2013-05-14T08:12:06-05:00 2012-06-30 470757164 ALEGENT CREIGHTON HEALTH 12809 W DODGE ROAD OMAHA NE 68154 990 2011-07-01 470765154 ALEGENT CREIGHTON CLINIC ALEG 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 SCOTT M WOOTEN 4023434323 2013-05-13 1 ANGELA LEA P01051055 4023434323 2011 2016-03-07 17:11:31Z SCOTT M WOOTEN 12809 WEST DODGE ROAD OMAHA NE 68154 116713554 0 X WWW.ALEGENTCREIGHTON.COM X 1993 NE CLINIC HEALTHCARE SERVICES 13 2 1093 0 7039 0 39139 28346 99872990 115155075 -747 15340 1281832 1486383 101193214 116685144 2632317 2096188 0 0 97219937 108922030 0 0 0 38288038 42408598 138140292 153426816 -36947078 -36741672 17033215 16538043 167348474 203594974 -150315259 -187056931 X FAITHFUL TO THE HEALING MINISTRY OF JESUS CHRIST, OUR MISSION IS TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. OUR COMMITMENT TO HEALING CALLS US TO:CREATE CARING AND COMPASSIONATE ENVIRONMENTS RESPECT THE DIGNITY OF EVERY PERSON CARE FOR THE RESOURCES ENTRUSTED TO US AS RESPONSIBLE STEWARDS COLLABORATE WITH OTHERS TO IMPROVE THE HEALTH OF OUR COMMUNITIES ATTEND ESPECIALLY TO THE NEEDS OF THOSE WHO ARE POOR AND DISADVANTAGED ACT WITH INTEGRITY IN ALL ENDEAVORS TO ACHIEVE THIS MISSION, WE PLEDGE TO BE CREATIVE, VISIONARY LEADERS COMMITTED TO HOLISTIC HEALTHCARE IN THE REGION. 0 0 64470575 1156886 63894678 ALEGENT CREIGHTON CLINIC PRIMARY CARE PHYSICIANS ARE DEDICATED TO PROVIDING PATIENTS WITH EXCELLENT HEALTHCARE. IN FISCAL YEAR 2012, PRIMARY CARE PHYSICIANS CARED FOR 382,617 OUTPATIENT VISITS AT THE CLINICS. ALEGENT CREIGHTON CLINIC HAS 31 PRIMARY CLINICS CONVENIENTLY LOCATED THROUGHOUT THE OMAHA/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. 16243145 292418 16148519 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 2012, OBSTETRICS AND GYNECOLOGY PHYSICIANS CARED FOR 55,643 OUTPATIENT VISITS AT THE CLINICS. 16048325 229323 12668621 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 2012, HEART AND VASCULAR SPECIALISTS CARED FOR 24,530 OUTPATIENT VISITS AT THE CLINICS. 49683054 417561 23049155 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. 49683054 417561 23049155 146445099 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 X 47 0 1 1093 1 1 1 0 0 0 0 0 0 0 0 0 X 13 2 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X SCOTT M WOOTEN SENIOR VPCFO 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 X JULIE ROTHLISBERGER-CASTILLO MD 60.00 X X 462030 0 36210 RICHARD HACHTEN II 4.00 X X 119819 1606342 297951 THOMAS PRUSE MD 60.00 X X 184804 0 47049 KAREN MILLER MD 60.00 X X 360719 0 27548 SCOTT CAROLLO MD 60.00 X 587091 0 42551 JOHN HEWITT 2.00 X 0 0 0 SCOTT WOOTEN 4.00 X X 49138 658780 134300 KEVIN NOHNER MD 60.00 X 277583 0 48415 J RUSSELL BOWEN MD 60.00 X 352631 0 38611 PAT HENSLEY 2.00 X 0 0 0 RICHARD ROLSTON MD 60.00 X X 32626 437395 1280141 HEATHER TAGGART MD 60.00 X 674289 0 18374 BODO TREU MD 60.00 X 411928 0 37976 RANDY PRITZA MD 60.00 X 590311 0 37038 KENNETH LAWONN 4.00 X 39216 525750 115906 PAUL EBMEIER 60.00 X 393678 0 80834 JOAN NEUHAUS 4.00 X 44451 595931 179065 RICK MILLER MD 4.00 X 28268 378979 86623 MICHAEL BARSOOM MD 60.00 X 846444 0 37356 JOSEPH JARZOBSKI MD 60.00 X 847719 0 32528 ERIN EVANS MD 60.00 X 801349 0 13248 JON THOMAS MD 60.00 X 782034 0 45750 ANN SULLIVAN MD 60.00 X 764567 0 39249 MARTIN HICKEY MD 0.00 X 36500 489347 0 FRED HOSLER MD 0.00 X 37505 502804 889 LARRY BROWN MD 60.00 X 650762 0 42928 MARK KESTNER MD 0.00 X 9133 122445 1669 9384595 5317773 2722209 150 1 1 0 NAVIGANT CONSULTING 30 S WACKER DRIVE SUITE 3100 CHICAGO IL 60606 MANAGEMENT CONSULTING 432472 MERCHANTS CREDIT ADJUSTERS INC 17055 FRANCES STREET STE 100 OMAHA NE 68130 DEBT COLLECTION 411803 EMDEON CORPORATION 3055 LEBANON PIKE NASHVILLE TN 37214 REVENUE CYCLE MANAGEMENT 276279 KAUFMAN HALL & ASSOC 5202 OLD ORCHARD ROADSTE N700 SKOKIE IL 60077 MANAGEMENT CONSULTING 267802 GENERAL SERVICE BUREAU 8429 BLONDO STREET OMAHA NE 68134 DEBT COLLECTION 181284 10 28346 28346 NET PATIENT REVENUE 621110 108648875 108648875 REVENUE FROM AFFILIATE 900099 4851935 4851935 MEANINGFUL USE 900099 1652102 1652102 OTHER REVENUE 900099 2163 2163 115155075 7039 0 7039 7039 7039 43750 28410 15340 15340 15340 SYSTEM REV ALLOCATION 900099 871283 871283 OTHER REVENUE 900099 608061 608061 1479344 116685144 115760973 7039 888786 28407 28407 2067781 2067781 7229405 6867935 361470 88815937 84375140 4440797 1613470 1532797 80673 7072340 6718723 353617 4190878 3981334 209544 17160 16302 858 1394986 1325237 69749 55455 52682 2773 7356360 6988542 367818 7533014 7533014 298611 283680 14931 261993 261993 13373 13373 3533579 3356900 176679 1019243 968281 50962 PURCHASED SERVICES 10696089 10161285 534804 BAD DEBT 5840439 5548417 292022 SYSTEM EXP ALLOCATIONS 2795489 2795489 TAXES AND LICENSES 589510 589510 1003297 978277 25020 153426816 146445099 6981717 0 165451 423110 8456870 10305124 3600 2700 450965 598970 327119 85703 15841312 10718876 7629210 5122436 17033215 16538043 8714298 7949324 158634176 195645650 167348474 203594974 X -150315259 -187056931 -150315259 -187056931 17033215 16538043 -36741672 0 X 0 1 1 X 0 X 2132534 1926767 205767 1723449 907110 816339 10512345 7812004 2700341 1472984 72995 1399989 5122436 INTERCOMPANY PAYABLES 195645650 195645650 116685144 153426816 -36741672 -36741672 PART X, LINE 2 - ENTITIES OF THE ALEGENT HEALTH SYSTEM RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. SUCH TAX POSITIONS, WHICH ARE MORE THAN 50% LIKELY OF BEING REALIZED, ARE MEASURED AT THEIR HIGHEST VALUE. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. DURING 2011 AND 2010, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 ALEGENT HEALTH FOUNDATION 12809 WEST DODGE ROAD OMAHA NE 68154 470648586 501(C)(3) 26200 GENERAL SUPPORT 1 0 CHARITY CARE - ASSISTANCE TO LOW INCOME QUALIFIED INDIVIDUALS. 5427 2067781 BOOK REDUCTION OR WRITE OFF OF PATIENT SERVICES. PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MOST DISBURSEMENTS IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS ARE MADE DIRECTLY IN THE ACTIVE CONDUCT OF THE ACTIVITIES CONSTITUTING THE EXEMPT PURPOSE OR FUNCTION OF THE ORGANIZATION. OTHERWISE, DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES OR SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. ALEGENT CREIGHTON CLINIC RECOGNIZES THE RIGHT TO QUALITY HEALTHCARE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, OR ABILITY TO PAY. BUSINESS OFFICE STAFF HELPS PATIENTS SEEK LOCAL, STATE, AND FEDERAL REIMBURSEMENT AT NO CHARGE WHEN NO OTHER SOURCE OF PAYMENT IS AVAILABLE. FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS WITH DEMONSTRATED INABILITY TO PAY FOR MEDICALLY NECESSARY SERVICES. THESE FUNDS ARE DIRECTLY USED TO OFFSET THE PATIENTS' ACCOUNTS RECEIVABLE. 1 1 1 0 1 0 1 1 0 0 JULIE ROTHLISBERGER-CASTILLO MD 395754 0 50000 0 16276 0 16642 0 21069 0 499741 0 0 0 RICHARD HACHTEN II 47872 641788 29925 401187 42022 563367 19599 262751 1186 15897 140604 1884990 32128 430719 THOMAS PRUSE MD 170547 0 0 0 14257 0 32255 0 15420 0 232479 0 0 0 KAREN MILLER MD 335177 0 0 0 25542 0 4620 0 24203 0 389542 0 0 0 SCOTT CAROLLO MD 526473 0 45000 0 15618 0 14427 0 29615 0 631133 0 0 0 SCOTT WOOTEN 25303 339232 14886 199567 8949 119981 7983 107018 1521 20387 58642 786185 3374 45239 KEVIN NOHNER MD 250963 0 0 0 26620 0 24309 0 26698 0 328590 0 0 0 J RUSSELL BOWEN MD 339260 0 0 0 13371 0 14700 0 25103 0 392434 0 0 0 RICHARD ROLSTON MD 24552 329152 6147 82410 1927 25833 88045 1180371 1493 20014 122164 1637780 0 0 HEATHER TAGGART MD 635206 0 9966 0 29117 0 14700 0 6017 0 695006 0 0 0 BODO TREU MD 331742 0 50000 0 30186 0 14700 0 24212 0 450840 0 0 0 RANDY PRITZA MD 527905 0 45000 0 17406 0 14427 0 25921 0 630659 0 0 0 KENNETH LAWONN 20244 271405 12041 161431 6931 92914 7845 105173 297 3981 47358 634904 2769 37123 PAUL EBMEIER 258789 0 93516 0 41373 0 59855 0 22797 0 476330 0 20451 0 JOAN NEUHAUS 23838 319573 12829 171997 7784 104361 12430 166635 390 5224 57271 767790 2912 39035 RICK MILLER MD 16457 220627 8799 117969 3012 40383 4162 55798 2138 28669 34568 463446 683 9158 MICHAEL BARSOOM MD 684461 0 130000 0 31983 0 12250 0 26598 0 885292 0 0 0 JOSEPH JARZOBSKI MD 528017 0 300000 0 19702 0 14427 0 19424 0 881570 0 0 0 ERIN EVANS MD 758255 0 0 0 43094 0 12250 0 2489 0 816088 0 0 0 JON THOMAS MD 677884 0 50000 0 54150 0 21572 0 25622 0 829228 0 0 0 ANN SULLIVAN MD 741004 0 0 0 23563 0 13475 0 27265 0 805307 0 0 0 MARTIN HICKEY MD 0 0 0 0 36500 489347 0 0 0 0 36500 489347 36501 489347 FRED HOSLER MD 0 0 0 0 37505 502804 0 0 62 827 37567 503631 37470 502336 LARRY BROWN MD 344187 0 236382 0 70193 0 17304 0 27312 0 695378 0 0 0 MARK KESTNER MD 0 0 0 0 9133 122445 116 1553 0 0 9249 123998 9133 122445 PART I, LINE 1A AS PART OF THE EXECUTIVE COMPENSATION ARRANGEMENT, EXECUTIVES ARE PROVIDED WITH A SET SUM, APPROXIMATELY 30 - 40% OF THEIR BASE SALARY, WHICH CAN BE USED TO ELECT VARIOUS BENEFITS. EXECUTIVES WHO RECEIVED THIS BENEFIT WERE RICHARD HACHTEN II, SCOTT WOOTEN, KENNETH LAWONN, PAUL EBMEIER, JOAN NEUHAUS, RICHARD ROLSTON, AND RICK MILLER. SOME OF THE BENEFITS AVAILABLE FOR ELECTION INCLUDE HEALTH CLUB DUES, AUTOMOBILE ALLOWANCE, HOUSING ALLOWANCE, FINANCIAL PLANNING FEES AND LEGAL FEES. PAYMENT FOR THESE BENEFITS ARE EITHER MADE DIRECTLY BY ALEGENT CREIGHTON HEALTH OR REIMBURSED TO THE EXECUTIVE AFTER THE APPROPRIATE SUBSTANTIATION FOR THE EXPENSE IS PROVIDED. THE AMOUNT PAID FOR THESE BENEFITS IS INCLUDED IN THE EXECUTIVE'S WAGES AS TAXABLE INCOME. PART I, LINES 4A-B THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2011 CALENDAR YEAR AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE AS COMPENSATION ON SCHEDULE J: FRED HOSLER, MD - $539,806 MARK KESTNER, MD - $131,578 MARTIN HICKEY, MD - $475,218 RICHARD HACTEN II - $346,579. PART I, LINE 4B: THE FOLLOWING REPORTABLE INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2011 CALENDAR YEAR. AMOUNTS DEFERRED FROM THE PLAN WERE INCLUDED IN COLUMN C OF THE SCHEDULE J: RICHARD HACHTEN II - $141,223 PAUL EBMEIER - $22,752 JOAN NEUHAUS - $53,374 RICHARD ROLSTON - $40,680 RICK MILLER, MD - $36,480 MARTIN HICKEY, MD - $50,630 KENNETH LAWONN - $47,270 SCOTT WOOTEN - $58,678. PART I, LINE 4B: THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED A PAY OUT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2011 CALENDAR YEAR. AMOUNTS PAID OUT FROM THE PLAN WERE INCLUDED IN THE INDIVIDUAL'S TAXABLE WAGES AND REPORTED IN COLUMN E OF THE SCHEDULE J: RICHARD HACTEN II - $116,268 SCOTT WOOTEN - $48,613 RICK MILLER, MD - $9,841 LARRY BROWN, MD - $12,411 KENNETH LAWONN - $39,892 JOAN NEUHAUS - $41,947 PAUL EBMEIER - $20,451 MARTIN HICKETY, MD - $50,630. PART I, LINE 5 ALEGENT CREIGHTON CLINIC PHYSICIANS ARE COMPENSATED BASED ON THEIR INDIVIDUAL REVENUES LESS EXPENSES. ABSENT EXTENUATING CIRCUMSTANCES, THERE IS NO GUARANTEED BASE SALARY OR MINIMUM SALARY PAST THEIR INITIAL START-UP PERIOD. SOME PHYSICIANS ARE COMPENSATED BASED ON THEIR WORK RVU PRODUCTION WHICH IS A NATIONALLY ACCEPTED MEASURE OF PHYSICIAN PRODUCTIVITY. PART I, LINE 6 COMPENSATION FOR MEMBERS OF MANAGEMENT OF ALEGENT CREIGHTON HEALTH AND RELATED ENTITIES IS DETERMINED AT A SYSTEM LEVEL. MEMBERS OF ALEGENT CREIGHTON HEALTH MANAGEMENT ARE ELIGIBLE FOR AN ANNUAL INCENTIVE BONUS. INCENTIVE AWARDS ARE BASED ON FOUR INDIVIDUAL PERFORMANCE MEASURES WHICH ARE LINKED TO FOUR SYSTEM PERFORMANCE GOALS. FOR EACH MANAGER, 75% OF THE INCENTIVE AWARD WILL BE DETERMINED BY SYSTEM PERFORMANCE GOALS AND 25% DETERMINED BY INDIVIDUAL PERFORMANCE MEASURES. ONE OF THE FOUR SYSTEM PERFORMANCE GOALS IS DEPENDENT UPON THE FINANCIAL RESULTS OF THE ENTIRE ALEGENT CREIGHTON HEALTH SYSTEM FOR THE FISCAL YEAR. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: ALEGENT CREIGHTON HEALTH GOVERNANCE OF EXECUTIVE COMPENSATION: ACTING AS PRUDENT STEWARDS OF ITS FINANCIAL RESOURCES, THE ALEGENT CREIGHTON HEALTH BOARD COMPENSATION COMMITTEE RECOMMENDS AND THE BOARD EXECUTIVE COMMITTEE APPROVES THE EXECUTIVE COMPENSATION PHILOSOPHY, POLICY AND GUIDELINES. IT DOES SO WITH THE OBJECTIVE OF ATTRACTING AND RETAINING TOP EXECUTIVE TALENT TO ENSURE ALEGENT CREIGHTON HEALTH IS ABLE TO FULFILL ITS FAITH-BASED MISSION AND ACHIEVE ITS VISION OF BECOMING WORLD-CLASS. THE ALEGENT CREIGHTON HEALTH COMPENSATION COMMITTEE FOLLOWS A THOROUGH AND INTENTIONAL PROCESS THAT INCLUDES CONSULTATION WITH INDEPENDENT, EXPERT COUNSEL AND CAREFULLY COMPARES COMPENSATION LEVELS TO MARKET-BASED COMPENSATION OF SIMILAR SIZED, NON-PROFIT AND FOR-PROFIT HEALTH SYSTEMS AND ALSO UTILIZES A BLEND OF NON-PROFIT AND GENERAL INDUSTRY DATA FOR EXECUTIVE ROLES WHERE THE RECRUITING MARKET IS ARGUABLY BROADER THAN THE NON-PROFIT SECTOR. TOTAL COMPENSATION INCLUDES BASE COMPENSATION, AND ALSO INCLUDES PERFORMANCE-BASED INCENTIVE COMPENSATION FOR ACHIEVING BOARD-SET GOALS FOR CLINICAL QUALITY, PATIENT SAFETY AND SATISFACTION, PHYSICIAN PERCEPTION, STRATEGIC AND FACILITY PLANNING AND FINANCIAL PERFORMANCE. IT MAY ALSO INCLUDE OTHER CASH PAYMENTS SUCH AS ONE-TIME RELOCATION COSTS, AND/OR CASH PAYMENTS FOR DEFERRED COMPENSATION. SCHEDULE J, PART II: THE ALEGENT CREIGHTON HEALTH EXECUTIVES HAVE A PROVISION IN THEIR COMPENSATION AGREEMENT THAT PROVIDES FOR POTENTIAL SEVERANCE PAYMENTS IN THE EVENT OF TERMINATION WITHOUT CAUSE OR CHANGE OF CONTROL. THE AMOUNT OF SEVERANCE AN EXECUTIVE MAY OR MAY NOT RECEIVE IF TERMINATED ACCORDING TO THE COMPENSATION AGREEMENT IS INCLUDED AS DEFERRED COMPENSATION IN COLUMN C. FORM 990, PART I, LINE 5 AND PART V, LINE 2A: THE EMPLOYEES LISTED IN PART I, LINE 5 AND PART V, LINE 2A ARE EMPLOYED BY ALEGENT CREIGHTON CLINIC. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT CREIGHTON HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT CREIGHTON CLINIC. FORM 990, PART V, LINE 1C: PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE MADE BY ALEGENT CREIGHTON HEALTH, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT CREIGHTON CLINIC. ALEGENT CREIGHTON HEALTH FILES THE FORM 1099S AND COMPILES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY ALEGENT CREIGHTON HEALTH 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 THIRTEEN (13) 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 11 ALEGENT CREIGHTON CLINIC IS PART OF THE ALEGENT CREIGHTON HEALTH SYSTEM. TAX RETURNS FOR ENTITIES OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE PREPARED BY THE SYSTEM TAX DEPARTMENT. FOLLOWING THE PREPARATION OF ALEGENT CREIGHTON CLINIC FORM 990 BY ALEGENT CREIGHTON HEALTH INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE ALEGENT CREIGHTON HEALTH TAX DIRECTOR AND THE CHIEF FINANCIAL OFFICER. THE FINAL TAX RETURN IS POSTED ON THE ELECTRONIC DIRECTOR'S PORTAL TO BE REVIEWED AND PRESENTED AT THE FINANCE AND AUDIT COMMITTEE OF THE BOARD. THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR ARE PRESENT AT THE FINANCE AND AUDIT COMMITTEE MEETING TO ANSWER QUESTIONS. ADDITIONALLY, THE BOARD OF DIRECTORS ARE NOTIFIED THAT THE FINAL FORM 990, INCLUDING ALL REQUIRED SCHEDULES, IS AVAILABLE ON THE ELECTRONIC PORTAL FOR REVIEW AND WILL BE FILED ON MAY 15, 2013. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY - ALEGENT CREIGHTON CLINIC HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF ALEGENT CREIGHTON HEALTH. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY THE ALEGENT CREIGHTON HEALTH COMPLIANCE OFFICER AND REPORTED TO THE CONFLICTS OF INTEREST COMMITTEE. THE CONFLICTS OF INTEREST COMMITTEE REVIEWS THE INVESTIGATION AND MAKES RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE MAKES THE FINAL DETERMINATION OF WHETHER OR NOT THERE IS A DISQUALIFYING EVENT AND COMMUNICATES IT TO THE ALEGENT CREIGHTON CLINIC BOARD OF DIRECTORS. AT ANY TIME A BOARD MEMBER OR KEY EMPLOYEE MAY DECLARE A CONFLICT OF INTEREST AND RECUSE HIS/HERSELF FROM THE DISCUSSION. THE INDIVIDUAL IS ALSO REQUIRED TO DISCLOSE ANY KNOWN OR POSSIBLE CONFLICTS OF INTEREST THAT ARISE DURING THE CALENDAR YEAR. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD OF ALEGENT CREIGHTON HEALTH ENGAGED THE SERVICES OF AN INDEPENDENT CONSULTING FIRM THAT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT THAT IS QUALIFIED TO AND REGULARLY PERFORMS EXECUTIVE AND OFFICER COMPENSATION STUDIES. THE CONSULTING FIRM CONDUCTED A REVIEW AND ANALYSIS OF THE TOTAL COMPENSATION PAID TO THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, BASED ON COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS AND DETERMINED THAT THE COMPENSATION WAS REASONABLE. THE CONSULTING FIRM ISSUED AN OPINION LETTER AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PAID TO EMPLOYEES IDENTIFIED AS DISQUALIFIED PERSONS. THE OPINION LETTER SETTING FORTH THE FINDINGS WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS WERE MAINTAINED. FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.ALEGENTCREIGHTON.COM. ALEGENT CREIGHTON CLINIC DOES NOT MAKE THE FINANCIAL STATEMENTS OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE ARTICLES OF INCORPORATION ARE AVAILABLE AT WWW.SOS.STATE.NE.US. PART VII, SECTION A: EXECUTIVES OF THE ALEGENT CREIGHTON HEALTH SYSTEM HOURS WORKED ARE SPLIT OUT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. THE FOLLOWING EMPLOYEES ARE EXECUTIVES OF THE ALEGENT CREIGHTON HEALTH SYSTEM: RICHARD HACHTEN II, SCOTT WOOTEN, KENNETH LAWONN, JOAN NEUHAUS, RICHARD ROLSTON, MD, AND RICK MILLER, MD. THEREFORE, THEIR AVERAGE NUMBER OF HOURS WORKED PER WEEK FOR THE AFFILIATE ORGANIZATIONS ARE 56. FORM 990, SCHEDULE A, PART I, LINE 3: 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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