ALEGENT CREIGHTON CLINIC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
ALEGENT CREIGHTON CLINIC (EIN 47-0765154)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-13
IRS object ID
201121339349302807
Schema version
2009v1.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-05-13T11:13:04-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1TWO CENTRAL PARK PLAZA SUITE 1501AddressLine1
CityOMAHACity
StateNEState
ZIP Code68102ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN470765154EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ALEGENT HEALTH CLINICBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlALEGNameControl
Phone4023434323Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68154ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSCOTT M WOOTENName
TitleSENIOR VP/CFOTitle
Phone4023434323Phone
Date Signed2011-05-13DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameHeidi KrieteName
Phone4023481450Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonSCOTT M WOOTENNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68154ZIPCode
FieldValueIRS element (for citing)
Gross Receipts99744048GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.alegent.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1993YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionCLINIC HEALTHCARE SERVICESActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members4NbrIndependentVotingMembers
Total Nbr Employees1032TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year34898ContributionsGrantsPriorYear
Contributions Grants Current Year34825ContributionsGrantsCurrentYear
Program Service Revenue Prior Year80876970ProgramServiceRevenuePriorYear
Program Service Revenue CY98473473ProgramServiceRevenueCY
Investment Income Prior Year24272InvestmentIncomePriorYear
Investment Income Current Year-487InvestmentIncomeCurrentYear
Other Revenue Prior Year-5051460OtherRevenuePriorYear
Other Revenue Current Year-5551634OtherRevenueCurrentYear
Total Revenue Prior Year75884680TotalRevenuePriorYear
Total Revenue Current Year92956177TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year1014178GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2124439GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year70924227SalariesEtcPriorYear
Salaries Etc Current Year84919670SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year24245400OtherExpensePriorYear
Other Expenses Current Year50415646OtherExpensesCurrentYear
Total Expenses Prior Year96183805TotalExpensesPriorYear
Total Expenses Current Year137459755TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-20299125RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-44503578RevenuesLessExpensesCY
Total Assets BOY27215478TotalAssetsBOY
Total Assets EOY18479919TotalAssetsEOY
Total Liabilities BOY96080081TotalLiabilitiesBOY
Total Liabilities EOY131848100TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-68864603NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-113368181NetAssetsOrFundBalancesEOY
Mission DescriptionFaithful 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.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense57520749Expense
Grants1366316Grants
Revenue54080294Revenue
DescriptionAlegent Health Clinics primary care physicians are dedicated to providing patients with excellent healthcare. In Fiscal Year 2010, primary care physicians cared for 362,107 outpatient visits at the clinics. Alegent Health Clinic has 23 primary clinics conveniently located throughout the Omaha/Council Bluffs area. A full range of medical services are provided to patients covered by Medicare and Medicaid. Alegent Health Clinic follows a reasoned and thoughtful approach to help patients who lack insurance or financial resources to pay for the medical care they need.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense19239500Expense
Grants495034Grants
Revenue17186771Revenue
DescriptionAlegent Health Clinic provides our patients with physicians that specialize in Obstetrics and Gynecology. Each physician has the special knowledge, skills and professional capabilities in the medical and surgical care of the female reproductive system and associated disorders. In Fiscal Year 2010, Obstetrics and Gynecology physicians cared for 63,696 outpatient visits at the clinics.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense11969133Expense
Grants178459Grants
Revenue11968151Revenue
DescriptionAlegent Health Clinic provides a comprehensive range of cardiac services, from prevention to treatment and rehabilitation. The team of clinical physicians include highly trained medical professionals from many disciplines. In Fiscal Year 2010, heart and vascular specialists cared for 20,260 outpatient visits at the clinics.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense42835632Expense
Grants84630Grants
Revenue15717573Revenue
DescriptionAlegent Health Clinic is a network of skilled physicians devoted to providing exceptional healthcare in accordance with our mission. The skilled physicians provide outstanding care in the following services: Plastic & Reconstructive Surgery, Neuroscience, General Surgery and other areas of specialty care. Each clinic team is supported by physician assistants and nurse practitioners, who have the expertise to prevent, diagnose and treat each one of our PATIENT'S conditions.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp42835632TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt84630TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev15717573TotalOfOtherProgramServiceRev
Total Program Service Expense131565014TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations1GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With1096185NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees1032NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members4NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1SCOTT M WOOTEN SENIOR VPCFOBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4023434323TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68154ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (35 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
JULIE ROTHLISBERGER-CAST
DIRECTOR/PHYSICIAN60.00X358344037327
RICHARD HACHTEN II
DIRECTOR/AH President4.00X1071181529772734490X
Fred hosler MD
DIRECTOR/AH CMO4.00X61151873301369747X
WILLIAM LOWNDES MD
DIRECTOR/PHYSICIAN60.00X356031040298
THOMAS S PRUSE MD
DIRECTOR/PHYSICIAN60.00X268865066481
KAREN M MILLER MD
DIRECTOR/PHYSICIAN60.00X181373029407
PATRICIA MURDOCK-LANGAN
DIRECTOR/PHYSICIAN60.00X250402018713
WAYNE A SENSOR
DIRECTOR/AH CEO4.00X114968164186623329X
MICHAEL J WALTS MD
DIRECTOR/PHYSICIAN60.00X221448040690
JOHN HEWITT
DIRECTOR2.00X000
SCOTT WOOTEN
DIRECTOR/AH SVP/CFO4.00X4985371197420275X
ROBERT L BOYLE
DIRECTOR2.00X000
NAGI AYOUB MD
DIRECTOR/PHYSICIAN60.00X412307036276
J RUSSELL BOWEN MD
SECRETARY/PHYSICIAN60.00X271996036125X
LARRY BROWN MD
VICE CHAIR/PHYSICIAN60.00X210277043748X
ANTHONY HATCHER DO
CHAIRPERSON/PHYSICIAN60.00X4782632000035268X
BETHEL KOPP MD
DIRECTOR2.00X034583137085
LESLIE ANDERSEN
DIRECTOR2.00X000
PAT HENSLEY
DIRECTOR2.00X000
MARTIN HICKEY MD
DIRECTOR/AHC CEO4.00X5340876272245701X
D Randall Pritza MD
DIRECTOR/PHYSICIAN60.00X486518032310
KENNETH LAWONN
SVP INFORMATION TECH4.004232760447038536X
MARGARET BREEN
SVP HUMAN RESOURCES4.003090644138017268X
AMY PROTEXTER
SVP MARKETING & COMM OFF4.002680638281528487X
Paul Ebmeier
Chief Operating Officer4.002170530997822704X
MARK KESTNER MD
SVP CMO4.0034399491262158309X
JOAN NEUHAUS
SVP COO4.0030387433947185399X
DAVID HESSELINK
AHC CFO4.001131316155532841X
Jeffrey Carstens MD
PHYSICIAN60.001204717039520X
Atul Ramachandran MD
PHYSICIAN60.001191066043322X
Eric Van De Graaff MD
PHYSICIAN60.001191342040277X
Himanshu Agarwal MD
PHYSICIAN60.001191297043602X
Joseph Thibodeau MD
PHYSICIAN60.001191273040297X
THEODORE SCHWAB
FORMER CIO0.002438034817219719X
DUANE DAVID
FORMER SVP CLINICS0.00137041957050X
FieldValueIRS element (for citing)
Total Reportable Comp From Org10087944TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs9254750TotalReportableCompFrmRltdOrgs
Total Other Compensation2357551TotalOtherCompensation
Number Individuals GT100 K137NumberIndividualsGT100K
Formers Listed1FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Siemens Medical Solutions USA Inc
1302 North 183rd AveElkhornNE68022DIAGNOSTIC IMAGING SERVICES786939
Xerox Corporation
101 S 108th Ave 104OmahaNE68154Business Services/Office419551
Merchants Credit Adjusters Inc
17055 Frances Street Ste 100OmahaNE68130Debt Collection316129
Sanofi Pasteur Inc
Discovery DriveSwiftwaterPA18370Vaccine Research301995
Midland Medical Supply Co
4850 Old Cheney RoadlincolnNE68516MEDICAL & SURGICAL SUPPLIES301562
FieldValueIRS element (for citing)
Number Of Contractors GT100 K30NumberOfContractorsGT100K
All Other Contributions34825AllOtherContributions
Total Contributions34825TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
NET PATIENT REVENUE6211109620270596202705
REVENUE FROM AFFILIATE90009920152132015213
OTHER REVENUE900099255555255555
FieldValueIRS element (for citing)
Total Program Service Revenue98473473TotalProgramServiceRevenue

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real30705Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real6674294Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-6643589Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-6643589TotalRevenueColumn
Exclusion-$6,643,589ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other113090Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other113577Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-487Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-487TotalRevenueColumn
Exclusion-$487ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
MANAGEMENT ALLOCATION900099612639$612,639
Other Revenue900099479316479316
FieldValueIRS element (for citing)
Total Other Revenue1091955TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column92956177TotalRevenueColumn
Related Or Exempt Function Income98952789RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion-$6,031,437ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total14847Total
Program Services14847ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2109592Total
Program Services2109592ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4452183Total
Program Services4229574ProgramServices
Management And General222609ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total68514317Total
Program Services65088601ProgramServices
Management And General3425716ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1801832Total
Program Services1711740ProgramServices
Management And General90092ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total6514980Total
Program Services6189231ProgramServices
Management And General325749ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total3636358Total
Program Services3454540ProgramServices
Management And General181818ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4666232Total
Program Services4432920ProgramServices
Management And General233312ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total32199Total
Program Services30589ProgramServices
Management And General1610ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total8375920Total
Program Services7957124ProgramServices
Management And General418796ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total117302Total
Program Services117302ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total307823Total
Program Services292432ProgramServices
Management And General15391ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total312557Total
Program Services312557ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total37295Total
Program Services37295ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3077107Total
Program Services2923252ProgramServices
Management And General153855ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1167303Total
Program Services1108938ProgramServices
Management And General58365ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
A/R ADJUSTMENT1509700015097000
PURCHASED SERVICES70881376733730354407
BAD DEBT66816026681602
MANAGEMENT ALLOCATIONS20172141916353100861
OTHER680655680655

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total757300Total
Program Services445140ProgramServices
Management And General312160ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total137459755Total
Program Services131565014ProgramServices
Management And General5894741ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY812618BOY
EOY1186060EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY19537002BOY
EOY8402246EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY4500EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY539065BOY
EOY514190EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY46708BOY
EOY46708EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis15519121LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec8471860LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY4679274BOY
EOY7047261EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY983741BOY
EOY661884EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY617070BOY
EOY617070EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY27215478BOY
EOY18479919EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5348458BOY
EOY7035365EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY1000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY90731623BOY
EOY124811735EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY96080081BOY
EOY131848100EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-68864603BOY
EOY-113368181EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-68864603BOY
EOY-113368181EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY27215478BOY
EOY18479919EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2418107OtherCostOrOtherBasis
Depreciation1917993Depreciation
Book Value500114BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1702233OtherCostOrOtherBasis
Depreciation637625Depreciation
Book Value1064608BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis8748701OtherCostOrOtherBasis
Depreciation5916242Depreciation
Book Value2832459BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis2650080OtherCostOrOtherBasis
Book Value2650080BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7047261TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
INTERCOMPANY PAYABLES$124,625,495
PAYABLE UNDER DEFERRED COMPENSATION PLANS$186,240
FieldValueIRS element (for citing)
Total Of Amounts124811735TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
ExplanationPART 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 RECOGNIZE 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.Explanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1ALEGENT HEALTH FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68154ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient470648586EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant12400AmountOfCashGrant
Purpose Of GrantGENERAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantCHARITY CARE - ASSISTANCE TO LOW INCOME QUALIFIED INDIVIDUALS.TypeOfGrant
Number Of Recipients5716NumberOfRecipients
Amount Of Non Cash Assistance2109592AmountOfNonCashAssistance
Method Of ValuationBOOKMethodOfValuation
Description Of Non Cash AssistanceREDUCE OR WRITE OFF OF PATIENT SERVICES.DescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
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.
Other Information:Part IV:Alegent Health CLINIC recognizes the right to quality healthcare regardless of age, sex, race, religion, national origin, or ability to pay. Business office staff helps patients seek local, state, and federal reimbursement at no charge when no other source of payment is available. Financial assistance is provided to patients with demonstrated inability to pay for medically necessary services. THESE FUNDS ARE DIRECTLY USED TO OFFSET THE PATIENTS ACCOUNTS RECEIVABLE.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment1SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org1CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs1CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (31 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JULIE ROTHLISBERGER-CASTILLO MD
323298026246088000202240171030395671000
RICHARD HACHTEN II
188612693641058151028719912453064791468426515121601551832216197846771209290
Fred hosler MD
24321347326117541678582507635811723744339099452645285347121885221592308354
WILLIAM LOWNDES MD
318246000377850193800209180396329000
THOMAS S PRUSE MD
25694900011916057131093500335346000
KAREN M MILLER MD
1506160137810169760133170160900210780000
PATRICIA MURDOCK-LANGAN MD
22955000020852016930017830269115000
WAYNE A SENSOR
3519950266621549307747582208314531107158224195981116494166366954011771346
MICHAEL J WALTS MD
1723040302760188680178330228570262138000
SCOTT WOOTEN
2458135105411149159228141232016928671238845965615117973092312610180086
NAGI AYOUB MD
3188270500000434800163000199760448583000
J RUSSELL BOWEN MD
260847000111490169300191950308121000
LARRY BROWN MD
177677000326000207990229490254025000
ANTHONY HATCHER DO
341253200005745407955601938001588805135312000000
BETHEL KOPP MD
0299740030814015277026454010631038291600
MARTIN HICKEY MD
253823624899324133153187022670802429346935618018563988054337122101709
D Randall Pritza MD
3707750001157430193800129300518828000
KENNETH LAWONN
1869826702488441263041478521114221143018640858284484964048413611194386
MARGARET BREEN
12321175969839011981910195145592962137391682399320364575188721124545
AMY PROTEXTER
9357133626802711463694221345531337190925277531286704094387353105005
Paul Ebmeier
17802254245330347168600856511081582237853962319133119600
MARK KESTNER MD
146962098886705957491299818562597351390326248918447586392129557136485
JOAN NEUHAUS
1918927403558708382653287608611887169756246351042520607213509272721
DAVID HESSELINK
8425120321142920404145920830899128411250178511346219224700
Jeffrey Carstens MD
97971500022500202073201878801244237000
Atul Ramachandran MD
101710300017396302073202259001234388000
Eric Van De Graaff MD
101737900017396301811102216601231619000
Himanshu Agarwal MD
99365700019764002073202287001234899000
Joseph Thibodeau MD
92972600026154701811102218601231570000
THEODORE SCHWAB
00002438034817224134381050149902567136660024347347723
DUANE DAVID
00001370419570500001370419570513673195264

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aAs part of the executive compensation arrangement, executives are provided with a set sum, approximately 30 - 40% of their base salary, which can be used to elect various benefits. EXECUTIVES WHO RECEIVED THIS BENEFIT WERE RICHARD HACHTEN II, WAYNE SENSOR, SCOTT WOOTEN, MARTIN HICKEY, MD, FRED HOSLER, MD, THEODORE SCHWAB, KENNETH LAWONN, DUANE DAVID, AMY PROTEXTER, PAUL EBMEIER, MARK KESTNER, MD, JOAN NEUHAUS AND MARGARET BREEN. 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 4aThe 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 - $371,911 MARGARET BREEN - $53,962 RICHARD HACHTEN II - $363,816 AMY PROTEXTER - $49,415 WAYNE SENSOR - $124,126 FRED HOSLER, MD - $87,750 Mark Kestner, MD - $63,691. 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 Theodore SCHWAB - $159 WAYNE SENSOR - $701,232 Scott Wooten - $192,696 KENNETH LAWONN - $207,997 MARTIN HICKEY, MD - $108,830 MARGARET BREEN - $79,304 AMY PROTEXTER - $62,943 MARK KESTNER, MD - $82,351 JOAN NEUHAUS - $77,813.
Part I, Line 5Alegent Health Clinic Physicians are compensated based on their individual practice revenues less practice expenses. Absent extenuating circumstances, there is no guaranteed based salary or minimum salary past their initial practice start-up period. Some physicians are compensated based on their work RVU production which is a nationally accepted measure of physician productivity.
Part I, Line 6COMPENSATION 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.
Part IIISCHEDULE 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.Supplemental Information

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section A, line 6THE SOLE MEMBER OF ALEGENT HEALTH CLINIC IS ALEGENT HEALTH.
Form 990, Part VI, Section A, line 7aTHE BOARD OF DIRECTORS SHALL BE APPOINTED BY ALEGENT HEALTH AND SHALL CONSIST OF THIRTEEN (13) DIRECTORS. ALEGENT HEALTH SHALL CONSIDER THE SLATE OF THE NOMINATIONS SUBMITTED TO IT BY ALEGENT HEALTH CLINIC'S BOARD OF DIRECTORS. ALEGENT HEALTH CLINIC'S BOARD OF DIRECTORS SHALL SOLICIT NOMINATIONS FROM ALEGENT HEALTH CLINIC'S PHYSICIAN EMPLOYEES.
Form 990, Part VI, Section A, line 7bALEGENT HEALTH SHALL HAVE, IN ADDITION TO ALL RIGHTS AND POWERS GRANTED BY LAW WITH RESPECT TO THE GOVERNANCE OF ALEGENT HEALTH CLINIC, THE RIGHT TO: A. INITIATE AND APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS; B. INITIATE AND APPROVE PHYSICIAN COMPENSATION AND BENEFITS AND RECRUITMENT INCENTIVES; C. INITIATE AND APPROVE JOINT VENTURES IN WHICH ALEGENT HEALTH CLINIC PROPOSES TO PARTICIPATE, PURSUANT TO GUIDELINES ESTABLISHED FROM TIME TO TIME BY ALEGENT HEALTH; D. APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, ALL MEMBERS OF THE GOVERNING BOARD; E. APPROVE THE INCURRENCE OF ANY DEBT BY ALEGENT HEALTH CLINIC THAT IS IN EXCESS OF A THRESHOLD ESTABLISHED FROM TIME TO TIME BY ALEGENT HEALTH; F. INITIATE AND APPROVE PHYSICIAN FEE SCHEDULES; G. INITIATE AND APPROVE THE MERGER OR CONSOLIDATION OF ALEGENT HEALTH CLINIC INTO OR WITH ANY OTHER CORPORATION, ORGANIZATION, OR ASSOCIATION; H. INITIATE AND APPROVE THE DISSOLUTION OR LIQUIDATION OF ALEGENT HEALTH CLINIC; I. APPROVE THE INCORPORATION OR DISSOLUTION OF AFFILIATED ENTITIES, ORGANIZATIONS, OR ASSOCIATIONS; J. INITIATE AND APPROVE THE SALE, LEASE, EXCHANGE, TRANSFER, OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY, OTHER THAN IN THE USUAL AND REGULAR COURSE OF BUSINESS; K. INITIATE AND APPROVE THE MORTGAGE, PLEDGE, DEDICATION TO REPAYMENT OF INDEBTEDNESS, OR OTHER ENCUMBRANCE OF ANY OR ALL OF ALEGENT HEALTH CLINIC'S PROPERTY; L. APPROVE ANNUAL CAPITAL AND OPERATING BUDGETS AND ANY DEVIATIONS IN EXCESS OF A THRESHOLD ESTABLISHED FROM TIME TO TIME BY ANY MEMBER; AND M. APPROVE THE PURCHASE OF A MEDICAL PRACTICE.
Form 990, Part VI, Section B, line 11ALEGENT HEALTH CLINIC IS PART OF THE ALEGENT HEALTH SYSTEM. TAX RETURNS FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM ARE PREPARED BY THE SYSTEM TAX DEPARTMENT. FOLLOWING THE PREPARATION OF ALEGENT HEALTH CLINIC FORM 990 BY ALEGENT HEALTH INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE ALEGENT HEALTH TAX DIRECTOR, EXTERNAL TAX ADVISOR AND THE CHIEF FINANCIAL OFFICER. THE FINAL TAX RETURN IS POSTED TO ALEGENT HEALTH'S ELECTRONIC DIRECTOR'S PORTAL TO BE REVIEWED AND PRESENTED AT THE ALEGENT HEALTH FINANCE AND AUDIT COMMITTEE OF THE BOARD. THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR ARE PRESENT AT THE ALEGENT HEALTH FINANCE AND AUDIT COMMITTEE MEETING TO ANSWER QUESTIONS. THEREFORE, REVIEW PRIOR TO FILING IS COMPLETED ON A SYSTEM LEVEL AND NOT BY ALEGENT HEALTH CLINIC BOARD OF DIRECTORS.
Form 990, Part VI, Section B, line 12cWritten Conflict of Interest Policy - ALEGENT HEALTH CLINIC has adopted the conflict of interest policy and conflict investigation process of Alegent Health. 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 ALEGENT HEALTH CLINIC Board OF DIRECTORS. At any time a Board Member or Key Employee may declare a conflict of interest and recuse his/herself from the discussion. The individual is also required to disclose any known or possible conflicts of interest that arise during the calendar year.
Form 990, Part VI, Section B, line 15The 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.
Form 990, Part VI, Section C, line 19The conflict of interest policy is made available to the public on the website at www.alegent.com. ALEGENT HEALTH CLINIC does not make the financial statements or governing documents available to the public. However, the ARTICLES OF INCORPORATION Are available at www.sos.state.ne.us.
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 CLINIC. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT HEALTH CLINIC.
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 CLINIC. 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 CLINIC ARE REPORTED.
FORM 990, SCHEDULE A, PART I, LINE 3:ALEGENT HEALTH CLINIC IS RECOGNIZED AS A HOSPITAL BY THE INTERNAL REVENUE SERVICE UNDER IRC SECTION 170(B)(1)(A)(III). HOWEVER, ALEGENT HEALTH CLINIC DOES NOT CURRENTLY OPERATE ANY LICENSED hospital FACILITIES; THEREFORE, NO SCHEDULE H IS REQUIRED.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNABusiness Name Line1DirectControllingEntityName/BusinessNameLine1
ALEGENT HEALTH
12809 WEST DODGE ROADOMAHANE68154470757164LICENSED HOSPITAL/ADMINISTRATIVE SUPPORTNE501(C)(3)L3N/A
ALEGENT HEALTH FOUNDATION
12809 WEST DODGE ROADOMAHANE68154470648586SUPPORT OF ALEGENT HEALTH AND AFFILIATES EXEMPT ACTIVITIESNE501(C)(3)L7ALEGENT HEALTH
ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM
7500 MERCY ROADOMAHANE68124470484764LICENSED HOSPITALNE501(C)(3)L3ALEGENT HEALTH
ALEGENT HEALTH-IMMANUEL MEDICAL CENTER
6901 NORTH 72ND STREETOMAHANE68122470376615LICENSED HOSPITALNE501(C)(3)L3ALEGENT HEALTH
ALEGENT HEALTH MEMORIAL HOSPITAL CORNING IOWA
603 ROSARY DRIVECORNINGIA50841420782518LICENSED HOSPITALIA501(C)(3)L3ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM
MERCY HEALTH CARE FOUNDATION
603 ROSARY DRIVECORNINGIA50841421461064SUPPORT OF ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IA EXEMPT ACTIVITIESIA501(C)(3)L11 IALEGENT HEALTH MEMORIAL HOSPITAL CORNING IOWA
ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE
104 WEST 17TH STREETSCHUYLERNE68661470399853LICENSED HOSPITALNE501(C)(3)L3ALEGENT HEALTH-IMMANUEL MEDICAL CENTER
SCHUYLER MEMORIAL HOSPITAL FOUNDATION
104 WEST 17TH STREETSCHUYLERNE68661363630014SUPPORT OF ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER EXEMPT ACTIVITIESNE501(C)(3)L11 IALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE
AH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA
631 NORTH 8TH STREETMISSOURI VALLEYIA51555420776568LICENSED HOSPITALIA501(C)(3)L3ALEGENT HEALTH-IMMANUEL MEDICAL CENTER
COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION
631 NORTH 8TH STREETMISSOURI VALLEYIA51555421294399SUPPORT OF ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY,IA501(C)(3)L11 IALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MO VALLEY IA
MERCY HOSPITAL FOUNDATION
800 MERCY DRIVECOUNCIL BLUFFSIA51503421178204SUPPORT OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM EXEMPT ACTIVITIESIA501(C)(3)L11 IALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM

Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
Prairie Health Ventures LLC
421 South 9th Street Suite 102LincolnNE68508204962103PROFESSIONAL TECH SERVICESNEN/ARELATED00
Avantas LLC
11128 John Galt Blvd Suite 400OMAHANE68124392045003STAFFING OF NURSESNEN/ARELATED00
Lakeside Ambulatory SuRgical Center LLC
17030 Lakeside Hills Plaza Ste 110OmahaNE68116204267902AMBULATORY SURGICAL CENTERNEN/ARELATED00
Lakeside Endoscopy Center LLC
17001 Lakeside Hills Plaza Suite 20OMahaNE68116205544496Endoscopy ServicesNEN/ARELATED00
Omaha Ambulatory Investment Company LLC
12809 West Dodge RoadOMahaNE68154061786989PARENT HOLDING COMPANY ASCNEN/ARELATED00
Alegent Health Northwest Imaging Center LLC
3606 N 156th Street Suite 104OMahaNE68154061786985DIAGNOSTIC TESTING FACILITYNEN/ARELATED00
Bergan Mercy Surgery Center LLC
7710 Mercy Road Suite 100OMahaNE68124208671994AMBULATORY SURGICAL CENTERNEN/ARELATED00

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Alegent Health Creighton St Joseph Managed Care ServicesBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68154ZIPCode
FieldValueIRS element (for citing)
EIN470802306EIN
Primary ActivityMANAGED CARE SERVICESPrimaryActivity
Legal Domicile StateNELegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org1ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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