efile Public Visual Render
ObjectId: 201511339349305446 - Submission: 2015-05-13
TIN: 91-1858433
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.
Attach to Form 990.
See separate instructions.
Information about Schedule R (Form 990) and its instructions is at
www.irs.gov/form990
.
OMB No. 1545-0047
20
13
Open to Public Inspection
Name of the organization
The Nebraska Medical Center
Employer identification number
91-1858433
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
(1)
Bellevue Medical CTR
2500 BMC Dr
Bellevue
,
NE
68123
20-4305186
Acute Care
NE
-3,344,534
25,135,255
NMC
Part II
Identification of Related Tax-Exempt Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization
(b)
Primary activity
(c)
Legal domicile (state
or foreign country)
(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))
(f)
Direct controlling
entity
(g)
Section 512(b)(13) controlled entity?
Yes
No
(1)
NHS CLARKSON HOSPITAL SERVICE LEAGUE
988145 NEBRASKA MEDICAL CENTER
OMAHA
,
NE
68198
47-6028036
SUPPORT TNMC
NE
501(C)(3)
L11,TYPEIII
NA
No
(2)
CLARKSON COLLEGE
101 SOUTH 42ND STREET
OMAHA
,
NE
68131
36-3649217
COLLEGE
NE
501(C)(3)
LINE 2
NMC
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Page 2
Schedule R (Form 990) 2013
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
(1)
BELLEVUE MEDICAL CTR
2500 BMC DR
BELLEVUE
,
NE
68123
20-4305186
ACUTE CARE
NE
NMC
RELATED
-1,211,835
34,455,230
No
Yes
86.350 %
(2)
NEBRASKA HEALTH NETWORK (ACA)
8511 W DODGE RD
OMAHA
,
NE
68114
27-1784907
HEALTHCARE
NE
NH PARTNERS
RELATED
-37,110
125,409
No
No
50.000 %
(3)
NC LAB LLC
8303 DODGE ST
OMAHA
,
NE
68114
46-1173104
DIAGNOSTIC SVC
NE
NMC
RELATED
-32,688
105,573
No
-1,464
Yes
25.000 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust
Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes
No
(1)
NHS ORTHOPAEDIC SERVICES INC
988145 NEBRASKA MEDICAL CENTER
OMAHA
,
NE
681988145
47-0845238
INVESTMENT SVC
NE
NMC
C Corp
2,962,287
11,370,782
100.000 %
Yes
(2)
NEBRASKA HEALTH PARTNERS INC
988145 NEBRASKA MEDICAL CENTER
OMAHA
,
NE
681988145
47-0816463
MANAGEMENT
NE
NMC
C Corp
950,659
3,461,311
100.000 %
Yes
Schedule R (Form 990) 2013
Page 3
Schedule R (Form 990) 2013
Page
3
Part V
Transactions With Related Organizations
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1
During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a
Receipt of
(i)
interest,
(ii)
annuities,
(iii)
royalties, or
(iv)
rent from a controlled entity
.
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1a
No
b
Gift, grant, or capital contribution to related organization(s)
.
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1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
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1c
No
d
Loans or loan guarantees to or for related organization(s)
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1d
Yes
e
Loans or loan guarantees by related organization(s)
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1e
No
f
Dividends from related organization(s)
.
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1f
No
g
Sale of assets to related organization(s)
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1g
No
h
Purchase of assets from related organization(s)
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1h
Yes
i
Exchange of assets with related organization(s)
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1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
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1j
Yes
k
Lease of facilities, equipment, or other assets from related organization(s)
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1k
Yes
l
Performance of services or membership or fundraising solicitations for related organization(s)
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1l
Yes
m
Performance of services or membership or fundraising solicitations by related organization(s)
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1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
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1n
Yes
o
Sharing of paid employees with related organization(s)
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1o
Yes
p
Reimbursement paid to related organization(s) for expenses
.
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.
1p
No
q
Reimbursement paid by related organization(s) for expenses
.
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1q
No
r
Other transfer of cash or property to related organization(s)
.
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1r
No
s
Other transfer of cash or property from related organization(s)
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1s
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1)
CLARKSON COLLEGE
b
1,370,802
BOOK
(2)
BELLEVUE MEDICAL CENTER
d
25,081,006
BOOK
(3)
BELLEVUE MEDICAL CENTER
j
24,671,664
BOOK
(4)
CLARKSON COLLEGE
j
12,794,221
BOOK
(5)
BELLEVUE MEDICAL CENTER
l
4,852,449
BOOK
(6)
CLARKSON COLLEGE
l
1,938,759
BOOK
(7)
NEBRASKA HEALTH PARTNERS
o
488,444
BOOK
Schedule R (Form 990) 2013
Page 4
Schedule R (Form 990) 2013
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income
(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2013
Page 5
Schedule R (Form 990) 2013
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference
Explanation
DISREGARDED ENTITY
SCHEDULE R, PART I, LINE 1 ON 6/1/2014, BELLEVUE MEDICAL CENTER BECAME A DISREGARDED ENTITY OF THE NEBRASKA MEDICAL CENTER.
Schedule R (Form 990) 2013
Additional Data
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