Civic Intelligence

Chi Nebraska

990 • Fiscal year 2016 • EIN 36-3233121

Jul 01, 2015 to Jun 30, 2016 • Filed on May 13, 2017

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12809 West Dodge RoadOmaha, NE 68154

(402) 325-4600

Siviq Scores

Precomputed percentiles for this filing year versus similar nonprofits in the same peer cohort.

Liabilities / Assets

96th percentile

1.23x

Higher debt load relative to assets than 96% of similar nonprofits.

2016 filings • 501(c)3 • $100M-$250M nonprofits • Source year 2016

Liabilities / Revenue

Score unavailable

No value available

Liabilities-to-revenue requires both liabilities and revenue on this filing.

Source year 2016

Net Margin

Score unavailable

No value available

Net margin requires both revenue and expenses on this filing.

Source year 2016

Top Officer Pay

98th percentile

$3,953,490

Higher top officer pay than 98% of similar nonprofits.

2016 filings • 501(c)3 • $100M-$250M nonprofits • Source year 2016

Asset Growth

97th percentile

59%

Faster asset growth than 97% of similar nonprofits.

2016 filings • 501(c)3 • $100M-$250M nonprofits • Annualized from 2015 to 2016

Revenue Growth

1st percentile

-100%

Faster revenue growth than 1% of similar nonprofits.

2016 filings • 501(c)3 • $100M-$250M nonprofits • Annualized from 2015 to 2016

Assets

Up

$204,329,875

Up $75,817,068 (+59%) from 2015

Net Assets

Down

-$46,110,898

Down $1,131,481 (-2.5%) from 2015

Liabilities

Up

$250,440,773

Up $76,948,549 (+44%) from 2015

Revenue

Down

$0

Down $59,948 (-100%) from 2015

Expenses

Down

$126

Down $47,778,580 (-100%) from 2015

Net Income

Up

-$126

Up $47,718,632 (+100%) from 2015

Historical Trend

Balance Sheet Trend

The highlighted filing sits inside the broader history for assets, liabilities, and net assets.

$80B$60B$40B$20B$0-$20BAssets 2011: $4,956,162Liabilities 2011: $2,339,053Net Assets 2011: $2,617,1092011Assets 2012: $14,516,019Liabilities 2012: $2,406,587Net Assets 2012: $12,109,4322012Assets 2013: $6,455,253Liabilities 2013: $4,820,065Net Assets 2013: $1,635,1882013Assets 2014: $32,453,221Liabilities 2014: $29,713,880Net Assets 2014: $2,739,3412014Assets 2015: $128,512,807Liabilities 2015: $173,492,224Net Assets 2015: -$44,979,4172015Assets 2016: $204,329,875Liabilities 2016: $250,440,773Net Assets 2016: -$46,110,8982016Assets 2017: $148,747,063Liabilities 2017: $195,117,082Net Assets 2017: -$46,370,0192017Assets 2020: $10,578,687,155Liabilities 2020: $10,622,358,792Net Assets 2020: -$43,671,6372020Assets 2021: $13,147,524,252Liabilities 2021: $13,190,773,342Net Assets 2021: -$43,249,0902021Assets 2022: $17,268,140,068Liabilities 2022: $17,311,381,034Net Assets 2022: -$43,240,9662022Assets 2024: $61,017,491,345Liabilities 2024: $61,060,670,305Net Assets 2024: -$43,178,9602024

Highlighted filing

2016

Assets$204,329,875
Liabilities$250,440,773
Net Assets-$46,110,898

Operations Trend

Revenue, expenses, and net income across loaded years, with this filing highlighted.

$200M$100M$0-$100MExpenses 2011: $22,791,1402011Expenses 2012: $176,315,2712012Expenses 2013: $54,784,2322013Revenue 2014: $65,301,151Expenses 2014: $56,050,086Net Income 2014: $9,251,0652014Revenue 2015: $59,948Expenses 2015: $47,778,706Net Income 2015: -$47,718,7582015Revenue 2016: $0Expenses 2016: $126Net Income 2016: -$1262016Revenue 2017: $126Expenses 2017: $17,371Net Income 2017: -$17,2452017Revenue 2020: $0Expenses 2020: $180,000Net Income 2020: -$180,0002020Revenue 2021: $0Expenses 2021: $91,624Net Income 2021: -$91,6242021Revenue 2022: $0Expenses 2022: $0Net Income 2022: $02022Revenue 2024: $0Expenses 2024: $0Net Income 2024: $02024

Highlighted filing

2016

Revenue$0
Expenses$126
Net Income-$126
Jump To
Filing Snapshot
Filing Period
Jul 1, 2015 to Jun 30, 2016
Signed
May 13, 2017
Return Version
2015v3.0
Gross Receipts
$0
Mission and Program Overview

Mission

CHI Nebraska improves health care access and fosters community wellness through affiliated hospitals, physicians, and home care entities, dedicated to providing high quality service with a caring touch.

Balance Sheet Detail
LineBeginningEndChange
Assets
Savings and Temporary Cash Investments$36,865,523$0▼ $36,865,523
Accounts Receivable$81,033$24,962,422▲ $24,881,389
Prepaid Expenses and Deferred Charges$382,498$0▼ $382,498
Land, Buildings, and Equipment, Net$206,103$0▼ $206,103
Cash and Non-Interest-Bearing Accounts-$59,462-
Other Notes and Loans Receivable, Net$0$0→ $0
Pledges and Grants Receivable$0$0→ $0
Receivable From Disqualified Prsn-$0-
Receivables From Officers Etc-$0-
Investments Other Securities$0--
Investments Program Related$0--
Investments in Publicly Traded Securities$0$0→ $0
Intangible Assets$0$0→ $0
Inventories for Sale or Use$0$0→ $0
Total Assets$128,512,807$204,329,875▲ $75,817,068
Other Assets Total$90,977,650$179,307,991▲ $88,330,341
Liabilities
Other Liabilities$170,639,466$250,300,276▲ $79,660,810
Accounts Payable and Accrued Expenses$2,852,758$140,497▼ $2,712,261
Grants Payable$0$0→ $0
Mortgage Notes Payable Secured by Investment Property$0$0→ $0
Unsecured Notes Loans Payable$0$0→ $0
Deferred Revenue$0$0→ $0
Escrow Account Liability$0$0→ $0
Tax Exempt Bond Liabilities$0$0→ $0
Total Liabilities$173,492,224$250,440,773▲ $76,948,549
Net Assets / Fund Balance
Permanently Rstr Net Assets$0$0→ $0
Temporarily Rstr Net Assets$0$0→ $0
Unrestricted Net Assets$-44,979,417$-46,110,898▼ $1,131,481
Total Net Assets Fund Balance$-44,979,417$-46,110,898▼ $1,131,481
Total Liabilities and Net Assets / Fund Balance$128,512,807$204,329,875▲ $75,817,068

Asset Categories

AssetBook ValueDepreciationBasis
Other Assets Org$250,000--
Compensation and Service Providers

Employees

NameTitleFull / Part TimeBaseOtherTotal
-Former VP Strategy & PlanningFT$225,452$236,937$236,937

Board Members and Trustees

NameTitle
-Board Chair
-Vice Chair
-Board Member
-Board Member/CEO CHI Health
-Board member/CHI EVP & COO
-CFO, CHI Health
-Secretary/treasurer
-VP Human Resources
Revenue and Support

Revenue Composition

Contributions and Grants
$0
Program Service Revenue
$0
Investment Income
$0
Other Revenue
$0
All Other Contributions
$0
Change in Net Assets
$-126
Expenses and Functional Allocation

Major Expense Lines

Line ItemAmount
Other Expenses$126
Grants and Similar Amounts Paid$0
Professional Fundraising Fees$0
Salaries, Compensation, and Employee Benefits$0
Total Fundraising Expense$0

Functional Expense Allocation

Line ItemProgramManagementFundraisingTotal
Office Expenses-$126-$126
Total Functional Expenses$0$126$0$126
Fundraising, Events, and Gaming
Fundraising activities
No
Gaming activities
No
Professional fundraiser used
No

Fundraising and Gaming Totals

Line ItemAmount
Fundraising Direct Expenses$0
Fundraising Gross Income$0
Gaming Direct Expenses$0
Gaming Gross Income$0
Professional Fundraising Fees$0
Political and Lobbying Activity
Political campaign activity
No
Lobbying activity
No
Subject to proxy tax
No
Insider Transactions and Loans

Loans and Receivables

Line ItemBeginningEndChange
Receivables from Disqualified Persons-$0-
Receivables from Officers, Directors, Trustees, and Key Employees-$0-
Debt and Bond Financing

Other Reported Liabilities

LiabilityAmount
Overdrawn Bank Balance$170,394,599
Intercompany Payable$74,911,422
Accrued Expenses$4,994,255
Governance and Compliance

Governance Checklist

Compiled or reviewed by an accountant
No
Annual disclosure for covered persons
Yes
Audit committee
Yes
Business relationship with family members
No
Business relationship with organization members
No
Material changes to governing documents
No
Compensation from other sources disclosed
No
CEO compensation reviewed
Yes
Other officer compensation reviewed
Yes
Conflict-of-interest policy
Yes
Audited financial statements prepared
Yes
Key decisions subject to board approval
Yes
Management duties delegated
No

Governance Explanations

Form 990, Part VI, Line 1A Delegate broad authority to A committee

Pursuant to the organization's Bylaws, the Executive Committee shall consist of only directors of the corporation and shall be composed of the chairperson of the board, the vice chairperson of the board, and the President and Chief Executive Officer, each of whom shall serve as an ex officio voting member of the Executive Committee, and two voting members appointed by the Board of Directors. The executive committee has and may exercise such powers as may be delegated to it by the board of directors. Additionally, the executive committee has the power to transact routine business of the corporation in the interim periods between regularly scheduled meetings of the board of directors, provided their actions are consistent with any actions or policies of the board or the corporate member. All actions taken are contemporaneously documented and reported to the board at the earliest meeting.

Form 990, Part VI, Line 6 Classes of members or stockholders

According to the bylaws of chi nebraska, the entity's sole corporate member is catholic health initiatives, a colorado nonprofit corporation.

Form 990, Part VI, Line 7A Members or stockholders electing members of governing body

According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the Executive Vice President and Chief Operating Officer or other designee. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation.

Form 990, Part VI, Line 7B Decisions requiring approval by members or stockholders

The organization's corporate member is Catholic Health Initiatives ("CHI"). Pursuant to the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: - Substantial change in the mission or philosophy of CHI Nebraska - Amendment of the corporate documents of CHI Nebraska - Approve members of the CHI Nebraska board - Removal of a member of the governing body of CHI Nebraska - Approval of issuance of debt by CHI Nebraska - Approval of participation of CHI Nebraska in a joint venture - Approval of formation of a new corporation by CHI Nebraska - Approval of a merger involving CHI Nebraska - Approval of the sale of all or substantially all of the assets of CHI Nebraska - To require the transfer of assets by CHI Nebraska to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts - Adoption of long range and strategic plans for CHI Nebraska Pursuant to Section 5.5.2 of the organization's bylaws, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate.

Form 990, Part VI, Line 11B Review of form 990 by governing body

Following the preparation of the form 990 by tax analysts of Catholic Health Initiatives, a related organization, the return is reviewed by the CHI tax director and the local chief financial officer. After incorporation of any changes resulting from this review, the form 990 is reviewed at the finance committee meeting and the chief financial officer and CHI tax director are present at the meeting to answer questions. Additionally, the board of directors are provided the final form 990 and related schedules to review and are able ask the chief financial officer and tax director questions prior to filing with the IRS. Upon chief financial officer approval and signature, the tax analyst files the final form 990 as presented to the board and finance committee, making any non-substantive changes necessary in order to effect e-filing. Any such changes are not re-submitted to the board.

Form 990, Part VI, Line 12C Conflict of interest policy

Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy in place to maintain the integrity of all of its activities. The policy applies to CHI Board of Stewardship Trustees and members of its committees; all board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each person has a general ongoing obligation to promptly and fully report to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must report the actual or potential conflict as soon as she/he becomes aware of it. In any situation where the person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI Entity may reject a Person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential COI. If the C-CIRC determines that there is a potential or actual conflict of interest that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing person be allowed to participate in the activity or transaction subject to restrictions as outlined in the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and

Form 990, Part VI, Line 15A Process to establish compensation of top management official

Compensation for the top management official was established and paid by Catholic Health Initiatives (CHI), a related organization. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Korn Ferry Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Korn Ferry Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Korn Ferry Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September 13, 2016. In addition, Korn Ferry Hay Group completed a comprehensive review of all positions at the level of vice president and above in the fall of 2014 to determine and validate appropriate compensation levels. These levels have been reviewed annually since and revised based on market data, where applicable. For other members of management who were paid under CHI Health for calendar year 2015, CHI Health Human Resources completes a compensation market study to determine salary.

Form 990, Part VI, Line 15B Process to establish compensation of other employees

See disclosure for Form 990, Part VI, Section B, Line 15A.

Form 990, Part VI, Line 19 Required documents available to the public

The Organization's governing documents are available from the Nebraska Secretary of State. The organization's conflict of interest policy is not made available to the public. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.CatholicHealthInit.org or at www.DACBOND.org.

Filing and Contact Details

Filer

Filer Name
CHI Nebraska
EIN
36-3233121
Phone
4023254600
Address
12809 West Dodge Road, Omaha, NE 68154
Doing Business As
CHI Health

Signing Officer

Name
Jeanette Wojtalewicz
Title
CFO, CHI Health
Signed
2017-05-13
Discuss with paid preparer
Yes

Organization Details

Formed
1982
Legal Domicile
Ne
Voting Board Members
16
Independent Board Members
11
Employees
51
Volunteers
13

Preparer

Firm
Catholic Health Initiatives
Address
198 Inverness Drive West, Englewood, CO 80112
Preparer
Angela Noel CPA
Phone
3032989100
Supplemental Narrative

Additional Explanations

Form 990, Part III, Line 4A PROGRAM SERVICE ACCOMPLISHMENTS

Primary exempt purpose chi nebraska's purpose is to own, operate, staff, or manage health care related activities and operate, supervise, support, and manage the affairs, property, business, and activity of affiliated exempt organizations, which support the health care mission of catholic health initiatives by improving access to health care and fostering the wellness of the communities in its service areas. Exempt purpose achievements chi nebraska, f/k/a saint elizabeth health systems, was incorporated in 1982 as a nebraska 501(c)(3), not-for-profit organization. Chi nebraska is guided by its christian based philosophy to develop, promote, and implement programs that bring value to the community in a healing and compassionate environment. The organization works through an affiliated group of tax exempt organizations to promote essential health care services by building healthy relationships that promote the health of the communities and individuals within them. Chi nebraska is a member of catholic health initiatives. Community service has always been at the core of chi nebraska's activities. Each year, services and programs are expanded to promote healthy communities through innovative programs, collaborations, and partnerships. The programs and services described throughout this report not only serve the community, but also reduce the burdens on the government. For example, if chi nebraska and affiliates did not provide charity care, the burden of providing charity care would fall on government-supported institutions.

Form 990, Part III, Line 3 Significant changes in program services

CHI Nebraska's purpose is to own, operate staff, or manage health care related activities and operate, supervise, support and manage the affairs, property, business and activity of affiliated exempt organizations. On July 1, 2016, CHI Nebraska transferred responsibility of these activities to Alegent Creighton Health, a 100% owned subsidiary of CHI Nebraska.

Form 990, Part V, Line 2A Employees

From January 1, 2015 through June 30, 2015, CHI Nebraska employed 51 employees. Those employees were transferred to Alegent Creighton Health, a 100% owned subsidiary, on July 1, 2015, and therefore no salaries or benefits were reported by CHI Nebraska for the tax return period of July 1, 2015 through June 30, 2016.

Form 990, Part XI, Line 9 Other changes in net assets or fund balances

Capital Pool Contribution - -1144495; Affiliate transfer - -9642; Error suspense - 22782;

990 Part III Line 1 Mission

The mission of the corporation is to nurture the healing ministry of the church, supported by education and research. Fidelity to the gospel urges the corporation to emphasize human dignity and social justice as it creates healthier communities. The corporation, sponsored by a lay-religious partnership, calls other catholic sponsors and systems to unite to ensure the future of catholic health care. To fulfill this mission, the corporation, as a values-based organization, will assure the integrity of the ministry in both current and developing organizations and activities; research and develop new ministries that integrate health, education, pastoral, and social services; promote leadership development and formation for ministry throughout the entire organization; advocate for systemic changes with specific concern for persons who are poor, alienated, and underserved; and steward resources by general oversight of the entire organization

Financial Statement Notes

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

CHI Nebraska's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2016, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. As of June 30, 2016, CHI has a deferred tax asset of $96.1 million related to net operating loss (NOL) carryforwards. CHI believes that most of the NOL carryforwards will expire unused and has established a valuation allowance of $91.6 million against the deferred tax asset associated with these NOL carryforwards. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements."

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Filings

Peer Organizations

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