2011-05-13T11:13:04-05:00 2010-06-30 KPMG LLP TWO CENTRAL PARK PLAZA SUITE 1501 OMAHA NE 681021626 990 2009-07-01 470757164 ALEGENT HEALTH ALEG 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 SCOTT M WOOTEN 4023434323 2011-05-13 1 Heidi Kriete 4023481450 2009 2016-02-24 21:20:13Z SCOTT WOOTEN 12809 WEST DODGE ROAD OMAHA NE 68154 288746579 0 X WWW.ALEGENT.COM X 1992 NE TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. 11 9 10632 596 1484261 -199152 1766353 2662462 230137296 241206547 471446 92338 40536658 41122919 272911753 285084266 9790879 16241095 0 106992057 107465681 0 0 130067400 137484602 246850336 261191378 26061417 23892888 434550454 501799634 316951850 373360570 117598604 128439064 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 21607065 1731454 128802063 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. 10342417 828776 56949551 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. 7381781 591529 48159349 The Alegent 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 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. 164657327 13089336 38149531 ALEGENT HEALTH GIVES BACK TO OUR COMMUNITY THROUGH A VARIETY OF MEDICALSERVICES AND PARTNERSHIPS. ALEGENT HEALTH QUICK CARE PROVIDES URGENTMEDICAL TREATMENTS, SCREENINGS AND ADULT IMMUNIZATIONS FOR PATIENTS 18MONTHS AND OLDER. THROUGH OUR COLLABORATION WITH OTHER LOCAL COMMUNITYORGANIZATIONS SUCH AS BOYS TOWN, CREIGHTON UNIVERSITY, OUR HEALTHYCOMMUNITY PARTNERSHIP AND ONE WORLD COMMUNITY HEALTH CENTER, ALEGENTHEALTH IS HELPING TO IDENTIFY AND ADDRESS COMMUNITY HEALTH NEEDS. INADDITION, ALEGENT HEALTH ALSO PROVIDES THE FOLLOWING SERVICES:MATERNITY CARE SERVICES, MENTAL AND BEHAVIORAL HEALTH CARE, ONCOLOGY,PROCEDURE CENTER AND INPATIENT FACILITIES INCLUDING INTENSIVE CARE. 164657327 13089336 38149531 203988590 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 890 0 1 10632 1 1 1 0 0 0 0 0 0 0 0 11 9 0 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 ERIC GURLEY 4.00 X 0 0 0 JOHN HEWITT 6.00 X X 0 0 0 KEITH SCHMODE 4.00 X 5000 0 0 LESLIE R ANDERSEN 6.00 X X 0 0 0 MARTIN MANCUSO MD 4.00 X 16000 0 0 Michael DeFreece 4.00 X 0 0 0 Paul Edgett III 4.00 X 0 0 0 SR LILLIAN MURPHY RSM 4.00 X 0 0 0 RICHARD VIERK 4.00 X 23500 0 0 ANTHONY HATCHER DO 6.00 X X 20000 478263 35568 SUSAN PEACH RN 4.00 X 0 0 0 GUILLERMO HUERTA MD 4.00 X 0 0 0 RICHARD HACHTEN II 12.00 X 329030 1307860 734490 AMY PROTEXTER 12.00 X 82338 327283 28487 MARTIN HICKEY MD 12.00 X 164050 652080 45701 MARK KESTNER MD 12.00 X 105663 419998 158309 JOAN NEUHAUS 12.00 X 93336 370998 185399 FRED HOSLER MD 12.00 X 187834 746618 369747 KENNETH LAWONN 12.00 X 130013 516784 38536 MARGARET BREEN 12.00 X 94934 377352 17268 SCOTT WOOTEN 12.00 X 153134 608693 20275 WAYNE A SENSOR 12.00 X 353142 1403692 23329 SHEREE KEELY 12.00 X 44070 175173 21999 Elizabeth LLEWELLYN 12.00 X 53790 213810 21048 PATRICIA MASEK 12.00 X 43915 174555 43277 FRANK EMSICK 12.00 X 53685 213397 24436 SHANE SEYMOUR 12.00 X 68160 270927 18732 PAUL EBMEIER 12.00 X 66672 265011 22704 CINDY ALLOWAY 12.00 X 84927 337573 57045 KEVIN NOKELS 12.00 X 80911 321613 32136 PATRICIA NADLE 12.00 X 26576 105636 252626 JAYNE MCCORMICK MD 60.00 X 232062 0 16991 MICHAEL WESTCOTT MD 12.00 X 56617 225044 32506 Marie Knedler 12.00 X 134770 535690 156737 ANTONIO SAQUETON MD 12.00 X 80468 319851 32756 Ann Schumacher 12.00 X 87502 347813 34147 Darren Splonskowski MD 60.00 X 267600 0 33877 DUANE DAVID 0.00 X 42093 167316 0 THEODORE SCHWAB 0.00 X 74886 297666 19719 JARROD JOHNSON 0.00 X 44196 175673 5703 JOHN MAY 0.00 X 52874 210165 3737 PETE FESTERSEN 0.00 X 36955 146898 1088 Ann Jones 0.00 X 52570 208959 4177 DAVID TEW 0.00 X 126164 501484 141864 MICHAEL ANDERSON MD 0.00 X 30924 122918 4835 3573785 12441157 2386623 136 1 1 0 Pulmonary Medicine Specialists PC 7710 Mercy Rd 428 omaha NE 68124 PULMONARY SERVICES 2594158 GALLUP INC 901 F STREET NW WASHINGTON DC 20004 PERFORMANCE MGMT CONSULTING 1861933 CASSLING DIAGNOSTIC IMAGINGINC 13808 F STREET OMAHA NE 68137 DIAGNOSTIC IMAGING SERVICES 1821828 PRN FUNDING LLC 3659 GREEN ROAD STE 318 CLEVELAND OH 44122 Healthcare Factory 1605314 HRS Erase Inc 9300 Underwood Ave 160 OMAHA NE 68114 ACCOUNT RECONCILIATION 843134 80 402766 190773 2068923 2662462 NET PATIENT SVC REV 561300 224096220 223844419 251801 MANAGEMENT SVCS-AFFIL. 900003 12075940 12075940 PHARMACY SALES 446110 3057549 926870 2130679 COMMUNITY BENEFIT REIM 900099 1215594 1215594 FOOD & NUTRITION 722320 722844 15485 707359 38400 38400 241206547 130492 -80242 210734 2410377 2620845 -210468 -210468 -210468 1003314 1041468 -38154 -38154 -38154 REIMBURSED SERVICES 900099 34692385 34692385 OTHER INCOME 812900 4299300 364596 3934704 OPERATING JOINT VENTUR 900003 1695230 1695230 646472 193756 5751 446965 41333387 285084266 272060494 1484261 8877049 862830 862830 15378265 15378265 2441558 1953246 488312 84881273 67905018 16976255 6456431 5165145 1291286 4867620 3894096 973524 8818799 7055039 1763760 651228 651228 413175 413175 244425 244425 18303885 773563 17530322 5031664 4025331 1006333 43437550 34750040 8687510 5809143 4647314 1161829 1247169 997735 249434 285894 228715 57179 3114069 2491255 622814 20676774 20623188 53586 120605 96484 24121 Taxes & Licenses 13090471 10472377 2618094 BAD DEBT 12480773 12480773 PURCHASED SERVICES 7393756 5915005 1478751 miscellaneous 4557717 3646173 911544 Membership & Dues 273457 169881 103576 352847 212692 140155 261191378 203988590 57202788 0 2068157 5295211 12232646 10084778 23585713 22402931 9132 6912 3884507 4999891 3276752 6580955 558845000 240055510 295814860 318789490 9310454 11181790 2567488 84368233 119890188 434550454 501799634 203226607 142411048 267334 346516 60330158 142815506 53127751 87787500 316951850 373360570 X 117598604 128439064 117598604 128439064 434550454 501799634 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 X 244425 262701 244425 262701 260946952 530861023 261191377 531123724 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 124534 136554 176941 262701 700730 250000 250000 250000 250000 1000000 1500000 1552292 639081 8441 278190 1921624 2368143 -340443 -4285 471123 1552292 0.00000 0.00000 1.00000 0 1 1 12559945 12559945 207269323 49029955 158239368 6865806 2912806 3953000 312001434 188112749 123888685 20148492 20148492 318789490 LAND HELD FOR EXPANSION 6475402 INTERCOMPANY RECEIVABLES 111120641 CASH SURRENDER VALUE OF LIFE INSURANCE 2294145 119890188 THIRD PARTY PAYOR RESERVE 131959 DEFERRED COMPENSATION/RETIREMENT PROGRAMS 4249801 MINIMUM PENSION LIABILITY 42745950 INTERCOMPANY LIABILITIES 40659790 87787500 Part V, Line 4: Description of Intended Use of Endowment Funds: ENDOWMENT FUNDS ARE held by Alegent Health Foundation to help with the Organizational operations of Alegent Health. PART X - THE ENTITIES REPORTED IN THE CONSOLIDATED AUDIT HAVE ADOPTED FASB INTERPRETATION NO. 48, ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES, INCLUDED IN FASB ASC SUBTOPIC 740-10, INCOME TAXES - OVERALL, ENTITIES OF ALEGENT HEALTH RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. DURING 2010 AND 2009, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 0 0 1 1 0 1 1 6865 4868961 4868961 0.01960 6865 4868961 4868961 0.01960 21405 1068868 158039 910829 0.00370 553 5638 5638 0.00000 60 352593 287688 64905 0.00030 2788563 591642 2196921 0.00880 1669 1151324 1151324 0.00460 23687 5366986 1037369 4329617 0.01740 30552 10235947 1037369 9198578 0.03700 4 503435 47911 455524 0.00180 113 890496 10109 880387 0.00350 19 1746 1746 0.00000 136 1395677 58020 1337657 0.00530 1 4599518 955302 30797941 45255342 -14457401 X 1 1 Lakeside Ambulatory Surgery Center LLC Ambulatory Surgical Center 0.51000 0.49000 Lakeside Endoscopy Center LLC Ambulatory Surgical Center 0.51000 0.49000 AH-NORTHWEST IMAGING CENTER LLC DIAGNOSTIC TESTING 0.51000 0.49000 ALEGENT HEALTH MIDLANDS HOSPITAL

11111 S 84TH STREET PAPILLION NE 68046

X X X ALEGENT HEALTH LAKESIDE HOSPITAL

16901 LAKESIDE HILLS COURT OMAHA NE 68130

X X X THE LIGHTHOUSE HEALTHCARE RESIDENCE

17600 ARBOR STREET OMAHA NE 68130

SKILLED NURSING FACILITY Part I, Line 3c: Midlands Hospital in Sarpy County, NE and Lakeside Hospital in Douglas County, NE serve the OMAHA METROPOLITAN STATISTICAL AREA and are part of the Alegent Health system. The amount of financial assistance write-off for entities of the Alegent 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. REPRESENTATIVES OF THE Alegent Health 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 THE Alegent Health SYSTEM'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 I, line 6a: Alegent Health produces a 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 WWW.ALEGENT.COM. 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, Line 7g: Alegent Health provides subsidized health to the broader community via an inpatient behavioral residential treatment center. Part I, Line 7f: Bad debt of $12,480,773 included in THE functional expense total FROM FORM 990, part IX, line 25 is not included in the total operating expense used to calculate the table 7 percentages. Part III, Line 4: THE AUDITED FOOTNOTES FOR ENTITIES OF THE ALEGENT 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 HEALTH ARE 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 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: Alegent Health 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 the Medicare cost reports which use a cost to charge ratio. Part III, Line 9b: Alegent HEALTH'S SELF PAY BILLING AND BAD DEBT POLICY HAS A CLEARLY DELINEATED PROCESS FOR COLLECTION AGENCIES TO FOLLOW, INCLUDING EXPLICIT INSTRUCTIONS THAT ENSURE THE CHARITY CARE PATIENTS WHO HAVE BEEN IDENTIFIED DO NOT GO TO COLLECTIONS. PART V: 1 SKILLED NURSING FACILITY AND 8 OUTPATIENT QUICKCARE CLINICS. Part VI, Line 2: The Alegent Health system approaches community needs assessment as a corporate activity that develops and integrates county based health profiles for each of the counties within which one of our licensed hospitals is located. The process to develop the assessments is collaborative in nature and involves health departments, existing health coalitions, community members and hospital leadership, AND is supported by the Alegent Health Planning and Community Benefit Department staff. The Alegent Health Planning department conducts market assessments that identify the OMAHA MSA'S population and demographic characteristics. Additionally, in cooperation with local health departments and coalitions, the Alegent Health Community Benefit/Healthier Community department conducts an annual review of the documented community health needs and plans of each of the communities it serves. This assessment process involves summarizing existing data and research from local health department reports and local coalition reports into a comprehensive summary grid incorporating a multitude of factors including- demographics, health status metrics, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY DATA, documented health issues, qualitative information from qualitative and community based processes and identification of Alegent HEALTH'S participation and specific strategic action plans. The profiles are integrated into the governance and planning for Alegent Health on two levels- I. Reporting to the committee of the Board of Directors charged with health planning oversightII. Into the annual strategic planning processes of Alegent Health. Particular to Douglas County, within which Lakeside Hospital and Lighthouse serve, needs assessment and reporting of those needs is led by Live Well Omaha (LWO), a membership based coalition. LWO has been in existence for 14 years and Alegent Health was a founding member and is the largest financial contributor. This coalition includes the director of the Sarpy/Cass Health Department, in which Midlands Hospital is located. In addition MIDLAND'S Hospital leadership is actively engaged with Sarpy county SCHOOLS' leadership in the ongoing county based conversations to impact school health education and practices. Part VI, Line 3: There are several financial assistance access points throughout a PATIENT'S care cycle. Signs are posted in clinics and hospitals, and there is information on financial assistance posted at registration points throughout clinics and hospitals. Bills contain financial assistance verbiagE. Information on Alegent HEALTH'S financial assistance policies are located several places on www.alegent.com. Part VI, Line 4: Alegent Health system serves the Omaha MSA, with an estimated population of 842,976, ranking 60th out of 366 MSAs in total population. On average, the population is older than the U.S. with a current median age of 34.9 years that is projected to increase to 35.5 by 2014. 50.6% of the population is female. The Omaha MSA'S racial and ethnic makeup is approximately 83.9% white, 7.7% black and 7.6% Hispanic or Latino. 2009 Estimates show that there are approximately 326,989 households, which is projected to increase over the next five years. The average household income is $68,637, with a per capita income of $26,840 (vs national of $26,410). Part VI, Line 5: 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 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 Health hospitals. The community coalition known as Live Well Omaha Kids (LWOK) is staffed and funded by Alegent Health. An Executive Committee consisting of community leaders and policy makers have directed an ecological approach to improve programs, policies and builD THE environment to promote physical activity and healthy eating and build THE capacity for healthy choices at the individual and organizational level. More than 200 volunteers have participated in the planning and Implementation of LWOK initiatives. A portion of this investment in LWOK is allocated to Midlands and Lakeside hospitals. THE Alegent Health SYSTEM also provides leadership and funding to: Live Well Omaha-a community coalition addressing community health issues that produces a community health report card; Live Well Pottawattamie County and YMCA for a healthy living needs assessments, the Domestic Violence Coordinating Council and YWCA Omaha to combat intimate partner violence, Tobacco and Drug Free Coalitions to address substance abuse in Sarpy County, local Chamber of Commerce for economic development, and local health departments. Part VI, Line 6: The primary care physician clinics that are part of the parent ALEGENT HEALTH SYSTEM participate in medical student preceptorships that advance the healthcare provider education process. The affiliated not-for-profit corporation has the same financial policy that makes access for the poor as barrier free as possible. Alegent Health has Open Medical staffS AND ARE one of 3 health systems that fund the operations of a coalition that exists to provide access for the patients of 3 area FQCHCs to specialty physician services and hospital based diagnostics and treatment. Alegent Health IS the sole comprehensive acute mental health provider in the Omaha MSA area AND IS A joint venture partner in a not-for-profit Hospice inpatient hospital and provides the management support contract. Alegent 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 Was first used in FY2010 with the economic downturn. Alegent Health has a current commitment to set aside up to 6% of its EARNINGS in a given fiscal year for collaborative initiatives to improve the health of the communities served, which is the Catalyst Fund. A portion of this expense is allocated to Alegent Health - MIDLANDS Hospital and Alegent Health - LAKESIDE HOSPITAL. EMERGENCY DEPARTMENT - ALEGENT 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.MEDICAL STAFF - The hospitals maintain 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 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.BOARD OF DIRECTORS - ALEGENT 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. The Board of Directors consists of twelve voting members and two non-voting members. Part VI, Line 7: The senior leadership of the individual hospitals is engaged in the community needs assessment process that is conducted from the corporate offices of the Alegent Health system (See Part VI-2/Community Needs Assessment). The hospitalS ARE involved in shared budget decision making to meet the prioritized community health needs in collaboration with community partners. The corporate function is funded from the operations of the individual hospitals to leverage expertise and time that is focused on promoting health versus addressing acute care needs. The individual hospitals become more involved in specific strategic responses through the services they provide and their participation in the coalitions across the Alegent Health service area. 1 American Cancer Society 9850 Nicholas Street OMAHA NE 68114 237040934 501(c)(3) 19500 GENERAL SUPPORT American Diabetes Association 12838 Augusta Avenue Omaha NE 68144 131623888 501(c)(3) 5500 GENERAL SUPPORT AMERICAN HEART ASSOCIATION 10100 J Street OMAHA NE 68127 135613797 501(c)(3) 58000 GENERAL SUPPORT Catholic Charities 3300 N 60th Street Omaha NE 68104 470376612 501(c)(3) 70000 GENERAL SUPPORT Charles Drew Health Center 2915 Grant Street Omaha NE 68111 470666715 501(c)(3) 100000 GENERAL SUPPORT GREATER OMAHA CHAMBER FOUNDATION 1301 HARNEY STREET OMAHA NE 68102 470258610 501(c)(3) 110000 GENERAL SUPPORT Iowa Legal Aid 1111 9TH St Ste 230 Des Moines IA 50314 421079227 501(c)(3) 25000 GENERAL SUPPORT Iowa Western Comm College 2700 College Road Council Bluffs IA 51502 421224333 501(c)(3) 10000 GENERAL SUPPORT JUNIOR ACHIEVEMENT OF MIDLANDS 11248 Davenport St Ste 100 OMAHA NE 68154 470468426 501(c)(3) 6820 GENERAL SUPPORT MARCH OF DIMES 11840 NICHOLAS STREET SUITE 220 OMAHA NE 68154 131846366 501(c)(3) 10000 GENERAL SUPPORT MEMORIAL Community Hospital Foundation 810 N 22nd St BLAIR NE 68008 113660156 501(c)(3) 50000 GENERAL SUPPORT MISSOURI VALLEY CANCER CONSORTIUM CCOP 6818 Grover Street 200 Omaha NE 68131 470773531 501(c)(3) 110652 gENERAL SUPPORT Omaha Community Foundation 302 S 36th Street Ste 100 Omaha NE 68131 470645958 501(c)(3) 20200 GENERAL SUPPORT Omaha Development Foundation 1301 Harney Street Omaha NE 68102 470629134 501(c)(3) 10000 GENERAL SUPPORT Omaha Symphony Association 1605 Howard Omaha NE 68102 476039304 501(c)(3) 11000 GENERAL SUPPORT ONEWORLD COMMUNITY HEALTH CENTERS INC 4920 South 30th Street STE 103 OMAHA NE 68107 470548990 501(c)(3) 118038 GENERAL SUPPORT St Peter Claver Cristo Ray High School 5301 South 36th Street Omaha NE 68107 300348098 501(c)(3) 22500 GENERAL SUPPORT SUSAN G KOMEN FOUNDATION 5005 LBJ Freeway Dallas TX 75244 751835298 501(c)(3) 10000 GENERAL SUPPORT 18 0 CHARITY CARE 6865 15378265 BOOK REDUCE 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. SCHEDULE I, PART I, LINE 2: ALEGENT HEALTH ONLY DISTRIBUTES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS WITH THE SAME MISSION and PURPOSE AS THE ALEGENT HEALTH SYSTEM. THESE DISTRIBUTIONS ARE MONITORED TO ENSURE THEY ARE BEING USED AS SPECIFIED BY THE ORGANIZATION. Other Information: Part IV: SCHEDULE I, PART III: ALEGENT 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 1 1 X X X X X 1 1 0 1 0 1 1 0 0 ANTHONY HATCHER DO 20000 341253 0 57454 0 79556 0 19380 0 16188 20000 513831 0 0 RICHARD HACHTEN II 57935 230289 3248 12912 267847 1064659 147175 585004 464 1847 476669 1894711 260100 1033867 AMY PROTEXTER 28741 114242 24657 98007 28940 115034 4106 16322 1620 6439 88064 350044 22585 89773 MARTIN HICKEY MD 77966 309905 28639 113838 57445 228337 7463 29660 1723 6855 173236 688595 21876 86954 MARK KESTNER MD 45144 179441 20594 81859 39925 158698 29904 118863 1918 7624 137485 546485 29356 116686 JOAN NEUHAUS 58941 234283 18030 71666 16365 65049 36512 145131 755 3001 130603 519130 15641 62172 FRED HOSLER MD 74704 296942 36104 143508 77026 306168 72935 289908 1388 5516 262157 1042042 66322 263623 KENNETH LAWONN 57433 228289 27166 107982 45414 180513 6493 25807 1254 4982 137760 547573 41809 166187 MARGARET BREEN 37848 150443 25771 102437 31315 124472 2955 11746 516 2051 98405 391149 26788 106478 SCOTT WOOTEN 75505 300129 34248 136130 43381 172434 2664 10591 1411 5609 157209 624893 38734 153962 WAYNE A SENSOR 108117 429748 66192 263104 178833 710840 3403 13527 1286 5113 357831 1422332 165905 659453 SHEREE KEELY 29552 117465 9432 37490 5086 20218 3487 13862 935 3715 48492 192750 5027 19982 Elizabeth LLEWELLYN 29154 115884 11044 43898 13592 54028 4028 16009 203 808 58021 230627 9985 39687 PATRICIA MASEK 27758 110332 8899 35372 7258 28851 7916 31469 782 3110 52613 209134 4475 17789 FRANK EMSICK 33655 133781 10900 43327 9130 36289 3424 13607 1488 5917 58597 232921 8904 35391 SHANE SEYMOUR 39092 155386 11688 46457 17380 69084 2398 9530 1367 5437 71925 285894 14563 57887 PAUL EBMEIER 54685 217363 10145 40325 1842 7323 3403 13527 1161 4613 71236 283151 0 0 CINDY ALLOWAY 49611 197199 16063 63847 19253 76527 9631 38282 1835 7297 96393 383152 17495 69542 KEVIN NOKELS 41121 163452 15400 61213 24390 96948 4388 17442 2072 8234 87371 347289 20695 82261 JAYNE MCCORMICK MD 175075 0 0 0 56987 0 16672 0 319 0 249053 0 0 0 MICHAEL WESTCOTT MD 43321 172194 6722 26721 6574 26129 4881 19399 1653 6573 63151 251016 0 0 Marie Knedler 53829 213961 16519 65660 64422 256069 30543 121406 962 3826 166275 660922 63655 253022 ANTONIO SAQUETON MD 75802 301304 0 0 4666 18547 3429 13629 3156 12542 87053 346022 0 0 Ann Schumacher 54700 217428 17697 70345 15105 60040 4638 18433 2226 8850 94366 375096 14808 58860 Darren Splonskowski MD 252244 0 0 0 15356 0 17506 0 16371 0 301477 0 0 0 DUANE DAVID 0 0 0 0 42093 167316 0 0 0 0 42093 167316 41998 166939 THEODORE SCHWAB 0 0 0 0 74886 297666 740 2940 3224 12815 78850 313421 74790 297281 JARROD JOHNSON 1836 7296 5836 23197 36524 145180 456 1810 691 2746 45343 180229 34976 139027 JOHN MAY 1993 7919 6633 26365 44248 175881 533 2120 218 866 53625 213151 42275 168036 PETE FESTERSEN 2074 8246 4901 19483 29980 119169 0 0 219 869 37174 147767 29498 117251 Ann Jones 1623 6452 6716 26694 44231 175813 0 0 840 3337 53410 212296 43199 171710 DAVID TEW 23547 93593 19032 75650 83585 332241 27199 108115 1317 5233 154680 614832 30678 121943 MICHAEL ANDERSON MD 1850 7350 6265 24904 22809 90664 832 3306 140 557 31896 126781 21690 86214 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, financial planning fees and legal fees. Payment for these benefits are either made directly by Alegent 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, Line 4a THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM ALEGENT HEALTH DURING THE 2009 CALENDAR YEAR AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE AS COMPENSATION ON SCHEDULE J: DUANE DAVID - $208,937 THEODORE SCHWAB - $371,912 WAYNE SENSOR - $124,126 RICHARD HACHTEN II - $363,816 FRED HOSLER, MD - $87,750 MARGARET BREEN - $53,962 AMY PROTEXTER - $49,415 ANN JONES - $187,565 JARROD JOHNSON - $162,988 MARK KESTNER, MD - $63,691 JOHN MAY - $185,254 MICHAEL ANDERSON - $29,164 PETE FESTERSEN - $136,893 SHANE SEYMOUR - $16,704. Schedule J, Part I, Line 4b: ALEGENT HEALTH HAS A MARKET BASED NONQUALIFIED RETIREMENT PLAN APPROVED BY THE BOARD OF DIRECTORS THAT EXECUTIVES PARTICIPATE IN OF WHICH ANNUAL CONTRIBUTIONS ARE MADE. DURING 2009, THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TERMINATED AND PARTICIPANTS RECEIVED A TOTAL PAYOUT OF THEIR BALANCE. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS FROM ALEGENT HEALTH DURING THE 2009 CALENDAR YEAR AND THE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE AS COMPENSATION ON SCHEDULE J: RICHARD HACHTEN II - $930,151 FRED HOSLER, MD - $242,195 KENNETH LAWONN - $207,997 MARGARET BREEN - $79,304 DAVID TEW - $152,621 MARTIN HICKEY, MD - 108,830 MARIE KNEDLER - $316,677 JARROD JOHNSON - $11,015 ANN JONES - $27,343 SHEREE KEELY - $25,009 MARK KESTNER, MD - $82,351 ELIZABETH LLEWELLYN - $49,672 PATRICIA MASEK - $22,264 FRANK EMSICK - $44,295 JOHN MAY - $25,057 JOAN NEUHAUS - $77,813 AMY PROTEXTER - $62,943 SCOTT WOOTEN - $192,696 SHANE SEYMOUR - $55,747 WAYNE SENSOR - $701,232 THEODORE SCHWAB - $159 ANN SCHUMACHER - $73,668 KEVIN NOKELS - $102,956 PETE FESTERSEN - $9,856 MICHAEL ANDERSON - $78,739 CINDY ALLOWAY - $87,037. Part I, Line 5 PHYSICIANS EMPLOYED BY ALEGENT HEALTH ARE ELIGIBLE FOR QUARTERLY PRODUCTIVITY BONUSES BASED ON INDIVIDUAL QUALITY MANAGEMENT, WHICH INCLUDE CORE MEASURES, 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 HEALTH AND RELATED ENTITIES IS DETERMINED AT A SYSTEM LEVEL. MEMBERS OF ALEGENT 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. ONE OF THE FOUR SYSTEM PERFORMANCE GOALS IS DEPENDENT ON THE FINANCIAL RESULTS OF THE ENTIRE ALEGENT HEALTH SYSTEM FOR THE FISCAL YEAR. Supplemental Information Part III SCHEDULE J, PART I, LINE 3: ALEGENT HEALTH GOVERNANCE OF EXECUTIVE COMPENSATION: ACTING AS PRUDENT STEWARDS OF ITS FINANCIAL RESOURCES, THE ALEGENT 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 HEALTH IS ABLE TO FULFILL ITS FAITH-BASED MISSION AND ACHIEVE ITS VISION OF BECOMING WORLD-CLASS. THE ALEGENT 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 NOT-FOR PROFIT AND GENERAL INDUSTRY DATA FOR EXECUTIVE ROLES WHERE THE RECRUITING MARKET IS ARGUABLY BROADER THAN THE NOT-FOR-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 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 VI, Section A, line 6 ALEGENT 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 EXECEPTION 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 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 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 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, External Tax Advisor 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 16, 2011. 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 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 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 positions: President and Chief Executive Officer Executive Vice President Senior Vice President and Chief Financial Officer Chief Executive Officer Alegent Health Clinic Senior Vice President Chief Operations Officer Senior Vice President Chief Medical Officer Medical Directors Vice President Operations (Bergan Mercy) Vice President Operations (Immanuel) Vice President Operations (Mercy) Vice President Operations (Lakeside) Vice President Operations (Midlands) Senior Vice President Chief Information Officer Senior Vice President Human Resources Senior Vice President Marketing Form 990, Part VI, Section C, line 19 The conflict of interest policy is made available to the public on the website at www.alegent.com. Alegent 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. FORM 990, PART I, LINE 5 AND PART V, LINE 2A: ALEGENT HEALTH IS A COMMON PAY AGENT FOR RELATED ENTITIES WITHIN THE ALEGENT HEALTH SYSTEM. THE NUMBER OF EMPLOYEES ON FORM 990, PART I, LINE 5 AND PART V, LINE 2A REPRESENT EMPLOYEES OF ALEGENT HEALTH AND EMPLOYEES OF RELATED ENTITIES. THE PAYROLL EXPENSES OF THE RELATED ENTITIES ARE ALLOCATED BY ALEGENT HEALTH TO EACH ENTITY. FORM 990, PART V, LINE 1A: PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT HEALTH SYSTEM ARE MADE BY ALEGENT HEALTH. ALEGENT 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 HEALTH HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, ALEGENT 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 PURPOSES 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. ALEGENT HEALTH QUICKCARE LLC 12809 WEST DODGE ROAD OMAHA NE 68154 203437352 EXPRESS CARE CLINIC NE 1367647 117641 N/A ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 6901 N 72ND STREET OMAHA NE 68122 470376615 LICENSED HOSPITAL NE 501(C)(3) L3 N/A ALEGENT HEALTH CLINIC 12809 WEST DODGE ROAD OMAHA NE 68154 470765154 CLINICAL SERVICES NE 501(C)(3) L3 N/A ALEGENT HEALTH FOUNDATION 12809 WEST DODGE ROAD OMAHA NE 68154 470648586 SUPPORT OF ALEGENT HEALTH AND AFFILIATES EXEMPT ACTIVITIES NE 501(C)(3) L7 N/A ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 7500 MERCY ROAD OMAHA NE 68124 470484764 LICENSED HOSPITAL NE 501(C)(3) L3 N/A ALEGENT HEALTH MERCY HOSPITAL CORNING IOWA 603 ROSARY DRIVE CORNING IA 50841 420782518 LICENSED HOSPITAL IA 501(C)(3) L3 ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM MERCY HEALTH CARE FOUNDATION 603 ROSARY DRIVE CORNING IA 50841 421461064 SUPPORT OF ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA EXEMPT ACTIVITIES IA 501(C)(3) L11 I ALEGENT HEALTH MERCY HOSPITAL CORNING IOWA AH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA 631 N 8TH STREET MISSOURI VALLEY IA 51555 420776568 LICENSED HOSPITAL IA 501(C)(3) L3 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION 631 N 8TH STREET MISSOURI VALLEY IA 51555 421294399 SUPPORT OF ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY,IA IA 501(C)(3) L11 I ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MO VALLEY IOWA ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER 104 W 17TH STREET SCHUYLER NE 68661 470399853 LICENSED HOSPITAL NE 501(C)(3) L3 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH STREET SCHUYLER NE 68661 363630014 SUPPORT OF ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER EXEMPT PURPOSE. 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