Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2016
Open to Public
Inspection
Name of the organization
The Nebraska Medical Center
 
Employer identification number
91-1858433
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) 100 Black Men of Omaha
2221 North 24th Street
Omaha,NE68110 		47-0384577 501(C)(3) 12,500       General Support
(2) American Heart Association
10100 J Street Ste A
Omaha,NE68127 		47-0258610 501(C)(3) 21,500       General Support
(3) Brain Injury Alliance of NE
PO Box 22147
Lincoln,NE68542 		47-0659701 501(C)(3) 15,000       General Support
(4) Community Alliance Foundation
4001 Leavenworth St
Omaha,NE68105 		47-6039304 501(C)(3) 10,000       General Support
(5) Cystic Fibrosis Foundation
11917 Pierce Plaza
Omaha,NE68144 		36-3727896 501(C)(3) 10,000       General support
(6) Father Flanagan's Boy Home
13603 Flanagan Blvd
Omaha,NE680107501 		47-0556061 501(C)(3) 25,075       General Support
(7) Greater Omaha Chamber Foundation
1301 Harney Street
Omaha,NE68102 		47-0376605 501(C)(3) 30,000       General Support
(8) Girl Scouts Spirit of Nebraska
2121 So 44th Street
Omaha,NE68105 		47-0548990 501(C)(3) 10,000       General Support
(9) Joslyn Art Museum
2200 Dodge St
Omaha,NE68102 		13-5613797 501(C)(3) 52,500       General Support
(10) Knights of Ak-Sar-Ben Foundation
8707 W Center Rd 101
Omaha,NE68124 		46-2673752 501(C)(3) 9,334       General Support
(11) The Kim Foundation
1309 California
Omaha,NE68154 		47-0376545 501(C)(3) 10,000       General Support
(12) Lauritzen Gardens
100 Bancroft St
Omaha,NE68108 		23-7208431 501(C)(3) 6,500       General support
(13) Leukemia and Lymphoma Society
12100 W Center Rd Ste 202
Omaha,NE68154 		47-0755104 501(C)(3) 15,000       General Support
(14) Make a Wish
11926 Arbor St Ste 102
Omaha,NE68144 		47-0483506 501(C)(3) 7,500       General Support
(15) March of Dimes
11840 Nicholas Street
Omaha,NE68154 		13-1930701 501(C)(3) 9,250       General support
(16) Mid-America Council BSA
12401 W Maple Rd
Omaha,NE681641853 		47-0527737 501(C)(3) 10,000       General support
(17) National Safety Council
11620 M Circle
Omaha,NE68137 		81-0614816 501(C)(3) 10,000       General support
(18) Nebraska Aids Project
250 So 77th St Ste A
Omaha,NE68114 		47-0834161 501(C)(3) 10,000       General support
(19) Nebraska Child Health & Education Alliance
1141 H Street Ste B
Lincoln,NE68508 		13-1846366 501(C)(3) 10,000       General Support
(20) Omaha Equestrian Foundation
1004 Farnam St Ste 400
Omaha,NE68102 		47-0594056 501(C)(3) 10,000       General Support
(21) Omaha Symphony
1605 Howard St
Omaha,NE68102 		13-5644916 501(C)(3) 30,000       General Support
(22) Partnership 4 Kids
1004 Farnam St Ste 200
Omaha,NE68102 		47-0447496 501(C)(3) 10,000       General support
(23) Project Harmony
7110 F Street
Omaha,NE68117 		27-2460810 501(c)(3) 10,000       General Support
(24) Ronald McDonald House
620 S 38th Street
Omaha,NE681051104 		47-0671096 501(C)(3) 47,850       General support
(25) Susan G Komen Nebraska
8707 West Center Road
Omaha,NE68124 		47-0789054 501(C)(3) 10,000       General Support
(26) United Way of the Midlands
1805 Harney St
Omaha,NE68102 		47-0642708 501(C)(3) 65,431       General support
(27) Visiting Nurse Foundation
12565 W Center Rd Ste 100
Omaha,NE68144 		13-5644916 501(C)(3) 15,000       General support
(28) Board of Regents of the Univ of NE
3835 Holdrege
Lincoln,NE68583 		47-0376531 501(C)(3) 8,000,000       General support
(29) Clarkson College
101 S 42nd Street
Omaha,NE681312739 		36-3649217 501(C)(3) 2,848,991       General support
(30) Clarkson Regional Health Sevices Inc
9300 Underwood Ave Ste 110
Omaha,NE68114 		47-0376531 501(C)(3) 8,000,000       General Support
(31) University of Nebraska Foundation
2285 S 67th St Ste 200
Omaha,NE68106 		47-0376531 501(C)(3) 21,000       General Support
(32) University of Nebraska Medical Center
986800 Ne Med Ctr
Omaha,NE681986800 		47-0049123 501(C)(3) 62,553,455       General support
(33) UNMC Physicians
988145 Ne Med Ctr
Omaha,NE681988145 		47-0785575 501(C)(3) 69,680,020       General support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
33
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2016

Schedule I (Form 990) 2016
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) Financial Assistance (Charity Care) 6948   71,721,477 BOOK CHARITY CARE
(2) Financial Assistance (Renal-Indigent Patients) 33   326,419 BOOK INDIGENT DIALYSIS
(3) Financial Assistance (Pharmaceuticals) 2354   111,291 BOOK PHARMACEUTICALS
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
SCHEDULE I, PART I, LINE 1 REVIEW AND APPROVAL OF CHARITABLE CONTRIBUTIONS THE NEBRASKA MEDICAL CENTER (NMC) HAS A COMMITTEE WHOSE RESPONSIBILITY IS TO REVIEW AND APPROVE OR DISPROVE REQUESTS FOR SPONSORSHIP. THIS COMMITTEE IS COMPRISED OF KEY EXECUTIVES AND OTHER MEMBERS OF THE LEADERSHIP TEAM, AS WELL AS REPRESENTATIVES FROM THE UNIVERSITY OF NEBRASKA MEDICAL CENTER. DECISIONS ARE MADE ON EACH REQUEST INDIVIDUALLY BASED ON A SET OF GUIDELINES ESTABLISHED BY THE ORGANIZATION. IN ORDER TO EFFECTIVELY EVALUATE AND REVIEW THE MANY REQUESTS WE RECEIVE, EACH REQUEST IS BROUGHT BEFORE OUR SPONSORSHIPS AND CHARITABLE CONTRIBUTIONS COMMITTEE FOR CONSIDERATION. THIS COMMITTEE IS COMPRISED OF KEY EXECUTIVES AND OTHER MEMBERS OF THE HOSPITAL LEADERSHIP TEAM. THE COMMITTEE CONSIDERS EACH REQUEST INDIVIDUALLY, AND CONTRIBUTIONS ARE MADE BASED ON THREE PRIMARY OBJECTIVES: 1) TO SUPPORT THE COMMUNITY NEED FOR RESOURCES ADDRESSING NEBRASKA'S LEADING CAUSES OF DEATH; INCLUDING CANCER, STROKE AND HEART DISEASE. 2) TO ALIGN WITH ORGANIZATIONS FURTHERING NMC'S CHARITABLE MISSION TO SUPPORT CAUSES WHICH SIGNIFICANTLY IMPACT THE OVERALL HEALTH STATUS OF THE COMMUNITY. 3) TO SUPPORT ORGANIZATIONS WHICH IMPACT FAVORABLY THE PUBLIC IMAGE OF THE HOSPITAL AND ENHANCE EXISTING PARTNERSHIPS OR INITIATIVES. IF A SPONSORSHIP OR CHARITABLE CONTRIBUTION REQUEST FALLS WITHIN OUR THREE PRIMARY OBJECTIVES, THE FOLLOWING CRITERIA ARE THEN APPLIED TO FURTHER ASSIST THE COMMITTEE IN MAKING FUNDING DECISIONS: 1) ORGANIZATION MUST PROVIDE PROOF OF 501(C)(3) STATUS FROM THE IRS, OR NONPROFIT DESIGNATION AS A GOVERNMENTAL OR TRIBAL ENTITY. 2) ALL REQUESTS MUST BE RECEIVED IN WRITING- NO PHONE REQUESTS WILL BE CONSIDERED. 3) REQUESTOR MUST BE ABLE TO PROVIDE THE ORGANIZATION'S NON-DISCRIMINATION POLICY. 4) MUST BE ABLE TO PROVIDE AN ORGANIZATIONAL OPERATING BUDGET AND PROJECT BUDGET UPON REQUEST. 5) PROPOSAL MUST INCLUDE A LIST OF BOARD MEMBERS, DIRECTORS, AND KEY PROJECT STAFF MEMBERS AND THE ROLE THEY SERVE IN THE ORGANIZATION. 6) REQUEST MUST INCLUDE A BRIEF NARRATIVE OF THE PROJECT, INCLUDING AN ESTIMATE OF NUMBERS OF PEOPLE SERVED BY THE REQUEST AND LOCATION OF COMMUNITIES IMPACTED BY THE ORGANIZATION'S MISSION. 7) REQUESTS FOR SPONSORSHIP NEED TO BE SUBMITTED AT LEAST 90 DAYS PRIOR TO THE EVENT, WITH REQUESTS OVER $10,000 BEING SUBMITTED BY MARCH 1 FOR CONSIDERATION IN THE NEXT FISCAL YEAR. GROUPS, PROGRAMS, AND ACTIVITIES NOT SUPPORTED BY NMC: 1) ORGANIZATIONS WITHOUT IRS 501(C)(3) OR EQUIVALENT TAX EXEMPT STATUS. 2) ORGANIZATIONS THAT DISCRIMINATE ON THE BASIS OF AGE, DISABILITY, RELIGION, ETHNIC ORIGIN, GENDER, OR SEXUAL ORIENTATION. 3) ORGANIZATIONS WITH DIVISIVE OR LITIGIOUS PUBLIC AGENDAS. 4) MEMBER BASED ORGANIZATIONS, INCLUDING CHAMBERS OF COMMERCE, ROTARY CLUBS OR IRS 501(C)(4) LEGIONS AND ASSOCIATIONS. 5) MUNICIPALITIES, INCLUDING FIRE AND POLICE DEPARTMENTS OR RELATED SOCIAL SERVICE GROUPS AND POLITICAL ORGANIZATIONS. 6) RELIGIOUS ORGANIZATIONS OR SECTARIAN PROGRAMS FOR RELIGIOUS PURPOSES. 7) FRATERNAL ORGANIZATIONS, SOCIAL CLUBS, SPORTS TEAMS OR CLUBS, ATHLETIC COMPETITIONS. 8) ENDOWMENTS. 9) MULTIYEAR REQUESTS AND PLEDGES. 10) INDIVIDUALS REQUESTING LOANS, DEBT RETIREMENTS, SCHOLARSHIP OR FELLOWSHIP ASSISTANCE. 11) TRAVEL- INCLUDING STUDENT TRIPS OR TOURS. 12) MARKETING ACTIVITIES OR PROMOTIONAL MERCHANDISE. 13) PURCHASE OR MAINTENANCE OF VEHICLES. 14) FILM OR VIDEO PROJECTS, INCLUDING DOCUMENTARIES. 15) BEAUTY PAGEANTS.
SCHEDULE I, PART I, LINE 2 GRANT MONITORING PROCEDURES BASED ON THE DETAILED GIFT POLICY OUTLINED IN PART I, LINE 1, THE FUNDS ARE ONLY PROVIDED FOR CHARITABLE PURPOSES, AND THOSE ORGANIZATIONS THAT RECEIVE MONIES FROM NMC ARE REQUIRED TO FOLLOW THEIR 501(C)(3) REQUIREMENTS SURROUNDING THE USE OF FUNDS RECEIVED.
SCHEDULE I, PART III AMOUNTS PROVIDED TO PATIENTS ARE DETERMINED BY THE NEBRASKA MEDICAL CENTER'S WRITTEN AND PUBLISHED FINANCIAL ASSISTANCE POLICY.
Schedule I (Form 990) 2016



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