TY 2021 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/1099-NEC)
(1) KEVIN WERTS...................................................................... CHAIRPERSON	1.00 ................. 1.00	X	X	0	0
(2) DAVID GANNON MD...................................................................... VICE CHAIRPERSON	1.00 ................. 0.00	X	X	0	0
(3) PAUL DONGILLI...................................................................... PRESIDENT AND CEO	40.00 ................. 1.00	X	X	675,289	38,284
(4) FR JOHN SULLIVAN...................................................................... VICE PRESIDENT	1.00 ................. 0.00	X	X	0	0
(5) WILL DOUGLAS...................................................................... SECRETARY	1.00 ................. 0.00	X	X	0	0
(6) LAUREN PUGLIESE...................................................................... TREASURER	1.00 ................. 0.00	X	X	0	0
(7) SCOTT BECKER CPA...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(8) MARK FAHLESON...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(9) KACEY LEMPKA...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(10) BRAD NIETFELDT...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(11) GARY PERKINS...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(12) SARAH PILLEN...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(13) LYNN ROPER...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(14) PATRICK SPETHMAN...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(15) MIKE PALLESEN...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(16) GREG VASEK...................................................................... MEMBER	1.00 ................. 0.00	X		0	0
(17) TIFFANY VERZAL...................................................................... MEMBER	1.00 ................. 0.00	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/1099-NEC)
(18) TERRY ZACH MD........................................................................ MEMBER	1.00 .......................0.00	X			0	0
(19) JIM FITCH........................................................................ MEMBER	1.00 .......................1.00	X			0	0
(20) DAN VOKOUN........................................................................ MEMBER	1.00 .......................0.00	X			0	0
(21) SUSAN K KLANECKY........................................................................ VP PATIENT CARE & ADMIN MRSH-LINCOLN	40.00 .......................0.00		X		268,071	20,261
(22) CHRISTOPHER A LEE........................................................................ VP AND COO	40.00 .......................0.00		X		288,986	34,354
(23) LOU ANN MANSKE........................................................................ VP HUMAN RESOURCES	40.00 .......................0.00		X		266,322	12,183
(24) LYNN R HALLOWELL-GOTTSLEBEN........................................................................ VP REHABILITATION	40.00 .......................0.00		X		202,417	23,629
(25) LINDA S SUNDELL-SULLIVAN........................................................................ VP REFERRAL RELATIONS	40.00 .......................0.00		X		190,564	20,701
(26) DANIEL GRIESS........................................................................ VP FACILITIES MANAGEMENT S	40.00 .......................0.00		X		245,784	20,226
(27) MICHAEL HEDDERMAN........................................................................ VP AND CFO	40.00 .......................0.00		X		303,970	29,429
(28) JEFF GROMOWSKY........................................................................ VP & PHYSICIAN PRACTICE AD	40.00 .......................0.00		X		196,484	30,748
(29) DONALD SCHMIDT........................................................................ VP OF MEDICAL AFFAIRS/CHIE	40.00 .......................0.00		X		362,701	32,884
(30) ADAM T KAFKA........................................................................ STAFF PHYSIATRIST	40.00 .......................0.00			X	622,104	19,179
(31) JIAXIN TRAN........................................................................ STAFF PHYSIATRIST	40.00 .......................0.00			X	497,824	28,468
(32) MORGAN L LAHOLT........................................................................ STAFF PHYSIATRIST	40.00 .......................0.00			X	443,738	15,405
(33) PAUL L KRABBENHOFT........................................................................ STAFF PHYSIATRIST	40.00 .......................0.00			X	357,391	28,362
(34) MATTHEW DRIEWER........................................................................ STAFF PHYSIATRIST	40.00 .......................0.00			X	390,619	20,949

(A) Name and business address	(B) Description of services	(C) Compensation
RTG MEDICAL 1005 E 23RD ST STE 200 FREMONT,NE68025	MEDICAL SERVICES	3,011,482
NEBRASKA MEDICINE 4350 DEWEY AVE OMAHA,NE68105	MEDICAL SERVICES	1,897,132
UNMC 985045 NEBRASKA MEDICAL CENTER OMAHA,NE68198	MEDICAL EDUCATION	1,703,538
FUSION MEDICAL STAFFING LLC PO BOX 82674 LINCOLN,NE685012674	STAFFING SERVICES	1,346,946
NOLL HEALTHCARE NETWORK 12905 W DODGE RD OMAHA,NE68154	MEDICAL SERVICES	1,051,640
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 34

- TIN:

SCHEDULE A
(Form 990)

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

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

Page 2

Part II

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

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 on 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 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

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

2021

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

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) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization MADONNA REHABILITATION HOSPITAL

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	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) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization MADONNA REHABILITATION HOSPITAL		Employer identification number 47-0439599

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization MADONNA REHABILITATION HOSPITAL			Employer identification number 47-0439599
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ 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) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Part I-A

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

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	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) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

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

c	Total lobbying expenditures

d	Grassroots nontaxable amount

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

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

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|No

(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)? ........

Yes

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

Yes

44,122

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

44,122

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
PART II-B, LINE 1:	MADONNA REHABILITATION HOSPITAL ("MADONNA") HAS RETAINED THE LOBBYING SERVICES OF A LOCAL LOBBYING FIRM TO MONITOR LEGISLATION AT THE STATE LEVEL IN NEBRASKA IMPACTING NEBRASKA HOSPITALS AND LONG TERM CARE FACILITIES GENERALLY, AND MADONNA SPECIFICALLY. MADONNA IS A MEMBER OF THE NEBRASKA HOSPITAL ASSOCIATION ("NHA"). AS PART OF ITS ACTIVITIES, THE NHA PROVIDES LOBBYING SERVICES AND MONITORS STATE LEGISLATION OF CONCERN TO ITS MEMBERS. ON THE NATIONAL LEVEL, MADONNA IS A MEMBER OF THE AMERICAN REHABILITATION PROVIDERS ASSOCIATION ("AMRPA") AND THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS ("NALTH"). AMONG OTHER SERVICES PROVIDED TO ITS MEMBERS, AMRPA AND NALTH LOBBY AND MONITOR FEDERAL LEGISLATION ON BEHALF OF THEIR MEMBERS.

Return Reference

Explanation

PART II-B, LINE 1:

MADONNA REHABILITATION HOSPITAL ("MADONNA") HAS RETAINED THE LOBBYING SERVICES OF A LOCAL LOBBYING FIRM TO MONITOR LEGISLATION AT THE STATE LEVEL IN NEBRASKA IMPACTING NEBRASKA HOSPITALS AND LONG TERM CARE FACILITIES GENERALLY, AND MADONNA SPECIFICALLY. MADONNA IS A MEMBER OF THE NEBRASKA HOSPITAL ASSOCIATION ("NHA"). AS PART OF ITS ACTIVITIES, THE NHA PROVIDES LOBBYING SERVICES AND MONITORS STATE LEGISLATION OF CONCERN TO ITS MEMBERS. ON THE NATIONAL LEVEL, MADONNA IS A MEMBER OF THE AMERICAN REHABILITATION PROVIDERS ASSOCIATION ("AMRPA") AND THE NATIONAL ASSOCIATION OF LONG TERM HOSPITALS ("NALTH"). AMONG OTHER SERVICES PROVIDED TO ITS MEMBERS, AMRPA AND NALTH LOBBY AND MONITOR FEDERAL LEGISLATION ON BEHALF OF THEIR MEMBERS.

Schedule C (Form 990) 2021

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" 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 FASB 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 FASB 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 FASB 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) 2021

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

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)

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

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 .....	9,246,148		9,246,148
b	Buildings ....	142,839,206	59,257,590	83,581,616
c	Leasehold improvements
d	Equipment ....	78,510,467	56,535,911	21,974,556
e	Other .....	53,959,821	2,390,344	51,569,477
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				166,371,797

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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

Investments - Program 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)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

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
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	4,680,352
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) 2021

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	178,016,329
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-9,544,336
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	-9,544,336
3	Subtract line 2e from line 1..................			3	187,560,665
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	11,215
c	Add lines 4a and 4b....................			4c	11,215
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	187,571,880

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	182,843,462
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e	0
3	Subtract line 2e from line 1...................		3	182,843,462
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5	182,843,462

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART X, LINE 2:	MADONNA ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. MADONNA RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT JUNE 30, 2022 AND 2021, MADONNA HAD NO UNCERTAIN TAX POSITIONS ACCRUED.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	CHANGES IN TEMPORARILY RESTRICTED NET ASSETS 11,215.

Schedule D (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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 30000.0000000000 %

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: . . . . . . . .

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	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	1,743,473	1,743,473	0.970 %
b	Medicaid (from Worksheet 3, column a) . . . . .	5,508,673	5,508,673	3.070 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	7,252,146	7,252,146	4.040 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	267,238	267,238	0.150 %
f	Health professions education (from Worksheet 5) . . .	1,757,488	1,757,488	0.980 %
g	Subsidized health services (from Worksheet 6) . . . .	582,396	582,396	0.320 %
h	Research (from Worksheet 7) .	790,176	790,176	0.440 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	343,860	343,860	0.190 %
j	Total. Other Benefits . .	3,741,158	3,741,158	2.080 %
k	Total. Add lines 7d and 7j .	10,993,304	10,993,304	6.120 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other	2	529,988	1,718	528,270	0.290 %
10	Total	2	529,988	1,718	528,270	0.290 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare 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. ......

3,423,314

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).....

45,731,877

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

60,172,426

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

-14,440,549

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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

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?3Name, 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)			Other (describe)	Facility reporting group
1	MADONNA REHABILITATION HOSPITAL LINCOLN 5401 SOUTH STREET LINCOLN,NE685062134 WWW.MADONNA.ORG 500005	X	ACUTE REHABILITATION HOSPITAL	A
2	MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN 5401 SOUTH STREET LINCOLN,NE685062134 WWW.MADONNA.ORG 507001	X	LONG TERM CARE HOSPITAL	A
3	MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA 17500 BURKE STREET OMAHA,NE681182244 WWW.MADONNA.ORG H000129	X	LONG TERM CARE HOSPITAL	A

Schedule H (Form 990) 2021

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)

	FACILITY REPORTING GROUP - A
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

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 21

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

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

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): HTTP://WWW.MADONNA.ORG/MY-MADONNA/CHNA.HTML

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 21

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

If "Yes" (list url):

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

10b

Yes

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) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	FACILITY REPORTING GROUP - A
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 300.000000000000%
and FPG family income limit for eligibility for discounted care of %

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):

WWW.MADONNA.ORG/PATIENT-RESOURCES/PATIENT-FINANCIAL-SERVICES

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

WWW.MADONNA.ORG/PATIENT-RESOURCES/PATIENT-FINANCIAL-SERVICES

A plain language summary of the FAP was widely available on a website (list url):
WWW.MADONNA.ORG/PATIENT-RESOURCES/PATIENT-FINANCIAL-SERVICES

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) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	FACILITY REPORTING GROUP - A
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 (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

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

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) 2021

Page 7

Part VFacility Information (continued)

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

	FACILITY REPORTING GROUP - A
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) 2021

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, 20a, 20b, 20c, 20d, 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
PART V, SECTION B	FACILITY REPORTING GROUP A
FACILITY REPORTING GROUP A CONSISTS OF:	- FACILITY 1: MADONNA REHABILITATION HOSPITAL LINCOLN, - FACILITY 2: MADONNA REHABILITATION SPECIALTY HOSPITAL LINC, - FACILITY 3: MADONNA REHABILITATION SPECIALTY HOSPITAL OMAH
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5:	MADONNA USES MULTIPLE AVENUES TO COLLECT DATA REGARDING THE NEEDS OF ITS COMMUNITY, INCLUDING PATIENT SATISFACTION SURVEYS, MEETING MINUTES FROM LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS, CAPITAL CAMPAIGN REQUESTS AND OTHER DATA SOURCES. THIS IS AN ONGOING PROCESS THAT IS INTEGRATED INTO STRATEGIC PLANNING AND ANNUAL GOAL SETTING. A NEEDS ASSESSMENT QUESTIONNAIRE WAS DISTRIBUTED TO THE COMMUNITY AND THE RESULTS WERE COLLECTED AND ANALYZED IN FISCAL YEAR 2022 (TAX YEAR 2021). THE RESULTS WERE DISCUSSED AT STRATEGIC PLANNING COMMITTEE MEETINGS DURING THE PLANNING PHASES FOR FISCAL YEAR 2023. HOSPITAL LEADERSHIP REGULARLY REVIEWS AND DISCUSSES COMMUNITY NEEDS DURING WEEKLY ADMINISTRATIVE TEAM MEETINGS. MANY OF THESE NEEDS ARE ADDRESSED THROUGH CAPITAL ITEM REQUESTS AND PROGRAMMING UPDATES AND/OR ADDITIONS. ADDITIONALLY, COMMUNITY NEEDS ARE BROUGHT FORTH AND DISCUSSED IN NUMEROUS ORGANIZATIONAL AND INDIVIDUAL MEETINGS AT ALL LEVELS. MADONNA REHABILITATION HOSPITAL EXECUTIVES, MANAGERS AND CLINICIANS ARE ENCOURAGED TO MEET WITH THEIR COUNTERPARTS IN PEER INSTITUTIONS AND TO PURSUE LEADERSHIP POSITIONS IN THEIR AREAS OF EXPERTISE. EACH YEAR, MADONNA STAFF MEMBERS ARE ELECTED AND/OR ARE APPOINTED TO BOARDS, SPECIAL TASK FORCES AND OTHER LEADERSHIP POSITIONS. IN THESE POSITIONS, MADONNA STAFF GETS DIRECT INPUT FROM COLLEAGUES IN AFFILIATED ORGANIZATIONS AND WITH PATIENTS IN THE COMMUNITY SERVED.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11:	PURPOSE FOR THE PLANTHIS IMPLEMENTATION STRATEGY (STRATEGY) ADDRESSES THE PRIORITIZED COMMUNITY HEALTH CARE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) CONDUCTED FOR THE FISCAL 2022 YEAR AND APPROVED BY THE HOSPITAL'S BOARD OF DIRECTORS. THE PLAN ALSO MEETS THE REQUIREMENTS FOR COMMUNITY BENEFIT PLANNING AS SET FORTH IN SECTION 501(R) OF THE INTERNAL REVENUE CODE (THE "CODE") AS PART OF THE AFFORDABLE CARE ACT. THE CHNA FOR MADONNA REHABILITATION HOSPITAL MAY BE REVIEWED IN ITS ENTIRETY AT HTTPS://V4WU8F03-A.AKAMAIHD.NET/UPLOADS-USERS/COMMUNITY_HEALTH_NEEDS_ASSESSMENT_FY2122.PDFAREAS OF FOCUSAS A RESULT OF THE ANALYSIS, THREE AREAS WERE IDENTIFIED AS THE PRIORITIES ON WHICH MADONNA WILL FOCUS FOR THE NEXT THREE YEARS. THESE THREE NEEDS ARE: LINCOLN CAMPUS PHYSICAL PLANT ALIGNMENT WITH CLINICAL NEEDS, LINCOLN CAMPUS CLINICAL AND ANCILLARY SERVICES EXPANSION, AND THE NEBRASKA PHYSIATRY RESIDENCY PROGRAM.PRIORITY #1: ALIGN THE LINCOLN CAMPUS PHYSICAL PLANT WITH SPACE REQUIRED TO MEET THE CLINICAL NEEDS OF A HIGH-ACUITY, SPECIALIZED PATIENT POPULATION (MADONNA'S "COMMUNITY").STRATEGY: EXPAND AND CONSTRUCT PHYSICAL SPACE TO SUPPORT THE SPECIALIZED EQUIPMENT, CUTTING EDGE TECHNOLOGY AND FAMILY INVOLVEMENT REQUIRED FOR PHYSICAL MEDICINE AND REHABILITATION PROGRAMS.PRIORITY #2: EXPAND LINCOLN CAMPUS ON-SITE CLINICAL AND ANCILLARY SERVICES REQUIRED TO MEET THE CLINICAL NEEDS OF A HIGH-ACUITY, SPECIALIZED PATIENT POPULATION (MADONNA'S "COMMUNITY").STRATEGY: IMPLEMENT/EXPAND APPROPRIATE ON-SITE DIAGNOSTIC IMAGING, LABORATORY, TELEMETRY, SPECIALIZED PHYSICIAN SERVICES AND NURSING SKILLS TO IMPROVE PATIENT QUALITY AND OUTCOMES. PRIORITY #3: COMPLETE THE IMPLEMENTATION OF THE NEWLY ESTABLISHED PHYSICAL MEDICINE AND REHABILITATION GRADUATE MEDICAL EDUCATION RESIDENCY TRAINING PROGRAM. STRATEGY: IN COLLABORATION WITH THE UNIVERSITY OF NEBRASKA MEDICAL CENTER COLLEGE OF MEDICINE (UNMC-COM), GRADUALLY INCREASE THE NUMBER OF RESIDENTS TO THE FOUR YEAR PROGRAM CAPACITY OF 16 RESIDENTS IN 2022. ADDITIONALLY, IN COLLABORATION WITH UNMC-COM, RECRUIT AND FILL ALL REQUIRED FACULTY POSITIONS.NEXT STEPSTHIS IMPLEMENTATION STRATEGY WILL BE EXECUTED OVER THE NEXT THREE YEARS. PERIODIC EVALUATION OF OBJECTIVES FOR EACH IDENTIFIED PRIORITY WILL BE CONDUCTED TO ASSURE THAT MADONNA IS ON TRACK TO COMPLETE THE PLAN AS DESCRIBED. AT THE END OF FISCAL YEAR 2022 MADONNA REHABILITATION HOSPITAL WILL REVIEW THE IMPLEMENTATION STRATEGY AND REPORT ON THE SUCCESS EXPERIENCED THROUGH THE COLLABORATIVE EFFORTS OF IMPROVING THE HEALTH NEEDS OF THE COMMUNITY.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13B:	FPG IS USED TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE. IF FINANCIAL ASSISTANCE IS GRANTED, IT IS FOR FREE CARE ONLY.
FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 20E:	MADONNA REHABILITATION HOSPITAL OFFERS THE FOLLOWING:1. ASSISTANCE WITH FILLING OUT APPLICATIONS FOR SSI, SSD, MEDICAID AND/OR GENERAL ASSISTANCE2. ADVOCATE FOR THE PATIENT WITH THIRD PARTY PAYERS, GOVERNMENT PAYERS, AND OTHER ENTITIES THAT MAY RESTRICT OR DENY BENEFITS INAPPROPRIATELY3. ASSIST PATIENT/FAMILIES WITH BILLING/PAYMENT QUESTIONS FROM PRIOR STAYS TO HELP ESCALATE RESOLUTION AND ENSURE THAT ALL APPROPRIATE DOCUMENTS HAVE BEEN RETURNED TO THE PAYER FOR CLAIMS ADJUDICATION4. EXTENDED PAYMENT PLANS5. LIABILITY SETTLEMENT PENDING WITHOUT ANY OTHER PAYER SOURCE6. COURTESY CALLS AT TIME OF FINAL NOTICE AND PRIOR TO LISTING FOR COLLECTIONS
FACILITY REPORTING GROUP - A, PART V, SECTION B, LINE 22D:	THE AMOUNT OF FINANCIAL ASSISTANCE IS CONSIDERED TO BE 100% OF CHARGES LESS THE CONTRACTUAL ADJUSTMENT FOR AMOUNTS GENERALLY BILLED (AGB). AGB IS THE WEIGHTED AVERAGE PERCENTAGE AS CALCULATED BY DIVIDING THE SUM OF COMMERCIAL AND MEDICARE CONTRACTUAL ADJUSTMENTS BY THE SUM OF COMMERCIAL AND MEDICARE GROSS CHARGES.

Schedule H (Form 990) 2021

Page 9

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?4
Name and address		Type of Facility (describe)
1	1 - ST JANE DE CHANTAL 2200 S 52ND STREET LINCOLN,NE685062134	NURSING FACILITY (NF)
2	2 - MADONNA THERAPY PLUS 5401 SOUTH STREET LINCOLN,NE685062134	OUTPATIENT CLINICS (4)
3	3 - MADONNA PROACTIVE HEALTH & FITNESS 7111 STEPHANIE LANE LINCOLN,NE68516	MEDICAL FITNESS CENTER
4	4 - REHABILITATION SPECIALISTS 5445 SOUTH STREET LINCOLN,NE685062134	INPATIENT & OUTPATIENT PHYSICIAN CLINIC
5
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3C:	THE ORGANIZATION USES FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE CARE.
PART I, LINE 6A:	THE COMMUNITY BENEFIT REPORT IS MADE AVAILABLE TO THE PUBLIC IN THE ANNUAL REPORT AT WWW.MADONNA.ORG/ANNUAL-REPORT
PART I, LINE 7:	MEDICARE LOSSES HAVE INCREASED SIGNIFICANTLY IN RECENT YEARS AND NO LONGER APPROXIMATE THE COSTS INCURRED TO SERVE MEDICARE PATIENTS. THIS IS DUE TO REIMBURSEMENT METHODOLOGY CHANGES THAT HAVE RESULTED IN DECREASING PAYMENTS DESPITE INFLATIONARY GROWTH IN COSTS.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,423,314.
PART II, COMMUNITY BUILDING ACTIVITIES:	MADONNA'S MEDICALLY BASED HEALTH AND FITNESS CENTER (MADONNA PROACTIVE) IS FOCUSED ON IMPROVING THE OVERALL WELLNESS OF THE COMMUNITY BY REDUCING CHRONIC RISK FACTORS THROUGH VARIOUS HEALTH PROGRAMS.MADONNA'S ADAPTIVE SPORTS PROGRAM PROVIDES OPPORTUNITIES FOR CHILDREN AND ADULTS WITH ACQUIRED PHYSICAL DISABILITIES TO PARTICIPATE IN RECREATIONAL ACTIVITIES THAT ARE DESIGNED TO PROMOTE PHYSICAL HEALTH AND WELLNESS. THE PROGRAM IS OPEN TO MADONNA INPATIENTS AND OUTPATIENTS AS WELL AS COMMUNITY MEMBERS.
PART III, LINE 2:	GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THETRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE. FOR THE YEARS ENDED JUNE 30, 2022 AND 2021, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.
PART III, LINE 3:	THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND ASSESSES THOSE ACCOUNTS THAT WILL TRANSITION TO SELF-PAY PATIENTS BASED ON ANALYSIS OF PAYMENT HISTORY. THOSE TRANSITION ACCOUNTS ARE CONSIDERED IN CONJUNCTION WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL). THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT CERTAIN PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN MANY CASES, THE HOSPITAL IS ABLE TO NEGOTIATE PAYMENT SUBSEQUENT TO THE INITIAL DETERMINATION OF THE COLLECTABILITY OF THE ACCOUNT. IN THESE CASES, THE HOSPITAL RECORDS ADDITIONAL CONTRACTUAL ALLOWANCES AND DISCOUNTS. UPON CONSIDERATION OF THE FACT CERTAIN PATIENT ACCOUNTS THAT WERE PREVIOUSLY ALLOWED FOR ARE COLLECTED THROUGH NEGOTIATION AND ADJUSTED AT THE TIME OF PAYMENT, THE HOSPITAL HAS DETERMINED THE PROVISION FOR BAD DEBTS IS NOT SIGNIFICANT TO THE FINANCIAL STATEMENTS AND HAS COMBINED WITH CONTRACTUAL ALLOWANCES AND DISCOUNTS. NO PORTION OF THIS IS CONSIDERED A COMMUNITY BENEFIT.
PART III, LINE 4:	THE HOSPITAL'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 9, AND 10 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "CHARITY CARE."
PART III, LINE 8:	A COST ACCOUNTING SYSTEM IS USED BY MADONNA AND IT ADDRESSES ALL PATIENT SEGMENTS. NONE OF THE SHORTFALL HAS BEEN REPORTED AS COMMUNITY BENEFIT.
PART III, LINE 9B:	ALL CHARGES FOR PATIENTS FOUND ELIGIBLE FOR FINANCIAL ASSISTANCE ARE WAIVED. ONCE THIS ELIGIBILITY IS CONFIRMED, ALL COLLECTION ACTIVITIES ARE DISCONTINUED.
PART VI, LINE 2:	MADONNA USES MULTIPLE AVENUES TO COLLECT DATA REGARDING THE NEEDS OF ITS COMMUNITY, INCLUDING PATIENT SATISFACTION SURVEYS, MEETING MINUTES FROM LOCAL, STATE, REGIONAL AND NATIONAL ORGANIZATIONS, CAPITAL CAMPAIGN REQUESTS AND OTHER DATA SOURCES. THIS IS AN ONGOING PROCESS THAT IS INTEGRATED INTO STRATEGIC PLANNING AND ANNUAL GOAL SETTING. A NEEDS ASSESSMENT QUESTIONNAIRE WAS DISTRIBUTED TO THE COMMUNITY AND THE RESULTS WERE COLLECTED AND ANALYZED IN FISCAL YEAR 2022 (TAX YEAR 2021). THE RESULTS WERE DISCUSSED AT STRATEGIC PLANNING COMMITTEE MEETINGS DURING THE PLANNING PHASES FOR FISCAL YEAR 2023. HOSPITAL LEADERSHIP REGULARLY REVIEWS AND DISCUSSES COMMUNITY NEEDS DURING WEEKLY ADMINISTRATIVE TEAM MEETINGS. MANY OF THESE NEEDS ARE ADDRESSED THROUGH CAPITAL ITEM REQUESTS AND PROGRAMMING UPDATES AND/OR ADDITIONS. ADDITIONALLY, COMMUNITY NEEDS ARE BROUGHT FORTH AND DISCUSSED IN NUMEROUS ORGANIZATIONAL AND INDIVIDUAL MEETINGS AT ALL LEVELS. MADONNA REHABILITATION HOSPITAL EXECUTIVES, MANAGERS AND CLINICIANS ARE ENCOURAGED TO MEET WITH THEIR COUNTERPARTS IN PEER INSTITUTIONS AND TO PURSUE LEADERSHIP POSITIONS IN THEIR AREAS OF EXPERTISE. EACH YEAR, MADONNA STAFF MEMBERS ARE ELECTED AND/OR ARE APPOINTED TO BOARDS, SPECIAL TASK FORCES AND OTHER LEADERSHIP POSITIONS. IN THESE POSITIONS, MADONNA STAFF GETS DIRECT INPUT FROM COLLEAGUES IN AFFILIATED ORGANIZATIONS AND WITH PATIENTS IN THE COMMUNITY SERVED.
PART VI, LINE 3:	THE INSURANCE STATUS OF ALL PATIENTS IS ASSESSED AT THE TIME OF ADMISSION. THE ADMISSIONS PROCESS INCLUDES REGULAR COMMUNICATION WITH PATIENTS AND THEIR FAMILIES, AND INSURANCE STATUS IS A SIGNIFICANT PART OF THIS PROCESS. PATIENTS WITHOUT INSURANCE ARE ASSISTED IN THEIR APPLICATIONS FOR MEDICAID IF IT APPEARS THEY MAY QUALIFY. PATIENTS WHOSE MEDICAID APPLICATIONS ARE PENDING ARE REGULARLY ADMITTED. FINANCIAL ASSISTANCE IS GRANTED TO PATIENTS WHO ARE DENIED FOR MEDICAID BUT ARE UNABLE TO PAY, IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 4:	THE DESCRIPTION OF MADONNA REHABILITATION HOSPITAL'S COMMUNITY IN THE 2022 CHNA:MADONNA IS ONE OF THE NATION'S LARGEST SPECIALIZED REHABILITATION HOSPITALS. MADONNA TREATS CHILDREN AND ADULTS WITH COMPLEX DISABILITIES DUE TO TRAUMATIC BRAIN INJURY, SPINAL CORD INJURY, STROKE, NEUROLOGICAL DISORDERS, BURNS, PULMONARY DISEASE, AND OTHER DISABLING CONDITIONS. THIS IS MADONNA'S "COMMUNITY" - THE PEOPLE WHO REQUIRE INPATIENT POST-ACUTE PHYSICAL REHABILITATION TO REDUCE OR ELIMINATE IMPAIRMENTS, ACTIVITY LIMITATIONS, AND PARTICIPATION RESTRICTIONS. UNLIKE ACUTE CARE HOSPITALS, MADONNA DOES NOT DEFINE "COMMUNITY SERVED" AS A GEOGRAPHIC AREA, BUT RATHER BY THE PRIORITY POPULATION THAT REQUIRES THESE HIGHLY SPECIALIZED SERVICES. THIS POPULATION INCLUDES PEOPLE OF ALL AGES, GENDER, INCOME LEVEL, AND RACE FROM THROUGHOUT THE COUNTRY.
PART VI, LINE 5:	IN AN EFFORT TO MEET THE GROWING NEEDS OF THE PEDIATRIC POPULATION, MADONNA HAS EXPANDED ITS DESIGNATED AREA AND FEATURES A PEDIATRIC THERAPY GYM, ALLOWING THE YOUNGEST PATIENTS TO RECEIVE AGE-APPROPRIATE REHABILITATION SERVICES. MADONNA HAS ALSO RENOVATED THE KIT SCOTT THERAPEUTIC LEARNING CENTER. THE GOAL OF THE LEARNING CENTER IS TO HELP STUDENTS SUCCESSFULLY TRANSITION BACK TO THEIR HOME AND SCHOOL SETTINGS. MADONNA ALSO PROVIDES SERVICES TO THE COMMUNITY WHICH WOULD OTHERWISE BE UNAVAILABLE OR UNDERSERVED, SUCH AS COMMUNITY MEDICAL TRANSPORTATIONS. MADONNA PHYSICIANS AND THERAPISTS ALSO PRESENT AT NUMEROUS CONFERENCES THROUGHOUT THE YEAR, PROVIDING RECOGNIZED EXPERTISE TO THE COMMUNITY ON REHABILITATION AND OTHER RELEVANT TOPICS. IN ADDITION TO OUR MEDICAL FACILITIES (WHICH INCLUDE LINCOLN'S FIRST MEDICAL FITNESS FACILITY), MADONNA PROVIDES VOLUNTEER AND FINANCIAL SUPPORT TO THE COMMUNITY. MADONNA EMPLOYEES DONATE HUNDREDS OF UNITS OF BLOOD ONSITE EACH YEAR AND SERVE MORE THAN 1,000 MEALS EACH YEAR AT MATT TALBOT KITCHEN. FINANCIAL SUPPORT INCLUDE INDIVIDUAL EMPLOYEE AND ORGANIZATIONAL DONATIONS OF MONEY AND SUPPLIES TO PATIENTS AND THEIR FAMILIES, AREA FOOD BANKS, CHURCHES, MISSIONARIES, SOCIAL SERVICES ORGANIZATIONS, AND HEALTH ASSOCIATIONS. IN SOME CASES, MADONNA ORGANIZES FUNDRAISERS DESIGNED TO BENEFIT THESE ORGANIZATIONS.OUTSIDE ORGANIZATIONS ARE ALSO ALLOWED TO USE MADONNA'S MEETING ROOMS AT NO CHARGE.
PART VI, LINE 6:	MADONNA IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATES	NE

Schedule H (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

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

2021

Open to Public Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

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 on 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 .....

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 on Line 1a? ....

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

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

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

Yes

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

Yes

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1PAUL DONGILLI PRESIDENT AND CEO	(i) (ii)	637,215 ------------- 0	38,074 ------------- 0	0 ------------- 0	34,550 ------------- 0	3,734 ------------- 0	713,573 ------------- 0	0 ------------- 0
2ADAM T KAFKA STAFF PHYSIATRIST	(i) (ii)	622,104 ------------- 0	0 ------------- 0	0 ------------- 0	11,576 ------------- 0	7,603 ------------- 0	641,283 ------------- 0	0 ------------- 0
3JIAXIN TRAN STAFF PHYSIATRIST	(i) (ii)	497,824 ------------- 0	0 ------------- 0	0 ------------- 0	26,898 ------------- 0	1,570 ------------- 0	526,292 ------------- 0	0 ------------- 0
4MORGAN L LAHOLT STAFF PHYSIATRIST	(i) (ii)	443,738 ------------- 0	0 ------------- 0	0 ------------- 0	9,000 ------------- 0	6,405 ------------- 0	459,143 ------------- 0	0 ------------- 0
5MATTHEW DRIEWER STAFF PHYSIATRIST	(i) (ii)	390,619 ------------- 0	0 ------------- 0	0 ------------- 0	16,174 ------------- 0	4,775 ------------- 0	411,568 ------------- 0	0 ------------- 0
6DONALD SCHMIDT VP OF MEDICAL AFFAIRS/CHIE	(i) (ii)	348,824 ------------- 0	13,877 ------------- 0	0 ------------- 0	25,833 ------------- 0	7,051 ------------- 0	395,585 ------------- 0	0 ------------- 0
7PAUL L KRABBENHOFT STAFF PHYSIATRIST	(i) (ii)	357,391 ------------- 0	0 ------------- 0	0 ------------- 0	21,050 ------------- 0	7,312 ------------- 0	385,753 ------------- 0	0 ------------- 0
8MICHAEL HEDDERMAN VP AND CFO	(i) (ii)	288,189 ------------- 0	15,781 ------------- 0	0 ------------- 0	25,510 ------------- 0	3,919 ------------- 0	333,399 ------------- 0	0 ------------- 0
9CHRISTOPHER A LEE VP AND COO	(i) (ii)	274,074 ------------- 0	14,912 ------------- 0	0 ------------- 0	27,445 ------------- 0	6,909 ------------- 0	323,340 ------------- 0	0 ------------- 0
10SUSAN K KLANECKY VP PATIENT CARE & ADMIN MRSH-LINCOLN	(i) (ii)	254,232 ------------- 0	13,839 ------------- 0	0 ------------- 0	20,253 ------------- 0	8 ------------- 0	288,332 ------------- 0	0 ------------- 0
11LOU ANN MANSKE VP HUMAN RESOURCES	(i) (ii)	251,357 ------------- 0	14,965 ------------- 0	0 ------------- 0	12,763 ------------- 0	-580 ------------- 0	278,505 ------------- 0	0 ------------- 0
12DANIEL GRIESS VP FACILITIES MANAGEMENT S	(i) (ii)	232,630 ------------- 0	13,154 ------------- 0	0 ------------- 0	19,374 ------------- 0	852 ------------- 0	266,010 ------------- 0	0 ------------- 0
13JEFF GROMOWSKY VP & PHYSICIAN PRACTICE AD	(i) (ii)	186,385 ------------- 0	10,099 ------------- 0	0 ------------- 0	23,236 ------------- 0	7,512 ------------- 0	227,232 ------------- 0	0 ------------- 0
14LYNN R HALLOWELL-GOTTSLEBEN VP REHABILITATION	(i) (ii)	192,038 ------------- 0	10,379 ------------- 0	0 ------------- 0	20,570 ------------- 0	3,059 ------------- 0	226,046 ------------- 0	0 ------------- 0
15LINDA S SUNDELL-SULLIVAN VP REFERRAL RELATIONS	(i) (ii)	180,724 ------------- 0	9,840 ------------- 0	0 ------------- 0	17,544 ------------- 0	3,157 ------------- 0	211,265 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 5

ALL HOSPITAL MANAGERS, APPROXIMATELY EIGHTY, ARE ELIGIBLE PARTICIPANTS OF THE HOSPITAL'S MANAGEMENT INCENTIVE COMPENSATION PLAN. THE PLAN PROVIDES A STRUCTURE FOR MEASURING THE HOSPITAL'S OVERALL QUALITY AND FINANCIAL PERFORMANCE. THIS PLAN ALLOWS FOR RECOGNITION AND COMPENSATION WHEN THE HOSPITAL'S PERFORMANCE EXCEEDS BASELINE CRITERIA. UPON ACHIEVEMENT OF AN ESTABLISHED QUALITY BENCHMARK, COMPENSATION IS DETERMINED BASED UPON A FIXED FORMULA ENCOMPASSING REVENUES, EARNINGS AND PARTICIPANTS' WAGES. THE FORMULA IS APPLIED EQUALLY TO ALL PARTICIPANTS.

PART I, LINE 6

SEE EXPLANATION FOR LINE 5.

Schedule J (Form 990) 2021

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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 instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
MADONNA REHABILITATION HOSPITAL

Employer identification number
47-0439599

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(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 NO 2 - OF DOUGLAS COUNTY NE	52-1440796	SUPPLINFO	09-25-2014	86,048,946	CONSTRUCT, EQUIP, AND FURNISH NEW HOSPITAL FACILITY IN OMAHA, NE.		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................	20,110,000
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	86,048,946
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............	5,911,150
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	989,867
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	79,147,929
11 Other spent proceeds .............
12 Other unspent proceeds .............
13 Year of substantial completion .............	2016
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X
16 Has the final allocation of proceeds been made? ..........	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X

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

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....	0 %
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 .........	0 %
6 Total of lines 4 and 5 .............	0 %
7 Does the bond issue meet the private security or payment test? ...		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......		X
b Exception to rebate? ........		X
c No rebate due? .........	X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...	X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X

Part Ⅵ

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

Return Reference	Explanation
SCHEDULE K SUPPLENTAL INFORMATION	CUSIP NUMBERS INCLUDE THE FOLLOWING: 25923P AA3 25923P AB1 25923P AC9 25923P AD7 25923P AE5 25923P AF2 25923P AS4 25923P AG0 25923P AH8 25923P AJ4 25923P AV7 25923P AK1 25923P AL9 25923P AM7 25923P AN5 25923P AP0 25923P AR6 25923P AT2 25923P AU9 25923P AQ8 PART IV, LINE 2C: REBATE COMPUTATION PERFORMED MAY 15, 2018.

Schedule K (Form 990) 2021

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( VARIOUS OTHER )	X	195	80,261	COST
26 Other ( EQUIPMENT )	X	21	23,634	COST
27 Other ( )
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

Yes

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

Yes

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

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

Cat. No. 51227J

Schedule M (Form 990) (2021)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
PART I, LINE 32B:	MADONNA REHABILITATION HOSPITAL USES ITS SUPPORTING ORGANIZATION, THE MADONNA FOUNDATION, TO SOLICIT, PROCESS AND SELL NONCASH CONTRIBUTIONS.

Schedule M (Form 990) (2021)

Additional Data

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SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 1A	THE EXECUTIVE COMMITTEE, COMPRISED OF THE CHAIR, VICE CHAIR, SECRETARY AND TREASURER, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 3	FOOD SERVICE OPERATIONS ARE CONTRACTED WITH ARAMARK; AN OUTSIDE MANAGEMENT CORPORATION. NO CURRENT OR FORMER OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, OR HIGHEST COMPENSATED EMPLOYEES WERE COMPENSATED BY ARAMARK DURING THE TAX YEAR.
FORM 990, PART VI, SECTION A, LINE 6	THE DIOCESAN HEALTH MINISTRIES, A NEBRASKA NONPROFIT CORPORATION, IS THE SOLE MEMBER OF MADONNA REHABILITATION HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	THE DIOCESAN HEALTH MINISTRIES MAY DESIGNATE ONE MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS, AS PROVIDED IN THE ORGANIZATION'S ARTICLES OF INCORPORATION.
FORM 990, PART VI, SECTION A, LINE 7B	THE MEMBER, DIOCESAN HEALTH MINISTRIES, HAS FINAL APPROVAL OF: (1) CHANGES IN PHILOSOPHY AND MISSION; (2) MATTERS INVOLVING SALE, LEASE, TRANSFER, EXCHANGE, DISPOSITION, PLEDGE OR ALIENATION OF REAL PROPERTY IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00); (3) MATTERS INVOLVING PURCHASE AND/OR ENCUMBRANCE WITH DEBT, IN ANY WAY, OF REAL PROPERTY IN EXCESS OF FIVE HUNDRED THOUSAND DOLLARS ($500,000.00); (4) COMMUNITY MEMBERS NOMINATED TO SERVE ON THE BOARD OF DIRECTORS; (5) AMENDMENTS, ALTERATIONS OR CHANGES IN THE ARTICLES OF INCORPORATION OR BYLAWS; (6) THE ANNUAL CAPITAL BUDGET; (7) CEO SELECTION; (8) MERGER, CONSOLIDATION, DISSOLUTION. THE BOARD OF DIRECTORS APPROVES AND FORWARDS TO THE MEMBER, FOR ITS REVIEW THE ANNUAL REPORT AND THE OPERATING BUDGET.
FORM 990, PART VI, SECTION B, LINE 11B	PRIOR TO FILING THE ORGANIZATION'S FORM 990, THE CHIEF FINANCIAL OFFICER PRESENTS THE COMPLETED FORM 990 AND AN EXECUTIVE OVERVIEW OF THE FORM 990 TO THE FINANCE AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS AT A REGULARLY SCHEDULED MEETING. THE FINANCE AND AUDIT COMMITTEE APPROVES A MOTION TO ACCEPT AND FORWARD TO THE BOARD OF DIRECTORS THE FORM 990. SUBSEQUENTLY, THE FINANCE AND AUDIT COMMITTEE BOARD CHAIRPERSON (THE ORGANIZATION'S BOARD TREASURER) PRESENTS THE FORM 990 TO THE BOARD OF DIRECTORS. UPON BOARD RESOLUTION TO ACCEPT THE FORM 990 THE FORM 990 IS FILED WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C	THE ORGANIZATION ANNUALLY DISTRIBUTES ITS CONFLICT OF INTEREST POLICY AND DISCLOSURE FORM TO DIRECTORS, OFFICERS AND KEY EMPLOYEES. THE RESPONSES ARE REVIEWED BY THE BOARD OF DIRECTORS AND ITS COUNSEL, AND ANY APPROPRIATE ACTION IS TAKEN, BASED UPON THOSE RESPONSES AND THE SUBSEQUENT REVIEW.
FORM 990, PART VI, SECTION B, LINE 15	THE EXECUTIVE COMPENSATION COMMITTEE WILL MAKE RECOMMENDATIONS FOR THE ANNUAL COMPENSATION OF THE CHIEF EXECUTIVE OFFICER (CEO), AND CHIEF FINANCIAL OFFICER (CFO). THE MADONNA EXECUTIVE COMPENSATION PLAN REQUIRES NATIONAL SALARY BENCHMARKS BE USED FOR THE CEO AND CFO POSITIONS. -BASE SALARY: THE EXECUTIVE COMPENSATION COMMITTEE ANNUALLY DETERMINES THE CEO'S BASE SALARY BY REVIEWING 990 DATA FROM NONPROFIT REHABILITATION HOSPITALS AT A NATIONAL LEVEL AS WELL AS OTHER RELEVANT DATA. IDEALLY, THE DATA FROM NONPROFIT REHABILITATION HOSPITALS SHOULD BE FOR HOSPITALS WITHIN APPROXIMATELY PLUS OR MINUS 50% OF MADONNA'S GROSS REVENUES RECOGNIZING A NEED FOR A MINIMUM OF AT LEAST EIGHT COMPARABLE SIZED INSTITUTIONS. THE ANALYSIS INCLUDES REPORTING THE SALARIES FOR BENCHMARK FIRMS (FROM 990 DATA) REPORTED BY THE VICE PRESIDENT HUMAN RESOURCES. OTHER SOURCES OF INFORMATION AND DATA MAY BE USED AS NEEDED FROM THIRD PARTY SALARY SURVEYS IN ADDITION TO OR IN LIEU OF 990 DATA AS DEEMED NECESSARY FROM YEAR TO YEAR. THE ANNUAL COMPENSATION ADJUSTMENT FOR THE CEO AND CFO IS TO REPRESENT BOTH THE MARKET CHANGES AND THE MERIT PERFORMANCE.
FORM 990, PART VI, SECTION C, LINE 19	SUMMARIZED FINANCIAL INFORMATION IS MADE AVAILABLE TO THE PUBLIC ON AN ANNUAL BASIS THROUGH THE PUBLICATION OF THE HOSPITAL'S PUBLIC ANNUAL REPORT. IN ADDITION, THE PUBLIC ANNUAL REPORT IS AVAILABLE ON THE HOSPITAL'S WEBSITE. THE HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC.
FORM 990, PART IX, LINE 11G	CONTRACT LABOR: PROGRAM SERVICE EXPENSES 15,880,888. MANAGEMENT AND GENERAL EXPENSES 1,543,707. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,424,595. MEDICAL SERVICE FEES: PROGRAM SERVICE EXPENSES 4,177,965. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,177,965. MAINTENANCE: PROGRAM SERVICE EXPENSES 85,250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 85,250.
FORM 990, PART XI, LINE 9:	CHANGE IN TEMP RESTRICTED NET ASSETS AND AMOUNT RECOGNIZED FROM PRIOR YEAR 11,215.
FORM 990, PART XII, LINE 2C:	THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT AUDITOR. THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART XII, LINE 3B:	MADONNA RECEIVED CARES RELIEF FUNDING THAT WILL BE TREATED AS A FEDERAL AWARD SUBJECT TO A SINGLE AUDIT.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

MADONNA REHABILITATION HOSPITAL

Employer identification number

47-0439599

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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)MADONNA FOUNDATION 5401 SOUTH STREET LINCOLN,NE68506 23-7159940	FUNDRAISING SUPPORT	NE	501(C)(3)	LINE 12B, II	MADONNA REHABILITATION HOSPITAL	Yes
(2)MADONNA INC 5401 SOUTH STREET LINCOLN,NE68506 36-3397284	HEALTHCARE MANAGEMENT	NE	501(C)(3)	LINE 12B, II	MADONNA REHABILITATION HOSPITAL	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

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	(h) Percentage ownership	Yes	No

Schedule R (Form 990) 2021

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

Yes

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

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

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) MADONNA FOUNDATION	L	163,000	FINANCIAL RECORD
(2) MADONNA FOUNDATION	M	1,246,651	FINANCIAL RECORD
(3) MADONNA FOUNDATION	P	773,276	FINANCIAL RECORD
(4) MADONNA INC	S	23,747	FINANCIAL RECORD
(5) MADONNA FOUNDATION	C	1,855,538	FINANCIAL RECORD

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: MADONNA REHABILITATION HOSPITAL IS A CATHOLIC ORGANIZATION THAT EXISTS TO PROVIDE MEDICAL AND PHYSICAL REHABILITATION SERVICES TO CHILDREN AND ADULTS THROUGHOUT THE NATION. WE REHABILITATE THOSE WHO HAVE SUSTAINED INJURIES OR DISABLING CONDITIONS SO THEY CAN FULLY PARTICIPATE IN LIFE; LEAD RESEARCH TO IMPROVE OUTCOMES; AND PREVENT PHYSICAL DISABILITIES AND PROMOTE WELLNESS THROUGH COMMUNITY PROGRAMS.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	20
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	19
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	2,451
6	Total number of volunteers (estimate if necessary) .............	6	125
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	13,016,784	4,459,418
9	Program service revenue (Part VIII, line 2g) .........	182,288,547	180,184,942
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	13,381,638	2,927,520
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	208,686,969	187,571,880
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	125,650,210	127,027,808
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)....	47,919,159	55,815,654
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	173,569,369	182,843,462
19	Revenue less expenses. Subtract line 18 from line 12.......	35,117,600	4,728,418
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	298,912,526	294,312,557
21	Total liabilities (Part X, line 26).............	90,830,012	91,034,746
22	Net assets or fund balances. Subtract line 21 from line 20.....	208,082,514	203,277,811

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 108,759,340 including grants of $ ) (Revenue $ 129,921,913 )
	MADONNA FULFILLS THIS MISSION BY DELIVERING EXPERT AND COMPREHENSIVE REHABILITATION, TREATING EACH PERSON AS A UNIQUE INDIVIDUAL. MADONNA'S HOSPITALS INTEGRATE THE PHYSICAL, PSYCHOLOGICAL, SOCIAL, SPIRITUAL AND VOCATIONAL ASPECTS OF EACH PATIENT'S LIFE. THE HOSPITALS' PROGRAMS SUPPORT THE UNMET NEEDS OF OUR COMMUNITY AND REGION AND ARE DEVOTED TO RETURNING PEOPLE TO THEIR HOMES, COMMUNITIES AND JOBS OR SCHOOL. IN FY 2022 MADONNA ADMITTED 2,264 HOSPITAL INPATIENTS FROM 19 STATES. THE HOSPITAL RECEIVED REFERRALS FROM 850 PHYSICIANS AND 101 HOSPITALS OR HEALTH CARE FACILITIES. IN FY 2022, MADONNA OPERATED TWO INPATIENT REHABILITATION FACILITIES (IRFS): MADONNA REHABILITATION HOSPITAL LINCOLN (MRH-L) AND ACUTE REHABILITATION OMAHA (AR-O) AND TWO LONG-TERM CARE HOSPITALS (LTCHS): MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN (MRSH-L) AND MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA (MRSH-O). MRH-L, AR-O, MRSH-L AND MRSH-O OFFER COMPREHENSIVE CARE TO ENSURE CONTINUITY AS PATIENTS' PROGRESS IN THEIR RECOVERY OR FROM ONE HOSPITAL TO ANOTHER. ALL HOSPITALS EMPLOY AN INTERDISCIPLINARY TEAM APPROACH INVOLVING THE PATIENT AND FAMILY, REFERRING PHYSICIAN, REHABILITATION PHYSICIAN, HOSPITALIST, CASE MANAGER, NUTRITION THERAPIST, RESPIRATORY THERAPIST, REHABILITATION NURSE, PHYSICAL AND OCCUPATIONAL THERAPISTS, ORTHOTIC AND PROSTHETIC TECHNICIAN, PSYCHOLOGIST, SOCIAL WORKERS, SPEECH-LANGUAGE PATHOLOGISTS, THERAPEUTIC RECREATION SPECIALISTS, VOCATIONAL REHABILITATION CONSULTANTS AND SPIRITUAL CARE COUNSELORS. MADONNA'S EXPERIENCED STAFF TREAT THOUSANDS OF INDIVIDUALS THROUGH INPATIENT AND OUTPATIENT SERVICES EVERY YEAR, OFFERING EVERY PATIENT THE LATEST TECHNIQUES AND METHODS TO PRODUCE THE BEST RESULTS. AS ONE OF THE LARGEST, FREESTANDING REHABILITATION HOSPITAL SYSTEMS IN THE UNITED STATES, MADONNA PROVIDES:-INTENSIVE THERAPY PROGRAMMING-PROGRAMS WITH LESS INTENSIVE THERAPY, DEPENDING ON THE NEEDS OF THE PATIENT-24-HOUR REHABILITATION NURSING AND PHYSICIAN SUPERVISION-A CONTINUUM OF SERVICES TO ENSURE PROGRESS IS MAINTAINED FROM INPATIENT TO OUTPATIENT PROGRAMSOUR SPECIALTY REHABILITATION PROGRAMS FOCUS ON THE NEEDS OF CHILDREN AND ADULTS FOLLOWING TRAUMATIC INJURY AND ILLNESS, INCLUDING: BRAIN INJURY, SPINAL CORD INJURY, STROKE, PULMONARY CONDITIONS, NEUROLOGICAL DISORDERS AND MAJOR MULTIPLE TRAUMA. MADONNA REHABILITATION HOSPITAL HAS 20 SEPARATE PROGRAM ACCREDITATIONS FROM THE COMMISSION ON THE ACCREDITATION OF REHABILITATION FACILITIES (CARF) IN THE AREA OF MEDICAL REHABILITATION. THIS INCLUDES: -INPATIENT REHABILITATION PROGRAMS FOR THE IRFS, LTCHS AND TRANSITIONAL CARE UNIT (TCU)-BRAIN INJURY PROGRAM INPATIENT/OUTPATIENT (ADULT AND PEDIATRIC)-CANCER SPECIALTY PROGRAM INPATIENT/OUTPATIENT (ADULT AND PEDIATRIC), OMAHA ONLY-SPINAL CORD SPECIALTY PROGRAM INPATIENT/OUTPATIENT (ADULT AND PEDIATRIC), LINCOLN ONLY-STROKE SPECIALTY PROGRAM INPATIENT/OUTPATIENT (ADULT)-PEDIATRIC SPECIALTY PROGRAM INPATIENT/OUTPATIENT-INTERDISCIPLINARY OUTPATIENT MEDICAL REHABILITATION PROGRAMS MULTIPLE SERVICEMADONNA REHABILITATION HOSPITAL LINCOLN PATIENTS AT MRH-L RANK IN THE TOP 3% NATIONALLY IN TERMS OF COMPLEXITY, WHILE DISCHARGING BACK TO COMMUNITY SETTINGS AT A HIGHER RATE ACCORDING TO INDUSTRY BENCHMARKS. DESPITE THIS COMPLEXITY, 75.6% OF PATIENTS DISCHARGED DIRECTLY TO A COMMUNITY SETTING, COMPARED TO EREHAB BENCHMARK OF 71.9%. PATIENTS AT MRH-L MADE HIGHER FUNCTIONAL GAINS IN AREAS SUCH AS MOBILITY AND SELF-CARE THAN THE NATION AND DISCHARGED AT A HIGHER FUNCTIONAL LEVEL OVERALL. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRH-L WAS 87.3%. ACUTE REHABILITATION OMAHA IN OCTOBER OF 2022, MADONNA WILL COMPLETE ITS SIXTH YEAR OF OPERATING REHABILITATION BEDS IN OMAHA. AR-O, OVERALL, RETURNED 77.5% OF PATIENTS TO A COMMUNITY DESTINATION RATHER THAN TO AN INSTITUTION, APPROXIMATING THE EREHAB DATA BENCHMARKS. PATIENTS AT AR-O MADE HIGHER FUNCTIONAL GAINS IN AREAS SUCH AS MOBILITY AND SELF-CARE THAN THE NATION AND DISCHARGED AT A HIGHER FUNCTIONAL LEVEL OVERALL. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR AR-O WAS 94.7%.MADONNA REHABILITATION SPECIALTY HOSPITAL LINCOLN MRSH-L FY 2022 PATIENT DISCHARGE TO HOME OR TO AN ACUTE REHABILITATION HOSPITAL TO CONTINUE THEIR RECOVERY WAS 57.9% FOR THE YEAR. 75% OF PATIENTS ADMITTED ON A MECHANICAL VENTILATOR WEANED IN AN AVERAGE OF 19.7 DAYS. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRSH-L WAS 83.6%.MADONNA REHABILITATION SPECIALTY HOSPITAL OMAHA MRSH-O FY 2022 PATIENT DISCHARGE TO HOME OR TO AN ACUTE REHABILITATION HOSPITAL TO CONTINUE THEIR RECOVERY WAS 55.9% FOR THE YEAR. 54.6% OF PATIENTS ADMITTED ON A MECHANICAL VENTILATOR WEANED IN AN AVERAGE OF 11.3 DAYS. ADDITIONALLY, THE OVERALL PATIENT SATISFACTION RATE FOR MRSH-O WAS 93.5%.

4b	(Code: ) (Expenses $ 24,957,721 including grants of $ ) (Revenue $ 22,916,836 )
	ST. JANE DE CHANTAL (ST. JANE) IS COMPRISED OF A 30-BED VENTILATOR AND SPECIAL CARE UNIT (VAU/SN), A 30-BED TRANSITIONAL CARE REHABILITATION UNIT (TCU) AND A 66-BED NURSING HOME. THE EXPANSION OF TCU TO INCLUDE ALL PRIVATE ROOMS TO CARE FOR CLINICALLY COMPLEX PATIENTS HAS BEEN COMPLETED. PATIENT/FAMILY SATISFACTION HAS INCREASED. ST. JANE RECEIVED A THREE YEAR CARF ACCREDITATION FOR OUR INPATIENT REHABILITATION PROGRAMS SKILLED NURSING (ADULTS), EFFECTIVE JULY 2021 - JULY 2024.IN 2021 ST. JANE RECEIVED A DEFICIENCY FREE SURVEY FROM THE DEPARTMENT OF HEALTH AND HUMAN SERVICES (DHHS). ST. JANE MAINTAINED A CMS 5-STAR RATING AND "COVID 19 HERO'S" AWARD DUE TO OUR LOW INCIDENCE OF COVID CASES. ST. JANE CONTINUES TO BE RECOGNIZED AS ONE OF THE BEST NURSING HOMES IN NEBRASKA AS PUBLISHED IN U.S. NEWS & WORLD REPORT, 2021-2022. ST. JANE RECEIVED RECOGNITION IN 2021 AS ONE OF THE TOP NURSING HOMES IN NEBRASKA 5 STAR RATED AS PUBLISHED IN MEDICARE.GOV 2021.

4c	(Code: ) (Expenses $ 10,546,541 including grants of $ ) (Revenue $ 10,716,290 )
	MADONNA THERAPYPLUS IS COMMITTED TO PROVIDING EXCELLENT CARE FOR PATIENTS WHO NEED OUTPATIENT REHABILITATION. THERAPYPLUS OFFERS A RANGE OF REHABILITATION SERVICES FOR SPORTS INJURIES, ORTHOPEDIC SPRAINS, STRAINS AND POST-OPERATIVE CARE TO COMPREHENSIVE REHABILITATION FOR NEUROLOGICAL CONDITIONS. THERAPYPLUS INCLUDES THE FIT FOR WORK PROGRAM, WHICH COMBINES OCCUPATIONAL HEALTH, WELLNESS, SAFETY AND COORDINATION OF WORKERS' COMPENSATION WITH THE EXPERT SERVICES CONVENIENTLY AVAILABLE FROM MADONNA REHABILITATION HOSPITALS, MADONNA THERAPYPLUS OUTPATIENT CLINICS AND MADONNA PROACTIVE.IN FY 2022, THERAPYPLUS HAD A 14% INCREASE IN THE NUMBER OF PATIENTS SERVED ACROSS ALL LOCATIONS AND FOR ALL SERVICES COMPARED TO PRIOR YEAR. THE RESUMPTION OF ELECTIVE SURGERIES AS WELL AS, PEOPLE RESUMING PARTICIPATION IN PREVENTATIVE AND OTHER HEALTH CARE SERVICES WERE KEY FACTORS IN THIS GROWTH. AS EXPECTED, THERE WERE OCCASIONAL VOLUME IMPACTS DUE TO THE COMMUNITY COVID-19 ACTIVITY ATTRIBUTED TO SEVERAL VARIANTS. IN FY2022, THERAPYPLUS LAUNCHED A COMPREHENSIVE POST-COVID REHABILITATION CLINIC. THIS CLINIC INCLUDES AN INTERDISCIPLINARY REHABILITATION TEAM INCLUDING NEUROPSYCHOLOGY AND PHYSIATRY. FOCUS THROUGH THE CLINIC IS TO ADDRESS THE WIDE SPECTRUM OF REHABILITATION NEEDS FOR THOSE WHO ARE EXPERIENCING LINGERING EFFECTS FROM COVID INFECTION. THE CLINIC PROVIDES AN INDIVIDUALIZED APPROACH FOR A SAFE RETURN TO LIFE AND WORK ACTIVITIES.

	(Code: ) (Expenses $ 18,582,145 including grants of $ ) (Revenue $ 16,629,903 )
	MADONNA PROACTIVE IS A MEDICALLY-BASED HEALTH, FITNESS AND WELLNESS FACILITY AND THE FIRST TO BE BASED ON A REHABILITATION MODEL. MADONNA PROACTIVE PROVIDES MEDICAL, THERAPEUTIC AND EDUCATIONAL FITNESS AND WELLNESS EXPERTISE IN ADDITION TO THE LATEST TECHNOLOGY.IN FY 2022, PROACTIVE SIGNIFICANTLY IMPROVED WITH MEMBERSHIP AND SERVICE UTILIZATION. SHIFTING AWAY FROM HOME-BASED GYM SETUPS THAT WERE CREATED IN THE INITIAL PHASES OF THE PANDEMIC AS WELL, COMMUNITY COMFORT AND COMMITMENT IN RESUMING PRIOR ACTIVITIES, HAVE BEEN THE KEY DRIVERS FOR THE VOLUME INCREASE. IN ADDITION, PROACTIVE CONTINUES TO EXPAND ESSENTIAL MEDICAL AND WELLNESS PROGRAMMING IN SEVERAL KEY AREAS TO FURTHER ENHANCE THE CONTINUUM OF CARE THAT MADONNA PROVIDES.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 18,582,145 including grants of $ ) (Revenue $ 16,629,903 )
4e	Total program service expenses162,845,747

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	5,312,264	0	375,062

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	1,855,538
e	Government grants (contributions)		1e	2,415,667

f	All other contributions, gifts, grants, and similar amounts not included above		1f	188,213

g	Noncash contributions included in lines 1a - 1f:$		1g	103,895

h Total. Add lines 1a-1f.......		4,459,418

		Business Code
2a	PATIENT SERVICE REVENUE, NET	900099	132,506,618	132,506,618
b	LONG-TERM CARE	900099	22,916,836	22,916,836
c	OUTPATIENT	900099	10,716,290	10,716,290
d	PHYSICIAN SERVICES	900099	8,417,248	8,417,248
e
f	All other program service revenue.		5,627,950	5,627,950
g	Total. Add lines 2a–2f .....		180,184,942

3 Investment income (including dividends, interest, and othersimilar amounts) ......			2,927,520			2,927,520
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses			7b
c	Gain or (loss)			7c
d	Net gain or (loss).........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			187,571,880	180,184,942	0	2,927,520

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,263,287		3,263,287
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	98,946,668	89,952,685	8,993,983
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	3,047,893	3,020,893	27,000
9	Other employee benefits .......	14,497,135	13,359,976	1,137,159
10	Payroll taxes ...........	7,272,825	6,743,471	529,354
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	93,166	35,447	57,719
c	Accounting ...........	61,500		61,500
d	Lobbying ...........	44,122		44,122
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	169,035		169,035
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	21,687,810	20,144,103	1,543,707
12	Advertising and promotion ....	914,485	288,757	625,728
13	Office expenses .......	12,105,553	11,823,079	282,474
14	Information technology ......	2,203,756	1,049,608	1,154,148
15	Royalties ..
16	Occupancy ...........	3,001,284	2,168,894	832,390
17	Travel ............	523,122	472,971	50,151
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	347,605	311,807	35,798
20	Interest ...........	2,933,761	2,655,727	278,034
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	9,758,970	9,009,732	749,238
23	Insurance ...	950,467	950,467
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MISCELLANEOUS	1,021,018	858,130	162,888
b
c
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	182,843,462	162,845,747	19,997,715	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 ........				1
2	Savings and temporary cash investments .........			20,537,657	2	21,787,362
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			34,482,363	4	38,798,982
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,943,445	8	1,942,901
9	Prepaid expenses and deferred charges ......			1,853,939	9	2,100,539
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	284,555,642
b	Less: accumulated depreciation	10b	118,183,845	145,553,031	10c	166,371,797
11	Investments—publicly traded securities .			93,897,853	11	62,361,448
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			644,238	15	949,528
16	Total assets. Add lines 1 through 15 (must equal line 33)...			298,912,526	16	294,312,557

17	Accounts payable and accrued expenses .....	23,442,338	17	24,781,949
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	63,337,110	20	61,572,445
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	4,050,564	25	4,680,352
26	Total liabilities. Add lines 17 through 25..	90,830,012	26	91,034,746

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	208,082,214	27	203,266,296
28	Net assets with donor restrictions ...........	300	28	11,515
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	208,082,514	32	203,277,811
33	Total liabilities and net assets/fund balances ........	298,912,526	33	294,312,557