TY 2018 Form 990

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) Rodrigo Lopez...................................................................... Chair	1.0 ................. 0.0	X	X	0	0
(2) Diane Duren...................................................................... Vice Chair	1.0 ................. 0.0	X	X	0	0
(3) Margaret Hershiser...................................................................... Secretary	1.0 ................. 0.0	X	X	0	0
(4) Jim Greisch...................................................................... Treasurer	1.0 ................. 0.0	X	X	0	0
(5) Richard Azizkhan MD...................................................................... President, CEO, Member	40.0 ................. 0.0	X	X	1,818,997	44,765
(6) Brad Brabec MD...................................................................... Member	1.0 ................. 0.0	X		0	0
(7) Bradley Britigan MD...................................................................... Member	1.0 ................. 0.0	X		0	0
(8) Joleen David...................................................................... Member	1.0 ................. 0.0	X		0	0
(9) Dave Diamond...................................................................... Member	1.0 ................. 0.0	X		0	0
(10) Robert Dunlay MD...................................................................... Member	1.0 ................. 0.0	X		0	0
(11) Mark Hasebroock...................................................................... Member	1.0 ................. 0.0	X		0	0
(12) Sherrye Hutcherson...................................................................... Member	1.0 ................. 0.0	X		0	0
(13) John Jenkins...................................................................... Member	1.0 ................. 0.0	X		0	0
(14) Steve Lindsay...................................................................... Member	1.0 ................. 0.0	X		0	0
(15) Samantha Mosser...................................................................... Member	1.0 ................. 0.0	X		0	0
(16) Michael Robino...................................................................... Member	1.0 ................. 0.0	X		0	0
(17) Amy Ryan...................................................................... Member	1.0 ................. 0.0	X		0	0

(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)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(18) Paul Sammut MD........................................................................ Member	1.0 .......................0.0	X				0	0
(19) Stacy Scholtz........................................................................ Member	1.0 .......................0.0	X				0	0
(20) Jayesh Thakker MD........................................................................ Member	1.0 .......................0.0	X				0	0
(21) Scot Thompson........................................................................ Member	1.0 .......................0.0	X				0	0
(22) Michael Brown........................................................................ EVP Strategy & Transformation	40.0 .......................0.0		X			960,776	113,236
(23) Fernando Ferrer MD........................................................................ SVP & Surgeon-in-chief	40.0 .......................0.0		X			724,150	110,791
(24) Kathy English........................................................................ EVP & COO	40.0 .......................0.0		X			625,745	106,704
(25) Amy Hatcher........................................................................ SVP & CFO	40.0 .......................0.0		X			608,410	73,221
(26) Christopher Maloney MD........................................................................ SVP & Chief Medical Officer	40.0 .......................0.0		X			517,088	63,413
(27) Steven C Burnham........................................................................ SVP Physician Networks	40.0 .......................0.0		X			471,360	77,048
(28) Amy Bones........................................................................ SVP & General Counsel	40.0 .......................0.0		X			459,519	79,087
(29) Suzanne Nocita........................................................................ SVP & CHRO	40.0 .......................0.0		X			377,447	75,883
(30) Mark Stastny........................................................................ VP & CIO	40.0 .......................0.0			X		473,600	47,005
(31) Jamie Drake MD........................................................................ Physician	40.0 .......................0.0			X		427,552	14,053
(32) Kari Krenzer........................................................................ Physician	40.0 .......................0.0			X		402,480	38,856
(33) Martin Beerman........................................................................ VP Market & Community Relation	40.0 .......................0.0			X		400,258	43,000
(34) Rachel McCann MD........................................................................ Physician	40.0 .......................0.0			X		385,797	35,062
(35) Deb Arnow........................................................................ SVP Pat Care Srvs & CNO	0.0 .......................0.0				X	311,127	9,896

(A) Name and business address	(B) Description of services	(C) Compensation
Choice Solutions LLC, 7015 College BLVD STE 300 OVERLAND PARK,KS66211	Consulting Services	1,931,201
Travercent LLC, 2425 N Central Expressway Ste 130 RICHARDSON,TX75080	Consulting Services	1,162,362
Fulgent Therapeutics LLC, PO Box 748677 LOS ANGELES,CA900748677	Genetic Testing	740,910
LOCUMTENENSCOM, PO Box 405547 ATLANTA,GA30384	STAFFING SERVICES	537,391
MCKESSON PLASMA BIOLOGICS, 16578 COLLECTIONS CENTER DR CHICAGO,IL60693	GENETIC TESTING	429,680
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 62

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2018

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv), 170(b)(1)(A)(vi), and 170(b)(1)(A)(ix)
(Complete only if you checked the box on line 5, 7, 8, or 9 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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

Gross receipts from related activities, etc. (see instructions) ..................

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

Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2017 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2018. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2017. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2018

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2014	(b) 2015	(c) 2016	(d) 2017	(e) 2018	(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.)..

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

Public support percentage for 2018 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2017 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2018 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2017 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2018. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2017. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2018

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

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.

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).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

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.

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.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

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.

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.

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).

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?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

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.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) 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.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

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

Schedule A (Form 990 or 990-EZ) 2018

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

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

A family member of a person described in (a) above?

11b

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

Section B. Type I Supporting Organizations

Yes

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.

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.

Section C. Type II Supporting Organizations

Yes

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).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

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).

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.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

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.

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.

Parent of Supported Organizations. Answer (a) and (b) below.

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.

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.

Schedule A (Form 990 or 990-EZ) 2018

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). 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

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) 2018

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2018 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-2018	(iii) Distributable Amount for 2018
1 Distributable amount for 2018 from Section C, line 6
2 Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2018:
a From 2013.......
b From 2014.......
c From 2015.......
d From 2016.......
e From 2017.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2018 distributable amount
i Carryover from 2013 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2018 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2018 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2019. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2014......
b Excess from 2015.....
c Excess from 2016.....
d Excess from 2017.....
e Excess from 2018.....

Schedule A (Form 990 or 990-EZ) (2018)

Schedule A (Form 990 or 990-EZ) 2018

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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution. An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Page 2

Name of organization Children's Hospital & Medical Center

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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 3

Name of organization Children's Hospital & Medical Center		Employer identification number 47-0379754

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) (2018)

Schedule B (Form 990, 990-EZ, or 990-PF) (2018)

Page 4


Name of organization Children's Hospital & Medical Center			Employer identification number 47-0379754
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2018)

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on 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

Children's Hospital & Medical Center

Employer identification number

47-0379754

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2018

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

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) ...............................	69,794
c	Total lobbying expenditures (add lines 1a and 1b) ...................................................................	69,794
d	Other exempt purpose expenditures ........................................................................	389,162,888
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............................................	389,232,682
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.	1,000,000
	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) .................................................	250,000
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? ...................................................................................................................		Yes No

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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) Total

2a	Lobbying nontaxable amount	1,000,000	1,000,000	1,000,000	1,000,000	4,000,000

b	Lobbying ceiling amount (150% of line 2a, column(e))					6,000,000

c	Total lobbying expenditures	75,525	45,055	63,273	69,794	253,647

d	Grassroots nontaxable amount	250,000	250,000	250,000	250,000	1,000,000

e	Grassroots ceiling amount (150% of line 2d, column (e))					1,500,000

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2018

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Total. Add lines 1c through 1i ....................................................................................................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

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

Schedule C (Form 990 or 990EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on 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 ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

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.

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 on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2018

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	(c)Two years back	(d)Three years back	(e)Four years back

1a	Beginning of year balance ....	80,139,900	71,680,965	53,221,749	52,709,846	52,569,968
b	Contributions ...	8,481,002	9,780,309	20,698,028	2,540,657	4,571,646
c	Net investment earnings, gains, and losses	127,409	338,557	249,787	115,359	103,409
d	Grants or scholarships ...	681,595	1,659,931	2,488,599	2,142,005	4,535,177
e	Other expenditures for facilities and programs ...				2,108
f	Administrative expenses ....
g	End of year balance ......	88,066,716	80,139,900	71,680,965	53,221,749	52,709,846

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

44.400 %

Permanent endowment SchDMd Bullet

7.600 %

Temporarily restricted endowment SchDMd Bullet

48.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations .................

3a(i)

(ii) related organizations .................

3a(ii)

Yes

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Yes

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" on 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 .....	28,605,071		28,605,071
b	Buildings ....	249,328,267	108,075,145	141,253,122
c	Leasehold improvements	18,546,749	10,616,326	7,930,423
d	Equipment ....	121,714,252	97,561,813	24,152,439
e	Other .....	84,759,179	306,293	84,452,886
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				286,393,941

Schedule D (Form 990) 2018

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered "Yes" on 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........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on 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
(1)PROJECT FUND-LT PORTION	57,303,451	C
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)	57,303,451

Part IX

Other Assets. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
DEFERRED COMPENSATION LIABILITY	3,299,451
SWAP LIABILITY	3,459,205
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	6,758,656
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) 2018

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
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
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
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
3	Subtract line 2e from line 1...................		3
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
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

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

Schedule D, Part V, Line 4

TO SUPPORT PROGRAMS, FUTURE CAPITAL IMPROVEMENTS, AND OPERATIONS OF CHILDREN'S HOSPITAL & MEDICAL CENTER.

Schedule D, Part X, Line 2

FIN 48 FOOTNOTE THE COMPANY RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. DURING 2018 AND 2017, THE COMPANY DID NOT RECORD ANY AMOUNTS RELATED TO UNCERTAIN TAX POSITIONS OR ANY ACCRUED INTEREST AND PENALTIES.

Schedule D (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(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) . . .	4,274,020		4,274,020	1.100 %
b	Medicaid (from Worksheet 3, column a) . . . . .	141,887,843	111,701,916	30,185,927	7.760 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	146,161,863	111,701,916	34,459,947	8.860 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	2,153,925	786,054	1,367,871	0.350 %
f	Health professions education (from Worksheet 5) . . .	24,430,061	1,110,834	23,319,227	5.990 %
g	Subsidized health services (from Worksheet 6) . . . .	138,762,919	102,477,401	36,285,518	9.320 %
h	Research (from Worksheet 7) .	3,868,856		3,868,856	0.990 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	1,320,404		1,320,404	0.340 %
j	Total. Other Benefits . .	170,536,165	104,374,289	66,161,876	16.990 %
k	Total. Add lines 7d and 7j .	316,698,028	216,076,205	100,621,823	25.850 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2018

Schedule H (Form 990) 2018

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.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development	11,000	11,000
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
10	Total	11,000	11,000

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

1,459,745

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. ......

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

Enter total revenue received from Medicare (including DSH and IME).....

118,456

Enter Medicare allowable costs of care relating to payments on line 5.....

216,456

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-98,000

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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 %
1None
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2018

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?1Name, 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)
1	CHILDREN'S HOSPITAL & MEDICAL CENTER 8200 DODGE STREET OMAHA,NE68114 WWW.CHILDRENSOMAHA.ORG 260005	X	X	X	X	X

Schedule H (Form 990) 2018

Page 4

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)

	CHILDREN'S HOSPITAL & MEDICAL CENTER
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

Community Health Needs Assessment

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?........................

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...............

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......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 18

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 .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

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. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): SEE PART V, SECTION C

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

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. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Section C

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

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

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on 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) 2018

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	CHILDREN'S HOSPITAL & MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.% and FPG family income limit for eligibility for discounted care of 400.%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

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):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, SECTION C

The FAP application form was widely available on a website (list url):

SEE PART V, SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 6

Part VFacility Information (continued)

Billing and Collections

	CHILDREN'S HOSPITAL & MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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 nonpayment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized 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?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs

Made a reasonable effort to orally notify individuals about the FAP and FAP application process

Processed incomplete and complete FAP applications

Made presumptive eligibility determinations

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2018

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	CHILDREN'S HOSPITAL & MEDICAL CENTER
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

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? ...............................

If "Yes," explain in Section C.

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? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2018

Page 8

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, 16j, 18e, 19e, 20e, 21c, 21d, 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
Schedule H, Part V, Line 5	AS PART OF THE 2018 COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY CONDUCTED ON BEHALF OF CHILDREN'S HOSPITAL & MEDICAL CENTER, BOYS TOWN NATIONAL RESEARCH HOSPITAL AND BUILDING HEALTHY FUTURES, KEY INFORMANTS (INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY) WERE CONTACTED BY EMAIL, INTRODUCED TO THE COMMUNITY HEALTH NEEDS ASSESSMENT KEY INFORMANT SURVEY AND PROVIDED A LINK TO TAKE THE SURVEY ONLINE; REMINDER EMAILS WERE SENT AS NEEDED TO INCREASE PARTICIPATION. SUPPORTING ORGANIZATIONS FOR THE CHNA INCLUDED: CHARLES DREW HEALTH CENTER, INC., DOUGLAS COUNTY HEALTH DEPARTMENT, LIVE WELL OMAHA, AND ONE WORLD COMMUNITY HEALTH CENTERS, INC. THESE POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS AMONG THE FAMILIES AND CHILDREN/ADOLESCENTS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. IN ALL, 166 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY, REPRESENTING COMMUNITY/BUSINESS LEADERS, PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, SOCIAL SERVICE PROVIDERS AND OTHER HEALTH CARE PROVIDERS. THESE KEY INFORMANTS REPRESENT ORGANIZATIONS THAT WORK WITH LOW-INCOME, MINORITY POPULATIONS, MEDICALLY UNDERSERVED POPULATIONS AND INDIVIDUALS WITH CHRONIC DISEASE CONDITIONS.
Schedule H, Part V, Line 6a	BOYS TOWN NATIONAL RESEARCH HOSPITAL
Schedule H, Part V, Line 6b	BUILDING HEALTHY FUTURES, CHARLES DREW HEALTH CENTER, INC., DOUGLAS COUNTY HEALTH DEPARTMENT, LIVE WELL OMAHA, AND ONE WORLD COMMUNITY HEALTH CENTERS, INC.
Schedule H, Part V, Line 7a	HTTPS://WWW.CHILDRENSOMAHA.ORG/GET-INVOLVED/ADVOCACY-OUTREACH/COMMUNITY-AD VOCACY/
Schedule H, Part V, Line 10A	HTTPS://WWW.CHILDRENSOMAHA.ORG/WP-CONTENT/UPLOADS/2018/05/201618CHNAIMPLEM ENTATION.PDF
Schedule H, Part V, Line 11	On November 29, 2018, the Board of Directors of Children's Hospital & Medical Center (Children's), which includes representatives from throughout the community, met to discuss this plan and the internal and external prioritization input for addressing the community health priorities identified through the 2018 Community Health Needs Assessment (CHNA). The Executive Committee has the power to transact all regular business of Children's. Upon review, the Executive Committee of the Board of Directors approved and adopted this CHNA and instructed Children's Center for the Child & Community (the Center) to develop a new implementation strategic plan for 2019-2021 to undertake these measures to meet the health needs of the community. Significant Health Needs of the Community 2018 Based on the information obtained through the Child & Adolescent CHNA and the guidelines set forth in Healthy People 2020, the following "Areas of Opportunity" represent the significant health needs of children and adolescents in the community. From these data sets, opportunities for children's health improvement exist in the area with regard to the following health issues. Areas of Opportunity Identified through this 2018 CHNA * Access to Health Services: - Difficulty Accessing Children's Healthcare - Finding a Physician - Appointment Availability - Lack of Transportation - Cost of Prescriptions * Cognitive & Behavioral Conditions: - Autism Prevalence - Cognitive & Behavioral Conditions ranked as a top concern in the Online Key Informant Survey. * Diabetes: - Childhood Diabetes Prevalence * Injury & Violence: - Age 1-4 Mortality - Children Exposed to Neighborhood Violence - Children Feeling Unsafe at School or Going To/From School * Mental Health: - Symptoms of Depression [ages 5-17] - Suicide Attempts [High Schoolers] - Diagnosed Anxiety [ages 5-17] - Chronic Worrying [ages 5-17] - Child Has Difficulty Sleeping [ages 5-17] - Lived with Someone with Serious Mental Health Issues - Family Stays Hopeful in Difficult Times - Mental & Emotional Health ranked as a top concern in the Online Key Informant Survey. * Neurological Conditions: - Brain Injuries/Concussions * Oral Health: - Condition of Teeth * Nutrition, Physical Activity, & Weight: - Overweight & Obesity - Fast Food Consumption - Nutrition, Physical Activity, and Weight ranked as a top concern in the Online Key Informant Survey. * Sexual Health: - Gonorrhea Incidence [Children/Adults] - Chlamydia Incidence [Children/Adults] - Condom Use [High Schoolers] - Use of Birth Control [High Schoolers] - Sexual Health ranked as a top concern in the Online Key Informant Survey. * Tobacco, Alcohol & Other Drugs: - Member of Household Smokes - Drinking & Driving [High Schoolers] - Lifetime Illicit Drug Use [High Schoolers] - Steroids (not Rx) - Heroin * Vison, Hearing, & Speech Conditions: - Recent Eye Exams - Chronic Ear Infections - Prevalence of Speech/Language Problems - Hearing Problems Based on the top health priorities identified through the 2015 CHNA process - and taking into account hospital resources and overall alignment with the hospital's mission, goals and strategic priorities - Children's focused on developing strategies and initiatives to improve: - Access to health care services - Injury and violence - Mental health - Nutrition, physical activity, & weight - Oral health - Vision, hearing & speech conditions - Asthma & other respiratory conditions - Sexual health In acknowledging the wide range of priority health issues that emerged from the CHNA process, Children's determined that it could only effectively focus on those which it deemed most pressing, most under-addressed and most within its ability to influence. Children's then created a 3-year implementation plan, to be carried out from 2016 through 2018, to address each strategic priority across our continuum of care, and identified appropriate resources to be included in each year's appropriate budget. 2018 Progress Summary Children's continues to progress in implementing the action plan that resulted from the 2015 Community Health Needs Assessment (CHNA) findings. Our team is working collaboratively across the organization to focus on hospital-based programs and services, community-based programs and partnerships that address each priority health issue identified through the CHNA process, guided by key strategies and specific tactics. Children's Center for the Child & Community serves as the infrastructure for community outreach activities. While each health issue is entirely unique, there is a common thread that connects them all: Children's is tasked to improve access to health care services, outreach and education to the community and the overall patient experience. Below are implementation highlights from each area that indicate how Children's is positively impacting the health needs of children and teens in our community. Children's Center for the Child & Community The Center is a statewide community health outreach hub of Children's, providing the infrastructure and leadership for both the internal and external partnerships around the pediatric CHNA planning and implementation. In 2018, the Center expanded its efforts to improve pediatric health statewide. Headquartered in Lincoln, Neb., Children's Center aims to integrate health care and public health efforts. The Center collaborates with communities across Nebraska to create local solutions to large-scale children's health issues, such as childhood obesity, poverty, injury prevention and food insecurity. Eight statewide strategic partnerships were formalized in 2018. Our strategic emphasis continues in the area of childhood obesity prevention, nutrition, physical activity and weight, which was the number one concern of community parents in the 2015 assessment. In another strategic effort, during 2018, Children's Preventing Childhood Obesity Community Grant program continued their learning collaborative led by Children's Center for the Child & Community and the Gretchen Swanson Center for Nutrition. The collaborative included skill building and technical assistance in the areas of planning, community engagement sustainability and data management. Children's also renewed seven "Preventing Childhood Obesity Community Scholarships" ($1,000 each) to college-bound high school seniors who plan to pursue a career related to health and wellness, with a significant focus on children. The other strategic efforts of the Center in the area of nutrition and physical activity are listed below in the 2018 highlights section. * Nutrition, Physical Activity & Weight - The Center launched a second Project ECHO (Extension for Community Healthcare Outcomes), a statewide learning collaborative that connects primary care providers across Nebraska with Children's specialists and leading national experts through free biweekly, online educational sessions on mental behavioral health. - Children's offered educational opportunities through Project ECHO that included free continuing medical education (CME) credits and optional participation in Maintenance of certification (MOC) Part IV quality improvement project through Children's. - Children's continues to bring health education into Omaha and southwest Iowa metro schools while expanding into Lancaster County classrooms through its sponsorship of GoNoodle, an online resource that helps local educators teach nutrition and physical activity. In 2018, 392 schools, 70,828 students and 3,260 teachers participated, logging more than 7.8 million minutes of movement. - Children's continued to provide Go NAP SACC (Nutrition and Physical Activity Self-Assessment for Child Care) technical assistance and training to childcare facilities statewide. Go NAP SACC is a partnership with Nebraska Department of Health and Human Services (NE DHHS) and is a component of the Step Up to Quality program for day care providers. The focus is to build healthy eating and physical activity habits in children within the childcare setting. In 2018, 25 Go NAP SACC trainers reached 280 early care & education professionals in 111 child care centers and homes that care for approximately 4,000 children. - In July 2018, the ENERGY Rx fitness program launched utilizing a newly created ENERGY Playbook. The Fitness program is a collaboration between the Center, the Lincoln YMCA, HEROES (Healthy Eating with Resources, Options and Everyday Strategies) pediatric weight management program, and primary care practices. This is a twice-weekly exercise program designed specifically for overweight and obese children. This new program has a research component in collaboration with the UNMC College of Public Health. (continue...)
Schedule H, Part V, Line 11 (continued)	- In 2018, Children's, in partnership with University of Nebraska - Lincoln (UNL) Extension, three farmer's markets, and one grocery store, continued the Double Up Food Bucks program. The effort increased the purchase of fresh fruits and vegetables by SNAP recipients in select Lincoln areas. Plans are underway to merge with other efforts, with a possible program expansion to other statewide sites. - Children's HEROES program continues to provide multidisciplinary clinical intervention for young people already experiencing medical complications from childhood obesity. The program includes Nebraska sites both in Omaha and Lincoln. - Other strategic tactics include Parenting U, a series of free parent education classes with topics focused on healthy eating and obesity prevention. * CHNA and Health Improvement Planning - In 2018, the management of the CHNA and health improvement planning processes transitioned to the Center. The Center has improved the process by revising the community survey to include more questions related to the social determinants of health. The Center engaged the community, especially the systems related to child health, and continues to collaborate with community stakeholders. * Early Childhood Health within communities - The Center led an Early Childhood Comprehensive Health Working Group (ECCHWG) and grew membership from an initial ten members representing six organizations to 70 individuals representing 38 organizations. (1) In collaboration with the ECCHWG and more than 100 community members, the Center completed an assessment using the MAPP (Mobilizing for Action through Planning and Partnerships) framework aimed specifically at early childhood. Together, they envisioned, "What are important characteristics/elements of a community where children are healthy and Kindergarten-ready?" (2) In 2018, the Center, along with ECCHWG, produced several issue briefs on community strategic issue, and explored a sustainable model to improve early childhood health via the Help Me Grow Model from Connecticut Children's Medical Center. (3) Dr. Karla Lester, the medical director for the Center, continues to serve as a Governor-appointed member to the Nebraska Early Childhood Interagency Coordinating Council (ECICC) which advises state government on improvement of services affecting young children and their families. * Literacy Improvement Program: - Four Children's Physicians (CP) offices (Creighton, Plattsmouth, Spring Valley, and UNMC) participated in Reach Out and Read, a nationally recognized program to improve literacy thanks to a donation made to CP. During well visits, 4,423 books were distributed since January 2018 (Creighton 709, Plattsmouth 868, Spring Valley 1,763, and UNMC 1,083). Priority Health Issues: Progress Highlights * Access to Health Care Services - CP's primary care network expanded into a Kearney, Neb., office location in July 2018; this is nearly 200 miles west of the main hospital in Omaha. This expansion increased access to pediatric health care services. - Walk-in services continued to expand within CP offices in 2018 with expanded walk-in physical days - four locations, two days; and have added walk-in flu vaccine clinics in all clinics on Saturdays. In addition, the ability to give caregiver/parent vaccine was added this past year. - CP implemented specialty visits at the CP office in Kearney - starting with Gastroenterology and Psychiatry. - In collaboration with behavioral health, there was expanded tele-psychiatry ability at several primary care offices. - In 2018, a consultant (Huron) worked with Children's Specialty Physicians (CSP) teams to increase efficiencies throughout outpatient specialty clinics and scheduling including a focus on early morning and evening visit times for family convenience. - Expanding the number of physician and advanced practice providers was another key strategy to improve access which is ongoing and actively occurring at Children's. The cardiology, pulmonology, palliative care, endocrinology, hemotology/oncology, gastroenterology, sports medicine, and neurology all added provider staff in 2018. - Across the Children's enterprise, 1,794 virtual care visits were performed in 2018. 97 percent of these visits were for Behavioral Health care while five other visit types were piloted (ADHD follow up, post-operative visit, lactation, rounding at Ambassador Health of Omaha and Lincoln Specialist visits). - An increasing number of outreach specialty clinic visits were held in 2018, with a few located greater than 50 miles away from the main campus (Lincoln, NE, Sioux City, IA and Dennison, IA). - The number of Children's outreach specialty clinic visits totaled 14,504 in 2018. * Care Transitions Team - There continues to be ongoing significant expansion in our Care Transitions department. This involves the outpatient and inpatient integration of social workers and nurse case managers across the continuum of care to assist children and their families in psychosocial aspects that affect health. o The care transitions focus in 2018 was to establish an enterprise-wide, patient-centered care coordination program that ensured high-risk and at-risk children were in the right setting to receive the right care across the entire continuum of care. The goal was to help children and their families manage their health, maintain their independence and improve their quality of life. o Ongoing 2018 initiatives to help reduce misuse of emergency department services: - Nurse case managers in the outpatient clinics reviewed frequent Emergency Department (ED) patients to determine if intervention would be appropriate and conducted a follow up phone call with patients that were seen in the ED. If appropriate, they were provided a level-of-care brochure and a listing of Urgent Care locations. - The ED care coordination team continued to offer care coordination in the ED seven days a week. - Care coordination teams across the enterprise continued to utilize Preliminary Risk Scores within the electronic health record to alert care coordination ED team members to review the patient chart and potentially meet with the family while they were in the current visit to provide appropriate interventions and supports. o To assess the Social determinants that affect health outcomes: - In 2018, CP expanded screening for food and housing insecurities during well-visits; these are known Social Determinants of Health (SDOH). There were 1,267 positive responses indicating food or housing insecurity. 60 percent were food-related and 40 percent were housing-related. Each location within CP had positive responses. * Injury & Violence Prevention - Children's Injury Prevention team provided 318 car seat checks in Children's fitting station in 2018. Children's provided another 428 car seat checks at community events, and gave out 260 safe car seats to families. - We continued to actively promote and explore increasing the number of community partners to help meet the demand for car seats and car seat education. Children's is working on grants to increase the number of Child Passenger Safety Technicians who will work in the growing immigrant and refugee populations in the area. Children's is also pursuing more car seat grants in order to provide more families with a safe car seat that fits their child. - In 2018, the emphasis on community outreach to increase child passenger safety seat checks through multiple community events has been implemented. Several of these events are specifically located and directed to the under-resourced Latino population in the Douglas County area. - A total of 905 children received free helmets and bike safety education from Children's in 2018. Hundreds more children were educated on safe bicycle skills and helmet use. - Children's continued to promote water safety/drowning prevention through partnership with the Joshua Collingsworth Memorial Foundation and Omaha Parks & Recreation. This initiative recognized a 24 percent reduction of total lifeguard rescues after life vest education was provided to all Omaha public pools. - In 2018, Children's significantly expanded Project Austin, a trauma outreach initiative that prepares rural hospitals and EMS providers to develop an emergency plan for each child and to have skill and knowledge training for the care of a medically complex child in their community. The program has newly enrolled 338 patients and has 529 actively enrolled patients. (continue...)
Schedule H, Part V, Line 11 (continued)	* Mental and Behavioral Health - Children's Behavioral Health expanded use of Tele-health services, improving access to care. More than 2,000 patients were seen in 2018 due to additional access hub sites. This is projected to eclipse 2,500 patients in 2019. - In 2018, Children's continued to partner with Westside Public Schools to continue the Student Assistance Program - a school-based mental health service that connects district families with Children's behavioral health team. This program saw 180 student referrals from the district during 2018 (approximating second semester 2017-2018 school year and 2018-2019 school year first semester). - In 2018, Children's also expanded behavioral health services into all CP primary care offices, resulting in more than 200 new patients. Children's also integrated behavioral health services into two oncology clinics as well as the Endocrinology DRIVE (Diabetes Resilience Independence Value and Empowerment), Cystic Fibrosis and Ulcerative Colitis/Crohn's outpatient clinics. - These efforts have allowed Children's Behavioral Health to log approximately 18,820 patient visits in 2018, an increase of approximately 19 percent from 2017. - In 2018, led by the Behavioral Health and Child Life team, the new Patient Assistance Team at Children's Hospital & Medical Center (PATCH) process created a pathway that facilitates communication between parents of Autism Spectrum Disorder, impacted patients and hospital staff. This helps ensure patient needs are clearly and efficiently identified and necessary modifications can be made to the care plan. A pilot PATCH process has begun within the outpatient surgical center and radiology departments, and has been well received by families and staff. Expansion throughout the enterprise is projected for 2019. * Oral Health - Oral health education is included in newborn booklets and discussions regarding oral health and dental home are incorporated into 12-month and 24-month well-check visits at CP locations. - Children's nursing case managers work with patients and families on the importance of pediatric oral health especially having a family dentist on an ongoing basis. - Children's continues to provide space within its Specialty Pediatric Center and the Outpatient Surgical Care suite for the UNMC College of Dentistry to treat children throughout the area with comprehensive oral health needs. * Vision, Hearing & Speech Conditions - Vision screenings are performed at 3-Year well-check visits, and hearing screenings are performed for each patient once between the 4-year and 6-year well-check visit at all CP locations. - In September 2018, Children's launched its Visionmobile, a mobile vision unit outfitted especially for pediatric vision care. The Visionmobile mission is to improve access to vision services for the underserved population, and its work first began at Omaha Public Schools. The program team included a full-time optometrist, an optician, care coordinator and van driver. During 2018, the Visionmobile visited 13 schools, providing comprehensive eye exams for 748 students and prescribing 427 pairs of glasses. Children's also provided and dispensed more than 100 pairs of glasses due to pairs being lost or broken. - The Child Vision Collaborative has been convened by Children's to connect with community child vision advocates. - Children's utilized five Colleges of nursing and allied health and interdisciplinary studies students to provide the manpower for vision screening. A Vision screening coordinator provided oversight and coordination of the events. In 2018, 14,642 students in 24 schools were screened for vision. In the first semester of the 2018-2019 school year, 39 percent of the children failed the vision screening and required a comprehensive eye exam, which is higher than the national average of 25 percent. * Asthma & Other Respiratory Conditions - Children's Project AIR (Asthma in-home Response) program is an ongoing collaboration with Omaha Healthy Kids Alliance. The program helps reduce asthma triggers in the home to prevent ED visits and hospitalizations. Patients who are identified have had three or more ED visits. The key collaborators from Children's who are referring families for this intensive healthy home and health environment evaluation and treatment are the CP primary care clinics & the Pulmonology and Allergy Clinics. - Children's Healthy Planet Asthma Project is progressing with the implementation of electronic health record improvements to enable better tracking of patients diagnosed with asthma. Work continues across the continuum with the care management program to reduce ED visits and hospital admissions due to asthma. In 2018, our care coordination team identified 70 patients who met the criteria for participation with 29 patients (41%) who enrolled and followed up with pulmonology or primary care within seven days. * Sexual Health - In 2016, CP developed an Adolescent Task Force to improve adolescent care throughout the organization. A standardized adolescent risk questionnaire assessed sexual health and other health risks (e.g. car safety and substance abuse), and provided an opportunity for the child to indicate they have questions for the provider about their health that may be confidential. The Adolescent Risk Questionnaire - which confidentially asked patients about their health risk behavior choices - was implemented during well visit exams and at other visits where the staff felt it was appropriate. o In 2018, this assessment was expanded to all 15 CP primary care offices. Since the implementation of the Adolescent Risk Questionnaire, Children's has increased the sexually transmitted infection (STI) testing by 85%. - Another barrier to appropriate STI testing was the inability to keep the testing confidential, as the tests are reported out to families by some third party payers on explanation of benefits documents. To address this barrier, CP has participated in a grant with the Women's Fund of Omaha's Adolescent Health Project. The project is designed to address the elevated Chlamydia/Gonorrhea rates in Douglas County amongst the 15-24 year old population as it is one of the highest in the nation. By participating in this grant, the CP offices in the metro Omaha region were able to offer free testing and treatment for their patients. * Women's Fund of Omaha - The Adolescent Health Project through the Women's Fund of Omaha has funded 1,149 Chlamydia/Gonorrhea tests at CP clinics since December 2017, out of the total 1,505 test administered. Participation in the grant has increased STI testing in our clinics by almost 900 tests per year compared to lab volumes prior to participation.
Schedule H, Part V, Line 13b	PRESUMPTIVE ELIGIBILITY CHILDREN'S RECOGNIZES THAT SOME PATIENTS WILL BE UNRESPONSIVE TO THE CHARITY CARE APPLICATION PROCESS DUE TO A VARIETY OF REASONS INCLUDING BUT NOT LIMITED TO: 1. LACK OF DOCUMENTATION REQUIRED TO COMPLY WITH THE TRADITIONAL CHARITY CARE APPLICATION REQUIREMENTS. 2. LACK OF THE EDUCATIONAL LEVEL TO UNDERSTAND AND COMPLETE THE CHARITY CARE APPLICATION. 3. FEAR THAT INFORMATION GATHERED DURING THE APPLICATION PROCESS WILL BE USED IN THE COLLECTION PROCESS IN THE EVENT THAT THE APPLICATION IS DENIED. 4. OUT OF STATE PATIENTS THAT DO NOT RESPOND TO COMPLETION OF A MEDICAID APPLICATION OR FINANCIAL ASSISTANCE APPLICATION. IN THE ABSENCE OF INFORMATION PROVIDED BY THE PATIENT OR IN CASES WHERE THE INFORMATION PROVIDED BY THE PATIENT IS INCOMPLETE, AN ASSESSMENT PROCESS UTILIZING A PREDICTIVE MODEL WILL BE DEPLOYED TO DETERMINE CHARITY CARE ELIGIBILITY. THE PREDICTIVE MODEL INCORPORATES INCOME AND HOUSEHOLD SIZE ESTIMATES, A SOCIO-ECONOMIC NEED FACTOR (WIC, SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM, HUD PROGRAMS), CENSUS BLOCK DATA, AS WELL AS INFORMATION ON HOME OWNERSHIP. THE APPLICATION OF THE PREDICTIVE SCORING PROCESS AND PRESUMPTIVE FINANCIAL ASSISTANCE WILL BE DEPLOYED PRIOR TO BAD DEBT ASSIGNMENT FOR ALL PATIENTS THAT HAVE NOT APPLIED FOR CHARITY CARE. CHILDREN'S IS NOT OBLIGATED TO NOTIFY THE PATIENT THAT THEY HAVE RECEIVED PRESUMPTIVE CHARITY CARE.
Schedule H, Part V, Line 16a	https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part V, Line 16b https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part V, Line 16c https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/ Schedule H, Part V, Line 16j THE POLICY IS PROVIDED TO THE PUBLIC IN SUMMARY AND They are DIRECTED TO VISIT THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE FOR THE FULL POLICY.
Schedule H, Part V, Line 24	AT CHILDREN'S, COMMERCIAL INSURERS, GOVERNMENT PAYORS AND SELF-PAY BILLING PARTIES ARE ALL BILLED THE SAME GROSS CHARGE RATE FOR EACH SPECIFIC PROCEDURE PERFORMED. GROSS CHARGES ON A FAP-PATIENT BILL ARE THEN DISCOUNTED ACCORDING TO THEIR FPG ELIGIBILITY WHICH REDUCES OR ELIMINATES THE AMOUNT THE PATIENT IS REQUIRED TO PAY.

Schedule H (Form 990) 2018

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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?2
Name and address		Type of Facility (describe)
1	LINCOLN CLINIC 5930 VANDERVOOT DR STE A LINCOLN,NE68516	PEDIATRIC CLINIC
2	CAROLYN SCOTT RAINBOW HOUSE 7825 FARNAM DRIVE OMAHA,NE68114	MINIMUM TO NO-COST ACCOMMODATIONS FOR FAMILIES OF PATIENTS
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Schedule H (Form 990) 2018

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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
Schedule H, Part I, Line 3c	FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. FINANCIAL ASSISTANCE IS AVAILABLE FOR MEDICALLY NECESSARY PROCEDURES AND SERVICES. SERVICES NOT ELIGIBLE FOR FINANCIAL ASSISTANCE INCLUDE COSMETIC AND OTHER ELECTIVE PROCEDURES, HELMET CLINIC, EATING DISORDERS PROGRAM AND HEROES WEIGHT MANAGEMENT PROGRAM. CERTIFICATION OR PROOF OF MEDICAID DENIAL IS A REQUIREMENT FOR FINANCIAL ASSISTANCE CONSIDERATION. FINANCIALLY RESPONSIBLE PARTIES WHO SUBMIT A COMPLETE AND VERIFIABLE APPLICATION FOR FINANCIAL ASSISTANCE (INCLUDING PROOF OF MEDICAID DENIAL) WILL BE CONSIDERED FOR FREE OR REDUCED ASSISTANCE ON THE BASIS OF FEDERAL POVERTY GUIDELINES (400% FPL LIMIT). FAMILIES THAT DO NOT QUALIFY FOR INCOME BASED FINANCIAL ASSISTANCE THAT HAVE VERIFIABLE OUT OF POCKET MEDICAL DEBT GREATER THAN 20% OF GROSS INCOME MAY QUALIFY FOR CATASTROPHIC ASSISTANCE LEAVING UP TO 1% OF THE FAMILY'S GROSS INCOME AS THE RESPONSIBILITY. PRESUMPTIVE ELIGIBILITY IS AVAILABLE IN A VARIETY OF CIRCUMSTANCES INCLUDING THE ABSENCE OF DOCUMENTATION REQUIRED TO COMPLY WITH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION REQUIREMENTS. THE PREDICTIVE INCORPORATES INCOME AND HOUSEHOLD SIZE ESTIMATES, A SOCIO-ECONOMIC NEED FACTOR, CENSUS BLOCK DATA, AS WELL AS INFORMATION ON HOME OWNERSHIP.
Schedule H, Part I, Line 6a	THE COMMUNITY BENEFIT REPORT IS PREPARED BY THE ORGANIZATION. THE VALUES REPORTED IN THE 2018 COMMUNITY BENEFIT REPORT INCLUDE $4.3M IN FINANCIAL ASSISTANCE.
Schedule H, Part I, Line 7	EXPLANATION OF THE COSTING METHODOLOGY USED TO CALCULATE SUBSIDIZED HEALTH SERVICES: SUBSIDIZED HEALTH SERVICES WERE CALCULATED USING A COMBINATION OF CHILDREN'S HOSPITAL & MEDICAL CENTER'S COST ACCOUNTING SYSTEM AND A COST TO CHARGE RATIO CALCULATION SIMILAR TO WORKSHEET 2 IN THE SCHEDULE H INSTRUCTIONS. THE REPORTED SUBSIDIZED LOSS REPRESENTS THE DIFFERENCE IN NET REVENUE RECEIVED FROM ALL PAYORS LESS TOTAL OPERATING EXPENSES INCLUDING INDIRECT COSTS APPLICABLE TO EACH DEPARTMENT. UNREIMBURSED MEDICAID COSTS REPORTED ON LINE 7B AND OTHER OPERATING EXPENSE APPLICABLE TO THE DEPARTMENT REPORTED ELSEWHERE ON SCHEDULE H AS A COMMUNITY BENEFIT is EXCLUDED FROM THE OPERATING EXPENSE TOTAL AS ARE BAD DEBT AND NONPATIENT CARE EXPENSE ASSOCIATED WITH EACH DEPARTMENT. INDIRECT COSTS FOR EACH DEPARTMENT WERE CALCULATED BY APPLYING THE MEDICARE COST REPORT OVERHEAD RATE APPLICABLE TO THAT DEPARTMENT TO THE DEPARTMENT'S TOTAL OPERATING EXPENSES EXCLUDING UNREIMBURSED MEDICAID EXPENSES AND/OR ANY OTHER EXPENSE ALREADY REPORTED ELSEWHERE ON SCHEDULE H AS A COMMUNITY BENEFIT.
Schedule H, Part I, Line 7G	THE ORGANIZATION DID NOT INCLUDE COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES.
Schedule H, Part II	COMMUNITY BUILDING ACTIVITIES CHILDREN'S HOSPITAL & MEDICAL CENTER SUPPORTS ECONOMIC DEVELOPMENT IN ITS SPONSORSHIP DONATIONS TO ORGANIZATIONS SUCH AS THE NEBRASKA CHAMBER OF COMMERCE & INDUSTRY.
Schedule H, Part III, Line 2	DESCRIBE THE METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON LINES 2 & 3: BAD DEBT EXPENSE AT 100% CHARGE VALUE WAS MULTIPLIED BY THE 2018 MEDICARE COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST VALUE. BAD DEBT EXPENSE AT 100% CHARGE VALUE $3,811,345 MEDICARE COST TO CHARGE RATIO X .383 BAD DEBT EXPENSE AT COST $1,459,745 ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY: THIS PROCESS INCLUDES IDENTIFYING CHARITY CARE FINANCIAL ASSISTANCE CODES CONGRUENT WITH THE FINANCIAL ASSISTANCE POLICY THAT WERE CHARGED TO BAD DEBT EXPENSE AT 100% CHARGE VALUE. THIS AMOUNT IS $0 FOR 2018 AND REFLECTS THE EFFORTS OF CHILDREN'S HOSPITAL & MEDICAL CENTER TO ENSURE THAT NO CHILD WITH A MEDICAL NEED IS TURNED AWAY DUE TO INABILITY TO PAY FOR HEALTH CARE. DESCRIBE HOW THE ORGANIZATION ACCOUNTS FOR DISCOUNTS OR PAYMENTS ON PATIENT ACCOUNTS IN DETERMINING BAD DEBT EXPENSE: BAD DEBT EXPENSE IS CREDITED FOR ANY PAYMENT RECEIVED ON ACCOUNTS PREVIOUSLY WRITTEN OFF.
Schedule H, Part III, Line 4	ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ADJUSTMENTS. IN EVALUATING PATIENT ACCOUNTS RECEIVABLE BY FINANCIAL CLASS, MANAGEMENT REGULARLY REVIEWS AN ANALYSIS OF ITS HISTORICAL COLLECTIBILITY TRENDS ALONG WITH AN AGING OF ACCOUNTS RECEIVABLE. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS, COLLECTIBILITY IS DETERMINED BASED ON A COMBINATION OF HISTORICAL TRENDS AND CONTRACTUAL AGREEMENTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, INCLUDING PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENTS, MANAGEMENT ANALYZES HISTORICAL TRENDS IN EACH OF ITS PREDETERMINED STAGES OF COLLECTIBILITY AND STATUS OF AGREED-UPON PAYMENT PLANS. THE DIFFERENCE BETWEEN THE STANDARD OR NEGOTIATED DISCOUNTED RATES AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
Schedule H, Part III, Line 8	MEDICARE 2018 MEDICARE CHARGES REPORTED BY The Centers for Medicare and Medicaid Services (CMS) IN THE PROVIDER STATISTICAL AND REIMBURSEMENT SYSTEM FOR PROVIDER FYE 12/31 WERE MULTIPLIED BY THE 2018 COST TO CHARGE RATIO TO ARRIVE AT AN APPROXIMATE COST OF CARE RELATED TO THE REIMBURSEMENT PAYMENTS REPORTED ON Schedule H, Part III, LINE 5.
Schedule H, Part III, Line 9b	COLLECTION PRACTICES SELF PAY ACCOUNTS WITH NO VERIFIABLE INSURANCE AND BALANCE AFTER INSURANCE ACCOUNTS ARE CONSIDERED FOR FINANCIAL ASSISTANCE THROUGHOUT THE COLLECTION PROCESS FOR THOSE GUARANTORS WHO ARE FINANCIALLY UNABLE TO PAY, EITHER THROUGH A GOVERNMENT PROGRAM OR THROUGH CHILDREN'S HOSPITAL & MEDICAL CENTER'S FINANCIAL ASSISTANCE PROGRAM. ALL CORRESPONDENCE, INCLUDING STATEMENTS AND COLLECTION LETTERS STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE.
Schedule H, Part VI, Line 2	2-Needs Assessment Children's Hospital & Medical Center (Children's) uses numerous resources to benchmark, align and conduct assessments of the health care needs of children in the communities we serve. These resources include focused stakeholder input and prioritization, national public health (Healthy People 2020) and pediatric care standards. We also review data from the American Academy of Pediatrics, as listed in our 2018 Community Health Needs Assessment (CHNA) report, and trends as identified by Children's Hospital Association (CHA). During this 2018 Child and Adolescent CHNA, additional community feedback on prioritization of health needs was obtained with leadership and active participation within the Douglas County Mobilizing for Action through Planning and Partnerships (MAPP) process and the Live Well Omaha's 2018 Changemaker summit. Douglas County Health Department and Children's partnered to facilitate a series of strategic assessments (Forces of Change Assessment, a Local Public Health Systems Assessment and a Community Strengths and Themes Assessment) by using the MAPP process. This framework applies strategic thinking to the priority health issues to identify resources to meet the challenges and opportunities. On November 5, 2018, findings from this CHNA were presented at Live Well Omaha's 2018 Changemaker Summit. The Changemaker Summit is the region's largest multi-sector health conference, which gathers more than 170 leaders from across Douglas, Sarpy, Cass and Pottawattamie Counties to celebrate the milestones of our collective work and advance future work while learning from local, regional and national experts. At this event, data was shared reflecting the significant health issues identified from the research and the MAPP process. Individuals' ratings from this summit yielded the following prioritized list of community health needs for children and adolescents in the Omaha metro area: 1. Mental Health 2. Nutrition, Obesity & Physical Activity 3. Access to Health Services 4. Sexual Health 5. Tobacco, Alcohol & Other Drugs Organizations sponsoring or supporting this CHNA will use the information from this CHNA to develop implementation strategies to address the significant health needs in the community. The results of this prioritization exercise will be used to inform the development of action plans to guide community health improvement efforts in the coming years. By using this process in connection with the CHNA data, our community is positioned to improve the efficiency and effectiveness of local public health systems across the region. Several other current clinical assessments include the Pedi-Boost Risk score, a medical and social risk screening for all children who make an encounter with the enterprise. For those children with high or rising risk, a complete psychosocial assessment is performed by our care transition team of social workers or nurse case managers in the outpatient and inpatient setting. Several departments routinely utilize depression screening PHQ9 for those youth 12 and older. A postpartum depression screening is performed at 2 weeks, 2 months and 4 months for primary care well visits. New in 2018, within the primary care well visit is a brief food and housing insecurity screening. Internal resources that assist with the assessment of child health needs are Children's Family Advisory Councils, social workers and nurse case managers, physicians and clinical service units and IT analysts/reporters. An analysis of the information and/or data collected from these various resources is conducted to identify potential gaps in child health needs in the communities served. Needs that align with the hospital's mission and capacity are selected for review by administration, which prioritizes needs and authorizes implementation based on the scope or seriousness of the problem, availability of community resources, availability of funding, and/or alignment with the hospital's expertise and strategic goals.
Schedule H, Part VI, Line 3	3-PATIENT EDUCATION OF ELIGIBILITY FINANCIALLY RESPONSIBLE PARTIES WHO EXPERIENCE DIFFICULTY IN MEETING THEIR FINANCIAL OBLIGATIONS WILL BE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGH GOVERNMENT PROGRAMS AND OTHER POTENTIAL FUNDING SOURCES OR ALTERNATIVELY QUALIFIED FOR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. ELIGIBILITY FOR FINANCIAL ASSISTANCE IS IDEALLY DETERMINED EITHER PRIOR TO SERVICES BEING PROVIDED OR AT THE TIME SERVICES ARE RENDERED AND IS BASED UPON FAMILY/GUARANTOR INCOME, FAMILY SIZE AND OTHER SPECIAL CONSIDERATIONS. THE PRIMARY RESPONSBILITY TO IDENTIFY FINANCIAL NEED IS WITH THE ACCESS PATIENT ADVOCATES, CENTRAL BILLING OFFICE AND SOCIAL WORK STAFF. THESE STAFF MEMBERS ARE TRAINED TO IDENTIFY PATIENT NEEDS AND ANSWER FINANCIAL ASSISTANCE QUESTIONS. THERE ARE SEVERAL POINTS IN THE PATIENT EXPERIENCE WHERE FINANCIAL ASSISTANCE RESOURCES ARE OFFERED. THE FIRST OCCURS AT THE PRE-REGISTRATION OF INPATIENT ADMITS AND OUTPATIENTS PRESENTING THROUGH CARES AND FOR THOSE PATIENTS SCHEDULED IN THE SPECIALTY PEDIATRIC CENTER CLINICS. AT THIS TIME, ELECTRONIC ELIGIBILITY IS RAN ON THE INSURED. THE BENEFIT DETAIL INCLUDING DEDUCTIBLE, COPAYMENT AND COINSURANCE AMOUNTS ARE DISCUSSED WITH THE FAMILY. ALL INDIVIDUALS WHO ARE FINANCIALLY UNABLE TO PAY WILL BE ENCOURAGED TO AND ASSISTED IN APPLYING FOR FINANCIAL HELP THROUGH GOVERNMENT PROGRAMS AND OTHER POTENTIAL FUNDING SOURCES OR ALTERNATIVELY QUALIFIED FOR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. AT THE TIME OF REGISTRATION, INSURANCE IS DISCUSSED AND FAMILIES AGAIN ARE OFFERED THE ASSISTANCE OF ACCESS CENTER PATIENT ADVOCATES WHO ARE AVAILABLE MONDAY THROUGH FRIDAY. ALL SELF PAY FAMILIES ARE ENCOURAGED TO SPEAK TO AN ACCESS CENTER PATIENT ADVOCATE. CARE ESTIMATES OR QUESTIONS REGARDING ESTIMATE OF COST FOR UPCOMING TESTING IS DIRECTED TO THE PATIENT ADVOCATES AND THESE SERVICES ARE AGAIN OFFERED PRIOR TO ENDING THE CONVERSATION. FINANCIAL ASSISTANCE INFORMATION IS ALSO LOCATED IN THE PATIENT HANDBOOKS. PATIENT STATEMENTS INCLUDE LEAFLETS AND ALL MAILED CORRESPONDENCE INCLUDING BILLS, STATEMENTS, AND COLLECTION LETTERS STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. CHILDREN'S HOSPITAL & MEDICAL CENTER'S INTERNET WEBSITE ALSO OFFERS A FINANCIAL ASSISTANCE LINK THAT INFORMS READERS IF YOU ARE UNINSURED OR HAVE LIMITED INCOME, YOU MAY QUALIFY FOR FINANCIAL ASSISTANCE THROUGH GOVERNMENT PROGRAMS OR CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. THE WEBSITE EXPLAINS THAT DEPENDING ON INCOME LEVEL, ALL OR PART OF THE MEDICAL COSTS MAY BE FUNDED BY MEDICAID AND ALTERNATIVELY IF THEY ARE DETERMINED NOT ELIGIBLE FOR MEDICAID AFTER PROVIDIING ALL OF THE REQUIRED DOCUMENTATION THAT THEY MAY THEN APPLY FOR THE CHILDREN'S FINANCIAL ASSISTANCE PROGRAM. CONTACT NUMBERS FOR THE PATIENT ADVOCATES AND HOURS OF SERVICE ARE PROVIDED. THE WEBSITE INCLUDES COPIES OF CHILDREN'S FINANCIAL ASSISTANCE POLICY, THE FINANCIAL ASSISTANCE APPLICATION FORM AND THE PLAIN LANGUAGE SUMMARY IN ENGLISH, ARABIC, CHINESE, FRENCH, PERSIAN, SPANISH AND VIETNAMESE. THE WEBSITE ALSO INCLUDES AMOUNTS GENERALLY BILLED IN ENGLISH. ALL OTHER BILLING, PAYMENT AND FINANCIAL RESPONSIBILITY RELATED LINKS ON CHILDREN'S WEBSITE STATE THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE. THE FINANCIAL ASSISTANCE POLICY IS CURRENTLY AVAILABLE ON THE CHILDREN'S HOSPITAL & MEDICAL CENTER WEBSITE AND IS ALSO AVAILABLE UPON REQUEST. https://www.childrensomaha.org/hospital-experience/insurance-billing-medic al-records/financial-assistance/
Schedule H, Part VI, Line 4	4-COMMUNITY INFORMATION THE HOSPITAL'S PRIMARY SERVICE AREA CONSISTS OF DOUGLAS AND SARPY COUNTIES IN NEBRASKA AND POTTAWATTAMIE COUNTY IN IOWA. THE PRIMARY SERVICE AREA HAS A CURRENT AGGREGATE POPULATION OF APPROXIMATELY 852,672. THE HOSPITAL'S SECONDARY SERVICE AREA CONSISTS OF EIGHT SURROUNDING COUNTIES IN NEBRASKA AND NINE SURROUNDING COUNTIES IN IOWA. FOR THE YEAR ENDED DECEMBER 31, 2018, 50.9% OF THE HOSPITAL'S INPATIENT DISCHARGES WERE FROM PATIENTS RESIDING IN THE THREE-COUNTY PRIMARY SERVICE AREA. PATIENTS RESIDING IN THE SEVENTEEN-COUNTY SECONDARY SERVICE AREA ACCOUNTED FOR 19.6% OF TOTAL HOSPITAL INPATIENT DISCHARGES DURING THIS SAME TIME PERIOD. THE REMAINING 26.5% OF TOTAL DISCHARGES WERE FROM PATIENTS RESIDING OUTSIDE THE PRIMARY AND SECONDARY SERVICE AREAS. 2018 DEMOGRAPHIC SUMMARY OMAHA METRO MARKET AREA: DOUGLAS, SARPY AND POTTAWATTAMIE COUNTIES SOURCES: ESRI (BASED ON US CENSUS BUREAU), UNITED STATES CENSUS BUREAU AND CHILDREN'S HOSPITAL AND MEDICAL CENTER PATIENT ENCOUNTER DATABASE. COMMUNITIES SERVED - URBAN, SUBURBAN AND RURAL # OF HOSPITALS SERVING COMMUNITY - 12 TOTAL POPULATION 852,672 PEDIATRIC POPULATION 214,197 AVERAGE HOUSEHOLD INCOME $88,261 PERCENT OF RESIDENTS BELOW FEDERAL POVERTY LEVEL TOTAL POPULATION 11.5% UNDER AGE 18 15.3% PERCENT OF RESIDENTS ON MEDICAID 10.4% AGE POPULATION % OF TOTAL LESS THAN 18 214,197 25.1% 18 TO 24 80,015 9.4% 25 TO 44 241,830 28.4% 45 TO 64 203,977 23.9% 65+ 112,653 13.2% TOTAL 852,672 100.0% RACE POPULATION % OF TOTAL WHITE 630,684 74.0% HISPANIC 97,489 11.4% BLACK 68,411 8.0% ASIAN/PACIFIC ISLANDER 28,207 3.3% OTHER/2+ RACES 24,722 2.9% AM. IND/ALASKA NAT 3,159 0.4% TOTAL 852,672 100.00% FEDERALLY-DESIGNATED MEDICALLY UNDERSERVED AREAS APPROXIMATE % OF PATIENTS FROM MEDICALLY UNDERSERVED AREAS:11.7% COUNTY # OF CENSUS TRACTS* TOTAL CNESUS TRACTS % OF TOTAL DOUGLAS 36 156 23.1% SARPY 12 43 27.9% POTTAWATTAMIE 3 30 10.0% TOTAL 51 229 22.3% *CENSUS TRACT IS A GEOGRAPHICAL DIVISION OF 500 TO 3,000 HOUSEHOLDS
Schedule H, Part VI, Line 5	Proudly serving children since 1948, Children's Hospital & Medical Center (Children's) mission is to improve the life of every child through dedication to exceptional clinical care, research, education and advocacy. Children's Center for the Child & Community is a statewide community outreach hub of Children's. The Children's Center for the Child & Community was launched in 2016 to serve as the infrastructure for community health improvement, leading both internal and external partnerships around Pediatrics Community Health Needs Assessment (CHNA) planning and implementation. In 2018, Children's provided medical care for 149,700 children. Children's is the only full-service, pediatric health care center in Nebraska. Some of the programs and services Children's offered to patients were: Behavorial Health, Rehab Services, Home Health, Urgent Care, HEROES (childhood obesity), and specialty care clinics. In addition, Children's offers Hand in Hand Palliative Care, Family Resources, Child Life Specialists, Pastoral Care, Social Workers, Nurse Case Managers, Interpreters, Financial Counselors, Patient Advocates, and other programs to enhance the patient experience. Children's has achieved the Magnet designation for nursing excellence and its Pediatric Intensive Care Unit has earned a Silver Beacon Award for Excellence from the American Association of Critical Care Nurses. The hospital has achieved Stage 6 on the HIMSS Analytics EMR Adoption Models (EMRAM). Children's is also recognized as a 2018-19 Best Children's Hospital by U.S. News & World Report in five pediatric specialties: Cardiology and Heart Surgery, Gastroenterology and GI Surgery, Orthopedics, Pulmonology, and Diabetes & Endocrine Disorders. Ten of the Children's Physicians primary care offices have achieved the highest NCQA Patient Centered Medical Home (PCMH) certification. A pediatric affiliation established between Children's and the University of Nebraska Medical Center College of Medicine (UNMC) supports enhancements in pediatric education, research and clinical care. Children's is the primary teaching site for the family practice and joint pediatrics residency programs at Creighton University and UNMC. Children's is committed to ensuring that no child with a medical need is ever turned away due to a family's inability to pay for services. In 2018, our hospital: - Provided $5.8 million in services in the form of uncompensated care [charity care ($4.3 million) and bad debt write-offs ($1.5 million)] to families unable to pay. With 44% of patient care revenues devoted to the care of low-income children assisted by Medicaid, the Medicaid reimbursement shortfall for FY 2018 was $30.2 million less than the cost of care provided. - Contributed $1.4 million towards community health education aimed at promoting health and preventing illness and injury made available through the Kohl's Cares GoNoodle grant partnership, injury prevention, obesity prevention, Parenting U education classes, outreach educational classes, health fairs, Just Kids magazine, and the consumer website. Children's gives back to the community through advocacy services which are available to anyone suspecting child abuse or neglect and lodging for families of out-of-town patients is offered at the Carolyn Scott Rainbow House at little or no cost. - Contributed $25.8 million in pediatric health care education costs to educate tomorrow's healers. - Provided $1.7 million in cash and in-kind donations/sponsorships to benefit the broader community In 2018, Children's provided in total, more than $103 million in community benefits representing 29% of the hospital's operating expenses.
Schedule H, Part VI, Line 6	6-AFFILIATED HEALTH CARE SYSTEM CHILDREN'S HOSPITAL & MEDICAL CENTER IS NOT AFFILIATED WITH A GREATER HEALTH CARE SYSTEM, BUT IS IT'S OWN HEALTH CARE SYSTEM WHICH THE HOSPITAL OPERATES THE FOLLOWING RELATED ORGANIZATIONS: - CHILDREN'S HOSPITAL & MEDICAL CENTER FOUNDATION - CHILDREN'S PHYSICIANS - CHILDREN'S HEALTH NETWORK
Schedule H, Part VI, Line 7	7-STATE FILING OF COMMUNITY BENEFIT REPORT THE CHILDREN'S HOSPITAL & MEDICAL CENTER COMMUNITY BENEFIT REPORT IS FILED IN THE STATE OF NEBRASKA THROUGH THE NEBRASKA HOSPITAL ASSOCIATION, AND IS AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.CHILDRENSOMAHA.ORG/COMMUNITY-BENEFIT-INFORMATION

Schedule H (Form 990) 2018

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Children's Hospital & Medical Center

Employer identification number
47-0379754

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) NE PEDIATRIC PRACTICE 8200 DODGE STREET OMAHA,NE68114	26-3064869	501(C)(3)	3,963,527				PEDIATRIC RESEARCH
(2) UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE 985520 NE MED CTR OMAHA,NE68198	47-0049123	501(C)(3)	4,031,356				SUPPORT FOR MED SCH

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2018

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1) CHARITY ASSISTANCE TO PATIENTS IN NEED	6830	11,159,320	BOOK	WRITEOFF PAT ACCT
(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Schedule I, Part I, Line 2	CHILDREN'S HOSPITAL & MEDICAL CENTER HAS A WRITTEN FINANCIAL ASSISTANCE/CHARITY CARE POLICY. THE AMOUNT OF FINANCIAL ASSISTANCE AN INDIVIDUAL CAN RECEIVE IS BASED ON THE ANNUAL GROSS INCOME THRESHOLDS USING THE CURRENT FEDERAL POVERTY LEVEL GUIDELINES. GRANTS TO ORGANIZATIONS ARE ONLY DISTRIBUTED TO 501(C)(3) ORGANIZATIONS BASED ON THE HOSPITAL'S EVALUATION CRITERIA.

Schedule I (Form 990) 2018

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

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 .........

Yes

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? ..

Yes

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2018

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 on 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 on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Richard Azizkhan MD President, CEO, Member	(i) (ii)	952,461 ------------- 0	354,690 ------------- 0	511,846 ------------- 0	35,000 ------------- 0	9,765 ------------- 0	1,863,762 ------------- 0	486,233 ------------- 0
2Deb Arnow SVP Pat Care Srvs & CNO	(i) (ii)	-855 ------------- 0	75,889 ------------- 0	236,093 ------------- 0	0 ------------- 0	9,896 ------------- 0	321,023 ------------- 0	0 ------------- 0
3Michael Brown EVP Strategy & Transformation	(i) (ii)	560,274 ------------- 0	176,712 ------------- 0	223,790 ------------- 0	100,096 ------------- 0	13,140 ------------- 0	1,074,012 ------------- 0	219,250 ------------- 0
4Fernando Ferrer MD SVP & Surgeon-in-chief	(i) (ii)	723,121 ------------- 0	0 ------------- 0	1,029 ------------- 0	109,179 ------------- 0	1,612 ------------- 0	834,941 ------------- 0	28,326 ------------- 0
5Kathy English EVP & COO	(i) (ii)	451,823 ------------- 0	169,493 ------------- 0	4,429 ------------- 0	97,939 ------------- 0	8,765 ------------- 0	732,449 ------------- 0	0 ------------- 0
6Amy Hatcher SVP & CFO	(i) (ii)	373,411 ------------- 0	149,970 ------------- 0	85,029 ------------- 0	64,903 ------------- 0	8,318 ------------- 0	681,631 ------------- 0	82,597 ------------- 0
7Christopher Maloney MD SVP & Chief Medical Officer	(i) (ii)	495,288 ------------- 0	0 ------------- 0	21,800 ------------- 0	79,979 ------------- 0	327 ------------- 0	597,394 ------------- 0	15,764 ------------- 0
8Steven C Burnham SVP Physician Networks	(i) (ii)	338,987 ------------- 0	125,996 ------------- 0	6,377 ------------- 0	63,973 ------------- 0	13,075 ------------- 0	548,408 ------------- 0	0 ------------- 0
9Amy Bones SVP & General Counsel	(i) (ii)	286,478 ------------- 0	115,325 ------------- 0	57,716 ------------- 0	71,721 ------------- 0	7,366 ------------- 0	538,606 ------------- 0	52,296 ------------- 0
10Suzanne Nocita SVP & CHRO	(i) (ii)	243,191 ------------- 0	75,378 ------------- 0	58,878 ------------- 0	63,086 ------------- 0	12,797 ------------- 0	453,330 ------------- 0	51,230 ------------- 0
11Mark Stastny VP & CIO	(i) (ii)	264,395 ------------- 0	111,590 ------------- 0	97,615 ------------- 0	35,342 ------------- 0	11,663 ------------- 0	520,605 ------------- 0	49,294 ------------- 0
12Jamie Drake MD Physician	(i) (ii)	397,436 ------------- 0	29,750 ------------- 0	366 ------------- 0	13,812 ------------- 0	241 ------------- 0	441,605 ------------- 0	0 ------------- 0
13Kari Krenzer Physician	(i) (ii)	369,900 ------------- 0	29,750 ------------- 0	2,830 ------------- 0	21,738 ------------- 0	17,118 ------------- 0	441,336 ------------- 0	0 ------------- 0
14Martin Beerman VP Market & Community Relation	(i) (ii)	262,832 ------------- 0	91,677 ------------- 0	45,749 ------------- 0	41,801 ------------- 0	1,199 ------------- 0	443,258 ------------- 0	42,187 ------------- 0
15Rachel McCann MD Physician	(i) (ii)	348,080 ------------- 0	35,000 ------------- 0	2,717 ------------- 0	19,250 ------------- 0	15,812 ------------- 0	420,859 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2018

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
Schedule J, Part I, Line 1a	FIRST-CLASS TRAVEL WAS PAID FOR BY THE ORGANIZATION AND WAS SOLELY FOR BUSINESS PURPOSES.
Schedule J, Part I, Line 1a	RICHARD AZIZKHAN'S SOCIAL CLUB DUES ARE PAID FOR BY THE ORGANIZATION TO BE USED FOR BUSINESS PURPOSES.
Schedule J, Part I, Line 4a	THE FOLLOWING EMPLOYEES RECEIVED SEVERANCE PAYMENTS DURING CALENDAR YEAR 2018: DEBRA ARNOW $236,093
Schedule J, Part I, Line 4b	THE FOLLOWING INDIVIDUALS PARTICIPATED IN A 457(F) PLAN DURING 2018. THE AMOUNTS OF DEFERRED COMPENSATION DISTRIBUTED AND ACCRUED FOR EACH OF THE INDIVIDUALS DURING 2018 ARE AS FOLLOWS: MICHAEL BROWN $75,346 ACCRUAL, $219,250 PLAN DISTRIBUTION KATHY ENGLISH $73,189 ACCRUAL, $0 PLAN DISTRIBUTION STEPHEN C BURNHAM $44,723 ACCRUAL, $0 PLAN DISTRIBUTION RICHARD AZIZKHAN, M.D. $0 ACCRUAL, $486,233 PLAN DISTRIBUTION AMY HATCHER $48,403 ACCRUAL, $82,597 PLAN DISTRIBUTION AMY BONES $37,221 ACCRUAL, $52,296 PLAN DISTRIBUTION SUSAN NOCITA $0 ACCRUAL, $51,230 PLAN DISTRIBUTION CHRISTOPHER MALONEY, M.D. $63,479 ACCRUAL, $15,764 PLAN DISTRIBUTION FERNANDO FERRER, M.D. $92,679 ACCRUAL, $28,236 PLAN DISTRIBUTION MARK STASTNY $27,092 ACCRUAL, $49,294 PLAN DISTRIBUTION MARTIN BEERMAN $22,679 ACCRUAL, $42,187 PLAN DISTRIBUTION

Schedule J (Form 990) 2018

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization
Children's Hospital & Medical Center

Employer identification number
47-0379754

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
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE	52-1440796	259230KT6	08-12-2008	100,881,609	REFUND BONDS (6/8/2007)	X			X		X
B	HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE	52-1440796		09-10-2014	19,900,000	REFUND BONDS (8/12/2008)		X		X		X
C	HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE	52-1440796	259230NJ5	03-14-2017	101,075,067	USED TO CONSTRUCT HUBBARD CENTER		X		X		X
D	HOSPITAL AUTHORITY #2 OF DOUGLAS CO NE	52-1440796		11-28-2017	26,885,000	REFUND BONDS (8/12/2008)		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	65,000,000		1,280,000		0		4,190,000
2 Amount of bonds legally defeased ..............	0		0		0		0
3 Total proceeds of issue ..................	100,892,260		20,416,445		103,562,643		26,885,000
4 Gross proceeds in reserve funds .............	0		0		0		0
5 Capitalized interest from proceeds .............	0		0		0		0
6 Proceeds in refunding escrows ...............	0		0		0		0
7 Issuance costs from proceeds ...............	751,783		207,632		1,064,167		305,601
8 Credit enhancement from proceeds .............	24,826		0		0		0
9 Working capital expenditures from proceeds .............	0		0		0		0
10 Capital expenditures from proceeds .............	2,755,000		0		45,195,025		0
11 Other spent proceeds .............	97,360,681		20,208,813		0		26,579,399
12 Other unspent proceeds .............	0		0		57,303,451		0
13 Year of substantial completion .............	2008		2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? ....	X			X		X	X
15 Were the bonds issued as part of an advance refunding issue? .....		X	X			X		X
16 Has the final allocation of proceeds been made? ..........	X		X			X	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X		X		X

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............	X		X			X	X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2018

Page 2

Part Ⅲ

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............	X		X			X	X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?	X		X				X
c Are there any research agreements that may result in private business use of bond-financed property? .............	X		X			X	X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?	X		X				X
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 ....	0.200 %		0.200 %		0 %		0.200 %
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 .........
6 Total of lines 4 and 5 .............	0.200 %		0.200 %				0.200 %
7 Does the bond issue meet the private security or payment test? ...		X		X		X		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		X		X		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? .............		X		X		X		X
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		X		X		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		X		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X		X	X			X
b Exception to rebate? ........	X			X		X	X
c No rebate due? .........	X		X			X	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			X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?	X			X		X		X
b Name of provider ..........	MORGAN STANLEY		0		0		0
c Term of hedge .........	25 %
d Was the hedge superintegrated? ......		X
e Was the hedge terminated? ........		X

Schedule K (Form 990) 2018

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		X		X		X
b Name of provider ..........	0		0		0		0
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		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X		X		X		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		X		X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
SCHEDULE K, PART II, LINE 3	THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN E DUE TO INVESTMENT EARNINGS.
SCHEDULE K, PART IV, LINE 2C	DATE THE REBATE COMPUTATION WAS PERFORMED: 10/02/2017 (2008 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 08/21/2018 (2014 BONDS) DATE THE REBATE COMPUTATION WAS PERFORMED: 05/21/2018 (2017B BONDS)

Schedule K (Form 990) 2018

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

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.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

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	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

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?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e)Original principal amount	(f)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

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) 2018

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?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) RICHARD AZIZKHAN MD	WIFE IS EMPLOYEE	128,400	EMPLOYMENT		No
(2) RICHARD AZIZKHAN MD	SON IS EMPLOYEE	35,937	EMPLOYMENT		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) 2018

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2018

Open to Public
Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

Return Reference	Explanation
Form 990, Part VI, Line 11b	GOVERNANCE, MANAGEMENT, AND DISCLOSURE A COMPLETE COPY OF THE FORM 990, INCLUDING SCHEDULE J, IS MADE AVAILABLE TO THE EXECUTIVE COMMITTEE OF THE BOARD EXCLUDING THE MEDICAL STAFF PRESIDENT. THE FORM 990, EXCLUDING PART VII AND SCHEDULE J - COMPENSATION INFORMATION, IS MADE AVAILABLE TO THE REMAINDER OF THE BOARD OF DIRECTORS, INCLUDING THE MEDICAL STAFF PRESIDENT. BOTH ARE MADE AVAILABLE THROUGH THE DIRECTOR'S DESK WEBSITE PRIOR TO FILING WITH THE IRS.
Form 990, Part VI, Line 12c	POLICIES THE CONFLICT OF INTEREST POLICY APPLIES TO ANY PERSON IN A POSITION TO EXERCISE INFLUENCE IN CONNECTION WITH ANY CONTRACT, TRANSACTION OR ARRANGEMENT PRESENTED TO THE BOARD OR A BOARD COMMITTEE FOR APPROVAL (INTERESTED PERSON). INTERESTED PERSON INCLUDES BUT NOT LIMITED TO ANY DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWER, OR KEY EMPLOYEE. AN INTERESTED PERSON MUST ANNUALLY SUBMIT A COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE IN THE FORMAT PRESCRIBED BY THE GOVERNANCE COMMITTEE. EACH INTERESTED PERSON SHALL ANNUALLY ACKNOWLEDGE IN WRITING THAT HE OR SHE (A) HAS RECEIVED A COPY OF THIS POLICY; (B) HAS READ AND UNDERSTANDS THE POLICY; (C) AGREES TO COMPLY WITH THE POLICY; (D) UNDERSTANDS THAT THE POLICY APPLIES TO THE BOARD AND COMMITTEES; (E) UNDERSTANDS THAT CHILDREN'S IS A NOT-FOR-PROFIT ORGANIZATION THAT MUST ENGAGE PRIMARILY IN EXEMPT ACTIVITIES; (F) AGREES TO PROMPTLY REPORT TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDREN'S GENERAL COUNSEL ANY CHANGE TO MATTERS PREVIOUSLY DISCLOSED ON THE CONFLICT OF INTEREST QUESTIONNAIRE; AND (G) STATES THAT THE INFORMATION PROVIDED IN THE CONFLICT OF INTEREST QUESTIONNAIRE IS TRUE AND ACCURATE TO THE BEST OF HIS OR HER KNOWLEDGE AND BELIEF. AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE ANY POTENTIAL CONFLICT OF INTEREST. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES OR WHENEVER IT INVOLVES A MATTER OF BOARD ACTION. DISCLOSURE MEANS PROMPTLY PROVIDING THE MATERIAL FACTS OF AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST TO THE CHAIR OF THE GOVERNANCE COMMITTEE AND CHILDREN'S GENERAL COUNSEL (IN WRITING IF TIME ALLOWS) OR TO THE BOARD OR BOARD COMMITTEE REVIEWING THE CONTRACT, TRANSACTION OR ARRANGEMENT. CERTAIN CIRCUMSTANCES, IN ADDITION TO FINANCIAL INTERESTS, COULD GIVE RISE TO A POTENTIAL CONFLICT OF INTEREST, INCLUDING INSTANCES WHERE THE ACTIONS OR ACTIVITIES OF AN INDIVIDUAL ON BEHALF OF CHILDREN'S, ALSO INVOLVES OBTAINING A PERSONAL GAIN OR ADVANTAGE, OR COULD HAVE AN ADVERSE EFFECT ON CHILDREN'S INTERESTS. ALSO, DISCLOSING OR USING INFORMATION RELATING TO CHILDREN'S BUSINESS FOR THE PERSONAL PROFIT OR ADVANTAGE OF AN INDIVIDUAL OR HIS OR HER FAMILY WOULD GIVE RISE TO A CLAIM OF CONFLICT. FULL DISCLOSURE OF ANY SUCH SITUATION OR ANY OTHER CIRCUMSTANCES IN DOUBT SHOULD BE MADE. A POTENTIAL CONFLICT OF INTEREST DOES NOT NECESSARILY RISE TO THE LEVEL OF AN ACTUAL CONFLICT OF INTEREST, BUT ONCE RECOGNIZED, IT MUST IN EVERY CASE BE DISCLOSED AND EVALUATED. IN SOME INSTANCES, IT MAY BE SO SERIOUS THAT IT PREVENTS THE INDIVIDUAL FROM FURTHER PARTICIPATION IN CHILDREN'S DELIBERATIONS WITH RESPECT TO A PARTICULAR TRANSACTION, OR COULD BE SO PERVASIVE THAT THE INDIVIDUAL MAY BE DISQUALIFIED FROM CONTINUED AFFILIATION WITH CHILDREN'S. ON THE OTHER HAND, IT MAY BE OF LITTLE OR NO SIGNIFICANCE ONCE IT HAS BEEN DISCLOSED. THE GOVERNANCE COMMITTEE WILL CONSIDER THE FOLLOWING FACTORS, AMONG OTHER RELEVANT FACTS, WHEN DETERMINING WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS: (I) THE PROXIMITY OF THE INTERESTED PERSON TO THE DECISION-MAKING AUTHORITY OF THE OTHER ENTITY INVOLVED IN THE TRANSACTION OF BUSINESS ARRANGEMENT; (II) THE MAGNITUDE OF THE FINANCIAL INTEREST; (III) THE DEGREE TO WHICH THE INTERESTED PERSON MIGHT BENEFIT PERSONALLY IF A PARTICULAR TRANSACTION OR BUSINESS ARRANGEMENT WERE APPROVED; AND (IV) THE ABILITY OF THE INTERESTED PERSON TO MAKE AN INDEPENDENT DECISION BASED ONLY ON THE BEST INTEREST OF CHILDREN'S. THE GOVERNANCE COMMITTEE SHALL REVIEW EACH COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE, AND MAY MAKE SUCH FURTHER INVESTIGATION OF POTENTIAL CONFLICTS AS IT MAY DETERMINE APPROPRIATE. THE GOVERNANCE COMMITTEE SHALL MAKE APPROPRIATE REPORTS TO THE BOARD CONCERNING ITS REVIEW, ANY FURTHER INVESTIGATION, AND ITS RECOMMENDATIONS TO THE BOARD REGARDING ANY POTENTIAL CONFLICT OF INTEREST. WHENEVER AN INTERESTED PERSON (OR A PERSON OTHER THAN THE INTERESTED PERSON) VOLUNTARILY IDENTIFIES OR DISCLOSES A POTENTIAL CONFLICT OF INTEREST, THE REMAINING BOARD/COMMITTEE MEMBERS REVIEW AND DETERMINE WHETHER A CONFLICT EXISTS. ONLY DISINTERESTED BOARD/COMMITTEE MEMBERS MAY VOTE TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS AND THE SUBJECT INTERESTED PERSON CANNOT BE PRESENT DURING THE VOTE. TRANSACTIONS OR BUSINESS ARRANGEMENTS INVOLVING INTERESTED PERSONS WITH CONFLICTS OF INTEREST MUST BE APPROVED IN ADVANCE BY A MAJORITY OF DISINTERESTED DIRECTORS. IN ORDER TO APPROVE AN ARRANGEMENT OR TRANSACTION INVOLVING AN ACTUAL CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DISINTERESTED DIRECTORS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN CHILDREN'S BEST INTEREST, IS FAIR AND REASONABLE TO CHILDREN'S AND THAT, AFTER REASONABLE INVESTIGATION, THE DISINTERESTED DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. IN CASES IN WHICH AN INTERESTED PERSON HAS A FINANCIAL INTEREST IN A PROPOSED ARRANGEMENT OR TRANSACTION, THE FOLLOWING ADDITIONAL STEPS MAY BE TAKEN, AT THE DISCRETION OF THE BOARD: (A) THE INTERESTED PERSON MAY BE REQUIRED TO LEAVE THE MEETING FOR THE GENERAL DISCUSSION OF THE MATTER AND THE BOARD VOTE; AND/OR (B) A DISINTERESTED PERSON OR COMMITTEE MAY BE APPOINTED TO INVESTIGATE ALTERNATIVES TO THE PROPOSED ARRANGEMENT OR TRANSACTION. THE GOVERNANCE COMMITTEE CAN RECOMMEND TO THE BOARD THAT A DIRECTOR OR A MEMBER OF A COMMITTEE WITH BOARD-DELEGATED POWERS BE ASKED TO RESIGN IN THE EVENT A CONFLICT OF INTEREST IS SO SUBSTANTIAL THAT IT WOULD BE INCOMPATIBLE WITH CHILDREN'S BEST INTERESTS TO HAVE SUCH AN INDIVIDUAL ON ITS BOARD/COMMITTEE. IF THE BOARD/COMMITTEE BELIEVES AN INTERESTED PERSON HAS FAILED TO COMPLY WITH THIS POLICY, THE BOARD SHALL INFORM THAT PERSON OF THE BASIS FOR ITS BELIEF AND GIVE THAT PERSON AN OPPORTUNITY TO ADDRESS THE ALLEGED FAILURE. AFTER HEARING THE RESPONSE AND CONDUCTING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED UNDER THE CIRCUMSTANCES, THE BOARD SHALL DETERMINE WHETHER SUCH PERSON HAS, IN FACT, VIOLATED THE DISCLOSURE REQUIREMENTS OF THIS POLICY. IF THE BOARD DETERMINES THAT THERE HAS BEEN A VIOLATION, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION WHICH MAY INCLUDE REMOVAL FROM THE BOARD.
Form 990, Part VI, Line 15b	POLICIES EACH YEAR AN INDEPENDENT COMPANY CONDUCTS A MARKET ANALYSIS OF EXECUTIVE COMPENSATION. THIS INFORMATION IS PRESENTED TO THE COMPENSATION COMMITTEE. EXECUTIVE BASE SALARIES ARE TARGETED FOR THE 50TH PERCENTILE OF THE MARKET. AN INDEPENDENT COMPANY ISSUES AN ANNUAL REASONABLENESS OPINION LETTER REGARDING THE APPROPRIATENESS OF THE EXECUTIVE PAY LEVELS. THE COMPENSATION COMMITTEE IS A SUB-COMMITTEE OF THE BOARD OF DIRECTORS. THE COMPENSATION COMMITTEE REVIEWS BASE PAY RANGES FOR ALL EXECUTIVES INCLUDING THE CHIEF EXECUTIVE OFFICER AND ALL EXECUTIVE VICE PRESIDENTS, SENIOR VICE PRESIDENTS, AND VICE PRESIDENTS. THE BOARD OF DIRECTORS RECEIVES A REPORT FROM THE COMMITTEE. THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR REVIEWING THE CEO'S PERFORMANCE WHICH AFFECTS HIS PAY RATE INDIRECTLY.
Form 990, Part VI, Line 19	GOVERNANCE, MANAGEMENT, AND DISCLOSURE GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. THE CHILDREN'S HOSPITAL & MEDICAL CENTER AND AFFILIATES AUDITED FINANCIAL STATEMENTS CAN BE OBTAINED THROUGH PUBLICLY AVAILABLE SOURCES SUCH AS EMMA.MSRB.ORG.
Form 990, Part XI, Line 9	($265,000) - CHANGE IN VALUE OF SPLIT INTEREST $903,493 - CHANGE IN VALUE OF SWAP ($47,535,180) - CAPITAL TRANSFERS FOUNDATION ($492,967) - CAPITAL TRANSFERS CHILDREN'S HEALTH NETWORK ($47,389,654) - TOTAL OTHER CHANGES IN NET ASSETS OR FUND BALANCES

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2018

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2018

Open to Public Inspection

Name of the organization

Children's Hospital & Medical Center

Employer identification number

47-0379754

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?
(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	Yes	No
(1)CHILDREN'S HOSPITAL FOUNDATION 8200 DODGE STREET OMAHA,NE68114 47-6105603	FUNDRAISING	NE	501(C)(3)	LINE 7	CHMC	Yes
(2)CHILDREN'S PHYSICIANS 8200 DODGE STREET OMAHA,NE68114 47-0689372	PED CLINICS	NE	501(C)(3)	LINE 10	CHMC	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2018

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	(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?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

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?
(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		Yes	No
(1) KENT INC 8200 DODGE STREET OMAHA,NE68114 47-0527928	REAL ESTATE	NE	CHMC	C Corp	0	219,495	100.000 %	Yes
(2) CHILDREN'S HEALTH NETWORK 8200 DODGE STREET OMAHA,NE68114 36-3967578	HEALTH NETWORK	NE	CHMC	C Corp	0	0	100.000 %	Yes

Schedule R (Form 990) 2018

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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

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) CHILDREN'S HOSPITAL FOUNDATION	c	3,320,295	BOOK
(2) CHILDREN'S HOSPITAL FOUNDATION	l,m,n	5,787,097	BOOK
(3) CHILDREN'S HOSPITAL FOUNDATION	r	41,748,084	BOOK
(4) CHILDREN'S HEALTH NETWORK	r	492,968	BOOK

Schedule R (Form 990) 2018

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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2018

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) 2018

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: CHILDREN'S HOSPITAL & MEDICAL CENTER DELIVERS EXTRAORDINARY CARE TO CHILDREN, EDUCATES HEALTH CARE PROFESSIONALS, AND PROMOTES PEDIATRIC RESEARCH
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	21
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	20
5	Total number of individuals employed in calendar year 2018 (Part V, line 2a) ......	5	3,409
6	Total number of volunteers (estimate if necessary) .............	6	238
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	194,368
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	950,277

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,256,733	4,858,054
9	Program service revenue (Part VIII, line 2g) .........	380,389,206	422,904,596
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-49,047	629,335
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	15,504,872	15,222,054
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	401,101,764	443,614,039
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	11,048,713	19,154,203
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)	187,415,316	207,855,199
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	156,979,984	162,223,280
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	355,444,013	389,232,682
19	Revenue less expenses. Subtract line 18 from line 12.......	45,657,751	54,381,357
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	521,346,658	542,357,225
21	Total liabilities (Part X, line 26).............	249,964,067	263,982,931
22	Net assets or fund balances. Subtract line 21 from line 20.....	271,382,591	278,374,294

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 315,636,908 including grants of $ 19,154,203 ) (Revenue $ 435,296,499 )
	THE HOSPITAL OPERATES A 145-BED PEDIATRIC HOSPITAL, WHICH INCLUDES SEVEN SURGICAL SUITES, A STATE OF THE ART HYBRID HEART CATHETERIZATION LAB, AN OUTPATIENT SURGERY CENTER, A HEART TRANSPLANT PROGRAM AND A FETAL CARE CENTER THAT FOCUSES ON THE COORDINATION OF CARE FOR BABIES DIAGNOSED WITH COMPLEX CONGENITAL DEFECTS BEFORE BIRTH. THE HOSPITAL WAS RECOGNIZED BY U.S. NEWS AND WORLD REPORT IN FIVE SPECIALTIES FOR CARDIOLOGY AND HEART SURGERY, PULMONOLOGY, GASTROENTEROLOGY AND GI SURGERY, ORTHOPEDICS, DIABETES, AND ENDOCRINOLOGY. CHILDREN'S SPECIALTY PEDIATRIC CENTER OFFERS MORE THAN 50 OUTPATIENT SPECIALTY CLINICS, PROVIDING DIAGNOSTICS, TREATMENT, AND THERAPY. IN ADDITION, CHILDREN'S PROVIDES OUTPATIENT BEHAVIORAL HEALTH AND A FULL ARRAY OF PEDIATRIC HOME HEALTHCARE SERVICES TO CHILDREN AND ADOLESCENTS WHO HAVE IMMEDIATE OR LONG-TERM HEALTH CARE NEEDS, INCLUDING HOME MEDICAL EQUIPMENT RENTALS AND SALES, HOME HEALTH NURSING, IN-HOME PRIVATE DUTY NURSING, AND HOME INFUSION THERAPY SERVICES. THE HOSPITAL IS HOME TO THE REGION'S ONLY LEVEL IV NEWBORN INTENSIVE CARE UNIT AND THE ONLY DEDICATED PEDIATRIC EMERGENCY DEPARTMENT WITH LEVEL II PEDIATRIC TRAUMA VERIFICATION. THE HOSPITAL ALSO PROVIDES SPECIALTY PEDIATRIC CARE SERVICES IN COMMUNITIES ACROSS A FIVE-STATE REGION. CHILDREN'S HOSPITAL & MEDICAL CENTER IS THE FIRST AND ONLY PEDIATRIC HOSPITAL IN NEBRASKA, AND THE ONLY PEDIATRIC HOSPITAL SERVING WESTERN IOWA AND NORTHWEST MISSOURI, TO RECEIVE PEDIATRIC TRAUMA VERIFICATION.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses315,636,908

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	8,964,306	0	932,020

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	3,320,295
e	Government grants (contributions)		1e	1,110,834

f	All other contributions, gifts, grants, and similar amounts not included above		1f	426,925

g	Noncash contributions included in lines 1a - 1f:$
h Total. Add lines 1a-1f.......		4,858,054

		Business Code
2a	NET PATIENT REVENUE	621110	422,904,596	422,904,596
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f ....		422,904,596

3 Investment income (including dividends, interest, and othersimilar amounts) ......			629,335			629,335
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		2,830,151
b	Less: rental expenses
c	Rental income or (loss)	0	2,830,151
d	Net rental income or (loss)......			2,830,151			2,830,151
		(ii) Other	(i) Securities
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).....			0
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a		0
b	Less: direct expenses ...b		0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
	a		0
b	Less: cost of goods sold ..b		0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	MANAGEMENT FEE INCOME		541610	7,390,945	7,390,945
b	CAFETERIA INCOME		900099	1,819,464	1,819,464
c	METHODIST SERVICE		541900	813,594	813,594
d	All other revenue ....			2,367,900	2,173,532	194,368
e	Total. Add lines 11a–11d ......			12,391,903
12	Total revenue. See Instructions......			443,614,039	435,102,131	194,368	3,459,486

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21	7,994,883	7,994,883
2	Grants and other assistance to domestic individuals. See Part IV, line 22	11,159,320	11,159,320
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, line 15 and 16.	0
4	Benefits paid to or for members	0
5	Compensation of current officers, directors, trustees, and key employees ....	6,486,391		6,486,391
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	0
7	Other salaries and wages	161,136,449	139,564,412	21,572,037
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	8,698,772	7,993,035	705,737
9	Other employee benefits .......	20,112,305	14,572,909	5,539,396
10	Payroll taxes ...........	11,421,282	9,975,025	1,446,257
11	Fees for services (non-employees):
a	Management ......	230,384	230,384
b	Legal .........	668,539	603,756	64,783
c	Accounting ...........	628,817	447,454	181,363
d	Lobbying ...........	69,794		69,794
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	38,829,908	27,154,226	11,675,682
12	Advertising and promotion ....	1,850,189	5,835	1,844,354
13	Office expenses .......	51,469,958	50,267,752	1,202,206
14	Information technology ......	8,072,131	8,072,131
15	Royalties ..	0
16	Occupancy ...........	8,571,835	4,117,615	4,454,220
17	Travel ............	628,983	383,907	245,076
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	3,058,342	3,058,342
21	Payments to affiliates .......	16,515,495	16,515,495
22	Depreciation, depletion, and amortization ..	20,989,172	9,988,755	11,000,417
23	Insurance ...	856,488	417	856,071
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	EQUIPMENT MAINTENANCE	2,749,999	2,033,830	716,169	0
b	COMMUNITY SERVICES	1,005,235	70,415	934,820
c	BUILDING MAINTENANCE	2,587,608	230,407	2,357,201
d	PROFESSIONAL FEES	725,905	725,905
e	All other expenses	2,714,498	470,698	2,243,800
25	Total functional expenses. Add lines 1 through 24e	389,232,682	315,636,908	73,595,774	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			4,545,090	1	5,509,170
2	Savings and temporary cash investments .........			86,492,538	2	83,751,779
3	Pledges and grants receivable, net ......			2,785,000	3	2,520,000
4	Accounts receivable, net .............			73,339,551	4	71,069,790
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L .............
				0	5	0
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 ..............
				0	6	0
7	Notes and loans receivable, net ....			0	7	0
8	Inventories for sale or use ........			5,211,165	8	7,034,648
9	Prepaid expenses and deferred charges ......			9,679,215	9	7,940,489
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	502,953,517
b	Less: accumulated depreciation	10b	216,559,576	226,269,563	10c	286,393,941
11	Investments—publicly traded securities .			0	11	0
12	Investments—other securities. See Part IV, line 11 .....			4,745,484	12	2,450,687
13	Investments—program-related. See Part IV, line 11 ..			91,066,772	13	57,303,451
14	Intangible assets ...............			0	14	0
15	Other assets. See Part IV, line 11 ...........			17,212,280	15	18,383,270
16	Total assets. Add lines 1 through 15 (must equal line 34)...			521,346,658	16	542,357,225

17	Accounts payable and accrued expenses .....	54,603,493	17	75,156,400
18	Grants payable ...	0	18	0
19	Deferred revenue .........	0	19	151,769
20	Tax-exempt bond liabilities .........	181,221,038	20	176,598,743
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
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..	0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	5,355,069	23	5,002,955
24	Unsecured notes and loans payable to unrelated third parties ..	731,936	24	314,408
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	8,052,531	25	6,758,656
26	Total liabilities. Add lines 17 through 25..	249,964,067	26	263,982,931

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	268,597,591	27	275,854,294
28	Temporarily restricted net assets ...........	2,785,000	28	2,520,000
29	Permanently restricted net assets	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here 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 ...........	271,382,591	33	278,374,294
34	Total liabilities and net assets/fund balances ........	521,346,658	34	542,357,225