2021-05-13T11:35:34-05:00 2020-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2019-07-01 470765154 ALEGENT CREIGHTON CLINIC ALEG 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 JEANETTE WOJTALEWICZ CFO 4023434323 2021-05-13 1 ANGELA NOEL P01051055 3032989100 2019 2022-09-23 18:48:47Z CHI HEALTH CLINIC CLIFF A ROBERTSON 12809 WEST DODGE ROAD OMAHA NE 68154 305428325 0 X WWW.CHIHEALTH.COM X 1993 NE CLINIC HEALTHCARE SERVICES. 16 2 2519 0 412337 0 59172 2725180 311127701 302410868 21037 32229 339060 260048 311546970 305428325 0 62 0 0 296354463 312840397 0 0 0 69346022 66743384 365700485 379583843 -54153515 -74155518 43825298 59512717 735716759 825752456 -691891461 -766239739 X AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 0 0 261686546 32 158223194 ALEGENT CREIGHTON CLINIC PRIMARY CARE PHYSICIANS ARE DEDICATED TO PROVIDING PATIENTS WITH EXCELLENT HEALTHCARE. IN FISCAL YEAR 2020, PRIMARY CARE PHYSICIANS CARED FOR 538,086 OUTPATIENT VISITS AT THE CLINICS. ALEGENT CREIGHTON CLINIC HAS 32 PRIMARY CLINICS CONVENIENTLY LOCATED THROUGHOUT THE OMAHA AND COUNCIL BLUFFS AREA. A FULL RANGE OF MEDICAL SERVICES ARE PROVIDED TO PATIENTS COVERED BY MEDICARE AND MEDICAID. ALEGENT CREIGHTON CLINIC FOLLOWS A REASONED AND THOUGHTFUL APPROACH TO HELP PATIENTS WHO LACK INSURANCE OR FINANCIAL RESOURCES TO PAY FOR THE MEDICAL CARE THEY NEED. 24892512 4 17846408 ALEGENT CREIGHTON CLINIC PROVIDES OUR PATIENTS WITH PHYSICIANS THAT SPECIALIZE IN OBSTETRICS AND GYNECOLOGY. EACH PHYSICIAN HAS SPECIAL KNOWLEDGE, SKILLS AND PROFESSIONAL CAPABILITIES IN THE MEDICAL AND SURGICAL CARE OF THE FEMALE REPRODUCTIVE SYSTEM AND ASSOCIATED DISORDERS. IN FISCAL YEAR 2020, OBSTETRICS AND GYNECOLOGY PHYSICIANS CARED FOR 67,494 OUTPATIENT VISITS AT THE CLINICS. 24547825 3 13109630 ALEGENT CREIGHTON CLINIC PROVIDES A COMPREHENSIVE RANGE OF CARDIAC SERVICES, FROM PREVENTION TO TREATMENT AND REHABILITATION. THE TEAM OF CLINICAL PHYSICIANS INCLUDE HIGHLY TRAINED MEDICAL PROFESSIONALS FROM MANY DISCIPLINES. IN FISCAL YEAR 2020, HEART AND VASCULAR SPECIALISTS CARED FOR 63,099 OUTPATIENT VISITS AT THE CLINICS. 49889578 23 112819299 ALEGENT CREIGHTON CLINIC IS A NETWORK OF SKILLED PHYSICIANS DEVOTED TO PROVIDING EXCEPTIONAL HEALTHCARE IN ACCORDANCE WITH OUR MISSION. THE SKILLED PHYSICIANS PROVIDE OUTSTANDING CARE IN THE FOLLOWING SERVICES: PLASTIC & RECONSTRUCTIVE SURGERY, NEUROSCIENCE, GENERAL SURGERY, AND OTHER AREAS OF SPECIALTY CARE. EACH CLINIC TEAM IS SUPPORTED BY PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS WHO HAVE THE EXPERTISE TO PREVENT, DIAGNOSE, AND TREAT EACH ONE OF OUR PATIENTS' CONDITIONS. 49889578 23 112819299 361016461 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 2519 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X JEANETTE WOJTALEWICZ 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 CLIFF ROBERTSON MD BOARD MEMBER/CEO CHI HEALTH 5.00 45.00 X X 0 2271574 46283 GANGADASU REDDY MD PLASTIC-RECONSTRUCTION SURGEON 60.00 0.00 X 1441485 0 43363 SAMUEL DUBROW MD ORTHOPEDIST-GENERAL 60.00 0.00 X 1151677 0 45617 JEANETTE WOJTALEWICZ BOARD MEMBER/CFO CHI HEALTH 5.00 45.00 X X 0 1053501 42366 MATTHEW DILISIO ORTHOPEDIST-GENERAL 60.00 0.00 X 1014690 0 45617 ROBERT FITZGIBBONS JR MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 997960 0 34989 KATHY BRESSLER CHI HEALTH SVP COO 5.00 45.00 X 0 922585 26744 HIMANSHU AGARWAL MD CARDIOLOGIST 60.00 0.00 X 893505 0 42271 KHALID BASHIR MD SECRETARY & TREASURER/PHYSICIAN 60.00 0.00 X X 672945 0 42800 VISHAL JANI MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 659448 0 28772 ERIC VAN DE GRAAFF MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 631526 0 33458 SANJAY SINGH MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 541530 0 45387 JULIE ROTHLISBERGER-CASTILLO MD PHYSICIAN (FORMER OFFICER) 60.00 0.00 X 524393 0 44210 KEITH JANKUSKI ACC PRESIDENT & COO 50.00 0.00 X 496750 0 41591 ROBERT KENT MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 480193 0 45349 ANTHONY MACDISSI MD VICE CHAIR/PHYSICIAN 60.00 0.00 X X 410598 0 42399 SANJEEV SHARMA MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 432661 0 18393 RENUGA VIVEKANANDAN MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 381179 0 45601 STEVE HOUSTON FORMER OFFICER 5.00 45.00 X 0 371218 34814 WILLIAM LOWNDES MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 347787 0 35092 KIRTI GUPTA MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 344830 0 34356 HEATHER MORGAN MD CHAIR/PHYSICIAN 60.00 0.00 X X 294032 0 42984 MICHAEL DAVIDIAN MD BOARD MEMBER/PHYSICIAN 60.00 0.00 X 300919 0 36033 KAREN MILLER MD PHYSICIAN (FORMER OFFICER) 60.00 0.00 X 245426 0 25710 MIKE WATTERS FORMER KEY EMPLOYEE 5.00 45.00 X 0 191790 32614 PAT HENSLEY BOARD MEMBER 1.00 0.00 X 0 0 0 RICHARD HERINK BOARD MEMBER 1.00 0.00 X 0 0 0 12263534 4810668 956813 536 1 1 0 COMPHEALTH 7259 S BINGHAM JCT BLVD MIDVALE UT 84047 STAFFING SOLUTIONS 1117439 AMN HEALTHCARE 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 HEALTHCARE CONSULTING 794187 LOCUM TENENS 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 STAFFING SOLUTIONS 650755 HAYES HEALTHCARE LLC 6700 N ANDREWS AVE STE 600 FORT LAUDERDALE FL 33309 HEALTHCARE RECRUITING & STAFFING SOLUTIO 533105 GENERAL SERVICE BUREAU INC 8429 BLONDO ST OMAHA NE 68134 COLLECTION AGENCY 452007 19 3513 2721667 2725180 NET PATIENT SERVICES 900099 215790451 215790451 0 0 INTERCOMPANY TRANSACTIONS 900099 81594924 81594924 0 0 MEDICAL SERVICES 621600 2981689 2569352 412337 0 INTERCOMPANY SERVICES 900099 2043804 2043804 0 0 302410868 32229 32229 OTHER MISCELLANEOUS REVENUE 900099 133325 0 0 133325 ADMINISTRATIVE SERVICES 561000 72090 0 0 72090 54633 54633 260048 305428325 301998531 412337 292277 62 62 6441678 5153342 1288336 261709933 249514735 12195198 10787545 10280474 507071 20611574 19624643 986931 13289667 12625184 664483 2233 2233 20232872 18913831 1319041 21530 20454 1076 1629753 1548265 81488 124340 118123 6217 18331751 17415163 916588 638262 606349 31913 56327 53511 2816 1800103 1710098 90005 2453087 2330432 122655 MEDICAL SUPPLIES 14381832 14381832 0 0 INTERCOMPANY ALLOCATION 4175902 3967107 208795 0 MISCELLANEOUS EXPENSES 1047598 995218 52380 0 DUES & SUBSCRIPTIONS 936021 889220 46801 0 911773 866185 45588 379583843 361016461 18567382 0 3121837 1153022 0 0 0 29694851 24913047 0 0 0 0 0 0 886563 955404 625415 720028 38525846 21509928 9496632 17015918 0 0 0 0 0 0 0 0 14755298 43825298 59512717 23030725 29171219 0 0 0 340000 0 0 0 0 0 0 0 0 0 712686034 796241237 735716759 825752456 X -691891461 -766239739 0 0 -691891461 -766239739 43825298 59512717 X -74155518 -192760 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2233 0 0 0 2233 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMGA - $2,233 580505 280133 300372 13095859 5769009 7326850 18539906 15445256 3094650 6309576 15530 6294046 17015918 RIGHT-OF-USE OPERATING LEASE 14755298 14755298 INTERCOMPANY PAYABLES 773431330 SELF-INSURANCE RESERVES AND CLAIMS 100000 MISC. CASH CLEARING 1711650 OPERATING LEASE LIABILITY 20419487 OTHER CURRENT LIABILITIES 578770 796241237 X PART X, LINE 2: ALEGENT CREIGHTON CLINIC'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH'S ASC 740 FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2020, READS AS FOLLOWS: COMMONSPIRIT HAS ESTABLISHED ITS STATUS AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE LAWS OF THE STATES IN WHICH IT OPERATES, AND AS SUCH, IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, COMMONSPIRIT'S EXEMPT ORGANIZATIONS ARE SUBJECT TO INCOME TAXES ON NET INCOME DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, WHICH DOES NOT FURTHER THE ORGANIZATIONS' EXEMPT PURPOSES. NO SIGNIFICANT INCOME TAX PROVISION HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR NET INCOME DERIVED FROM UNRELATED TRADE OR BUSINESS. COMMONSPIRIT'S FOR-PROFIT SUBSIDIARIES ACCOUNT FOR INCOME TAXES RELATED TO THEIR OPERATIONS. THE FOR-PROFIT SUBSIDIARIES RECOGNIZE DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF THEIR ASSETS AND LIABILITIES, ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS, FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. INCOME TAX INTEREST AND PENALTIES ARE RECORDED AS INCOME TAX EXPENSE. FOR THE YEARS ENDED JUNE 30, 2020 AND 2019, COMMONSPIRIT'S TAXABLE ENTITIES RECORDED AN IMMATERIAL AMOUNT OF INTEREST AND PENALTIES AS PART OF THE PROVISION FOR INCOME TAXES. COMMONSPIRIT'S TAXABLE ENTITIES DID NOT HAVE ANY MATERIAL UNRECOGNIZED INCOME TAX EXPENSE AS OF JUNE 30, 2020 AND 2019. COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 0 1 0 0 0 0 0 1 0 CLIFF ROBERTSON MD BOARD MEMBER/CEO CHI HEALTH 0 1062248 0 848919 0 360407 0 16675 0 29608 0 2317857 0 136676 GANGADASU REDDY MD PLASTIC-RECONSTRUCTION SURGEON 1440645 0 0 0 840 0 16675 0 26688 0 1484848 0 0 0 SAMUEL DUBROW MD ORTHOPEDIST-GENERAL 1150921 0 0 0 756 0 16675 0 28942 0 1197294 0 0 0 JEANETTE WOJTALEWICZ BOARD MEMBER/CFO CHI HEALTH 0 569967 0 340681 0 142853 0 15642 0 26724 0 1095867 0 48668 MATTHEW DILISIO ORTHOPEDIST-GENERAL 1013934 0 0 0 756 0 16675 0 28942 0 1060307 0 0 0 ROBERT FITZGIBBONS JR MD BOARD MEMBER/PHYSICIAN 980656 0 0 0 17304 0 15265 0 19724 0 1032949 0 0 0 KATHY BRESSLER CHI HEALTH SVP COO 0 556554 0 289321 0 76710 0 16675 0 10069 0 949329 0 0 HIMANSHU AGARWAL MD CARDIOLOGIST 891535 0 0 0 1970 0 15852 0 26419 0 935776 0 0 0 KHALID BASHIR MD SECRETARY & TREASURER/PHYSICIAN 669333 0 0 0 3612 0 16112 0 26688 0 715745 0 0 0 VISHAL JANI MD BOARD MEMBER/PHYSICIAN 658692 0 0 0 756 0 15517 0 13255 0 688220 0 0 0 ERIC VAN DE GRAAFF MD BOARD MEMBER/PHYSICIAN 629594 0 0 0 1932 0 16675 0 16783 0 664984 0 0 0 SANJAY SINGH MD BOARD MEMBER/PHYSICIAN 539598 0 0 0 1932 0 16445 0 28942 0 586917 0 0 0 JULIE ROTHLISBERGER-CASTILLO MD PHYSICIAN (FORMER OFFICER) 523133 0 0 0 1260 0 15536 0 28674 0 568603 0 0 0 KEITH JANKUSKI ACC PRESIDENT & COO 342987 0 138297 0 15466 0 15023 0 26568 0 538341 0 0 0 ROBERT KENT MD BOARD MEMBER/PHYSICIAN 474500 0 0 0 5693 0 16675 0 28674 0 525542 0 0 0 ANTHONY MACDISSI MD VICE CHAIR/PHYSICIAN 409844 0 0 0 754 0 15711 0 26688 0 452997 0 0 0 SANJEEV SHARMA MD BOARD MEMBER/PHYSICIAN 429049 0 0 0 3612 0 16689 0 1704 0 451054 0 0 0 RENUGA VIVEKANANDAN MD BOARD MEMBER/PHYSICIAN 380358 0 0 0 821 0 16659 0 28942 0 426780 0 0 0 STEVE HOUSTON FORMER OFFICER 0 333551 0 15372 0 22295 0 16675 0 18139 0 406032 0 0 WILLIAM LOWNDES MD BOARD MEMBER/PHYSICIAN 342435 0 0 0 5352 0 16857 0 18235 0 382879 0 0 0 KIRTI GUPTA MD BOARD MEMBER/PHYSICIAN 342898 0 0 0 1932 0 16121 0 18235 0 379186 0 0 0 HEATHER MORGAN MD CHAIR/PHYSICIAN 293302 0 0 0 730 0 16750 0 26234 0 337016 0 0 0 MICHAEL DAVIDIAN MD BOARD MEMBER/PHYSICIAN 296389 0 0 0 4530 0 16333 0 19700 0 336952 0 0 0 KAREN MILLER MD PHYSICIAN (FORMER OFFICER) 244840 0 0 0 586 0 9191 0 16519 0 271136 0 0 0 MIKE WATTERS FORMER KEY EMPLOYEE 0 184089 0 0 0 7701 0 16525 0 16089 0 224404 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2019, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. COMPENSATION FOR THE OTHER OFFICERS OF ALEGENT CREIGHTON CLINIC WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4A - SEVERANCE OR CHANGE-OF-CONTROL PAYMENT: FOR REPORTABLE INDIVIDUALS EMPLOYED PRIOR TO 2019, POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. OFFICERS, KEY EMPLOYEES AND CERTAIN HIGHLY COMPENSATED EMPLOYEES WHO BEGAN EMPLOYMENT AFTER NOVEMBER 1ST OF 2019 ARE COVERED BY A SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2019 CALENDAR YEAR. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DURING THE 2019 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/HOSPITAL PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2019 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: JEANETTE WOJTALEWICZ, $62,916; AND CLIFF ROBERTSON, $139,927. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2019 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2019, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: JEANETTE WOJTALEWICZ, $57,305; CLIFF ROBERTSON, $182,082; AND KATHY BRESSLER, $53,648. PART I, LINE 7 DURING THE 2019 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON REACHING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES ITS DISCRETION TO APPROVE AN EXCEPTION. SUCH EXCEPTIONS ARE NOT APPLIED TO INDIVIDUALS OR CLASSES OF INDIVIDUALS, BUT RATHER TO THE PROGRAM AS A WHOLE. FORM 990, PART V, LINE 1C: PAYMENTS TO VENDORS PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH (CSH) ARE MADE BY CSH, THEREFORE NO FORM 1099'S ARE ISSUED BY ALEGENT CREIGHTON CLINIC. CSH FILES THE FORM 1099'S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099'S ISSUED BY CSH ON BEHALF OF ALEGENT CREIGHTON CLINIC ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF ALEGENT CREIGHTON CLINIC IS ALEGENT CREIGHTON HEALTH. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS SHALL BE APPOINTED BY ALEGENT CREIGHTON HEALTH AND SHALL CONSIST OF NO MORE THAN EIGHTEEN (18) DIRECTORS. ALEGENT CREIGHTON HEALTH SHALL CONSIDER THE SLATE OF THE NOMINATIONS SUBMITTED TO IT BY ALEGENT CREIGHTON CLINIC'S BOARD OF DIRECTORS. ALEGENT CREIGHTON CLINIC'S BOARD OF DIRECTORS SHALL SOLICIT NOMINATIONS FROM ALEGENT CREIGHTON CLINIC'S PHYSICIAN EMPLOYEES. FORM 990, PART VI, SECTION A, LINE 7B ALEGENT CREIGHTON HEALTH SHALL HAVE, IN ADDITION TO ALL RIGHTS AND POWERS GRANTED BY LAW WITH RESPECT TO THE GOVERNANCE OF ALEGENT CREIGHTON CLINIC, THE RIGHT TO: A. INITIATE AND APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS; B. INITIATE AND APPROVE PHYSICIAN COMPENSATION AND BENEFITS AND RECRUITMENT INCENTIVES; C. INITIATE AND APPROVE JOINT VENTURES IN WHICH ALEGENT CREIGHTON CLINIC PROPOSES TO PARTICIPATE, PURSUANT TO GUIDELINES ESTABLISHED FROM TIME TO TIME BY ALEGENT CREIGHTON HEALTH; D. APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, ALL MEMBERS OF THE GOVERNING BOARD; E. APPROVE THE INCURRENCE OF ANY DEBT BY ALEGENT CREIGHTON CLINIC THAT IS IN EXCESS OF A THRESHOLD ESTABLISHED FROM TIME TO TIME BY ALEGENT CREIGHTON HEALTH; F. INITIATE AND APPROVE PHYSICIAN FEE SCHEDULES; G. INITIATE AND APPROVE THE MERGER OR CONSOLIDATION OF ALEGENT CREIGHTON CLINIC INTO OR WITH ANY OTHER CORPORATION, ORGANIZATION, OR ASSOCIATION; H. INITIATE AND APPROVE THE DISSOLUTION OR LIQUIDATION OF ALEGENT CREIGHTON CLINIC; I. APPROVE THE INCORPORATION OR DISSOLUTION OF AFFILIATED ENTITIES, ORGANIZATIONS, OR ASSOCIATIONS; J. INITIATE AND APPROVE THE SALE, LEASE, EXCHANGE, TRANSFER, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY, OTHER THAN IN THE USUAL AND REGULAR COURSE OF BUSINESS; K. INITIATE AND APPROVE THE MORTGAGE, PLEDGE, DEDICATION TO REPAYMENT OF INDEBTEDNESS, OR OTHER ENCUMBRANCE OF ANY OR ALL OF ALEGENT CREIGHTON CLINIC'S PROPERTY; L. APPROVE ANNUAL CAPITAL AND OPERATING BUDGETS AND ANY DEVIATIONS IN EXCESS OF A THRESHOLD ESTABLISHED FROM TIME TO TIME BY ANY MEMBER; AND M. APPROVE THE PURCHASE OF A MEDICAL PRACTICE. FORM 990, PART VI, SECTION B, LINE 11B FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH (CSH), A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE CSH TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO 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, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO MAINTAIN THE INTEGRITY OF ITS ACTIVITIES. THE POLICY APPLIES TO THE FOLLOWING PERSONS ("COVERED PERSONS"): MEMBERS OF THE COMMONSPIRIT HEALTH ("COMMONSPIRIT") BOARD OF STEWARDSHIP TRUSTEES AND ITS COMMITTEES; COMMONSPIRIT HEALTH CORPORATE OFFICERS; MEMBERS OF THE DIGNITY HEALTH BOARD OF STEWARDSHIP TRUSTEES AND ITS COMMITTEES. IN ADDITION, THE POLICY APPLIES TO ORGANIZATIONS THAT WERE AFFILIATES AND SUBSIDIARIES OF COMMONSPIRIT HEALTH PRIOR TO ITS AFFILIATION WITH DIGNITY HEALTH ("CHI ENTITIES"). COVERED PERSONS OF CHI ENTITIES INCLUDE: MEMBERS OF ANY CHI ENTITY DIRECT AFFILIATE OR SUBSIDIARY BOARD AND THEIR COMMITTEES; EMPLOYEES OF CHI ENTITIES; AND CHI ENTITY RESEARCHERS (AS DEFINED BY THE POLICY). DISCLOSURE, REVIEW AND MANAGEMENT OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS AND MUST DISCLOSE THAT CONFLICT TO HIS/HER DIRECT MANAGER (OR OTHER PERSON AS IS APPROPRIATE PER POLICY). SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR BOARD APPOINTMENT), AND ANNUALLY THEREAFTER. DISCLOSURES OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS ARE INITIALLY REVIEWED BY NATIONAL OR REGIONAL LEGAL OR CORPORATE RESPONSIBILITY TEAM MEMBERS TO DETERMINE WHETHER AN ACTUAL OR POTENTIAL CONFLICT MAY EXIST. IF IT IS DETERMINED THAT A POTENTIAL OR ACTUAL CONFLICT EXISTS, ISSUES ARE ELEVATED TO THE BOARD EXECUTIVE COMMITTEE OR BOARD CHAIR (FOR BOARD OR OFFICER CONFLICTS), OR THE CONFLICTS OF INTEREST REVIEW COMMITTEE (FOR ANY OTHER CONFLICT). THE PROCEDURES FOR ADDRESSING A CONFLICT RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES OR A CORPORATE OFFICER INCLUDE, BUT ARE NOT LIMITED TO 1) DISCLOSURE TO THE BOARD, 2) THE TRUSTEE OR CORPORATE OFFICER BEING EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST (ALTHOUGH HE OR SHE MAY RESPOND TO PERTINENT QUESTIONS IF THE KNOWLEDGE IS RELEVANT), AND 3) BOARD APPROVAL OF THE TRANSACTION BY A MAJORITY OF DISINTERESTED MEMBERS. IN ADDITION, BOARDS CAREFULLY REVIEW AND SCRUTINIZE ANY NON-TRANSACTIONAL CONFLICTS OF INTEREST. IN SUCH CIRCUMSTANCES, BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES, THE BOARD TAKES WHATEVER ACTION IS DEEMED APPROPRIATE. FOR CONFLICTS NOT INVOLVING A BOARD MEMBER OR OFFICER, THE CONFLICTS OF INTEREST REVIEW COMMITTEE ("C-CIRC") WILL FACILITATE A COI MANAGEMENT PLAN TO MITIGATE THE CONFLICT IF ADEQUATE CONTROLS AREN'T ALREADY IN PLACE. NOTWITHSTANDING THE FOREGOING, AT ITS SOLE DISCRETION, AN 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 CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15B SEE DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. IN ADDITION, THE ARTICLES OF INCORPORATION ARE AVAILABLE ON THE NEBRASKA SECRETARY OF STATE WEBSITE AT HTTP://WWW.SOS.NE.GOV/BUSINESS. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. FORM 990, PART VI, LINE 15A: TOP MANAGEMENT OFFICIAL COMPENSATION THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION WAS PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. THE COMMONSPIRIT HEALTH BOARD OF STEWARDSHIP TRUSTEES APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED EXCLUSIVELY OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR APPROVING REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY EMPLOYEES (INCLUDING THE PRESIDENT/CEO). THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF STEWARDSHIP TRUSTEES. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE AGREEMENT APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED AGREEMENT AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. FOR OTHER MEMBERS OF MANAGEMENT WHO WERE PAID UNDER ALEGENT CREIGHTON HEALTH FOR CALENDAR YEAR 2019, ALEGENT CREIGHTON HEALTH HUMAN RESOURCES COMPLETES A COMPENSATION MARKET STUDY TO DETERMINE SALARY. FORM 990, PART XI, LINE 9: ASC 842 ADJUSTMENT -192,384. OTHER CHANGES IN NET ASSETS -376. SCHEDULE A, PART I, LINE 3: SCHEDULE H NOT REQUIRED ALEGENT CREIGHTON CLINIC IS RECOGNIZED AS A HOSPITAL BY THE INTERNAL REVENUE SERVICE UNDER IRC SECTION 170(B)(1)(A)(III). HOWEVER, ALEGENT CREIGHTON CLINIC DOES NOT CURRENTLY OPERATE ANY LICENSED HOSPITAL FACILITIES; THEREFORE, NO SCHEDULE H IS REQUIRED. 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