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 470757164 ALEGENT CREIGHTON HEALTH ALEG 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 SCOTT M WOOTEN 4023434323 2013-05-13 1 ANGELA LEA P01051055 4023434413 2011 2016-03-07 17:11:31Z SCOTT WOOTEN 12809 WEST DODGE ROAD OMAHA NE 68154 292369263 0 X WWW.ALEGENTCREIGHTON.COM X 1992 NE TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. 12 8 10040 670 4593763 0 2507063 1765480 235318678 254512681 119015 279265 25003856 33792252 262948612 290349678 16156543 17646153 0 0 95804955 98434171 228250 191998 191998 124049289 126804116 236239037 243076438 26709575 47273240 552745187 577369235 311117547 346071724 241627640 231297511 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. 1 0 21181657 7132575 113259799 ALEGENT HEALTH LAKESIDE HOSPITAL AND ALEGENT HEALTH MIDLANDS HOSPITAL STAFF ARE FOCUSED ON RESTORING PATIENTS' HEALTH BY USING PERSONALIZED CARE AND STATE-OF-THE-ART TECHNOLOGY. THE DIAGNOSTIC CENTER AT BOTH HOSPITALS IS EQUIPPED WITH THE LATEST DIGITAL IMAGING TECHNOLOGY. HEALTHCARE PROVIDERS HAVE MEDICAL INFORMATION AT THEIR FINGER TIPS, SO DIAGNOSIS IS QUICKER AND TREATMENT CAN BE STARTED SOONER. EACH DIAGNOSTIC CENTER OFFERS A FULL RANGE OF DIAGNOSTIC IMAGING SERVICES INCLUDING BUT NOT LIMITED TO THE FOLLOWING: MRI, CT SCANNING, PET/CT SCAN, ULTRASOUND, MAMMOGRAMS, NUCLEAR MEDICINE, CLINICAL LABORATORY, X-RAY IMAGING, PULMONARY SERVICES, OUTPATIENT LABORATORY TESTING, ANGIOGRAPHY AND RADIOGRAPHY. 9047059 3995323 63445150 ALEGENT HEALTH MIDLANDS COMMUNITY HOSPITAL AND ALEGENT HEALTH LAKESIDE HOSPITAL OFFER A WIDE RANGE OF COMPREHENSIVE CARDIOVASCULAR SERVICES IN THE REGION, USING A TEAM APPROACH TO ADDRESS THE TOTAL NEEDS OF THE CARDIOVASCULAR PATIENT. CARDIAC SERVICES INCLUDE BUT ARE NOT LIMITED TO: HI-TECH DIAGNOSIS AND INTERVENTION, CARDIAC CATHETERIZATION LAB, ECHOCARDIOGRAPHY, VASCULAR ULTRASOUND, HEART SCANS AND HEART CHECKS, ANGIOPLASTY AND DRUG-ELUTING STENTS. 5959032 2883381 45774941 THE ALEGENT CREIGHTON HEALTH EMERGENCY DEPARTMENTS PROVIDE EXPERT TREATMENT FOR ADULTS AND CHILDREN. WHETHER IT'S A LIFE-THREATENING MEDICAL CONDITION OR HIGH FEVER, EXPERIENCED STAFF IS TRAINED AND READY TO HANDLE A WIDE RANGE OF EMERGENCY SITUATIONS. ALEGENT CREIGHTON HEALTH IS CONSTANTLY WORKING TO FIND NEW AND BETTER WAYS TO MAKE SURE EACH PATIENT RECEIVES THE BEST, MOST EFFICIENT EMERGENCY CARE POSSIBLE. THE EMERGENCY DEPARTMENT CONSISTENTLY SCORES IN THE HIGHEST PERCENTILE FOR QUALITY OF CARE, NURSE AND DOCTOR UNDERSTANDING AND CARING, AS WELL AS THE LEAST AMOUNT OF TIME PATIENTS SPEND WAITING FOR EMERGENCY CARE. 151080344 3634874 57738433 ALEGENT CREIGHTON HEALTH GIVES BACK TO OUR COMMUNITY THROUGH A VARIETY OF MEDICAL SERVICES AND PARTNERSHIPS. ALEGENT HEALTH QUICK CARE PROVIDES URGENT MEDICAL TREATMENTS, SCREENINGS AND ADULT IMMUNIZATIONS FOR PATIENTS 18 MONTHS AND OLDER. THROUGH OUR COLLABORATION WITH OTHER LOCAL COMMUNITY ORGANIZATIONS SUCH AS BOYS TOWN, CREIGHTON UNIVERSITY, OUR HEALTHY COMMUNITY PARTNERSHIP AND ONE WORLD COMMUNITY HEALTH CENTER, ALEGENT CREIGHTON HEALTH IS HELPING TO IDENTIFY AND ADDRESS COMMUNITY HEALTH NEEDS. IN ADDITION, ALEGENT CREIGHTON HEALTH ALSO PROVIDES THE FOLLOWING SERVICES: MATERNITY CARE SERVICES, MENTAL AND BEHAVIORAL HEALTH CARE, ONCOLOGY, PROCEDURE CENTER AND INPATIENT FACILITIES INCLUDING INTENSIVE CARE. 151080344 3634874 57738433 187268092 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 1 1 0 0 1 0 0 1 1 1 1 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 X 767 0 1 10040 1 1 1 0 0 0 0 0 0 0 0 0 X 12 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X SCOTT WOOTEN SENIOR VPCFO 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 X ERIC GURLEY 4.00 X 0 0 0 JOHN HEWITT 6.00 X X 0 0 0 H KEITH SCHMODE 4.00 X 18500 0 0 LESLIE ANDERSEN 4.00 X 0 0 0 MARTIN MANCUSO MD 4.00 X 18500 0 0 MICHAEL DEFREECE 6.00 X X 0 0 0 PAUL EDGETT III 4.00 X 0 0 0 SR LILLIAN MURPHY RSM 4.00 X 0 0 0 SR PHYLLIS HUGHES 4.00 X 0 0 0 RICHARD VIERK 4.00 X 26500 0 0 ANTHONY HATCHER DO 6.00 X X 26500 415270 19914 GUILLERMO HUERTA MD 4.00 X 0 0 0 ANTOINETTE HARDY-WALLER RN 4.00 X 17500 0 0 RICHARD HACHTEN II 12.00 X 357328 1368833 297951 SCOTT WOOTEN 12.00 X 146544 561374 134300 JOAN NEUHAUS 12.00 X 132564 507818 179065 KENNETH LAWONN 12.00 X 116952 448014 115906 RICK MILLER MD 12.00 X 84303 322944 86623 RICHARD ROLSTON MD 12.00 X 97299 372723 1280141 SHEREE KEELY 12.00 X 44357 169917 44935 ELIZABETH LLEWELLYN 12.00 X 53882 206406 49772 PATRICIA MASEK 12.00 X 47937 183631 66079 PAUL EBMEIER 12.00 X 0 393678 80834 CINDY ALLOWAY 12.00 X 86662 331981 85747 KEVIN NOKELS 12.00 X 75276 288360 77591 PATRICIA MURDOCK-LANGAN MD 20.00 X 0 281165 14033 JEFFREY STROHMYER MD 20.00 X 42694 165430 37254 JANE CARMODY 12.00 X 70070 268421 52886 NANCY WALLACE 12.00 X 68877 263846 66131 MARIE KNEDLER 12.00 X 95159 364529 165768 EYAD KAKISH MD 60.00 X 413502 0 25106 ANN SCHUMACHER 12.00 X 84432 323433 86976 JAMES REICHERT MD 60.00 X 70124 268629 13533 DARREN SPLONSKOWSKI MD 60.00 X 312366 0 35097 MARK KESTNER MD 0.00 X 27238 104340 1669 FRED HOSLER MD 0.00 X 111848 428461 889 LARRY BROWN MD 1.00 X 0 650762 42928 FRANK EMSICK 12.00 X 48061 184111 15597 MARTIN HICKEY MD 0.00 X 108854 416993 0 2803829 9291069 3076725 147 1 1 0 PULMONARY MEDICINE SPECIALISTS PC 7710 MERCY RD 728 OMAHA NE 68124 PULMONARY SERVICES 2418184 CASSLING DIAGNOSTIC IMAGINGINC 13808 F STREET OMAHA NE 68137 DIAGNOSTIC IMAGING SERVICES 1660980 HRS ERASE INC 9300 UNDERWOOD AVENUE OMAHA NE 68114 ACCOUNT RECONCILIATION 1332687 SIEMENS MEDICAL SOLUTIONS USA INC 51 VALLEY STREET PARKWAY MALVERN PA 19355 IT SOLUTIONS & CONSULTING 891226 EMDEON CORP 3055 LEBANON PIKE NASHVILLE TN 37214 REVENUE CYCLE SOLUTIONS 833140 67 736293 322567 249435 457185 1765480 NET PATIENT SVC REV 561300 233637282 231403487 2233795 MANAGEMENT SVCS-AFFIL. 900003 14280036 13649028 631008 MEANINGFUL USE 900099 3230283 3230283 PHARMACY SALES 446110 2673360 1056039 1617321 FOOD & NUTRITION 722320 625178 625178 66542 66542 254512681 203334 203334 2153268 1721301 431967 431967 431967 374215 298284 75931 75931 75931 SYSTEM REVENUE ALLOC. 812900 14997127 14976907 20220 OPERATING JOINT VENTUR 900003 13139553 13139553 MISC PROGRAM REVENUE 900099 4264862 3752523 512339 958743 140362 818381 33360285 290349678 280218323 4593763 3772112 509117 509117 17137036 17137036 2386714 1193357 1193357 76631684 57473763 19157921 7267813 5450860 1816953 3213077 2409808 803269 8934883 6701162 2233721 2848703 2848703 423609 423609 174575 174575 191998 191998 3406293 2554720 851573 4648800 3486600 1162200 39854836 29891127 9963709 8964972 6723729 2241243 1118592 838944 279648 302383 226787 75596 6017821 4513366 1504455 21303571 15977678 5325893 1449889 1449889 TAXES & LICENSES 15427508 11570631 3856877 BAD DEBT 12775994 12775994 MISCELLANEOUS 5733407 4444077 1289330 PURCHASED SERVICES 1697444 1273083 424361 655719 491789 163930 243076438 187268092 55616348 191998 18949874 -17033381 6246523 6101757 18907596 28969767 2756912 2886451 4712812 4435815 7699787 8708328 611729703 304309742 302722821 307419961 20505330 4305284 2588137 19572249 167655395 212003004 552745187 577369235 135214222 132789131 367755 444222 139864545 146163278 35671025 66675093 311117547 346071724 X 241627640 231297511 241627640 231297511 552745187 577369235 X 47273240 -57603369 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 X 174575 193039 174575 193039 187093517 410490746 187268092 410683785 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 176941 262701 106741 193039 739422 250000 250000 250000 250000 1000000 1500000 2273674 1194774 11314 23450 473283 2983029 1921624 733104 16251 397306 2273673 1552292 639081 8441 278190 1921624 2368143 -340443 -4285 471123 1552292 0.00000 1.00000 0 1 1 16472791 16472791 210843413 60135049 150708364 6759098 3753971 3005127 343528813 240420722 103108091 34125588 34125588 307419961 LAND HELD FOR EXPANSION 4351616 INTERCOMPANY RECEIVABLES 207015492 GOODWILL 595889 BOND ISSUANCE COSTS 40007 212003004 THIRD PARTY PAYOR RESERVE 2136445 DEFERRED COMPENSATION/RETIREMENT PROGRAMS 3363901 MINIMUM PENSION LIABILITY 50066258 INTERCORPORATE PAYABLES 11108489 66675093 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE HELD BY ALEGENT HEALTH FOUNDATION TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF ALEGENT HEALTH. PART X, LINE 2 - ALL RELATED ENTITIES HAVE BEEN RECOGNIZED AS NOT-FOR-PROFIT CORPORATIONS BY THE INTERNAL REVENUE SERVICE (IRS) AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE EXCEPT FOR A SPECIFIED MULTI-MEMBER PARTNERSHIP IDENTIFIED IN THE AUDIT. ALEGENT RECOGNIZES 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 2012 AND 2011, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. SUB-SAHARAN AFRICA 1 1 PROGRAM SERVICES ACH HAS ONE DESIGNATED EMPLOYEE WHO IS THE LIASON FOR THE HOSPITAL LOCATED IN TANZANIA. THE EMPLOYEE ASSISTS WITH THE PROGRAMS, SERVICES AND ACTIVITIES FOR THE HOUSES FOR HEALTH AND SCHOOL OF NURSING DEPARTMENTS. 209329 1 1 0 0 1 1 209329 0 209329 0 0 0 0 0 0 X X 1 PAUL J STRAWHECKER INC 4913 DODGE STREET OMAHA NE 68132 GRANT APPLICATION AND GRANT MANAGEMENT ASSISTANCE 0 3541074 191998 3349076 3541074 191998 3349076 1 1 X 0 0 1 1 1 0 1 1 5652 4616123 0 4616123 0.02000 658 9437045 8418536 1018509 0.00440 0 279620 336506 -56886 0.00000 6310 14332788 8755042 5577746 0.02440 15465 560288 36740 523548 0.00230 736 214311 0 214311 0.00090 0 0 0 0 35001 0 35001 0.00020 4643 159875 0 159875 0.00070 20844 969475 36740 932735 0.00410 27154 15302263 8791782 6510481 0.02850 0 8200 0 8200 0.00000 0 0 0 104 8855 0 8855 0.00000 0 0 0 26 223 0 223 0.00000 0 28201 0 28201 0.00010 0 0 0 155 7994 0 7994 0.00000 0 285 53473 53473 0.00010 1 3499345 640730 29701781 45807585 -16105804 X 1 1 1 LAKESIDE AMBULATORY SURGERY CENTER LLC AMBULATORY SURGICAL CENTER 0.52000 0.48000 2 LAKESIDE ENDOSCOPY CENTER LLC AMBULATORY SURGICAL CENTER 0.52000 0.48000 3 AH-NORTHWEST IMAGING CENTER LLC DIAGNOSTIC TESTING 0.51000 0.49000 4 NEBRASKA SPINE LLC SPINE HOSPITAL 0.51000 0.49000 3 1 ALEGENT HEALTH MIDLANDS HOSPITAL

11111 S 84TH STREET PAPILLION NE 68046

X X X 2 ALEGENT HEALTH LAKESIDE HOSPITAL

16901 LAKESIDE HILLS COURT OMAHA NE 68130

X X X 3 ALEGENT HEALTH PLAINVIEW AREA HOSPITAL

704 N 3RD STREET PLAINVIEW NE 68769

X X X ALEGENT HEALTH MIDLANDS HOSPITAL 1 1 0 0 1 X X X X 1 1 X X X X X X X 1 0 1 X 0 0 ALEGENT HEALTH LAKESIDE HOSPITAL 2 1 0 0 1 X X X X 1 1 X X X X X X X 1 0 1 X 1 0 ALEGENT HEALTH PLAINVIEW AREA HOSPITAL 3 1 0 0 1 X X X X 1 1 X X X X X X X 1 0 1 X 0 0 3 THE LIGHTHOUSE HEALTHCARE RESIDENCE

17600 ARBOR STREET OMAHA NE 68130

SKILLED NURSING FACILITY ACH-PLAINVIEW RURAL HEALTH CLINIC

704 N 3RD STREET PLAINVIEW NE 68769

RURAL HEALTH CLINIC PLAINVIEW HOME HEALTH AGENCY

704 N 3RD STREET PLAINVIEW NE 68769

HOME HEALTH AGENCY PART I, LINE 3C: MIDLANDS HOSPITAL IN SARPY COUNTY, NE AND LAKESIDE HOSPITAL IN DOUGLAS COUNTY, NE SERVE THE OMAHA MSA. PLAINVIEW HOSPITAL IS LOCATED IN PIERCE COUNTY, NE AND BECAME PART OF THE ALEGENT CREIGHTON HEALTH SYSTEM ON MARCH 1, 2012. ALL THREE HOSPITALS ARE PART OF THE ALEGENT CREIGHTON HEALTH SYSTEM. THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR ENTITIES OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED YEARLY.ALL EFFORTS ARE MADE TO ESTABLISH WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SERVICE IF POSSIBLE, OTHERWISE AS SOON AS POSSIBLE FOLLOWING SERVICE. ALEGENT CREIGHTON HEALTH REPRESENTATIVES HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH ALEGENT CREIGHTON HEALTH'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENTS ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENTS RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME.PART I, LINE 6A: THE ALEGENT CREIGHTON HEALTH SYSTEM PRODUCES AN ANNUAL PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY AND PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE, AND ON ITS PUBLIC WEBSITE AT HTTP://WWW.ALEGENTCREIGHTON.COM/COMMUNITY-BENEFIT . PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS 1-8 PROVIDED WITH THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE TOTAL COMMUNITY BENEFIT EXPENSE FOR CHARITY CARE, MEDICAID AND OTHER MEANS TESTED. PART I, L7 COL(F): BAD DEBT OF $12,775,994 INCLUDED IN FUNCTIONAL EXPENSE TOTAL PART IX, LINE 25, COLUMN (A) IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. THE DENOMINATOR USED IN THE CALCULATION WAS $230,300,441. PART II: ALEGENT CREIGHTON HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE COMMUNITY BUILDING SUCH AS: -LIVE WELL OMAHA KIDS- AS A RESULT OF COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2006 WHICH POINTED TO CHILDHOOD OBESITY AS A SERIOUS HEALTH NEEDS ISSUE ACROSS ALL OMAHA MSA COUNTIES SERVED, THE ALEGENT CREIGHTON HEALTH SYSTEM PARTNERED WITH THE COMMUNITY TO MAKE A MULTI-YEAR COMMITMENT TO IMPACT CHILDHOOD OBESITY THROUGH COMMUNITY BASED BEST PRACTICE INTERVENTIONS. THIS INITIATIVE HAS HAD A PRIMARY FOCUS OF IMPACT IN DOUGLAS COUNTY, BUT THE FUNDING TO UNDERWRITE HAS COME FROM THE FISCAL PERFORMANCE OF ALL ALEGENT CREIGHTON HEALTH HOSPITALS. THE COMMUNITY COALITION KNOWN AS LIVE WELL OMAHA KIDS (LWOK) IS STAFFED AND FUNDED BY ALEGENT CREIGHTON HEALTH. AN EXECUTIVE COMMITTEE CONSISTING OF COMMUNITY LEADERS AND POLICY MAKERS HAVE DIRECTED AN ECOLOGICAL APPROACH TO IMPROVE PROGRAMS, POLICIES AND THE BUILT ENVIRONMENT TO PROMOTE PHYSICAL ACTIVITY AND HEALTHY EATING AND BUILD CAPACITY FOR HEALTHY CHOICES AT THE INDIVIDUAL AND ORGANIZATIONAL LEVEL. MORE THAN 200 VOLUNTEERS AND 90 ORGANIZATIONS HAVE PARTICIPATED IN THE PLANNING AND IMPLEMENTATION OF LWOK INITIATIVES. A PORTION OF THIS INVESTMENT IN LWOK IS ALLOCATED TO THE HOSPITALS ON A NET SERVICE REVENUE BASIS. -COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE -STRATEGIC PLANNING AND CONSULTING SERVICES FOR COMMUNITY -SPONSORSHIP OF COMMUNITY NOT FOR PROFITS AND FUNDRAISING EVENTS -SUPPORT OF INTERNATIONAL HEALTH MINISTRIES IN TANZANIA AND DOMINICAN REPUBLIC -SUPPORT OF THE FEDERALLY QUALIFIED HEALTHCARE CENTERS -PARISH NURSING PROGRAM -COMMUNITY HEALTH FAIRS, SUPPORT GROUPS AND COMMUNITY EDUCATION -SCHOOL BASED HEALTHCARE SERVICES -LEADERSHIP IN AND FUNDING OF HEALTH COALITIONS INCLUDING- -LIVE WELL OMAHA-A COALITION FOUNDED BY ALEGENT CREIGHTON HEALTH AND THE COUNTY HEALTH DEPARTMENT THAT SERVES AS CONVENER OF BUSINESS, HEALTHCARE AND COMMUNITY LEADERS TO REVIEW HEALTH TRENDS AND CATALYZE COMMUNITY ACTION TO ADDRESS HEALTH ISSUES. ALEGENT CREIGHTON HEALTH SERVES ON THE BOARD OF DIRECTORS, IS A MEMBER AT THE HIGHEST LEVEL AND LEASES STAFF TO LIVE WELL OMAHA. -LIVE WELL POTTAWATTAMIE COUNTY -AN EMERGING COALITION TO ADDRESS OBESITY IN POTTAWATTAMIE COUNTY. ALEGENT CREIGHTON HEALTH PROVIDES STRATEGIC PLANNING, GRANT WRITING AND STAFF SUPPORT. -OMAHA BY DESIGN- A COALITION THAT SUPPORT HEALTHY AND SUSTAINABLE COMMUNITY DEVELOPMENT AND LAND USE -VIOLENCE PREVENTION-A PARTNERSHIP WITH CATHOLIC HEALTH INITIATIVES, WOMEN'S CENTER FOR ADVANCEMENT, UNIVERSITY OF NEBRASKA-OMAHA AND CREIGHTON UNIVERSITY TO IMPLEMENT A CAMPUS BASED VIOLENCE PREVENTION PLAN KNOWN AS "GREEN DOT." ALEGENT CREIGHTON HEALTH ALSO SUPPORTS ECPR TRAINING TO PROVIDE COMMUNITY CAPACITY AND SKILLS TO ADDRESS THE TRAUMA ASSOCIATED WITH VIOLENCE. -METRO AREA CONTINUUM OF CARE FOR THE HOMELESS- BOARD SERVICE AND FINANCIAL SUPPORT TO THIS COALITION ADDRESSING HOMELESSNESS IN THE SERVICE AREA. -HOPE MEDICAL COALITION-BOARD SERVICE AND ANNUAL OPERATING SUBSIDY. ALEGENT CREIGHTON HEALTH'S HOSPITALS AND PHYSICIANS PROVIDE SPECIALTY CARE TO PATIENTS UNABLE TO AFFORD MEDICAL SERVICES. -PARTICIPATION IN AND FUNDING OF MATERNAL HEALTH, BREASTFEEDING, SUBSTANCE ABUSE, CANCER, DIABETES AND OTHER COMMUNITY HEALTH COALITIONS -MENTAL HEALTH COALITIONS INCLUDING NATIONAL ALLIANCE ON MENTAL ILLNESS, NEBRASKA, NEBRASKA ASSOCIATION OF BEHAVIORAL HEALTH CARE ORGANIZATIONS, AND THE JUVENILE JUSTICE PROVIDER FORUM BEHAVIORAL HEALTH COMMITTEE. PLAINVIEW HOSPITAL BECAME A NOT-FOR-PROFIT HOSPITAL IN MARCH 2012 WHEN IT WAS ACQUIRED BY ALEGENT CREIGHTON HEALTH AND HAS BEEN WORKING TO QUANTIFY AND INTEGRATE ITS COMMUNITY OUTREACH INTO THE SYSTEM'S COMMUNITY BENEFIT PROGRAMS. PLAINVIEW HAS A HISTORY OF COMMUNITY EDUCATION AND CONDUCTING HEALTH SCREENS AND SPORTS PHYSICALS FOR THE COMMUNITY. PART III, LINE 4: THE AUDITED FOOTNOTES FOR ENTITIES OF THE ALEGENT CREIGHTON HEALTH SYSTEM DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATIONS WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS.BAD DEBT EXPENSE (AT COST) FOR ENTITIES OF ALEGENT CREIGHTON HEALTH IS DETERMINED BY USING THE COST TO CHARGE RATIO FROM MEDICARE COST REPORTS PER ENTITY AND MULTIPLYING THE RATIO BY THE ACTUAL BAD DEBT CHARGES PER ENTITY.TO DETERMINE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, REPRESENTATIVES OF THE ALEGENT CREIGHTON HEALTH SYSTEM DETERMINE IF AN ACCOUNT NEEDS TO BE MOVED FROM BAD DEBT TO CHARITY WHEN A PATIENT EITHER COMES FORWARD AND COMPLETES A CHARITY APPLICATION, WHICH IS APPROVED OR IF IT IS DETERMINED THAT THE PATIENT HAS NO OTHER RESOURCES TO PAY THE ACCOUNT BALANCE. PART III, LINE 8: THE ALEGENT CREIGHTON HEALTH SYSTEM DOES NOT CONSIDER MEDICARE SHORTFALLS TO BE COMMUNITY BENEFIT, PER THE RECOMMENDATION OF THE CATHOLIC HEALTH ASSOCIATION. THE MEDICARE CHARGES REPORTED ON LINE 5 AND 6 ARE FROM MEDICARE COST REPORTS WHICH USED A COST TO CHARGE RATIO. PART III, LINE 9B: THE ALEGENT CREIGHTON HEALTH SYSTEMS SELF PAY BILLING AND BAD DEBT POLICY HAS A CLEARLY DELINEATED PROCESS AND GUIDELINES FOR COLLECTION AGENCIES TO FOLLOW, INCLUDING EXPLICIT INSTRUCTIONS TO ADHERE TO THE SAME FINANCIAL ASSISTANCE GUIDELINES AS ALEGENT CREIGHTON HEALTH. ALEGENT HEALTH MIDLANDS HOSPITAL PART V, SECTION B, LINE 9: FOR ALEGENT HEALTH MIDLANDS HOSPITAL, ALEGENT HEALTH LAKESIDE HOSPITAL AND ALEGENT HEALTH PLAINVIEW AREA HOSPITAL, THE ELIGIBILITY FOR PROVIDING FREE CARE IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED YEARLY. ALL EFFORTS ARE MADE TO ESTABLISH WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SERVICE IF POSSIBLE, OTHERWISE AS SOON AS POSSIBLE FOLLOWING SERVICE. ALEGENT CREIGHTON HEALTH REPRESENTATIVES HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH ALEGENT CREIGHTON HEALTH'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME. ALEGENT HEALTH MIDLANDS HOSPITAL PART V, SECTION B, LINE 10: FOR ALEGENT HEALTH MIDLANDS HOSPITAL, ALEGENT HEALTH LAKESIDE HOSPITAL AND ALEGENT HEALTH PLAINVIEW AREA HOSPITAL, THE ELIGIBILITY FOR PROVIDING DISCOUNTED CARE IS BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED YEARLY. ALL EFFORTS ARE MADE TO ESTABLISH WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SERVICE IF POSSIBLE, OTHERWISE AS SOON AS POSSIBLE FOLLOWING SERVICE. ALEGENT CREIGHTON HEALTH REPRESENTATIVES HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH ALEGENT CREIGHTON HEALTH'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENTS ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENTS RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME. ALEGENT HEALTH MIDLANDS HOSPITAL PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION. ALEGENT HEALTH LAKESIDE HOSPITAL PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION. ALEGENT HEALTH PLAINVIEW AREA HOSPITAL PART V, SECTION B, LINE 11H: SIZE OF THE FAMILY IS ALSO USED IN THE CALCULATION. ALEGENT HEALTH MIDLANDS HOSPITAL PART V, SECTION B, LINE 13G: INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENTCREIGHTON.COM AND THROUGH BROCHURES PROVIDED AT THE MAIN PATIENT REGISTRATION AREAS. LETTERS AND BILLING STATEMENTS SENT OUT TO PATIENTS INCLUDE A STATEMENT THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE AND HOW TO OBTAIN ADDITIONAL INFORMATION. COUNSELORS OF THE ALEGENT CREIGHTON HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. ALEGENT HEALTH LAKESIDE HOSPITAL PART V, SECTION B, LINE 13G: INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENTCREIGHTON.COM AND THROUGH BROCHURES PROVIDED AT THE MAIN PATIENT REGISTRATION AREAS. LETTERS AND BILLING STATEMENTS SENT OUT TO PATIENTS INCLUDE A STATEMENT THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE AND HOW TO OBTAIN ADDITIONAL INFORMATION. COUNSELORS OF THE ALEGENT CREIGHTON HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. ALEGENT HEALTH PLAINVIEW AREA HOSPITAL PART V, SECTION B, LINE 13G: INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENTCREIGHTON.COM AND THROUGH BROCHURES PROVIDED AT THE MAIN PATIENT REGISTRATION AREAS. LETTERS AND BILLING STATEMENTS SENT OUT TO PATIENTS INCLUDE A STATEMENT THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE AND HOW TO OBTAIN ADDITIONAL INFORMATION. COUNSELORS OF THE ALEGENT CREIGHTON HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. ALEGENT HEALTH LAKESIDE HOSPITAL PART V, SECTION B, LINE 20: DURING FISCAL YEAR ENDING JUNE 30, 2012, FOUR PATIENTS WERE CHARGED MORE THAN THE AVERAGE OF THE THREE BEST NEGOTIATED COMMERCIAL INSURANCE RATES AT ALEGENT HEALTH LAKESIDE HOSPITAL. THE PATIENTS WERE IDENTIFIED PRIOR TO FISCAL YEAR END, THREE OF THE FOUR WERE REFUNDED AND THE OTHER PATIENT QUALIFIED FOR 100% FINANCIAL ASSISTANCE AND THEREFORE NEVER PERSONALLY INCURRED THE EXPENSE. PART VI, LINE 2: THE PROCESS TO DEVELOP ASSESSMENTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS COLLABORATIVE IN NATURE AND INVOLVES HEALTH DEPARTMENTS, EXISTING HEALTH COALITIONS, COMMUNITY MEMBERS AND HOSPITAL LEADERSHIP, AND IS SUPPORTED BY THE ALEGENT CREIGHTON HEALTH'S COMMUNITY BENEFIT AND HEALTHIER COMMUNITIES DEPARTMENT STAFF. EACH ALEGENT CREIGHTON HEALTH HOSPITAL PARTICIPATES IN THE CHNA PROCESS FOR THE COUNTY IN WHICH THE FACILITY IS LOCATED AT LEAST EVERY 3 YEARS IN PARTNERSHIP WITH THE LOCAL HEALTH DEPARTMENTS. THE ASSESSMENT VARIES IN EACH COMMUNITY BUT INCLUDES REVIEW OF PRIMARY DATA (SUCH AS SURVEYS, KEY INFORMANT INTERVIEWS, FOCUS GROUPS) AND SECONDARY DATA (SUCH AS COUNTY HEALTH RANKINGS, BRFRSS, YRBS, CENSUS DATA ETC) LEADERSHIP FROM ALEGENT CREIGHTON HEALTH PARTICIPATE IN MULTIPLE INTERNAL AND EXTERNAL VENUES TO GARNER COMMUNITY INPUT, PRIORITIZE COMMUNITY HEALTH NEEDS, AND DEVELOP COMMUNITY HEALTH IMPROVEMENT PLANS. THE CHNA REPORT FOR EACH COMMUNITY IS MADE AVAILABLE TO THE PUBLIC BY POSTING THE REPORT ON THE ALEGENT CREIGHTON HEALTH EXTERNAL WEBSITE AND BY MAKING IT AVAILABLE IN COMMUNITY VENUES. THE CHNAS ARE INTEGRATED INTO THE GOVERNANCE AND PLANNING FOR ALEGENT CREIGHTON HEALTH ON TWO LEVELS- -REPORTING INTO THE COMMITTEE OF THE BOARD OF DIRECTORS CHARGED WITH HEALTH PLANNING OVERSIGHT INTO THE ANNUAL STRATEGIC PLANNING AND BUDGETING PROCESSES OF ALEGENT CREIGHTON HEALTH. IN THE FOUR COUNTY OMAHA MSA WHICH MIDLANDS AND LAKESIDE HOSPITALS SERVE, ALEGENT CREIGHTON HEALTH PARTNERS WITH LOCAL HEALTH DEPARTMENTS, LIVE WELL OMAHA AND COMPETING HEALTH SYSTEMS TO RETAIN PROFESSIONAL RESEARCH CONSULTANTS TO CONDUCT A CHNA FOR THE OMAHA/COUNCIL BLUFFS METROPOLITAN SERVICE AREA. THE CHNA COVERS FOUR COUNTIES SERVED BY THE ALEGENT CREIGHTON HEALTH OMAHA AND COUNCIL BLUFFS HOSPITALS. THE CHNA REPORTS DATA AT THE COUNTY LEVEL AND FOR DOUGLAS COUNTY, BY FOUR QUADRANTS WITHIN THE COUNTY. ALEGENT CREIGHTON HEALTH LEADERS SERVE ON THE CHNA STEERING COMMITTEE AND PARTICIPATE IN KEY INFORMANT INTERVIEWS CONDUCTED AT HOSPITAL LOCATIONS. THE CHNA IS SHARED IN MULTIPLE VENUES WITH THE PUBLIC, INCLUDING AT THE LIVE WELL OMAHA SUMMIT. ALEGENT CREIGHTON HEALTH IS ONE OF THE FOUNDERS OF LIVE WELL OMAHA, A 35 MEMBER HEALTHY COMMUNITY COLLABORATION, AND CONTINUES TO BE A KEY FINANCIAL SUPPORTER AND MEMBER OF THE BOARD OF THE DIRECTORS. IN ADDITION, ALEGENT CREIGHTON HEALTH HAS JOINED WITH LOCAL HEALTH SYSTEMS AND HEALTH DEPARTMENTS TO FUND THE WEB BASED COMMUNITY HEALTH DASHBOARD. (HTTP://WWW.DOUGLASCOHEALTH.ORG/). PARTICULAR TO PIERCE COUNTY, NE, THE COUNTY IN WHICH PLAINVIEW HOSPITAL IS LOCATED, HOSPITAL LEADERSHIP AND OTHER COMMUNITY LEADERS FROM ANTELOPE, BOYD, BROWN, CHERRY, HOLT, KEYA PAHA, KNOX, PIERCE AND ROCK COUNTIES, NE PARTICIPATE IN A CHNA LED BY THE NORTH CENTRAL DISTRICT HEALTH DEPARTMENT. NORTH CENTRAL DISTRICT HEALTH DEPARTMENT RETAINS IONIA RESEARCH TO ADMINISTER BOTH ONLINE AND MAILED SURVEYS TO RANDOMLY SELECTED HOUSEHOLDS THROUGH THE DISTRICT. THE CHNA INCLUDES DATA FROM THE PUBLIC HEALTH ACTION NETWORK, BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM, YOUTH RISK BEHAVIOR SURVEY, BUREAU OF CENSUS, HEALTHY COMMUNITIES DATABASES (POPULATION HEATH INSTITUTE, UNIVERSITY OF WISCONSIN, ROBERT WOOD JOHNSON FOUNDATION) AND HEALTHY PEOPLE 2020. THE CHNA HAS BEEN SHARED IN MULTIPLE VENUES AND HOSPITAL LEADERSHIP HAS PARTICIPATED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN DEVELOPED COLLABORATIVELY WITH THE COMMUNITY. PART VI, LINE 3: THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE; SIGNS ARE POSTED IN CLINICS AND HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND HOSPITALS. INFORMATION ON THE ALEGENT CREIGHTON HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICIES ARE LOCATED SEVERAL PLACES ON THE SYSTEM'S WEBSITE-WWW.ALEGENTCREIGHTON .COM.ALL EFFORTS ARE MADE TO ESTABLISH WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SERVICE IF POSSIBLE, OTHERWISE AS SOON AS POSSIBLE FOLLOWING SERVICE. ALEGENT CREIGHTON HEALTH REPRESENTATIVES HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH ALEGENT CREIGHTON HEALTH'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME. PART VI, LINE 4: MIDANDS & LAKESIDE-ALEGENT CREIGHTON HEALTH SYSTEM SERVES THE EIGHT COUNTY GREATER OMAHA METROPOLITAN STATISTICAL AREA (MSA), WITH AN ESTIMATED POPULATION OF OVER 881,496, RANKING 60TH OUT OF 381 MSAS IN TOTAL POPULATION. THE MSA CONSISTS OF 3 IOWA AND 5 NEBRASKA COUNTIES ON BOTH SIDES OF THE MISSOURI RIVER AND COVERS 4,363 SQUARE MILES. NEARLY 1.3 MILLION PEOPLE LIVE WITHIN A 60-MILE RADIUS OF OMAHA. CHARACTERIZED BY STEADY GROWTH, THE MSA GREW BY 14.9 PERCENT BETWEEN 2000 AND 2011; THE 2016 PROJECTED POPULATION IS MORE THAN 946,000, A 7.3 PERCENT INCREASE. APPROXIMATELY 36 PERCENT OF THE POPULATION IS 25 YEARS OF AGE OR YOUNGER WITH A MEDIAN AGE OF 34.8 YEARS COMPARED TO A U.S. MEDIAN AGE OF 36.9. 50.8% OF THE POPULATION IS FEMALE. RACIAL MINORITIES COMPRISE ABOUT 17.4 PERCENT OF GREATER OMAHAS POPULATION, INCLUDING AN AFRICAN-AMERICAN POPULACE OF 7.8 PERCENT AND APPROXIMATELY 9.6 PERCENT HISPANIC. IN 2010 GREATER OMAHA HAD OVER 360,000 HOUSING UNITS. THE MEDIAN HOUSEHOLD INCOME IS $57,901 WHICH SURPASSES THE NATIONAL AVERAGE OF $53,658, WITH A PER CAPITA INCOME OF $27,915. GREATER OMAHA IS A WELL-EDUCATED COMMUNITY. MORE THAN 91 PERCENT OF ADULTS, AGE 25 AND OLDER, ARE HIGH SCHOOL GRADUATES AND 35.9 PERCENT HAVE A BACHELORS DEGREE OR HIGHER, COMPARED TO 28.6 PERCENT NATIONALLY. OMAHA IS HOME TO MANY MAJOR COMPANIES AND LARGE EMPLOYERS, INCLUDING SIX FORTUNE 500 COMPANIES, MAKING IT FOURTH IN THE NATION FOR NUMBER OF SUCH COMPANIES PER CAPITA.PLAINVIEW IS LOCATED IN NORTHEAST NEBRASKA IN PIERCE COUNTY. SERVED BY U.S. HIGHWAY 20 AND STATE HIGHWAY 13, PLAINVIEW IS 32 MILES NORTHWEST OF NORFOLK, NE; 55 MILES SOUTHWEST OF YANKTON, SD; 75 MILES WEST OF SIOUX CITY, IA; AND 145 MILES NORTHWEST OF OMAHA, NE. THE POPULATION OF PIERCE COUNTY IS 7,216, WITH 1,245 RESIDENTS LIVING IN PLAINVIEW. ALEGENT CREIGHTON HEALTH PLAINVIEW HOSPITAL SERVES PRIMARILY RURAL RESIDENTS OF PIERCE, ANTELOPE AND KNOX COUNTIES. PIERCE COUNTY IS RANKED FOURTH OUT OF 79 COUNTIES IN HEALTH OUTCOMES. THE MEDIAN AGE IS 37.9 COMPARED TO 35.3 STATEWIDE. THE RACIAL MAKEUP IS PRIMARILY CAUCASIAN. PART VI, LINE 5: ALEGENT CREIGHTON HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT AND HOSPITAL SPECIFIC COMMUNITY BENEFIT INVESTMENTS TO ADDRESS COMMUNITY HEALTH NEEDS OF THE PARTICULAR SERVICE AREA. EXAMPLES OF HOW ALEGENT CREIGHTON HEALTH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY INCLUDE: -FINANCIAL ASSISTANCE AND UNPAID COSTS OF MEDICAID -COMMUNITY HEALTH IMPROVEMENT SERVICES- -COMMUNITY EDUCATION, CLASSES AND PROGRAMS (CHILDBIRTH, DIABETES, ONCOLOGY, PHYSICAL ACTIVITY, HEALTHY EATING AND COOKING, HEALTH CAREERS, CANCER, SPORTS MEDICINE, ETC.) -SUPPORT GROUPS (CANCER, BEREAVEMENT, YOUTH, ETC.) -COMMUNITY HEALTH FAIRS AND SCREENINGS -IMMUNIZATION CLINICS -PARISH NURSING PROGRAM AND FAITH COMMUNITY OUTREACH -SCHOOL BASED HEALTHCARE SERVICES -HEALTH PROFESSIONAL EDUCATION- -CLINICAL PRECEPTORSHIPS FOR HEALTHCARE PROFESSIONALS -SCHOLARSHIPS AND MENTORSHIPS -AFFILIATION WITH AND SUPPORT OF CREIGHTON UNIVERSITY SCHOOL OF MEDICINE -PHYSICIAN RESIDENCY AND FELLOWSHIP PROGRAMS TRAINING MORE THAN 200 RESIDENTS AND FELLOWS ANNUALLY -RESEARCH-PARTICIPATION IN THE MISSOURI VALLEY CANCER CONSORTIUM -FINANCIAL AND IN-KIND CONTRIBUTIONS -SUPPORT OF THE FEDERALLY QUALIFIED HEALTHCARE CENTERS (AND HOPE MEDICAL COALITION WHICH PROVIDES ACCESS TO MEDICAL SERVICES SPECIFICALLY FOR THE UNDERSERVED -CORPORATE SPONSORSHIPS -TANZANIA AND DOMINICAN REPUBLIC HEALTH MINISTRIES -STAFF SERVICE ON HEALTH RELATED BOARD AND COALITIONS -SUBSIDIZED HEALTHCARE SERVICE INCLUDING BEHAVIORAL HEALTH, NICU, HOME HEALTH AND HOSPICE -COMMUNITY BUILDING ACTIVITIES- -COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE -STRATEGIC PLANNING AND CONSULTING SERVICES FOR COMMUNITY -HEALTH COALITIONS -LIVE WELL OMAHA-A COALITION FOUNDED BY ACH AND THE COUNTY HEALTH DEPARTMENT THAT SERVES AS CONVENER OF BUSINESS, HEALTHCARE AND COMMUNITY LEADERS TO REVIEW HEALTH TRENDS AND CATALYZE COMMUNITY ACTION TO ADDRESS HEALTH ISSUES. ACH SERVES ON THE BOARD OF DIRECTORS, IS A MEMBER AT THE HIGHEST LEVEL AND LEASES STAFF TO LIVE WELL OMAHA. -LIVE WELL OMAHA KIDS-A COALITION FUNDED AND STAFFED FOR SEVEN YEARS BY ACH TO ADDRESS CHILDHOOD OBESITY -LIVE WELL POTTAWATTAMIE-AN EMERGING COALITION TO ADDRESS OBESITY IN POTTAWATTAMIE COUNTY. ACH PROVIDES STRATEGIC PLANNING, GRANT WRITING AND STAFF SUPPORT. -VIOLENCE PREVENTION-A PARTNERSHIP WITH CATHOLIC HEALTH INITIATIVES, WOMENS CENTER FOR ADVANCEMENT, UNIVERSITY OF NEBRASKA-OMAHA AND CREIGHTON UNIVERSITY TO IMPLEMENT A CAMPUS BASED VIOLENCE PREVENTION PLAN KNOWN AS "GREEN DOT." -METRO AREA CONTINUUM OF CARE FOR THE HOMELESS- BOARD SERVICE AND FINANCIAL SUPPORT TO THIS COALITION ADDRESSING HOMELESSNESS IN THE SERVICE AREA. -HOPE MEDICAL COALITION-BOARD SERVICE AND ANNUAL OPERATING SUBSIDY. ACH HOSPITALS AND PHYSICIANS PROVIDE SPECIALTY CARE TO PATIENTS UNABLE TO AFFORD MEDICAL SERVICES. -PARTICIPATION IN AND FUNDING OF MATERNAL HEALTH, BREASTFEEDING, SUBSTANCE ABUSE, CANCER, DIABETES AND OTHER COMMUNITY HEALTH COALITIONS -MENTAL HEALTH COALITIONS INCLUDING NATIONAL ALLIANCE ON MENTAL ILLNESS, NEBRASKA ASSOCIATION OF BEHAVIORAL HEALTH CARE ORGANIZATIONS, AND THE JUVENILE JUSTICE PROVIDER FORUM BEHAVIORAL HEALTH COMMITTEE. -THE PRIMARY CARE PHYSICIAN CLINICS THAT ARE PART OF THE PARENT CORPORATION PROVIDE ACCESS TO CARE THROUGH THE SYSTEM'S FINANCIAL ASSISTANCE POLICY AND PARTICIPATE IN MEDICAL STUDENT PRECEPTORSHIPS THAT ADVANCE THE HEALTHCARE PROVIDER EDUCATION PROCESS -ALEGENT CREIGHTON HEALTH IS ONE OF THREE HEALTH SYSTEMS THAT FUND THE OPERATIONS OF A COALITION THAT EXISTS TO PROVIDE ACCESS FOR THE PATIENTS OF THREE AREA FEDERALLY QUALIFIED HEALTHCARES TO SPECIALTY PHYSICIAN SERVICES AND HOSPITAL BASED DIAGNOSTICS AND TREATMENT -ALEGENT CREIGHTON HEALTH IS THE SOLE COMPREHENSIVE MENTAL HEALTH PROVIDER IN THE OMAHA MSA AREA -ALEGENT CREIGHTON HEALTH IS A JOINT VENTURE PARTNER IN A NOT-FOR-PROFIT HOSPICE INPATIENT HOSPITAL AND PROVIDES THE MANAGEMENT SUPPORT CONTRACT. -ALEGENT CREIGHTON HEALTH BUDGETS FOR AN EMERGENCY FUND AS A SUBSET OF OTHER COMMUNITY DONATIONS TO RESPOND TO CRISIS OR UNPLANNED FUNDING NEEDS OF A VITAL COMMUNITY SERVICE, WHICH HAS FIRST USED IN FY11 WITH THE ECONOMIC DOWNTURN. (PART I 7.I)PLAINVIEW HOSPITAL IS LOCATED IN PLAINVIEW, NE, A COMMUNITY OF ABOUT 1,200 RESIDENTS LOCATED IN PIERCE COUNTY, NE. SINCE ITS OPENING IN 1968, PLAINVIEW HOSPITAL HAS BEEN PROVIDING CARE TO PATIENTS FROM PIERCE, NORTHEASTERN ANTELOPE AND SOUTHEASTERN KNOX COUNTIES WITH EXCEPTIONAL CARE AND QUALITY OUTCOMES. PLAINVIEW HOSPITAL IS A 16 BED CRITICAL ACCESS FACILITY WITH INPATIENT AND OUTPATIENT SERVICES INCLUDING: EMERGENCY, LABORATORY, RADIOLOGY, HOME HEALTH, SPECIALTY CLINICS, PHYSICAL THERAPY, CARDIAC REHAB, PULMONARY REHAB, SURGERY, OCCUPATIONAL THERAPY AND COUMADIN CLINICS.BOARD OF DIRECTORS - ALEGENT CREIGHTON HEALTH IS GOVERNED BY A BOARD OF DIRECTORS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF OUR LOCAL COMMUNITY WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. EMERGENCY DEPARTMENT - ALEGENT CREIGHTON HEALTH HOSPITALS HAVE FULL-TIME EMERGENCY DEPARTMENTS THAT ARE OPEN TO THE PUBLIC AND PROVIDE MEDICAL SCREENING EXAMINATIONS AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITY OF THE HOSPITALS REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE, AND/OR ABILITY TO PAY. THE HOSPITALS ARE IN COMPLIANCE WITH THE FEDERAL EMTALA REGULATIONS.IN ADDITION, ALEGENT CREIGHTON HEALTH, TOGETHER WITH UNRELATED HOSPITALS IN THE AREA, WORKS CLOSELY WITH LOCAL FIRE AND RESCUE DEPARTMENTS TO ENSURE THAT AMBULANCES TAKE PATIENTS TO THE APPROPRIATE HOSPITAL. THIS IS GENERALLY THE HOSPITAL THAT IS CLOSEST GEOGRAPHICALLY WITH EXCEPTIONS BASED ON PATIENT PREFERENCE, PATIENT'S PHYSICIAN PREFERENCE, AND CAPACITY OR THE AVAILABILITY OF SPECIALIZED FACILITIES OR PROGRAMS RELATED TO THE PATIENT'S CONDITION. FINALLY, ALEGENT CREIGHTON HEALTH MAINTAINS DETAILED PROCEDURES REGARDING WHEN AND UNDER WHAT CIRCUMSTANCES A PATIENT CAN BE TRANSFERRED. UNDER THIS POLICY, NO PATIENT WILL BE TRANSFERRED BASED ON RACE, CREED, RELIGION OR ABILITY TO PAY.MEDICAL STAFF - ALEGENT CREIGHTON HEALTH MAINTAINS AN OPEN MEDICAL STAFF. ALL QUALIFIED MDS, DOS, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITALS. ALEGENT CREIGHTON HEALTH'S POLICY ON PHYSICIAN CREDENTIALING IS THAT NO INDIVIDUAL IS TO BE DENIED MEDICAL STAFF APPOINTMENT BASED ON SEX, RACE, CREED, COLOR OR NATIONAL ORIGIN. THE STANDARDS A PHYSICIAN MUST MEET FOR APPOINTMENT RELATE TO (1) EDUCATIONAL QUALIFICATIONS AND LICENSING; (2) PROFESSIONAL COMPETENCE, (3) CHARACTER, (4) ETHICAL STANDING, AND (5) ABILITY TO RELATE TO AND WORK WITH OTHERS. APPLICATIONS ARE REVIEWED AT SEVERAL LEVELS WITHIN THE ORGANIZATION. PHYSICIANS WHO HAVE BEEN GRANTED STAFF PRIVILEGES AUTOMATICALLY BECOME MEMBERS OF THE MEDICAL STAFF AT THE HOSPITAL(S) FOR WHICH PRIVILEGES HAVE BEEN GRANTED. PART VI, LINE 6: THE SENIOR LEADERSHIP OF THE INDIVIDUAL HOSPITALS IS ENGAGED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS THAT IS SUPPORTED BY THE ALEGENT CREIGHTON HEALTH SYSTEM COMMUNITY BENEFIT AND HEALTHIER COMMUNITIES DEPARTMENT.(SEE PART VI-2/COMMUNITY NEEDS ASSESSMENT) EACH HOSPITAL PARTICIPATES IN THE DEVELOPMENT OF COMMUNITY HEALTH IMPROVEMENT ACTION PLAN TO ADDRESS THE NEEDS IDENTIFIED IN THE ASSESSMENT FOR THEIR PARTICULAR COMMUNITY. THE HOSPITAL IS INVOLVED IN SHARED SYSTEM-WIDE BUDGET DECISION MAKING TO MEET THE PRIORITIZED COMMUNITY HEALTH NEEDS IN COLLABORATION WITH COMMUNITY PARTNERS. THE CORPORATE SUPPORT AND COMMUNITY BENEFIT FUNCTION ARE FUNDED FROM THE OPERATIONS OF THE INDIVIDUAL HOSPITALS. THE INDIVIDUAL HOSPITALS BECOME MORE INVOLVED IN SPECIFIC STRATEGIC RESPONSES THROUGH THE SERVICES THEY PROVIDE AND THEIR PARTICIPATION IN THE COALITIONS AND THE COMMUNITY HEALTH IMPROVEMENT PLAN FOR THEIR SERVICE AREA. REPORTS FILED WITH STATES PART VI, LINE 7 NE,IA 1 MISSOURI VALLEY CANCER CONSORTIUM 6818 GROVER STREET OMAHA NE 68130 470773531 501(C)(3) 110706 GENERAL SUPPORT GREATER OMAHA CHAMBER FOUNDATION 1301 HARNEY STREET OMAHA NE 68102 470258610 501(C)(3) 68000 GENERAL SUPPORT MEMORIAL COMMUNITY HOSPITAL FOUNDATION 810 NORTH 22ND STREET BLAIR NE 68008 470426285 501(C)(3) 50000 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 10100 J STREET OMAHA NE 68127 135613797 501(C)(3) 30100 GENERAL SUPPORT FRIENDS OF NAIVASHA HOSPITAL 25002 MASON STREET WATERLOO NE 68069 030564411 501(C)(3) 29101 GENERAL SUPPORT AMERICAN CANCER SOCIETY 9850 NICHOLAS STREET OMAHA NE 68114 237040934 501(C)(3) 15780 GENERAL SUPPORT COUNCIL BLUFFS COMMUNITY HEALTH CENTER 300 WEST BROADWAY COUNCIL BLUFFS IA 51503 261570400 501(C)(3) 14625 GENERAL SUPPORT ONEWORLD COMMUNITY HEALTH CENTERS INC 4920 SOUTH 30TH STREET STE 103 OMAHA NE 68107 470548990 501(C)(3) 13525 GENERAL SUPPORT CATHOLIC CHARITIES OF ARCHDIOCESE OF OMAHA 3300 N 60TH STREET OMAHA NE 68104 470376612 501(C)(3) 12500 GENERAL SUPPORT SUSAN G KOMEN FOUNDATION 5005 LBJ FREEWAY DALLAS TX 75244 751835298 501(C)(3) 11026 GENERAL SUPPORT MARCH OF DIMES 1275 MAMAROMECK AVENUE WHITE PLAINS NY 10605 131846366 501(C)(3) 10850 GENERAL SUPPORT VOICES FOR CHILDREN IN NEBRASKA 7521 MAIN STREET NO 103 OMAHA NE 68127 363528940 501(C)(3) 10000 GENERAL SUPPORT NEBRASKA SYNOD ELCA 4980 S 118TH STREET STE D OMAHA NE 68137 363514308 501(C)(3) 10000 GENERAL SUPPORT PAPILLION RECREATION DEPARTMENT 1100 W LINCOLN ROAD PAPILLION NE 68046 476006318 501(C)(3) 10000 GENERAL SUPPORT CHARLES DREW HEALTH CENTER 2915 GRANT STREET OMAHA NE 68111 470666715 501(C)(3) 10000 GENERAL SUPPORT NEBRASKA LUTHERAN OUTDOOR MINISTRIES 27416 RANCH ROAD ASHLAND NE 68003 470488319 501(C)(3) 10000 GENERAL SUPPORT CITY OF CORNING 601 6TH STREET CORNING IA 50841 426004418 501(C)(3) 9000 GENERAL SUPPORT AMERICAN DIABETES ASSOCIATION 12838 AUGUSTA AVENUE OMAHA NE 68144 131623888 501(C)(3) 8700 GENERAL SUPPORT AMERICAN LUNG ASSOCIATION 14 WALL STREET NO 8C NEW YORK NY 10005 131632524 501(C)(3) 8225 GENERAL SUPPORT CREIGHTON UNIVERSITY 2500 CALIFORNIA PLAZA OMAHA NE 68178 470376583 501(C)(3) 6500 GENERAL SUPPORT JUNIOR ACHIEVEMENT OF THE MIDLANDS 13506 WEST MAPLE ROAD OMAHA NE 68164 470468426 501(C)(3) 5907 GENERAL SUPPORT BOYS AND GIRLS CLUB OF THE MIDLANDS 2610 HAMILTON STREET OMAHA NE 68131 470467350 501(C)(3) 5725 GENERAL SUPPORT ALEGENT HEALTH FOUNDATION 12809 W DODGE ROAD OMAHA NE 68154 470648586 501(C)(3) 5500 FMV 1.0 CT. DIAMOND CONTRIBUTION FOR GAME OF CHANCE AT FUNDRAISING EVENT 23 0 CHARITY CARE/FINANCIAL ASSISTANCE 5401 17137036 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 HEALTH ONLY DISTRIBUTES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS WITH THE SAME MISSION AND PURPOSE AS THE ALEGENT CREIGHTON HEALTH SYSTEM. THESE DISTRIBUTIONS ARE MONITORED TO ENSURE THEY ARE BEING USED AS SPECIFIED BY THE ORGANIZATION. SCHEDULE I, PART III: ALEGENT CREIGHTON HEALTH 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. X X 1 1 X X X X X 1 1 0 1 0 1 1 0 0 ANTHONY HATCHER DO 26500 388421 0 0 0 26849 0 0 0 21332 26500 436602 0 0 RICHARD HACHTEN II 142764 546895 89244 341869 125320 480069 58449 223901 3536 13546 419313 1606280 95813 367034 SCOTT WOOTEN 75461 289074 44393 170059 26690 102241 23806 91194 4535 17372 174885 669940 10063 38550 JOAN NEUHAUS 71088 272321 38261 146566 23215 88931 37068 141997 1162 4452 170794 654267 8683 33263 KENNETH LAWONN 60373 231276 35910 137562 20669 79176 23396 89622 885 3392 141233 541028 8258 31634 RICK MILLER MD 49078 188006 26242 100526 8983 34412 12412 47548 6377 24430 103092 394922 2037 7804 RICHARD ROLSTON MD 73220 280485 18332 70225 5747 22013 262572 1005844 4452 17054 364323 1395621 0 0 SHEREE KEELY 25975 99499 10310 39496 8072 30922 6972 26710 2616 10023 53945 206650 2260 8656 ELIZABETH LLEWELLYN 31349 120089 12559 48108 9974 38209 8321 31877 2159 8271 64362 246554 2674 10242 PATRICIA MASEK 29917 114601 11118 42590 6902 26440 10449 40029 3370 12911 61756 236571 2268 8688 PAUL EBMEIER 0 258789 0 93516 0 41373 0 59855 0 22797 0 476330 0 20450 CINDY ALLOWAY 50771 194492 20541 78688 15350 58801 14107 54039 4536 17374 105305 403394 4026 15423 KEVIN NOKELS 40957 156895 18043 69116 16276 62349 10758 41209 5549 21256 91583 350825 3719 14246 PATRICIA MURDOCK-LANGAN MD 0 266394 0 0 0 14771 0 13475 0 3025 0 297665 0 0 JEFFREY STROHMYER MD 41870 162238 0 0 824 3192 3010 11663 4632 17949 50336 195042 0 0 JANE CARMODY 52072 199476 10592 40576 7406 28369 8461 32412 2751 10538 81282 311371 803 3074 NANCY WALLACE 37694 144394 16338 62586 14845 56866 11374 43571 2649 10148 82900 317565 2848 10911 MARIE KNEDLER 60065 230093 21914 83947 13180 50489 30111 115347 4489 17198 129759 497074 4603 17634 EYAD KAKISH MD 412118 0 0 0 1384 0 0 0 26070 0 439572 0 0 0 ANN SCHUMACHER 50037 191676 19437 74457 14958 57300 13304 50964 5219 19994 102955 394391 4136 15844 JAMES REICHERT MD 56576 216730 11739 44970 1809 6929 2536 9714 530 2030 73190 280373 0 0 DARREN SPLONSKOWSKI MD 289559 0 0 0 22807 0 13489 0 22484 0 348339 0 0 0 MARK KESTNER MD 0 0 0 0 27238 104340 346 1324 0 0 27584 105664 27238 104340 FRED HOSLER MD 0 0 0 0 111848 428461 0 0 184 705 112032 429166 111744 428062 LARRY BROWN MD 0 344187 0 236382 0 70193 0 17304 0 27312 0 695378 0 12411 FRANK EMSICK 34314 131449 9196 35226 4551 17436 2476 9486 974 3733 51511 197330 0 0 MARTIN HICKEY MD 0 0 0 0 108854 416993 0 0 0 0 108854 416993 108854 416993 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. 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 ARE INCLUDED IN THE EXECUTIVE'S WAGES AS TAXABLE INCOME. PART I, LINES 4A-B THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS AS EXECUTIVES OF ALEGENT CREIGHTON HEALTH 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: RICHARD HACHTEN, II - $346,579 FRED HOSLER, MD - $539,806 MARK KESTNER, MD - $131,578 MARTIN HICKEY, MD - $475,218 SEVERANCE PAID TO RICHARD HACHTEN IN CALENDAR YEAR 2011 RELATES TO A CORRECTION MADE TO REPORT ADDITIONAL SEVERANCE OWED TO HIM FROM A PREVIOUS SEPARATION OF SERVICE. THE ADDITIONAL SEVERANCE WAS REPORTED ON A CORRECTED W-2C AND APPLICABLE TAXES WERE SUBMITTED TO THE IRS. SCHEDULE J, 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 SCOTT WOOTEN - $58,678 JANE CARMODY - $19,974 NANCY WALLACE - $19,182 RICK MILLER, MD - $36,480 RICHARD ROLSTON, ME - $40,680 KENNETH LAWONN - $47,270 JOAN NEUHAUS - $53,374 MARIE KNEDLER - $26,297 SHEREE KEELY - $12,358 ELIZABETH LLEWELLYN - $14,770 PATRICIA MASEK - $12,614 PAUL STRAWHECKER - $4,772 ANN SCHUMACHER - $23,746 CINDY ALLOWAY - $23,774 KEVIN NOKELS - $20,843 PAUL EBMEIER - $22,752 SCHEDULE J, PART I, LINE 4B: THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED A PAY OUT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH DURING THE 2011 CALENDAR YEAR. AMOUNTS PAID OUT FROM THE PLAN WERE INCLUDED IN THE INDIVIDUALS TAXABLE WAGES AND REPORTED IN COLUMN E OF THE SCHEDULE J: RICHARD HACHTEN II - $116,268 SCOTT WOOTEN - $48,613 JANE CARMODY - $3,877 NANCY WALLACE - $13,759 RICK MILLER, MD - $9,841 LARRY BROWN, MD - $12,411 KENNETH LAWONN - $39,892 JOAN NEUHAUS - $41,947 MARIE KNEDLER - $22,238 SHEREE KEELY - $10,915 ELIZABETH LLEWELLYN - $12,916 PATRICIA MASEK - $10,956 PAUL EBMEIER - $20,451 ANN SCHUMACHER - $19,981 CINDY ALLOWAY - $19,449 KEVIN NOKELS - $17,965 MARTIN HICKEY, MD - $50,630. PART I, LINE 5 PHYSICIANS EMPLOYED BY ALEGENT CREIGHTON HEALTH ARE ELIGIBLE FOR QUARTERLY PRODUCTIVITY BONUSES BASED ON INDIVIDUAL QUALITY MANAGEMENT, WHICH INCLUDE CORE MEASURES, REVENUE, PHYSICIAN REFFERAL AND ATTENDANCE AT MEETINGS. THE CORE MEASURES USED TO DETERMINE THE PHYSICIAN BONUSES ARE NATIONALLY ACCEPTED MEASURES 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 ON 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 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. GUILLERMO HUERTA MD - BOARD MEMBER PULMONARY MEDICINE SPECIALIST PC - PRESIDENT 2418184 HEALTHCARE SERVICES 0 MICHAEL DEFREECE - BOARD MEMBER SON IS EMPLOYED 89079 EMPLOYMENT 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 ALEGENT CREIGHTON HEALTH PURCHASED ALEGENT HEALTH PLAINVIEW AREA HOSPITAL IN PLAINVIEW, NEBRASKA ON MARCH 1, 2012. ALEGENT HEALTH PLAINVIEW AREA HOSPITAL IS A CRITICAL ACCESS HOSPITAL THAT WAS OWNED AND OPERATED BY THE CITY OF PLAINVIEW, NEBRASKA. THE HOSPITAL IS A 16 BED FACILITY WITH INPATIENT AND OUTPATIENT SERVICES INCLUDING: EMERGENCY, LABORATORY, RADIOLOGY, HOME HEALTH, SPECIALTY CLINICS, PHYSICAL THERAPY, CARDIAC REHAB, PULMONARY REHAB, SURGERY AND OCCUPATIONAL THERAPY. ALEGENT HEALTH PLAINVIEW AREA HOSPITAL ADOPTED ALL POLICIES AND PROCEDURES OF ALEGENT CREIGHTON HEALTH, INLCUDING FINANCIAL ASSISTANCE, BILLING AND COLLECTIONS AND EMERGENCY MEDICAL CARE. ADDITIONALLY, THE HOSPITAL PARTICIPATES IN THE CHNA OF PIERCE COUNTY, NEBRASKA. FORM 990, PART VI, SECTION A, LINE 2 PAUL EDGETT III AND SR PHYLLIS HUGHES - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 ALEGENT CREIGHTON HEALTH HAS TWO CORPORATE MEMBERS, IMMANUEL HEALTH SYSTEMS (IHS) AND CATHOLIC HEALTH INITIATIVES (CHI). FORM 990, PART VI, SECTION A, LINE 7A CHI AND IHS SHALL APPOINT SIX OF THE VOTING MEMBERS OF THE BOARD OF DIRECTORS, PROVIDED THAT EACH CORPORATE MEMBER SHALL RATIFY THE OTHER CORPORATE MEMBER'S APPOINTMENTS, WITH THE EXCEPTION OF THE REPRESENTATIVE OF THE CORPORATE MEMBER WHICH APPOINTMENT WILL NOT REQUIRE RATIFICATION BY THE OTHER CORPORATE MEMBER. IF A CORPORATE MEMBER DOES NOT RATIFY THE APPOINTMENT OF ONE OR MORE OF THE DIRECTORS APPOINTED BY THE OTHER CORPORATE MEMBER, THEN THE PROCESS WILL BE REPEATED UNTIL ALL OF THE DIRECTOR POSITIONS ARE FILLED. FORM 990, PART VI, SECTION A, LINE 7B THE BUSINESS AND AFFAIRS OF ALEGENT CREIGHTON HEALTH SHALL BE MANAGED BY OR UNDER THE DIRECTION OF THE BOARD OF DIRECTORS EXCEPT THAT THE FOLLOWING ACTIONS SHALL BE EFFECTIVE ONLY IF APPROVED BY THE BOARD OF DIRECTORS AND BY BOTH CORPORATE MEMBERS: (I) ADOPTION OR AMENDMENT OF THE UNIFIED PHILOSOPHY AND MISSION OF THE CORPORATION; (II) SALE, LEASE, TRANSFER, ENCUMBRANCE OR DISPOSITION OF THE TANGIBLE PROPERTY OR INVESTMENTS HAVING A FAIR MARKET VALUE IN ANY INDIVIDUAL TRANSACTION IN EXCESS OF $3 MILLION OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS; PROVIDED THAT TRANSFERS OF INVESTMENTS BETWEEN THE CORPORATION AND ANOTHER PARTICIPANT SHALL NOT REQUIRE THE APPROVAL OF CHI AND IHS; PROVIDED FURTHER THAT APPROVAL OF THE CORPORATE MEMBERS SHALL NOT BE REQUIRED FOR ANY TRANSFER OF ASSETS TO CHI BY THE CORPORATION PURSUANT TO THE TERMS OF THE ALEGENT FINANCING AGREEMENT(AFA); (III) INCURRENCE, ASSUMPTION OR GUARANTY IN ANY INDIVIDUAL TRANSACTION OF LONG-TERM INDEBTEDNESS, INCLUDING CAPITAL LEASES, OUTSTANDING FOR MORE THAN 365 DAYS, IN EXCESS OF $2 MILLION OR 2% OF THE TOTAL LONG TERM INDEBTEDNESS OF ALL PARTICIPANTS, OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS; AND (IV) MERGER, DISSOLUTION, CONSOLIDATION OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION, EXCEPT FOR A MERGER IN WHICH (I) THE CORPORATION IS THE SURVIVING ENTITY, AND (II) THE TOTAL BOOK VALUE OF THE ASSETS OF THE MERGING ENTITY DOES NOT EXCEED 2% OF THE TOTAL BOOK VALUE OF THE ASSETS OF ALL THE PARTICIPANTS, OR SUCH GREATER VALUE AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS. B. THE ARTICLES OF INCORPORATION AND BYLAWS MAY BE AMENDED, RESTATED OR REPEALED, OR NEW ARTICLES OF INCORPORATION OR BYLAWS ADOPTED ONLY UPON THE APPROVAL OF THE BOARD OF DIRECTORS OF THE CORPORATION AND CHI AND IHS. C. THE ACTIONS THAT CAN BE TAKEN WITHOUT THE APPROVAL OF THE CORPORATE MEMBERS INCLUDE, WITHOUT LIMITATION: (I) TERMINATION OF THE AFA IN ACCORDANCE WITH ITS TERMS. (II) FORMATION OF THE UNIFIED ALEGENT CREIGHTON HEALTH SYSTEM (III) PREPAYMENT OF THE FULL AMOUNTS OUTSTANDING ON NOTES TO CHI UNDER THE AFA, FOR PURPOSES OF EXERCISING THE RIGHTS OF TERMINATION OF THE AFA, OR FORMATION OF THE UNIFIED ALEGENT CREIGHTON HEALTH SYSTEM CREDIT, AND THE TAKING OF ALL ACTIONS NECESSARY OR APPROPRIATE TO OBTAIN FUNDING OR OTHERWISE MAKE ARRANGEMENTS TO PREPAY SUCH NOTES, INCLUDING WITHOUT LIMITATION INCURRENCE OF INDEBTEDNESS NECESSARY OR APPROPRIATE TO PREPAY NOTES OUTSTANDING. FORM 990, PART VI, SECTION B, LINE 11 FOLLOWING THE PREPARATION OF THE FORM 990 BY INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE 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 REFERRED TO THE ALEGENT CREIGHTON HEALTH TAX DIRECTOR IF THEY HAVE QUESTIONS. FINALLY, THE BOARD IS NOTIFIED OF THE DATE THE FINAL FORM 990 WILL BE FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY - 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 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. THIS PROCESS WAS USED FOR THE FOLLOWING EMPLOYEES: PRESIDENT AND CHIEF EXECUTIVE OFFICER SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER CHIEF EXECUTIVE OFFICER ALEGENT CREIGHTON CLINIC SENIOR VICE PRESIDENT AND SYSTEM CHIEF OPERATIONS OFFICER SENIOR VICE PRESIDENT STRATEGY AND TECHNOLOGY VICE PRESIDENT OPERATIONS (BERGAN MERCY & MERCY) VICE PRESIDENT OPERATIONS (IMMANUEL) VICE PRESIDENT OPERATIONS (LAKESIDE) VICE PRESIDENT OPERATIONS (MIDLANDS) MEDICAL DIRECTORS 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 HEALTH 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: UNRESTRICTED TRANSFERS TO/FROM OTHER ALEGENT AFFILIATES -37,357,000. UNRESTRICTED OTHER 40,243. PENSION MEASUREMENT DATE TRANSITION ADJUSTMENT -18,986,426. ADJUSTMENT FOR AH CREIGHTON SAINT JOSEPH MANAGED CARE SVC INC NET ASSETS -1,300,186. TOTAL TO FORM 990, PART XI, LINE 5: -57,603,369. FORM 990, PART I, LINE 5 AND PART V, LINE 2A: ALEGENT CREIGHTON HEALTH IS A COMMON PAY AGENT FOR RELATED ENTITIES WITHIN THE ALEGENT CREIGHTON HEALTH SYSTEM. THE NUMBER OF EMPLOYEES ON FORM 990, PART I, LINE 5 AND PART V, LINE 2A REPRESENT EMPLOYEES OF ALEGENT CREIGHTON HEALTH AND EMPLOYEES OF RELATED ENTITIES. THE PAYROLL EXPENSES OF RELATED ENTITIES ARE ALLOCATED BY ALEGENT CREIGHTON HEALTH TO EACH ENTITY. FORM 990, PART V, LINE 1A: PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE MADE BY ALEGENT CREIGHTON HEALTH. ALEGENT CREIGHTON HEALTH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. FORM 990, PART VI, SECTION B, LINE 16: ALEGENT CREIGHTON HEALTH HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, ALEGENT CREIGHTON HEALTH'S SYSTEM-WIDE JOINT VENTURE MODEL INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSE IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNER'S RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. PART VII, SECTION A: HOURS WORKED BY EXECUTIVES AND SOME EMPLOYEES OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE SPLIT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. THE FOLLOWING EXECUTIVES AND EMPLOYEES WORKED AN AVERAGE OF 48 HOURS FOR AFFILIATE ORGANIZATIONS WITHIN THE ALEGENT CREIGHTON HEALTH SYSTEM. RICHARD HACHTEN II, SCOTT WOOTEN, KENNETH LAWONN, JOAN NEUHAUS, RICHARD ROLSTON, MD, RICK MILLER, MD, JANE CARMODY, MARIE KNEDLER, SHEREE KEELY, ELIZABETH LLEWELLYN, PATRICIA MASEK, PAUL EBMEIER, NANCY WALLACE, FRANK EMSICK, CINDY ALLOWAY, KEVIN NOKELS AND ANN SCHUMACHER. LARRY BROWN, MD IS A FORMER EXECUTIVE OF THE ALEGENT CREIGHTON HEALTH SYSTEM. IN HIS CURRENT POSITION AS MEDICAL DIRECTOR OF SERVICE EXCELLENCE, COMMUNITY AND MISSION, HE WORKS 59 HOURS FOR AN AFFILITE ORGANIZATION. ANTHONY HATCHER, MD IS AN EMPLOYED PHYSICIAN OF THE ALEGENT CREIGHTON HEALTH SYSTEM AND HIS HOURS ARE SPLIT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. AVERAGE HOURS PER WEEK FOR AFFILIATE ORGANIZATIONS ARE 48. 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