedule K (Form 990) 2014

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)Written agreement?
To From Yes No Yes No Yes No
Total ......Small Bullet $  
Part III
Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2014
Schedule L (Form 990 or 990-EZ) 2014
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) MUHLEISEN ANGIE
  		FORMER DIRECTOR 163,554 INVESTMENT FEES   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2014

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 organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
Right pointing arrow large imageInformation about Schedule M (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
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 ( )
26 Other Right pointing arrow large image( )
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 through 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 an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) (2014)
Schedule M (Form 990) (2014)
Page 2
Part II
Supplemental Information. 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.
Return Reference Explanation
PART I, LINE 32B: MADONNA REHABILITATION HOSPITAL USES ITS SUPPORTING ORGANIZATION, THE MADONNA FOUNDATION, TO SOLICIT, PROCESS AND SELL NONCASH CONTRIBUTIONS.
Schedule M (Form 990) (2014)
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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
MADONNA REHABILITATION HOSPITAL
 
Employer identification number

47-0439599
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 3 FOOD SERVICE OPERATIONS ARE CONTRACTED WITH ARAMARK; AN OUTSIDE MANAGEMENT CORPORATION. NO CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY ARAMARK DURING THE TAX YEAR.
FORM 990, PART VI, SECTION A, LINE 6 THE DIOCESAN HEALTH MINISTRIES, A NEBRASKA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF MADONNA REHABILITATION HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A THE DIOCESAN HEALTH MINISTRIES MAY DESIGNATE ONE MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS, AS PROVIDED IN THE ORGANIZATION'S ARTICLES OF INCORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B THE MEMBER, DIOCESAN HEALTH MINISTRIES, HAS FINAL APPROVAL OF: (1) CHANGES IN PHILOSOPHY AND MISSION; (2) MATTERS INVOLVING SALE, LEASE, TRANSFER, EXCHANGE, DISPOSITION, PLEDGE OR ALIENATION OF REAL PROPERTY IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00); (3) MATTERS INVOLVING PURCHASE AND/OR ENCUMBRANCE WITH DEBT, IN ANY WAY, OF REAL PROPERTY IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00); (4) 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. -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. -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.
FORM 990, PART VI, SECTION C, LINE 19 SUMMARIZED FINANCIAL INFORMATION IS MADE AVAILABLE TO THE PUBLIC ON AN ANNUAL BASIS THROUGH THE PUBLICATION OF THE HOSPITAL'S PUBLIC ANNUAL REPORT. IN ADDITION, THE PUBLIC ANNUAL REPORT IS AVAILABLE ON THE HOSPITAL'S WEBSITE. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990, PART XI, LINE 9: LOSS ON INVESTMENT IN AFFILIATE, CHANGE IN TEMPORARILY RESTRICTED NET ASSET -4,253,845.
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) 2014

Additional Data


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SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
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 (if applicable) 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 entity?
Yes No
(1) MADONNA FOUNDATION
5401 SOUTH STREET

LINCOLN,NE68506
23-7159940 		FUNDRAISING SUPPORT NE 501(C)(3) 11B (TYPE II) MADONNA REHABILITATION HOSPITAL
 
Yes
 
(2) MADONNA INC
5401 SOUTH STREET

LINCOLN,NE68506
36-3397284 		HEALTHCARE MANAGEMENT NE 501(C)(3) 11B (TYPE II) MADONNA REHABILITATION HOSPITAL
 
Yes
 
(3) MADONNA REHABILITATION SYSTEMS
2500 BELLEVUE MEDICAL CENTER DR 4TH

BELLEVUE,NE681231591
46-4473701 		HEALTHCARE NE 501(C)(3) 3 MADONNA REHABILITATION HOSPITAL
 
Yes
 








For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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 -19,861 356,237   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
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) MADONNA REHABILITATION SYSTEMS

 B 1,000,000 FINANCIAL RECORD
(2) MADONNA FOUNDATION

 L 57,411 FINANCIAL RECORD
(3) MADONNA REHABILITATION SYSTEMS

 L 1,427,063 FINANCIAL RECORD
(4) MADONNA FOUNDATION

 M 927,793 FINANCIAL RECORD
(5) MADONNA FOUNDATION

 N 21,000 FINANCIAL RECORD
(6) MADONNA FOUNDATION

 P 45,048 FINANCIAL RECORD
(7) MADONNA FOUNDATION

 S 881,533 FINANCIAL RECORD
(8) MADONNA INC

 S 20,811 FINANCIAL RECORD
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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