4A (Expenses $ 314655951 including grants of $ 76588174) (Revenue $ 394538236)
Oncology Service Line Cancer treatment services offered by the corporation include treatment of lymphoma, leukemia, multiple myeloma, head and neck, breast, gastrointestinal, pancreatic, lung, genitourinary prostate, gynecologic, melanoma, brain, and spine cancers. The patients are supported by research that is conducted on the University of Nebraska Medical Center (UNMC) campus. The Nebraska Medical Center (TNMC) is the only clinical cancer center in its service area designated by the national cancer institute. In addition to treatment and clinical trials, TNMC offers support groups, social work, pain management, financial counselors, survivorship groups, genetic counseling, and a variety of additional patient supportive services. In June 2017, TNMC opened the Fred and Pamela Buffett Cancer Center. The center is jointly owned with UNMC, and it is one of the foremost cancer research and treatment facilities in the country. It is the site of inpatient hospital care, as well as outpatient and diagnostic care. UNMC's facilities, within the center, house research labs. TNMC operates cancer treatment locations in Bellevue, NE; West Omaha, NE; and in Shenandoah, IA. In addition, as one of the busiest programs in the world, the bone marrow transplantation program served 227 patients in the year ended June 30, 2022. A 24/7 emergency and evaluation treatment center are dedicated to cancer and transplants. The program benefits from the research conducted on TNMC/UNMC campuses. TNMC was one of the first cancer centers in the nation to participate in clinical trials for CAR-T cell therapy. It was FDA-Approved in October 2017. The therapy treatment was extended to leukemia patients in 2018 and multiple myeloma patients in 2019. During fiscal year 2022, the oncology service line treated 133,989 cases.

4B (Expenses $ 291497950 including grants of $ 57275518) (Revenue $ 295050538)
Neurological Sciences Service Line The core services include precise diagnosis and treatment of stroke and vascular disease, movement and memory disorders, multiple sclerosis brain and spinal tumors, spine as well as epilepsy. The epilepsy center is the only level four center in the region and treats patients from the State of Nebraska and surrounding region. The Nebraska Medical Center (TNMC) has one of the few magnetoencephalography (MEG) scanners and trained MEG scientists in the region. The MEG can detect brain activity in much greater detail and with more accuracy than previous methods and advances patient care and research opportunities. In July 2018, TNMC opened the Twin Creek Health Center, a dedicated neurological sciences ambulatory clinic in Bellevue, NE. TNMC has earned the American Heart Association/American Stroke Association's Get with the Guidelines Stroke Gold Plus Achievement Award. Get with the Guidelines is a hospital-based, quality-improvement program designed to ensure hospitals consistently care for cardiac and stroke patients following the most up-to-date guidelines and recommendations. TNMC also hosts the only young adult stroke support group to address the emotion and physical challenges of recovering from stroke.

4C (Expenses $ 217065846 including grants of $ 47550844) (Revenue $ 244954608)
Heart and Vascular Service Line The Nebraska Medical Center (TNMC) provides a wide range of cardiovascular services from diet counseling to surgical procedures and rehabilitation to patients from the surrounding region. TNMC has grown into one of the busiest centers in the country for ventricular assist device operations. TNMC has been successful in recruiting physicians and has the only heart failure specialist in the region, and the only heart failure program certified by the joint commission in the State of Nebraska. In 2016, TNMC began a lung transplant program, and in December 2017, TNMC performed the state's first heart and lung transplant. In the year ended June 30, 2022, TNMC performed 13 lung transplants. The congestive heart failure program and acute myocardial infarction program each received the gold seal of approval certification from the American Heart Association. This program is certified by the joint commission, and these services are the only nationally certified programs of their kind in the State of Nebraska. The chest pain center has received full chest pain center accreditation from the Society of Chest Pain Centers. TNMC has been recognized for service excellence under the J.D. Power and Associates Distinguished Hospital Program. TNMC has the only joint commission certified destination therapy program in the state and is the only hospital in the region performing adult heart transplants and implanting total artificial hearts. In the year ended June 30, 2022, 827 open heart surgeries were performed, including 43 heart transplants.

4D (Expenses $ 156336713 including grants of $ 34647457) (Revenue $ 178483780)
Digestive Disease and Kidney Service Line The Nebraska Medical Center (TNMC) operates one of the busiest solid organ transplant programs in the world. In 2016, TNMC joined a small number of transplant centers which have programs for transplants of all solid organs. TNMC's lung transplant program did its first transplant in February 2016, and 13 lung transplants were performed during 2022. In the year ended June 30, 2022, TNMC performed 295 solid organ transplants including liver, kidney, heart, lung, pancreas, and small bowel. The success of TNMC's solid organ transplant program is heightened by research done on the TNMC/University of Nebraska Medical Center (UNMC) campuses. Since its inception, patients have come to TNMC for single or multiple organ transplants from all fifty states and five continents.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - Group A. (CHNA) FOR NEBRASKA MEDICINE (WHICH INCLUDES THE NEBRASKA MEDICAL CENTER (TNMC) AND BELLEVUE MEDICAL CENTER (BMC)) FOR THE COMPREHENSIVE CHNA PROCESS, A STEERING COMMITTEE COMPRISED OF KEY STAKEHOLDERS FROM AREA HEALTH SYSTEMS, LOCAL COUNTY HEALTH DEPARTMENT REPRESENTATIVES, AND KEY INFORMANTS FROM SEVERAL COMMUNITY AGENCIES WORKED COLLABORATIVELY TO OVERSEE THE PROCESS. THE CHNA STEERING COMMITTEE RETAINED PROFESSIONAL RESEARCH CONSULTANTS (PRC), INC. TO CONDUCT THE SURVEY. PRC IS A NATIONALLY RECOGNIZED HEALTH CARE CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING CHNAS SUCH AS THIS IN HUNDREDS OF COMMUNITIES ACROSS THE UNITED STATES SINCE 1994. INPUT FROM COMMUNITY STAKEHOLDERS KEY INFORMANT FEEDBACK INCLUDED REPRESENTATION FROM ALL OF THE ASSESSED COUNTIES. THE PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS THE COMMUNITY OVERALL. ONE HUNDRED FIFTY COMMUNITY STAKEHOLDERS, INCLUDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, PUBLIC HEALTH REPRESENTATIVES AND BUSINESS AND COMMUNITY LEADERS PROVIDED FEEDBACK. A FULL LIST OF REPRESENTED ORGANIZATIONS CAN BE FOUND IN THE FULL COMMUNITY NEEDS ASSESSMENT HERE: WWW.NEBRASKAMED.COM/ABOUT-US/COMMUNITY-HEALTH-IMPROVEMENT STEERING COMMITTEE PARTICIPANT NAMES BELOW IS A LISTING OF THE PARTICIPANTS AND THE SPONSORING ORGANIZATIONS REPRESENTING THE CHNA STEERING COMMITTEE. CHARLES DREW HEALTH CENTER: KENNY MCMORRIS - CHIEF EXECUTIVE OFFICER CHI HEALTH: KELLY NIELSEN - DIRECTOR, HEALTHIER COMMUNITIES AND COMMUNITY BENEFIT ASHLEY CARROLL - COORDINATOR, HEALTHIER COMMUNITIES AND COMMUNITY BENEFIT DOUGLAS COUNTY HEALTH DEPARTMENT: DR. ADI POUR - HEALTH DIRECTOR KERRY KERNEN - DIVISION CHIEF, COMMUNITY HEALTH, NUTRITION & CLINICAL SERVICES METHODIST HEALTH SYSTEM: JEFF PROCHASKA - DIRECTOR, STRATEGIC PLANNING MIKE KRAUS - COORDINATOR, COMMUNITY BENEFIT NEBRASKA MEDICINE (TNMC AND BMC): BECKY JACKSON - DIRECTOR, PATIENT & COMMUNITY ENGAGEMENT OMAHA COMMUNITY FOUNDATION: EMILY NGUYEN - DIRECTOR, RESEARCH AND STRATEGY ONEWORLD COMMUNITY HEALTH CENTERS: ANDREA SKOLKIN - CHIEF EXECUTIVE OFFICER POTTAWATTAMIE COUNTY HEALTH DEPARTMENT: MATT WYANT - DIRECTOR, PLANNING AND DEVELOPMENT SARPY/CASS COUNTY HEALTH DEPARTMENT: SARAH SCHRAM - HEALTH DIRECTOR THE WELLBEING PARTNERS: SARAH SJOLIE - EXECUTIVE DIRECTOR

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - Group A. THE CHNA WAS CONDUCTED WITH OTHER HOSPITAL FACILITIES AS LISTED BELOW: * CHI HEALTH * METHODIST HEALTH SYSTEM

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - Group A. THE CHNA WAS CONDUCTED WITH OTHER COMMUNITY BASED FACILITIES AS LISTED BELOW: * CHARLES DREW HEALTH CENTER * DOUGLAS, POTTAWATTAMIE AND SARPY/CASS COUNTY HEALTH DEPARTMENTS * OMAHA COMMUNITY FOUNDATION * ONE WORLD COMMUNITY HEALTH CENTERS * THE WELLBEING PARTNERS

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - Group A. NEBRASKA MEDICINE HAS CURRENT PROGRAMS AND SERVICES IN PLACE TO ADDRESS EACH OF THE FOURTEEN PRIORITIZED 2021 CHNA-IDENTIFIED COMMUNITY NEEDS. HOWEVER, IN ORDER TO MAKE MEANINGFUL IMPACT, AND TO USE ITS FINANCES MOST EFFECTIVELY AND EFFICIENTLY, NEBRASKA MEDICINE WILL PLACE A PRIMARY FOCUS ON DIABETES, MENTAL HEALTH, PRENATAL HEALTH AND INFANT PLANNING, AND NUTRITION, PHYSICAL ACTIVITY AND WEIGHT. HOWEVER, IT HAS NO PLANS TO DISCONTINUE OTHER COMMUNITY BENEFIT EFFORTS ADDRESSING THE REMAINING CHNA-IDENTIFIED NEEDS, AND MAY TOUCH UPON EACH OF THESE CATEGORIES WITHIN ITS EFFORTS TO ADDRESS ISSUES SURROUNDING ACCESS TO CARE IN UNDERSERVED POPULATIONS. FURTHER, IN ORDER TO ENSURE ALL IDENTIFIED NEEDS WILL BE ADDRESSED IN THE COMMUNITY, NEBRASKA MEDICINE WILL CONNECT WITH THE OTHER LOCAL HEALTH SYSTEMS, COUNTY HEALTH DEPARTMENTS AND COMMUNITY PARTNERS TO DISCUSS THE CHNA-IDENTIFIED COMMUNITY NEEDS AND LOOK FOR OPPORTUNITIES TO COLLABORATE. THE IDENTIFIED NEEDS NOT BEING PRIORITIZED BY NEBRASKA MEDICINE IN 2022-2025 ARE IDENTIFIED AS SUBSTANCE ABUSE, SEXUAL HEALTH, INJURY & VIOLENCE, HEART DISEASE & STROKE, TOBACCO USE, POTENTIALLY DISABLING CONDITIONS, ORAL HEALTH, ACCESS TO HEALTHCARE SERVICES, RESPIRATORY DISEASES AND CANCER. EACH OF THESE REMAINING CHNA-IDENTIFIED NEEDS ARE BEING ADDRESSED BY ONE OF THE OTHER COMMUNITY HEALTH SYSTEMS, LOCAL MEDICAL SCHOOLS, COUNTY HEALTH DEPARTMENTS, OR COMMUNITY-BASED ORGANIZATIONS. A FULL LISTING OF THESE ARE PROVIDED IN TNMC'S CHNA REPORT AND CAN BE FOUND HERE: WWW.NEBRASKAMED.COM/ABOUT-US/COMMUNITY-HEALTH-IMPROVEMENT IMPLEMENTATION PLAN STATUS UPDATE NEBRASKA MEDICINE'S FISCAL 2019-2022 CHNA AND IMPLEMENTATION PLANNING CYCLE IDENTIFIED ELEVEN SIGNIFICANT HEALTH NEEDS, THREE OF WHICH WERE PRIORITIZED FOR THE PLANNING PERIOD:(1) INJURY & VIOLENCE PREVENTION, (2) MENTAL HEALTH AND (3) ACCESS TO HEALTHCARE SERVICES. BELOW ARE SOME HIGHLIGHTS FROM THE FISCAL 2019-2022 PLAN. * FUNDED OVER $912,000 TO COMMUNITY NONPROFIT PARTNERS TOWARDS INITIATIVES AND PROGRAMS RELATED TO ACCESSING CARE * FINANCIAL COUNSELORS ASSISTED OVER 21,700 PATIENTS WITH ENROLLMENT IN PUBLIC ASSISTANCE PROGRAMS * PROVIDED OVER $149,000 IN PHARMACY BENEFITS TO OPEN DOOR MISSION AND WALGREENS PATIENTS * CONTINUED PARTNERSHIP WITH MEDICARE ON THE PRIMARY CARE FIRST PROGRAM FOCUSING ON POPULATION HEALTH MANAGEMENT THROUGH PRIMARY CARE CLINIC SITES * CONDUCTED VIOLENCE PREVENTION PROGRAM DUSK TO DAWN IN 80 CLASSES FOR 619 ATTENDEES * SERVED 152 PARTICIPANTS IN ENCOMPASS OMAHA, A HOSPITAL-BASED VIOLENCE INTERVENTION PROGRAM * PROVIDED COMMUNITY-LEVEL TRAUMA EDUCATION WITH STOP THE BLEED OVER 900 ATTENDEES * DEVELOPMENT OF PSYCHIATRY SUBSPECIALTY CLINICS (WOMEN'S REPRODUCTIVE HEALTH, TREATMENT RESISTANT DEPRESSION, ASPIRE [SEVERE AND PERSISTENT MENTAL ILLNESS], ADDICTIONS, ANXIETY DISORDERS, DIALECTICAL BEHAVIOR THERAPY) * IMPLEMENTED UNIVERSAL SUICIDE SCREENING AND SAFETY PLANNING FOR HOSPITAL ADMISSIONS AT NEBRASKA MEDICAL CENTER AND BELLEVUE MEDICAL CENTER * STARTED ADDICTION PSYCHIATRY INPATIENT CONSULTATION-LIAISON SERVICE * ESTABLISHED BEHAVIORAL HEALTH CONNECTION PROGRAM * DEVELOPED ADDICTION MEDICINE FELLOWSHIP IN PARTNERSHIP WITH FAMILY MEDICINE * INCREASED OFFERING AND AVAILABILITY OF OUTPATIENT BEHAVIORAL HEALTH SERVICES VIA TELEHEALTH * OPENED A NEW 24/7 PSYCHIATRIC EMERGENCY SERVICES UNIT * PROVIDE PSYCHIATRIC SERVICES TO COMMUNITY ORGANIZATIONS SERVING UNDERSERVED COMMUNITIES, INCLUDING CHARLES DREW HEALTH CENTER, DOUGLAS COUNTY YOUTH CENTER, SANTEE HEALTH CENTER (SANTEE SIOUX RESERVATION), COMMUNITY ALLIANCE, PRIMARY CARE PRACTICES IN RURAL NE, OLSEN WOMEN'S CENTER, AND NM SPECIALTY CARE HIV AND TRANSGENDER CLINICS.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - Group A. PATIENTS WITH ANNUAL FAMILY INCOMES OF LESS THAN FOUR TIMES THE FEDERAL POVERTY LEVEL AND WITHIN ASSET LIMITS WILL QUALIFY FOR FINANCIAL ASSISTANCE. FREE CARE IS AVAILABLE TO PATIENTS WITH LIMITED ASSETS AND FAMILY INCOME EQUAL TO OR LESS THAN TWO TIMES THE FEDERAL POVERTY LEVEL. DISCOUNTED CARE IS AVAILABLE TO THOSE WITH INCOMES BETWEEN 200% AND 400% OF THE FEDERAL POVERTY LEVEL. CATASTROPHIC CARE PROVISIONS ARE AVAILABLE AND MAY APPLY TO INDIVIDUALS WITH EXTRAORDINARILY HIGH MEDICAL EXPENSES.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - Group A. POLICY FN16: DISCOUNT/FINANCIAL ADJUSTMENTS TALKS ABOUT DISCOUNTS FOR PATIENTS WITH NON THIRD-PARTY PAYMENT SOURCE, DISCOUNTS, SIMILAR TO DISCOUNTS OFFERED TO MANAGED CARE PLANS, ARE OFFERED FOR MOST PATIENTS THAT DO NOT HAVE THIRD PARTY INSURANCE AND DO NOT MEET THE GUIDELINES FOR GOVERNMENTAL ASSISTANCE PROGRAMS. THIS DISCOUNT IS SUBJECT TO CHANGE BASED ON THE RATES AGREED UPON THROUGH MANAGED CARE CONTRACTS. THESE DISCOUNTS ARE INDEPENDENT OF THE CHARITY ADJUSTMENTS, AND THAT CHARITY ADJUSTMENTS ARE APPLIED AFTER THE SELF-PAY ADJUSTMENT IS APPLIED TO THE BILLED CHARGES.

Schedule H, Part V, Section B, Line 16 Facility A, 1
Facility A, 1 - Group A. INFORMATION ON HOW TO GET FINANCIAL ASSISTANCE IS POSTED ON THE WEBSITE UNDER PATIENT FRIENDLY BILLING WHICH IS LOCATED UNDER THE PATIENT & VISITORS SECTION. THERE ARE DEPARTMENTS LISTED WITH PHONE NUMBERS TO CALL FOR MORE INFORMATION OR TO SET UP AN APPOINTMENT.

Schedule H, Part III Line 2 & 4
TNMC'S FOOTNOTES TO THE CONSOLIDATED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE SPECIFICALLY COVERING BAD DEBT EXPENSE. THOUGH PATIENT INCOME MAY QUALIFY THEM FOR FINANCIAL ASSISTANCE, THE PATIENT HAS OBLIGATIONS AS WELL TO COMPLETE FINANCIAL ASSISTANCE FORMS AND TO SUBMIT SUPPORTING DOCUMENTATION TO QUALIFY. PATIENTS WHO PROVIDE THIS INFORMATION AND QUALIFY FOR ASSISTANCE WOULD NEVER GO TO BAD DEBT. THEREFORE, IT IS REASONABLE TO STATE THAT OUR BAD DEBT EXPENSE IS FOR THOSE UNWILLING TO PAY OR UNWILLING TO WORK WITH US TO PROVIDE FINANCIAL ASSISTANCE, IF AVAILABLE. IF AN ACCOUNT IS COMPLETELY WRITTEN OFF TO BAD DEBT, THE TOTAL COST VIA THE COST ACCOUNTING SYSTEM IS APPLIED. IF ONLY A PORTION OF THE ACCOUNT WAS WRITTEN OFF TO BAD DEBT, THEN BAD DEBT AS A PERCENTAGE OF CHARGE IS THEN APPLIED TO THE TOTAL COST FOR THE ENCOUNTER TO ESTIMATE THE COST ASSOCIATED WITH THE BAD DEBT. THE AMOUNT THAT GOES TO COLLECTIONS IS PATIENT LIABILITY. NOT COLLECTING THESE DOLLARS IS A DIRECT EXPENSE TO THE ORGANIZATION. AS A NOT-FOR-PROFIT HEALTHCARE ORGANIZATION, IT IS OUR RESPONSIBILITY TO HELP ANYONE WHO PRESENTS THEMSELVES WITH A HEALTH ISSUE; AS SUCH, WE HAVE LESS CONTROL OVER WHAT GETS RECOGNIZED AS BAD DEBT. TO COMPUTE BAD DEBT AT COST, MANAGEMENT USED ALL DISCHARGED CASES IN PRIOR FISCAL YEAR WITH BAD DEBT WRITE-OFF. THE WRITE-OFF WAS COMPUTED AS A PERCENTAGE OF CHARGE AND THEN MULTIPLIED BY THE TOTAL COST (DETERMINED BY A DETAILED COST ACCOUNTING METHODOLOGY) TO ESTIMATE THE COST OF BAD DEBT.

Schedule H, Part I, Line 6a Community Benefit Report
THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE ACCESSED AT: WWW.NEBRASKAMED.COM/ABOUT-US/COMMUNITY-BENEFIT-REPORT

Schedule H, Part I, Line 7 Community Benefit
THESE NUMBERS ARE COMPUTED IN A COST ACCOUNTING SYSTEM THAT PRODUCES A COST FOR EVERY SERVICE THE HOSPITAL PROVIDES. RELATIVE VALUE UNITS, FOR SEVEN CATEGORIES OF EXPENSE, ARE UPDATED ANNUALLY FOR EACH PATIENT SERVICE WHICH KEEPS THE COST ACCOUNTING CURRENT. THESE COSTS PER UNIT VALUES ARE APPLIED TO THE PATIENT UTILIZATION TO COMPUTE THE TOTAL COST. THE COST ACCOUNTED TOTAL IS TIED BACK TO THE HOSPITAL'S FINANCIAL STATEMENTS TO ENSURE SYSTEM INTEGRITY.

Schedule H, Part I, Line 7f Column F
THE DENOMINATOR USED TO CALCULATE THE PERCENTAGE IN COLUMN(F) IS FORM 990, PART IX, LINE 25(A).

Schedule H, Part V, Section B, Line 20d Presumptive Eligibility Determinations
THE NEBRASKA MEDICAL CENTER (TNMC) IS UTILIZING THE SCORING MECHANISM IN ITS EPIC SOFTWARE. THE ORGANIZATION IS IN THE PROCESS OF INTEGRATING PRESUMPTIVE ELIGIBILITY FROM EXTERNAL VENDORS. CURRENTLY, TNMC IS CONSIDERING IF AN INDIVIDUAL HAS MEDICAID OR DECEASED WITH NO ESTATE TO BE DISCRETIONARY CHARITY AND QUALIFY THAT INDIVIDUAL.

Schedule H, Part V Section D
WE DO NOT HAVE REHABILITATION, FREE STANDING DIAGNOSTIC FACILITIES, OR SKILLED NURSING. OUR OFF SITE DIAGNOSTIC SERVICES ARE INCLUDED ON OUR HOSPITAL LICENSE AND OUR HOSPITAL ANCILLARY SERVICES ARE HOSPITAL BASED AND INCLUDED ON OUR LICENSE.

Schedule H, Part II Community Building Activities
COMMUNITY BUILDING ACTIVITIES ARE DESIGNED TO ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS. POVERTY, HOMELESSNESS, AND ENVIRONMENTAL PROBLEMS ALL CONTRIBUTE TO POOR HEALTH. THE TYPES OF PROGRAMS INCLUDED IN THIS CATEGORY SUPPORT WORKFORCE DEVELOPMENT AND TRAINING PROGRAMS TO PROVIDE EMPLOYMENT AND LEADERSHIP SKILLS, TRAINING, JOB SHADOWING FOR STUDENTS INTERESTED IN HEALTH CAREERS, AND ECONOMIC DEVELOPMENT SUPPORT GRANTS TO HELP REVITALIZE LOW-INCOME AREAS AND BUSINESSES.

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
OVERALL MEDICARE PATIENTS PRODUCE A NEGATIVE 13.32% MARGIN ON GROSS CHARGES. THIS IS SPREAD ACROSS MOST OF OUR PRODUCT LINES. OUR HEAVIEST LOSSES ARE FROM THE INPATIENT NEUROLOGY, ONCOLOGY AND CARDIAC PRODUCT LINES AND FROM ONCOLOGY AND SURGERY ON THE OUTPATIENT SIDE. IN GENERAL MEDICARE INPATIENTS DO COVER THE DIRECT COSTS OF PROVIDING THEIR CARE. HOWEVER, THE INDIRECT COSTS TO SUPPORT THE HOSPITAL MUST BE ACCOUNTED FOR AND TURNS THE MARGIN NEGATIVE. THESE NUMBERS ARE COMPUTED IN A COST ACCOUNTING SYSTEM THAT PRODUCES A COST FOR EVERY SERVICE THE HOSPITAL PROVIDES. THE SYSTEM IS UPDATED ANNUALLY AND TIED TO OUR FINANCIAL STATEMENTS TO ENSURE INTEGRITY OF THE PRODUCT LINE PROFITABILITY STATEMENTS.

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
A PATIENT KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE (ONCE ALL PAPERWORK IS RECEIVED AND APPROVED) ARE FLAGGED IN THE SYSTEM AND MONITORED ACCORDINGLY TO ENSURE FINANCIAL ASSISTANCE IS POSTED TO THE PATIENT ACCOUNT. WHEN THE 12 MONTH APPROVAL EXPIRES, PATIENTS ARE CONTACTED IF SERVICES HAVE BEEN RENDERED WITHIN THE LAST SIX MONTHS TO DISCUSS SUBMITTAL OF NEW INFORMATION FOR CONTINUATION OF ASSISTANCE. IF PATIENTS NO LONGER QUALIFY, OTHER PAYMENT OPTIONS ARE DISCUSSED PER ORGANIZATIONAL POLICY. REPORTS ARE UTILIZED FOR FOLLOW UP PURPOSES. PATIENTS WHO QUALIFY FOR 100% ASSISTANCE DO NOT RECEIVE GUARANTOR STATEMENTS (BILLS) FROM THE ORGANIZATION. PATIENTS WHO QUALIFY FOR AN 80% OR 60% DISCOUNT WORK WITH CUSTOMER SERVICE OR COLLECTION STAFF TO OUTLINE PAYMENT ARRANGEMENTS ACCORDING TO SET POLICY.

Schedule H, Part V, Section B, Line 16a FAP website
A - The Nebraska Medical Center: Line 16a URL: https://www.nebraskamed.com/patients/billing/financial-counseling;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - The Nebraska Medical Center: Line 16b URL: https://www.nebraskamed.com/patients/billing/financial-counseling;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - The Nebraska Medical Center: Line 16c URL: https://www.nebraskamed.com/patients/billing/financial-counseling;

Schedule H, Part VI, Line 2 Needs assessment
NEBRASKA MEDICINE USES DISEASE INCIDENCE AND PREVALENCE DATA, LEADING CAUSES OF DEATH, COMMUNITY HEALTH STATUS RESEARCH AND SUPPLY AND DEMAND ANALYSIS TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITIES IT SERVES. ADDITIONALLY, NEBRASKA MEDICINE ENGAGED PROFESSIONAL RESEARCH CONSULTANTS (PRC) TO PERFORM A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN COLLABORATION WITH THE LOCAL HEALTH SYSTEMS AND COUNTY HEALTH DEPARTMENTS.

Schedule H, Part VI, Line 7 State filing of community benefit report
NE

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE The Nebraska Medical Center (TNMC) AND Bellevue Medical Center (BMC) EMPLOY FINANCIAL COUNSELORS, CUSTOMER SERVICE STAFF AND COLLECTION STAFF, ALL OF WHOM ARE TRAINED IN ASSISTING OUR PATIENTS WITH RESOLUTION OF PATIENT LIABILITY. DEPENDING UPON INDIVIDUAL PATIENT NEEDS, PAYMENT ARRANGEMENTS OR FINANCIAL ASSISTANCE MAY BE OFFERED TO ASSIST OUR CUSTOMERS WITH RESOLUTION OF PATIENT BALANCES. ADDITIONALLY, THE ORGANIZATION WORKS WITH OUR SELF-PAY POPULATION TO PURSUE COVERAGE THROUGH STATE, FEDERAL, OR LOCAL PROGRAMS. CHARITY CARE POLICY: THIS POLICY OUTLINES THE GUIDELINES PATIENT FINANCIAL SERVICES (PFS) WILL USE TO ENSURE ADEQUATE AND APPROPRIATE FOLLOW UP IS COMPLETED IN ORDER FOR QUALIFYING PATIENTS TO RECEIVE CHARITY CARE. PFS WILL WORK WITH PATIENTS TO FIND PAYMENT SOLUTIONS WHEN AVAILABLE. THIS POLICY IS WRITTEN TO ENSURE A FAIR AND COMPREHENSIVE SYSTEM OF DISTRIBUTING CHARITY CARE TO FINANCIALLY BURDENED PATIENTS WITHIN THE AVAILABLE RESOURCES OF TNMC IN A MANNER THAT DOES NOT DISCRIMINATE BASED ON RACE, CREED, COLOR, SEX, NATIONAL ORIGIN, RELIGION, OR AGE. POLICY: A. CHARITY CARE IS AVAILABLE WHEN ALL OTHER RECOVERY SOURCES HAVE BEEN EXHAUSTED. B. CHARITY CARE IS PROVIDED TO PATIENTS WHO HAVE DEMONSTRATED INABILITY TO MEET THEIR FINANCIAL OBLIGATION TO TNMC. C. CHARITY CARE WILL NOT BE APPROVED FOR ELECTIVE AND/OR COSMETIC CARE. D. CHARITY CARE MAY BE APPROVED IN THE INSTANCE OF CATASTROPHIC CARE AS DEFINED. 1. THIS COULD BE OCCASIONED BY A PERSONAL CATASTROPHE OR UNAVOIDABLE CRISIS AFFECTING AN INDIVIDUAL WHO WOULD OTHERWISE BE ABLE TO PAY FOR SERVICE, OR A PERSON WHO HAS INCOME ABOVE POVERTY LEVEL BUT IS STILL NOT ABLE TO PAY THE ENTIRE COST OF SERVICE. 2. A PATIENT GENERALLY MAY QUALIFY FOR CATASTROPHIC CHARITY CARE IN INSTANCES WHERE THE PATIENT LIABILITY IS IN EXCESS OF 25% OF ANNUAL HOUSEHOLD INCOME. E. ALL TRANSPLANT AND IRP PATIENTS MUST MEET WITH A TRANSPLANT FINANCIAL COUNSELOR TO SECURE FINANCIAL CLEARANCE. TRANSPLANT AND IRP PATIENTS MUST PASS FINANCIAL SCREENING (ACCESS-FIC-082) OR MUST BE APPROVED VIA THE TRANSPLANT VARIANCE POLICY (FN 21) CHARITY APPROVAL FOR OTHER SERVICES PRIOR TO CONSIDERATION FOR TRANSPLANT DOES NOT MEET THIS REQUIREMENT. F. PRIOR APPROVAL FOR CHARITY CARE DOES NOT APPLY FOR FUTURE ELECTIVE OR COSMETIC PROCEDURES. GUIDELINES: A. IDENTIFICATION PROCESS 1) THE HOSPITAL MAINTAINS A SEPARATE POLICY IN ORDER TO ASSURE COMPLIANCE WITH THE EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT (EMTALA) AND A SEPARATE PATIENT RIGHTS AND ORGANIZATIONAL ETHICS POLICY. THIS CHARITY CARE POLICY IS SUBJECT TO THE TERMS OF THOSE POLICIES. 2) FINANCIAL COUNSELORS AUTHORIZED BY TNMC WILL IDENTIFY PATIENTS REQUIRING FINANCIAL SCREENING. B. VERIFICATION OF INSURANCE ELIGIBILITY AND BENEFITS 1) THE PATIENT WILL EXECUTE AN ASSIGNMENT OF INSURANCE BENEFITS ON BEHALF OF THE HOSPITAL. 2) VERIFICATION OF ELIGIBILITY, BENEFITS, AND PAYER SOURCE WILL BE PERFORMED IN A TIMELY MANNER ACCORDING TO PATIENT FINANCE AND ACCESS SERVICES DEPARTMENTAL PROCEDURES. C. FINANCIAL COUNSELING 1) FINANCIAL COUNSELORS AND CONTRACTED VENDORS WILL ASSIST PATIENTS REQUIRING FINANCIAL ASSISTANCE. 2) FINANCIAL COUNSELORS AND VENDORS WILL ASSIST PATIENTS IN SEEKING REIMBURSEMENT FROM LOCAL, STATE, AND FEDERAL PROGRAMS WHEN THERE IS NO OTHER SOURCE OF PAYMENT AS WELL AS ASSISTING PATIENTS WITH APPLICATIONS OR MAKING APPOINTMENTS TO QUALIFY FOR GOVERNMENT PROGRAMS. 3) PATIENTS ARE RESPONSIBLE FOR FOLLOW UP MEETINGS WITH AN AGENCY THAT MAY PROVIDE FINANCIAL RESOURCES FOR HEALTH CARE SERVICES. CHARITY ASSISTANCE MAY BE TERMINATED AT ANY TIME DUE TO NONCOMPLIANCE WITH THIS EXPECTATION.

Schedule H, Part VI, Line 4 Community information
WE SERVE MANY COMMUNITIES, INTERNATIONAL, REGIONAL, STATE, AND LOCAL OMAHA. THE STATISTICS BELOW DESCRIBE OUR LOCAL OMAHA COMMUNITY DEFINED AS DOUGLAS AND SARPY COUNTIES IN NEBRASKA. THIS LOCAL AREA REPRESENTS APPROXIMATELY 70% OF OUR INPATIENT AND OUTPATIENT DISCHARGES AND VISITS. THE 2022 ESTIMATED CENSUS POPULATION (DERIVED FROM THE US CENSUS BUREAU) FOR THIS LOCAL AREA IS 805,443. THE ESTIMATED RACE BREAKDOWN OF THE POPULATION IS BELOW. *WHITE ALONE 79.97% *BLACK ALONE 5.57% *AMERICAN INDIAN AND ALASKA NATIVE ALONE 0.93% *ASIAN ALONE 2.60% *PACIFIC ISLANDER ALONE 0.13% *TWO OR MORE RACES 2.73% HISPANIC OR LATINO 9.43% THERE ARE SIXTEEN ACUTE CARE AND CHILDREN'S HOSPITALS IN DOUGLAS AND SARPY COUNTY TO SERVE THE LOCAL COMMUNITY. BELLEVUE MEDICAL CENTER, BOYS TOWN NATIONAL RESEARCH HOSPITAL, CHI HEALTH CREIGHTON UNIVERSITY MEDICAL, CENTER - BERGAN MERCY, CHI HEALTH IMMANUEL, CHI HEALTH LAKESIDE, CHI HEALTH MIDLANDS, CHILDREN'S HOSPITAL & MEDICAL CENTER, DOUGLAS COUNTY HEALTH CENTER, MADONNA REHABILITATION HOSPITALS-OMAHA CAMPUS, METHODIST HOSPITAL, METHODIST WOMEN'S HOSPITAL, MIDWEST SURGICAL HOSPITAL, NEBRASKA SPINE HOSPITAL, ORTHONEBRASKA, SELECT SPECIALTY HOSPITAL - OMAHA, THE NEBRASKA MEDICAL CENTER. THERE ARE FIVE DESIGNATED MEDICALLY UNDERSERVED AREAS IN DOUGLAS COUNTY (THREE AREAS) AND SARPY COUNTY (TWO AREAS).

Schedule H, Part VI, Line 5 Promotion of community health
THE NEBRASKA MEDICAL CENTER (TNMC) RECOGNIZES THE COMMUNITY BENEFIT OF ADDRESSING ROOT CAUSES OF POOR HEALTH IN ORDER TO IMPROVE COMMUNITY HEALTH. THE HOSPITAL PARTICIPATED IN SEVERAL COMMUNITY BUILDING ACTIVITIES THROUGHOUT THE PAST YEAR DESIGNED TO ADDRESS THESE ROOT CAUSES. THE HOSPITAL SPENDS TIME COORDINATING RESOURCES TO ENSURE SMALLER, RURAL HOSPITALS CAN HAVE ACCESS TO THE EXPERTISE AND SERVICES OF A LARGE ACADEMIC MEDICAL CENTER. TNMC'S COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROGRAMS INTENDED TO DRIVE ENTRY INTO HEALTH CAREERS AND NURSING PRACTICE. MANY HOSPITAL STAFF MEMBERS GIVE EDUCATIONAL PRESENTATIONS ON THE HEALTH PROFESSIONS AND RESUME AND INTERVIEW HELP TO STUDENTS. TNMC ALSO PROVIDES JOB SHADOWING OPPORTUNITIES TO UNDERGRADUATE STUDENTS WHO WISH TO EXPLORE HEALTH CAREERS. ADDITIONALLY, TNMC HAS THE ONLY BIO-CONTAINMENT UNIT IN THE STATE AND ONE OF FEW ACROSS THE NATION, CONTRIBUTING TO DISASTER PREPAREDNESS ABOVE AND BEYOND LICENSURE REQUIREMENTS. MEMBERS OF THE HOSPITAL'S CRITICAL CARE AND TRAUMA STAFF SHARE EXPERTISE BY PARTICIPATING IN COMMUNITY COALITIONS TO IMPROVE SAFETY AND REDUCE ACCIDENTS AMONG CHILDREN, TEENS, AND SENIORS. THE HOSPITAL WORKS TO ENCOURAGE ECONOMIC GROWTH AND DEVELOPMENT BY SUPPORTING AN ECONOMIC DEVELOPMENT PARTNERSHIP AIMED AT THE DEVELOPMENT OF NEW BUSINESS IN THE CITY'S URBAN AREAS. BELLEVUE MEDICAL CENTER (BMC) HAS PARTICIPATED IN, AND HOSTED A NUMBER OF EVENTS DESIGNED TO PROMOTE A HEALTHIER COMMUNITY. IN ADDITION TO FINANCIAL SUPPORT OF SEVERAL COMMUNITY- BASED CHARITABLE ORGANIZATIONS, THE HOSPITAL'S LEADERSHIP TEAM IS ACTIVE ON COMMUNITY BOARDS. (CHNA) FOR NEBRASKA MEDICINE (WHICH INCLUDES TNMC AND BMC) FOR THE COMPREHENSIVE CHNA PROCESS, A STEERING COMMITTEE COMPRISED OF KEY STAKEHOLDERS FROM AREA HEALTH SYSTEMS, LOCAL COUNTY HEALTH DEPARTMENT REPRESENTATIVES, AND KEY INFORMANTS FROM SEVERAL COMMUNITY AGENCIES WORKED COLLABORATIVELY TO OVERSEE THE PROCESS. THE CHNA STEERING COMMITTEE RETAINED PROFESSIONAL RESEARCH CONSULTANTS (PRC), INC. TO CONDUCT THE SURVEY. PRC IS A NATIONALLY RECOGNIZED HEALTH CARE CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING CHNAS SUCH AS THIS IN HUNDREDS OF COMMUNITIES ACROSS THE UNITED STATES SINCE 1994.