2011-05-13T11:13:04-05:00 2010-06-30 KPMG LLP TWO CENTRAL PARK PLAZASUITE 1501 OMAHA NE 68102 990 2009-07-01 470484764 ALEGENT HEALTH- BERGAN MERCY HEALTH SYSTEM ALEG 4023434323 7500 MERCY ROAD OMAHA NE 68124 SCOTT M WOOTEN 4023434323 2011-05-13 1 Heidi Kriete 4023481450 2009 2016-02-24 21:20:13Z SCOTT M WOOTEN 12809 WEST DODGE ROAD OMAHA NE 68142 518051773 0 X WWW.ALEGENT.COM X 1961 NE TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. 11 9 3751 699 6725669 0 8798620 7217626 484475893 489519489 -6352313 8837616 6308823 8782526 493231023 514357257 31810962 45561805 0 223130050 215854278 0 468970 229901332 255705725 484842344 517121808 8388679 -2764551 530640380 621960900 96355027 188123787 434285353 433837113 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 21653183 2254122 153664814 Bergan Mercy Medical Center is equipped with the latest technologies in the Diagnostic Center. The Center is completely digital, so patients are never waiting on films. Female patients can count on expert imaging tests including ultrasound, bone density testing, stereotactic breast biopsy and digital mammography. There are a wide range of available tests at the Diagnostic Center that include the following: Digital Mammography, MRI and Open MRI, CT, PET CT and Cardiac CT, 64-Slice CT, Fluoroscopy, Pulmonary Function Testing, Ultrasound, Cardiovascular Imaging, Phlebotomy, Nuclear Medicine, Digital Imaging, EEG, EKG and EMG, Stress Testing and Arteriogram. 22561445 2348673 102486143 Bergan Mercy Medical Center and Mercy Hospital, Council Bluffs offer a wide range of the most comprehensive range of cardiovascular services in the region, using a team approach to address the total needs of the cardiovascular patient. Alegent Health-Bergan Mercy Health System provides a comprehensive range of cardiac services, including but not limited to: vascular and cardiac surgery, heart scans and heart checks, cardiac rehabilitation, vascular ultrasound, nuclear stress tests, dual source CT scanner and angioplasty. In 2006, Mercy Hospital opened a new state-of-the-art Cardiac Catheterization lab, allowing physicians to perform procedures such as heart catheterizations, coronary interventions including balloon angioplasty and stenting, as well as implantation of pacemakers and defibrillators. 6230969 648651 15849137 Bergan Mercy Medical Center and Mercy Hospital, Council Bluffs Cancer Support Team is comprised of a group of healthcare professionals who work together in a variety of ways to help the patient and family cope with cancer. Bergan Mercy Medical Center cancer center offers the full continuum of cancer care for both inpatients and outpatients. They are equipped to diagnose and treat patients with cancer and get them back to their life as soon as possible. The Cancer Center is also an area leader in stem cell research and transplantation. Individual team members include Cancer Support Service Specialists, Medical Social Workers, Cancer Rehabilitation Specialists, Pastoral Services, Dietitians, Oncology Nurse Navigators, Hospice & Home Care Services, Inpatient Nursing Services, Radiation Oncology, and Volunteer Services. 387222890 40310359 205601130 BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS PROVIDE ADDITIONAL SERVICES INCLUDING BUT NOT LIMITED TO: EMERGENCY DEPARTMENT, INPATIENT HOSPITAL FACILITIES, PROCEDURE CENTER, ORTHOPEDIC SERVICES, DIGESTIVE HEALTH CENTER, FAMILY LIFE CENTER, RADIOLOGY, UROLOGY AND PHYSICAL THERAPY. PATIENTS ARE AT THE CENTER OF EVERYTHING DONE AT BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS. 387222890 40310359 205601130 437668487 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 206 0 1 3751 1 1 1 0 0 0 0 1 1 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 IA X SCOTT M WOOTEN SENIOR VPCFO 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 LESLIE R ANDERSEN 6.00 X X 0 0 0 SR LILLIAN MURPHY RSM 4.00 X 0 0 0 ANTHONY HATCHER DO 6.00 X X 0 498263 35568 JOHN HEWITT 6.00 X X 0 0 0 MARTIN MANCUSo MD 4.00 X 0 16000 0 SUSAN PEACH RN 4.00 X 0 0 0 RICHARD VIERK 4.00 X 0 23500 0 MICHAEL DEFREECE 4.00 X 0 0 0 PAUL EDGETT III 4.00 X 0 0 0 ERIC GURLEY 4.00 X 0 0 0 KEITH SCHMODE 4.00 X 0 5000 0 GUILLERMO HUERTA MD 4.00 X 0 0 0 WAYNE A SENSOR 29.00 X 835445 921389 23329 RICHARD HACHTEN II 29.00 X 778407 858483 734490 FRED HOSLER MD 29.00 X 444370 490082 369747 KENNETH LAWONN 29.00 X 307577 339220 38536 SCOTT WOOTEN 29.00 X 362279 399548 20275 MARGARET BREEN 29.00 X 224591 247695 17268 AMY PROTEXTER 29.00 X 194791 214830 28487 PATRICIA NADLE 29.00 X 62873 69339 252625 MARK KESTNER MD 29.00 X 249972 275689 158309 JOAN NEUHAUS 29.00 X 220810 243524 185398 MARTIN HICKEY MD 29.00 X 388103 428027 45701 MARIE KNEDLER 29.00 X 318831 351629 156737 SHEREE KEELY 29.00 X 104258 114985 21999 Elizabeth LLEWELLYN 29.00 X 127254 140346 21048 PATRICIA MASEK 29.00 X 103892 114578 43278 FRANK EMSICK 29.00 X 127008 140074 24435 JOSEPH HOAGBIN 60.00 X 270412 0 34786 PAUL EBMEIER 29.00 X 157729 173955 22704 SHIRLEY HUERTER MD 60.00 X 0 485612 35837 ENEH OKORUWA MD 60.00 X 524876 0 36405 SRIRAMAMURTHY RAVIPATI 60.00 X 482016 0 41370 Stephen Budd MD 60.00 X 336896 0 36801 Craig Seamands MD 60.00 X 275606 0 35833 NARENDRA REDDY MD 60.00 X 347098 0 40399 THEODORE SCHWAB 0.00 X 177164 195389 19719 DUANE DAVID 0.00 X 99582 109827 0 DAVID TEW 0.00 X 298472 329176 141864 Ann Jones 0.00 X 124368 137161 4177 JARROD JOHNSON 0.00 X 104556 115313 5703 JOHN MAY 0.00 X 125085 137954 3737 PETE FESTERSEN 0.00 X 87430 96423 1087 MICHAEL ANDERSON MD 0.00 X 73158 80684 4836 8334909 7753695 2642488 86 1 1 0 CASSLING DIAGNOSTIC 13808 F STREET OMAHA NE 68137 DIAGNOSTIC IMAGING SERVICES 2224566 DELTA CONSTRUCTION SERVICES INC 1105 S 24TH STREET OMAHA NE 68108 CONSTRUCTION 1550187 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 84108 LABORATORY RESEARCH 1284709 NORTHWEST ANESTHESIA PC 6901 N 72ND STREET OMAHA NE 68122 ANESTHESIA SERVICES 1268517 CAPITAL EXPRESS 3326 S 67TH STREET OMAHA NE 68106 COURIER SERVICE 728973 44 143305 52500 171679 6814082 36060 7217626 NET PATIENT SERV REV 621500 462703761 459861264 2842497 REIMBURSABLE AFFILIATE 900099 17653307 17653307 PHARMACY 446110 7298607 3195641 4102966 FOOD SERVICE 722320 1777161 146429 1630732 HEALTH EDUCATION PRGMS 611710 86653 86653 489519489 254524 254524 2955705 1986875 968830 968830 968830 8755578 1164789 1337275 8755578 -172486 8583092 8583092 62192 52500 42135 20057 20057 49600 25822 23778 23778 651153 302409 348744 348744 REIMBURSED SERVICES 900099 4724694 4724694 CHILD CARE 624410 1392265 1392265 MISC OPERATING REVENUE 900003 1250183 487127 763056 53975 53975 7421117 514357257 477601224 6725669 22812738 28800 28800 45533005 45533005 5406236 4054677 1351559 164964088 132602623 32043310 318155 6655821 5556510 1099311 29498914 18790123 10601703 107088 9329219 7739249 1583811 6159 35765 35765 21390 21390 21759657 14874956 6884701 36631 36631 97524290 95676664 1847339 287 7951111 7951111 523709 225706 296712 1291 105134 105134 2706902 2706902 32369325 23646821 8722504 954570 609084 345486 BAD DEBTS 25774040 25774040 PURCHASED SERVICES 21194259 6999155 14159114 35990 MANAGEMENT ALLOCATIONS 20893828 20893828 Joint Venture 17825599 17825599 OTHER 5485005 5485005 544510 531474 13036 517121808 437668487 78984351 468970 3498916 1044159 31873899 20019456 49633782 50919748 1550000 2975000 8731671 9130447 22249 111548 554244137 257443541 243896027 296800596 148921057 192439888 31327779 16108779 11185000 32411279 530640380 621960900 19221301 13061612 355505 526305 75946369 171451063 831852 3084807 96355027 188123787 X 429831574 428915113 2653779 3131000 1800000 1791000 434285353 433837113 530640380 621960900 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 1 21390 0 0 0 21390 0 3665977 149013 298938 9996 142744 3961188 2688014 1800115 -448721 3875 369556 3665977 0.36000 0.64000 0 1 1 3341409 3341409 225134729 92503440 132631289 13394211 8695536 4698675 268447126 156244565 112202561 43926662 43926662 296800596 INTERCOMPANY RECEIVABLE 32411279 32411279 PAYABLE UNDER DEFERRED COMP PLANS 885451 3RD PARTY PAYER SETTLEMENT 2199356 3084807 Part V, Line 4: Description of Intended Use of Endowment Funds: ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. PART X, LINE 2 - 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. Candle Light Ball 114692 52500 62192 25000 17135 114692 52500 62192 25000 17135 42135 20057 49600 25822 1 0.04000 49600 25822 25822 23778 NE IA 1 0 0 0 0.00000 1.00000 ALEGENT HEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 0 Volunteers 0 Gaming responsibilities are handled by Volunteers of the Bergan and Mercy Auxiliaries. Therefore, no compensation is reported. 0 1 1 X 0 0 1 1 1 0 1 1 8419 17671748 273685 17398063 0.03540 5322 58012286 54990545 3021741 0.00610 13741 75684034 55264230 20419804 0.04150 2357 354380 53976 300404 0.00060 213 2420 45 2375 0.00000 9406050 7085925 2320125 0.00470 1022473 216935 805538 0.00160 1642 688810 0 688810 0.00140 4212 11474133 7356881 4117252 0.00830 17953 87158167 62621111 24537056 0.04980 2 184593 17568 167025 0.00030 29 326334 3706 322628 0.00070 7 660 660 0.00000 38 511587 21274 490313 0.00100 1 10468906 2779824 95766408 134836944 -39070536 X 1 1 ALEGENT HEALTH MERCY HOSPITAL

800 MERCY DRIVE COUNCIL BLUFFS IA 51503

X X X Alegent Health LASTING HOPE RECOVERY CTR

415 S 25th Avenue OMAHA NE 68131

X X X ALEGENT HEALTH HOSPICE

7070 Spring Street OMAHA NE 68106

Licensed Hospice ALEGENT HEALTH HOSPICE

703 Rosary Drive CORNING IA 50041

LICENsed Hospice ALEGENT HEALTH AT HOME

7070 Spring Street OMAHA NE 68106

HOME HEALTH AGENCY AH BERGAN MERCY MEDICAL CENTER

7500 MERCY ROAD OMAHA NE 68124

X X X Part I, Line 3c: Bergan Mercy Health System is 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 system 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 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 I, line 6a: The Alegent Health System 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 Bergan Mercy Health System provides subsidized health to the broader community via a neonative intensive care unit, home health and hospice care, and behavioral health services. Part I, Line 7f: Bad debt of $25,774,040 included in the functional expense total 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 CAREPOLICY, REPRESENTATIVES OF THE ALEGENT HEALTH SYSTEM DETERMINE IF ANACCOUNT NEEDS TO BE MOVED FROM BAD DEBT TO CHARITY WHEN A PATIENT EITHERCOMES FORWARD AND COMPLETES A CHARITY APPLICATION, WHICH IS APPROVED OR IF IT IS DETERMINED THAT THE PATIENT HAS NO OTHER RESOURCES TO PAY THEACCOUNT BALANCE. Part III, Line 8: The Alegent 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 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: 2 licensed hospices and 1 home health agency. 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 WHERE THE licensed hospitals ARE located. The process to develop the assessments is collaborative in nature and involves health departments, existing health coalitions, community members and hospital leadership, as is supported by the Alegent Health Planning and Community Benefit Department staff. The Alegent Health Planning department conducts market assessments that identify the OMAHA METROPOLITAN STATISTICAL AREA'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, which Bergan Mercy Medical Center resides, needs assessment and reporting of those needs is led by Live Well Omaha, a membership based coalition. LIVE WELL OMAHA has been in existence for 14 years and Alegent Health was a founding member and is the largest financial contributor. 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. Additionally, information on The Alegent Health SYSTEM'S financial assistance policies are located AT www.alegent.com. Part VI, Line 4: Alegent Health (system) serves the Omaha Metropolitan Statistical Area (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 racial and ethnic makeup is approximately 83.9% white, 7.7% black and 7.6% Hispanic or Latino. THE 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 AND Made 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. Executive Committee, which consists of community leaders and policy makers, have implemented an ecological approach that improves programs, policies and promotes physical activity and healthy eating habits at the individual and organizational levels. More than 200 volunteers have participated in the planning and implementation of LWOK initiatives. A portion of this investment in LWOK is allocated to the ALEGENT HEALTH-Bergan Mercy HEALTH System. Part VI, Line 6: The primary care physician clinics that are part of the ALEGENT HEALTH SYSTEM participate in medical student preceptorships that advance the healthcare provider education process. THE Alegent Health SYSTEM has Open Medical staffs AND THE Alegent Health SYSTEM IS one of 3 health systems that fund the operations of a coalition that exists to provide access for the patients of 3 area Federally Qualified Community Health CenterS to specialty physician services and hospital based diagnostics and Treatment. THE Alegent Health SYSTEM is the sole comprehensive acute mental health provider in the Omaha MSA area. THE Alegent Health SYSTEM is a joint venture partner in a not-for-profit Hospice inpatient hospital and provides the management support contract. THE Alegent Health SYSTEM 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. THE Alegent Health SYSTEM Has a current commitment to set aside up to 6% of its EBIDA in a given fiscal year for collaborative initiatives to improve the health of the communities served, which is the Catalyst Fund. BOARD OF DIRECTORS - THE ALEGENT HEALTH SYSTEM 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. EMERGENCY DEPARTMENT - ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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 HEALTH-BERGAN MERCY HEALTH SYSTEM, 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 HEALTH-BERGAN MERCY HEALTH SYSTEM 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 HEALTH-BERGAN MERCY HEALTH SYSTEM 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-BERGAN MERCY HEALTH SYSTEM'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 7: The senior leadership of the individual hospitals ARE 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 HARBOR HOUSE 12809 WEST DODGE ROAD OMAHA NE 68154 364003095 501(C)(3) 15000 GENERAL SUPPORT MOHMS PLACE 1435 N 15th St COUNCIL BLUFFS IA 51503 421407712 501(C)(3) 10000 General Support 2 SCHOLARSHIP 29 11900 Mercy Fund Distributions 58 32157 CHARITY CARE 8419 45488948 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. THE BERGAN MERCY AUXILIARY TEEN SCHOLARSHIP PROGRAM WAS SET UP IN 1986 BY BERGAN MERCY. THE PURPOSE OF THE SCHOLARSHIP PROGRAM IS TO PROVIDE COLLEGE SCHOLARSHIPS TO TEEN VOLUNTEERS WHO HAVE VOLUNTEERED THEIR SERVICES AT BERGAN MERCY MEDICAL CENTER. IN ORDER TO RECEIVE A SCHOLARSHIP IN THIS PROGRAM, THE APPLICANT MUST BE AN ACTIVE VOLUNTEER THROUGHOUT ALL THE YEARS THEY DO SERVICE, INCLUDING THEIR SENIOR YEAR. IF A STUDENT IS TO DROP OUT OF THE PROGRAM OR IS TO BE DISMISSED, THEY ARE NOT ELIGIBLE FOR THE SCHOLARSHIP. MERCY FUND DISTRIBUTIONS ARE ESTABLISHED FOR THE DISBURSEMENT OF ALEGENT HEALTH BERGAN MERCY AUXILIARY MONIES FOR PATIENT ASSISTANCE THAT ARE COMPLIANT WITH ALEGENT HEALTH POLICIES AND PROCEDURES, INTERNAL REVENUE SERVICE (IRS) REGULATIONS AND OTHER APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND REGULATIONS. Other Information: Part IV: Alegent Health-BERGAN MERCY HEALTH SYSTEM 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. SCHEDULE I, PART I, LINE 2: ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM OCCASIONALLY DISTRIBUTES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS. THESE DISTRIBUTIONS ARE MONITORED TO ENSURE THEY ARE BEING USED AS SPECIFIED BY THE ORGANIZATION. X 1 1 X X X X X 1 1 0 1 0 1 1 0 0 ANTHONY HATCHER DO 0 361253 0 57454 0 79556 0 19380 0 16188 0 533831 0 0 WAYNE A SENSOR 255776 282088 156594 172703 423075 466598 8051 8879 3043 3356 846539 933624 392491 432867 RICHARD HACHTEN II 137062 151162 7685 8475 633660 698846 348180 383999 1099 1212 1127686 1243694 615333 678634 FRED HOSLER MD 176733 194914 85413 94199 182224 200969 172546 190297 3283 3621 620199 684000 156902 173043 KENNETH LAWONN 135872 149850 64268 70880 107437 118490 15360 16940 2966 3270 325903 359430 98911 109086 SCOTT WOOTEN 178630 197006 81021 89356 102628 113186 6303 6952 3338 3682 371920 410182 91635 101061 MARGARET BREEN 89540 98751 60968 67240 74083 81704 6991 7710 1221 1346 232803 256751 63373 69893 AMY PROTEXTER 67994 74989 58331 64332 68466 75509 9715 10714 3832 4226 208338 229770 53431 58927 PATRICIA NADLE 61068 67349 0 0 1805 1990 118234 130398 1899 2094 183006 201831 0 0 MARK KESTNER MD 106800 117786 48721 53733 94451 104170 70744 78022 4538 5005 325254 358716 69449 76593 JOAN NEUHAUS 139440 153784 42654 47042 38716 42698 86378 95264 1786 1970 308974 340758 37003 40810 MARTIN HICKEY MD 184449 203423 67753 74723 135901 149881 17653 19469 4080 4499 409836 451995 51753 57077 MARIE KNEDLER 127346 140446 39079 43099 152406 168084 72258 79692 2276 2511 393365 433832 150593 166084 SHEREE KEELY 69912 77105 22313 24609 12033 13271 8250 9099 2211 2439 114719 126523 11893 13116 Elizabeth LLEWELLYN 68971 76067 26127 28815 32156 35464 9528 10509 481 530 137263 151385 23621 26051 PATRICIA MASEK 65668 72422 21053 23218 17171 18938 18730 20656 1851 2041 124473 137275 10587 11676 FRANK EMSICK 79624 87814 25787 28440 21597 23820 8098 8932 3521 3884 138627 152890 21064 23231 JOSEPH HOAGBIN 252770 0 0 0 17642 0 26730 0 8056 0 305198 0 0 0 PAUL EBMEIER 129370 142678 24001 26470 4358 4807 8051 8879 2746 3028 168526 185862 0 0 SHIRLEY HUERTER MD 0 427911 0 0 0 57701 0 19380 0 16457 0 521449 0 0 ENEH OKORUWA MD 371169 0 131265 0 22442 0 19380 0 17025 0 561281 0 0 0 SRIRAMAMURTHY RAVIPATI MD 467225 0 0 0 14791 0 21830 0 19540 0 523386 0 0 0 Stephen Budd MD 321623 0 0 0 15273 0 16930 0 19871 0 373697 0 0 0 Craig Seamands MD 253051 0 0 0 22555 0 19380 0 16453 0 311439 0 0 0 NARENDRA REDDY MD 322277 0 0 0 24821 0 19380 0 21019 0 387497 0 0 0 THEODORE SCHWAB 0 0 0 0 177164 195389 1750 1930 7627 8412 186541 205731 176935 195136 DUANE DAVID 0 0 0 0 99582 109827 0 0 0 0 99582 109827 99358 109579 DAVID TEW 55705 61435 45025 49657 197742 218084 64347 70967 3115 3435 365934 403578 72577 80044 Ann Jones 3840 4235 15888 17522 104640 115404 0 0 1986 2191 126354 139352 102197 112711 JARROD JOHNSON 4342 4789 13806 15227 86408 95297 1077 1188 1635 1803 107268 118304 82745 91258 JOHN MAY 4713 5199 15692 17306 104680 115449 1262 1391 515 569 126862 139914 100011 110300 PETE FESTERSEN 4908 5412 11596 12788 70926 78223 0 0 517 570 87947 96993 69785 76964 MICHAEL ANDERSON MD 4375 4825 14822 16347 53961 59512 1968 2170 332 366 75458 83220 51312 56591 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 is included in the EXECUTIVE'S wages as taxable income. Part I, Line 4a The following reportable individuals received severance payments from Alegent Health (a related organization) 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. 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 - 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 MICHAEL ANDERSON - $78,739 PETE FESTERSEN - $9,856 THEODORE SCHWAB - $159 WAYNE SENSOR - $701,232. Part I, Line 5 PHYSICIANS EMPLOYED BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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. 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. MICHAEL DEFREECE-BOARD MEMBER H-CARD,LLC - Officer 133410 SUPPLIER PAYMENT NETWORK 0 Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM IS CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES DOES NOT HAVE ANY VOTINGS RIGHTS AS A MEMBER OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. INSTEAD CATHOLIC HEALTH INITIATIVES ELECTS 50% OF THE DIRECTORS OF ALEGENT HEALTH. Form 990, Part VI, Section A, line 7a THE BUSINESS AND AFFAIRS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM ARE MANAGED BY OR UNDER THE DIRECTION OF THE ALEGENT HEALTH BOARD OF DIRECTORS, AND ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM DELEGATES TO THE ALEGENT BOARD OF DIRECTORS, TO THE EXTENT PERMITTED BY LAW, COMPLETE GOVERNANCE AUTHORITY OVER IT, SUBJECT ONLY TO THE APPROVAL POWERS OF THE ALEGENT CORPORATE MEMBERS SET FORTH IN THE ARTICLES OF INCORPORATION AND BYLAWS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. DIRECTORS SHALL BE APPOINTED BY THE ALEGENT BOARD IMMEDIATELY FOLLOWING THE APPOINTMENT AND RATIFICATION BY ALEGENT CORPORATE MEMBERS OF THE ALEGENT DIRECTORS PURSUANT TO THE ARTICLES OF INCORPORATION AND BYLAWS OF ALEGENT. THE ALEGENT BOARD SHALL APPOINT DIRECTORS SUCH THAT, AT ALL TIMES , ALL OF THE PERSONS SERVING AS ALEGENT DIRECTORS ALSO SHALL BE SERVING AS DIRECTORS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. Form 990, Part VI, Section A, line 7b THE FOLLOWING ACTIONS SHALL BE EFFECTIVE ONLY IF APPROVED BY THE ALEGENT BOARD AND BY BOTH IMMANUEL HEALTH SYSTEMS (IHS) AND CATHOLIC HEALTH INITIATIVES (CHI) IN THEIR CAPACITIES AS ALEGENT CORPORATE MEMBERS: A. ADOPTION OR AMENDMENT OF THE UNFIIED PHILOSOPHY AND MISSION OF THE CORPORATION; B. SALE, LEASE, TRANSFER, ENCUMBRANCE OR DISPOSITION OF THE TANGIBLE PROPERTY OR INVESTMENTS OF THE CORPORATION 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; AND PROVIDED FURTHER THAT APPROVAL OF CHI AND IHS SHALL NOT BE REQUIRED FOR ANY TRANSFER OF ASSETS TO CHI BY THE CORPORATION PURSUANT TO THE TERMS OF THE ALEGENT FINANCING AGREEMENT (AFA); C. INCURRENCE, ASSUMPTION OR GUARANTY BY THE CORPORATION IN ANY INDIVIDUAL TRANSACTION OF LONG-TERM INDEBTEDNESS, INCLUDING CAPTIAL LEASES, OUTSTANDING FOR MORE THAN 365 DAYS, IN EXCESS OF THE GREATER OF $2 MILLION OR 2% OF THE TOTAL LONG-TERM INDEBTEDNESS OF ALL THE PARTICIPANTS, OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS; D. 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; AND E. NOTWITHSTANDING ANY OTHER PROVISIONS IN THE BYLAWS TO THE CONTRARY. THE ACTIONS THAT CAN BE TAKEN WITHOUT THE APPROVAL OF IHS AND CHI INCLUDE, WITHOUT LIMITATION: (I) TERMINATION OF THE AFA IN ACCORDANCE WITH ITS TERMS. (II) FORMATION OF THE UNIFIED ALEGENT HEALTH SYSTEM (AS THAT TERM IS DEFINED IN THE AFA) (III) PREPAYMENT BY THE CORPORATION OF THE FULL AMOUNTS OUTSTANDING ON ITS 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 THE NOTES OUTSTANDING. Form 990, Part VI, Section B, line 11 Tax returns for entities of the Alegent Health system are prepared by THE SYSTEM tax department. Following the preparation of ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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 FINAL TAX RETURN IS PRESENTED AT THE SCHEDULED BOARD MEETING. THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR ARE PRESENT AT THE MEETING TO ANSWER ANY QUESTIONS THE BOARD MAY HAVE. 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 - ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM has adopted the conflict of interest policy and conflict investigation process of Alegent Health, the parent corporation of the Alegent Health System. 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 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 (Mercy) Senior Vice President Chief Information Officer (2010) 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-BERGAN MERCY HEALTH SYSTEM 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: THE EMPLOYEES LISTED IN PART I, LINE 5 AND PART V, LINE 2A ARE EMPLOYED BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. FORM 990, PART V, LINE 1A: PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT HEALTH SYSTEM ARE MADE BY ALEGENT HEALTH, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. ALEGENT HEALTH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. HOWEVER, PER THE INSTRUCTIONS, THOSE 1099S ISSUED BY ALEGENT HEALTH ON BEHALF OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM ARE REPORTED. FORM 990, PART VI, SECTION B, LINE 16: ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM 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-IMMANUEL MEDICAL CENTER 6901 N 72ND STREET OMAHA NE 68122 470376615 LICENSED HOSPITAL NE 501(C)(3) L3 ALEGENT hEALTH ALEGENT hEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 470757164 LICENSED HOSPITAL/ADIMINSTRATIVE SUPPORT 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 ALEGENT hEALTH ALEGENT HEALTH FOUNDATION 12809 WEST DODGE ROAD OMAHA NE 68154 470648586 SUPPORT OF ALEGENT HEALTH AND AFFILIATES EXEMPT ACTIVITIES NE 501(C)(3) L7 ALEGENT hEALTH Alegent Health-Mercy Hospital Corning IA 603 Rosary Drive CORNING IA 50841 420782518 LICENSED HOSPITAL IA 501(C)(3) L3 N/A Mercy Health Care Foundation Corning IA 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 IA Alegent Health Memorial Hospital Schuyler NE 104 West 17th Street SCHUYLER NE 68661 470399853 LICENSED HOSPITAL NE 501(C)(3) L3 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER Schuyler Memorial Hospital Foundation INC 104 West 17th Street SCHUYLER NE 68661 363630014 SUPPORT OF ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER EXEMPT ACTIVITIES NE 501(C)(3) L11 I Alegent Health Memorial Hospital Schuyler NE Alegent Health Community Memorial Hospital of MO Valley IA 631 North 8th Street Missouri Valley IA 51555 420776568 LICENSED HOSPITAL IA 501(C)(3) L3 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER Community Memorial Hospital Medical Service Foundation Missouri Valley IA 631 North 8th Street Missouri Valley IA 51555 421294399 SUPPORT OF ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IA 501(C)(3) L11 I Alegent Health Community Memorial Hospital of MO Valley IA MERCY HOSPITAL FOUNDATION 800 MERCY DRIVE COUNCIL BLUFFS IA 51503 421178204 SUPPORT OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM IA 501(C)(3) L11 I N/A AVANTAS LLC 11128 JOHN GALT BLVD STE 400 OMAHA NE 68137 392045003 STAFFING OF NURSES NE N/A RELATED -900402 4051219 0 125535 1 LAKESIDE AMBULATORY SURGICAL CENTER LLC 17030 LAKESIDE HILLS PLZ STE 206 OMAHA NE 68130 204267902 AMBULATORY SURGICAL CENTER NE N/A N/A 0 0 LAKESIDE ENDOSCOPY CENTER LLC 17001 Lakeside Hills Plaza STE 201 OMAHA NE 68130 205544496 ENDOSCOPY SERVICES NE N/A N/A 0 0 Omaha Ambulatory Investment Company LLC 12809 WEST DODGE ROAD OMAHA NE 68154 061786989 PARENT HOLDING COMPANY ASC NE N/A N/A 0 0 Alegent Health Northwest Imaging Center LLC 3606 N 156th Street Ste 104 OMAHA NE 68154 061786985 DIAGNOSTIC TESTING FACILITY NE N/A N/A 0 0 Prairie Health Ventures LLC 421 South 9th Street Ste 102 LINCOLN NE 68508 204962103 PROFESSIONAL TECH SERVICES NE N/A N/A 0 0 Bergan Mercy Surgery Center LLC 7710 Mercy Road Ste 100 OMAHA NE 68124 208671994 AMBULATORY SURIGICAL CENTER NE N/A N/A 0 0 Alegent HealthCreighton St Joseph Managed Care Services Inc 12809 WEST DODGE ROAD OMAHA NE 68164 470802396 MANAGED CARE SERVICES NE N/A C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 AVANTAS LLC D 2975000