2014-05-13T19:01:06-05:00 2013-06-30 470617373 CATHOLIC HEALTH INITIATIVES 12809 WEST DODGE ROAD OMAHA NE 68154 990 2012-07-01 470376615 ALEGENT HEALTH - IMMANUEL MEDICAL CENTER ALEG 4023434323 6901 NORTH 72ND STREET OMAHA NE 68154 JEANETTE WOJTALEWICZ 2014-05-13 true ANGELA LEA P01051055 4023434413 2012 2015-11-30 17:44:51Z JEANETTE WOJTALEWICZ 12809 WEST DODGE ROAD OMAHA NE 68154 269810134 false X WWW.ALEGENTCREIGHTON.COM X 1904 NE TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. 14 9 1857 313 152292 64873 158696 457479 219578766 227510598 24782403 32928054 40419729 6878834 284939594 267774965 21877790 19451389 0 0 115576440 111872954 0 0 0 107233926 100778105 244688156 232102448 40251438 35672517 617826265 603353569 151030035 130841202 466796230 472512367 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. false false 26053397 5022790 58038339 ALEGENT HEALTH IMMANUEL MEDICAL CENTER MENTAL HEALTH PHYSICIANS ARE UNIQUE IN THEIR CARE-GIVING APPROACH TO EMOTIONAL AND BEHAVIORAL PROBLEMS OF CHILDREN, ADOLESCENTS, ADULTS AND SENIORS. PHYSICIANS PROVIDE THE MOST APPROPRIATE CARE AT THE LEVEL OF SERVICE THAT EACH PATIENT NEEDS. OUTPATIENT AND INPATIENT BEHAVIORAL SERVICE PROGRAMS ARE PROVIDED. RECENTLY, IMMANUEL MEDICAL CENTER BUILT THE RESIDENTIAL TREATMENT CENTER. THIS NEW STATE OF THE ART FACILITY FEATURES 20 PRIVATE ROOMS FOR BOYS AND GIRLS BETWEEN THE AGES OF SIX AND EIGHTEEN YEARS OF AGE. 21416528 5499033 63541332 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER REHABILITATION CENTER PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT PROGRAMS FOR INDIVIDUALS OF ALL AGES. THE REHABILITATION CENTER IS THE REGION'S MOST COMPREHENSIVE CENTER FOR PHYSICAL MEDICINE AND REHABILITATION, OFFERING PATIENTS SOME OF THE MOST ADVANCED REHABILITATIVE TECHNOLOGY. IMMANUEL REHABILITATION CENTER HAS RECEIVED THE HIGHEST LEVEL OF ACCREDITATION AWARDED BY THE JOINT COMMISSION AND BY THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF). AT EVERY LEVEL OF CARE, A TEAM OF LICENSED AND CERTIFIED REHABILITATION PROFESSIONALS ARE AVAILABLE. EACH ONE OF THE REHABILITATION PROGRAMS ARE DESIGNED TO MAXIMIZE INDEPENDENCE AND QUALITY OF LIFE. 14729907 7993788 92368222 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER CANCER SUPPORT AND DIAGNOSTIC 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. EACH ONE OF THE PHYSICIANS ARE EQUIPPED TO DIAGNOSE AND AGGRESSIVELY TREAT CANCER AND GET PATIENTS BACK TO THERE LIFE AS SOON AS POSSIBLE. INDIVIDUAL TEAM MEMBERS INCLUDE CANCER SUPPORT SERVICE SPECIALISTS, MEDICAL SOCIAL WORKERS, CANCER REHABILITATION SPECIALIST, PASTORAL SERVICES, DIETITIANS, ONCOLOGY NURSE NAVIGATORS, HOSPICE & HOME CARE SERVICES, INPATIENT NURSING SERVICES, RADIATION ONCOLOGY, AND VOLUNTEER SERVICES. 160492009 935778 53827072 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER PROVIDES ADDITIONAL SERVICES INCLUDING BUT NOT LIMITED TO: WEIGHT MANAGEMENT, A 24 HOUR EMERGENCY DEPARTMENT, INPATIENT HOSPITAL FACILITIES, PROCEDURE CENTER, ORTHOPEDIC SERVICES, DIGESTIVE HEALTH CENTER, FAMILY LIFE CENTER, RADIOLOGY, UROLOGY, DIAGNOSTIC SERVICES AND PHYSICAL THERAPY. PATIENTS ARE AT THE CENTER OF EVERYTHING DONE AT ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. 160492009 935778 53827072 222691841 true true false true false false false false true true false false false true true false true false false false false false false true false true true true true true false false false false false false false false true false false false false true true false false false true X 93 0 true 1857 true true true false false false false true true false false false false X 14 9 true false false false true true true true true false false true true true true true true true true true false X JEANETTE WOJTALEWICZ 4023434671 12809 WEST DODGE ROAD OMAHA NE 68154 ANTHONY HATCHER 0.00 70.00 X X 0 432535 31780 MICHAEL DEFREECE 4.00 8.00 X X 0 0 0 ANTOINETTE HARDY-WALLER RN 4.00 10.00 X 0 18000 0 ERIC GURLEY 4.00 8.00 X 0 0 0 FR JAMES CLIFTON SJ 4.00 8.00 X 0 0 0 FR TIMOTHY LANNON SJ 4.00 8.00 X 0 0 0 GUILLERMO HUERTA MD 4.00 8.00 X 0 0 0 H KEITH SCHMODE 4.00 8.00 X 0 19000 0 JOHN HARRIS MD 4.00 64.00 X 0 489822 29488 JOHN HEWITT 4.00 12.00 X 0 0 0 LESLIE R ANDERSEN 4.00 12.00 X 0 0 0 MARTIN M MANCUSO MD 4.00 64.00 X 0 408077 23829 PAUL EDGETT 4.00 56.00 X 0 734377 86500 PHYLLIS HUGHES RSM DRPH 4.00 12.00 X 0 0 0 RICHARD J VIERK 4.00 8.00 X 0 27000 0 JOAN NEUHAUS 14.00 52.00 X 164216 598833 1683619 KENNETH LAWONN 14.00 42.00 X 138729 505892 1516722 RICHARD II HACHTEN 14.00 51.00 X 472632 1723510 2994304 RICHARD ROLSTON MD 14.00 52.00 X 172041 627371 1737544 RICK MILLER MD 14.00 42.00 X 107426 391741 1144918 SCOTT WOOTEN 14.00 50.00 X 168601 614823 1590996 ANN SCHUMACHER 14.00 52.00 X 95248 347334 114598 BETH LLEWELLYN 14.00 42.00 X 59779 217992 257222 JANE CARMODY 14.00 43.00 X 89980 328121 66938 JASON YUNGTUM 14.00 42.00 X 45510 165956 591119 MYLES GART MD 14.00 42.00 X 43304 157913 11419 NANCY WALLACE 14.00 42.00 X 81938 298796 347302 PATRICIA MASEK 14.00 44.00 X 52783 192478 80726 PAUL STRAWHECKER 14.00 44.00 X 59681 217634 32542 SHEREE KEELY 14.00 42.00 X 47790 174271 61176 ARUN SHARMA MD 60.00 0 X 428954 0 42138 BECKI HILL MD 60.00 0 X 353094 0 26858 CHRISTOPHER CRISCUOLO MD 60.00 0 X 345427 0 33338 HUDSON HSIEH MD 60.00 0 X 313263 0 38079 MICHAEL EGGER MD 60.00 0 X 352806 0 44261 FRANK EMSICK 14.00 30.00 X 48573 177128 21014 LARRY BROWN MD 0.00 64.00 X 0 342803 45707 MARTIN HICKEY MD 0.00 0.00 X 40889 149105 0 PAUL EBMEIER 0.00 0.00 X 0 402090 17770 3682664 9762602 12671907 147 true true false CASSLING DIAGNOSTIC IMAGING INC 13808 F STREET OMAHA NE 68137 DIAGNOSTIC IMAGING SERVICES 998597 DARLAND CONSTRUCTION CO 4115 S 133RD STREET OMAHA NE 68137 CONSTRUCTION SERVICES 824950 GRAHAM CONSTRUCTION INC 13210 CENTENNIAL ROAD OMAHA NE 68138 CONSTRUCTION SERVICES 528927 AMERITEX SERVICES 1321 SOUTH 20TH STREET OMAHA NE 68108 LAUNDRY SERVICES 419871 NORTHWEST ANESTHESIA PC 6901 N 72ND STREET OMAHA NE 68122 ANESTHESIA SERVICES 259105 21 64000 47440 187437 158602 33948 457479 NET PATIENT SVC REV 621500 218737576 218737576 REIMBURSABLE-AFFILIATE 621990 5519899 5519899 MEANINGFUL USE 900099 860333 860333 HOSPITAL PHARMACY 446110 1557317 1557317 FOOD & NUTRITION 722320 571464 571464 264009 264009 0 0 227510598 24345782 66922 24278860 0 0 2181893 1414503 767390 0 767390 767390 8774234 120228 0 312190 8774234 -191962 8582272 8582272 67547 47440 85543 -17996 -17996 14825 14825 14825 353976 222933 131043 131043 REIMBURSED SERVICES 621990 2359871 2359871 MISC OPERATING REV 561499 2622501 2539022 83479 CHILD CARE 624410 999309 999309 1891 0 1891 0 5983572 267774965 224760811 152292 42404381 83796 83796 19367593 19367593 0 0 1938185 1841275 96909 0 87597004 83217154 4379850 3473754 3300066 173688 13696774 13011935 684839 5167237 4908875 258362 1168755 1110317 58438 41903 39808 2095 0 5790 5790 0 1082732 1028596 54137 5472553 5198925 273628 0 21327 20261 1066 26155904 24848109 1307795 0 0 8992623 8542992 449631 128981 122532 6449 0 79483 75509 3974 4755062 4755062 0 13981591 13282512 699080 411002 411002 PURCHASED SERVICES 18446889 17524545 922344 BAD DEBTS 13608465 13608465 MANAGEMENT ALLOCATIONS 5658580 5658580 TAXES AND LICENSE 316451 300628 15823 450014 427513 22501 0 232102448 222691841 9410608 0 0 329410 2877297 67162725 23282864 26054466 0 0 2521225 2634344 314776 230776 148641606 10320898 135937704 138320708 348529930 418189987 0 0 39747631 10534594 3704442 0 806955 617826265 603353569 6209395 4189494 547360 0 128603611 15669669 126651708 151030035 130841202 X 461744717 472419042 3260513 93325 1791000 466796230 472512367 617826265 603353569 X 35672517 7420286 -38828162 1451496 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 0 0 5790 211323 5790 211323 222686051 665217288 222691841 665428611 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 262701 106741 193039 211323 773804 250000 250000 250000 250000 1000000 1500000 0 0 0 3486427 371183 208849 326703 665314 3074442 3218021 176396 143624 4500 47114 3486427 2938870 5001 464742 6642 183950 3218021 2665977 126695 298938 9996 142744 2938870 2688014 800115 -448721 3875 369556 2665977 0.00000 1.00000 false true true 17125987 17125987 83683555 4260910 79422644 212034 50514 161520 30295945 5227506 25068439 17324085 781967 16542118 138320708 0 THIRD PARTY PAYER SETTLEMENTS 2547603 INTERCOMPANY PAYABLES 124104105 126651708 X Intended uses of endowment funds Schedule D, Part V, Line 4 ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI'S FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2013 READS AS FOLLOWS: "CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. MANAGEMENT REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS." A NIGHT TO CELEBRATE 114987 47440 67547 32282 3520 43637 6104 0 0 114987 47440 67547 0 32282 3520 43637 0 6104 85543 -17996 true true X false false true true false true true 4502 7350879 685463 6665416 0.03050 41372279 30291437 11080842 0.05070 1618816 1517294 101522 0.00050 0 4502 50341974 32494194 17847780 0.08170 7631 566005 43416 522589 0.00240 1722 1050549 181985 868564 0.00400 195718 136426 59292 0.00020 45217 0 45217 0.00020 3212 137373 28 137345 0.00060 0 12565 1994862 361855 1633007 0.00740 0 17067 52336836 32856049 19480787 0.08910 0 50 0 50 0.00000 0 0.00000 0 0 0 0 0.00000 0 0.00000 0 0 0 0 0.00000 0 61437 0 61437 0.00020 0 0.00000 65 135 0 135 0.00000 0 0.00000 0 65 61622 0 61622 0.00020 true 4139694 602898 39952187 46495515 -6543328 X true true 1 1 ALEGENT HEALTH IMMANUEL MEDICAL CENTER

6901 NORTH 72ND STREET OMAHA NE 68122

X X X ALEGENT HEALTH IMMANUEL MEDICAL CENTER 1 true X X X X X X X X X 12 true true true X X X X X X X X X X X false false true false false true X X X X true true X X X X X X X true false true X false false 1 AH IMMANUEL FONTENELLE HOME

6809 NORTH 68TH PLAZA OMAHA NE 68152

SKILLED NURSING FACILITY Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO ALEGENT HEALTH-IMMANUEL MEDICAL CENTER) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG URBAN AND RURAL COMMUNITIES IN 17 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES ("FPG"), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. ALEGENT HEALTH-IMMANUEL MEDICAL CENTER BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. Community benefit report prepared by related organization Schedule H, Part I, Line 6a ALEGENT CREIGHTON HEALTH ANNUAL PUBLIC COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A YES, THE ALEGENT CREIGHTON HEALTH SYSTEM PRODUCES AN ANNUAL PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY AND PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE, AND ON ITS PUBLIC WEBSITE AT HTTP://WWW.ALEGENTCREIGHTON.COM/COMMUNITY-BENEFIT. Costing Methodology used to calculate financial assistance Schedule H, 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 7, COLUMN (F): BAD DEBT OF $13,608,465 INCLUDED IN FUNCTIONAL EXPENSE TOTAL PART IX, LINE 25, COLUMN (A) IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. THE DENOMINATOR USED TO CALCULATE THE COST TO CHARGE RATIO IS $218,493,983. BAD DEBT EXPENSE (AT COST) FOR ENTITIES OF ALEGENT CREIGHTON HEALTH IS DETERMINED BY USING THE COST TO CHARGE RATIO FROM MEDICARE COST REPORTS PER ENTITY AND MULTIPLYING THE RATIO BY THE ACTUAL BAD DEBT CHARGES PER ENTITY. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 13,608,465 Subsidized Health Services Schedule H, Part I, Line 7g ALEGENT CREIGHTON HEALTH IMMANUEL MEDICAL CENTER PROVIDES SUBSIDIZED HEALTH TO THE BROADER COMMUNITY THROUGH THE HOSPITALITY HOUSE. THE AMOUNT INCLUDED AS A SUBSIDIZED HEALTH SERVICE IS $59,292. Community Building Activities Schedule H, Part II ALEGENT CREIGHTON HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE COMMUNITY BUILDING SUCH AS: * LIVE WELL OMAHA KIDS- AS A RESULT OF COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2006 WHICH POINTED TO CHILDHOOD OBESITY AS A SERIOUS HEALTH NEEDS ISSUE ACROSS ALL OMAHA MSA COUNTIES SERVED, THE ALEGENT CREIGHTON HEALTH SYSTEM PARTNERED WITH THE COMMUNITY TO 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 CREIGHTON HEALTH HOSPITALS. THE COMMUNITY COALITION KNOWN AS LIVE WELL OMAHA KIDS (LWOK) IS STAFFED AND FUNDED BY ALEGENT CREIGHTON HEALTH. AN EXECUTIVE COMMITTEE CONSISTING OF COMMUNITY LEADERS AND POLICY MAKERS HAVE DIRECTED AN ECOLOGICAL APPROACH TO IMPROVE PROGRAMS, POLICIES AND THE BUILT ENVIRONMENT TO PROMOTE PHYSICAL ACTIVITY AND HEALTHY EATING AND BUILD CAPACITY FOR HEALTHY CHOICES AT THE INDIVIDUAL AND ORGANIZATIONAL LEVEL. MORE THAN 200 VOLUNTEERS AND 90 ORGANIZATIONS HAVE PARTICIPATED IN THE PLANNING AND IMPLEMENTATION OF LWOK INITIATIVES. A PORTION OF THIS INVESTMENT IN LWOK IS ALLOCATED TO THE BERGAN MERCY MEDICAL SYSTEM ON A NET SERVICE REVENUE BASIS. * COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE * STRATEGIC PLANNING AND CONSULTING SERVICES FOR COMMUNITY * SPONSORSHIP OF COMMUNITY NOT FOR PROFITS AND FUNDRAISING EVENTS * SUPPORT OF INTERNATIONAL HEALTH MINISTRIES IN TANZANIA AND DOMINICAN REPUBLIC * SUPPORT OF THE FEDERALLY QUALIFIED HEALTHCARE CENTERS * PARISH NURSING PROGRAM * COMMUNITY HEALTH FAIRS, SUPPORT GROUPS AND COMMUNITY EDUCATION * SCHOOL BASED HEALTHCARE SERVICES * LEADERSHIP IN AND FUNDING OF HEALTH COALITIONS INCLUDING: - LIVE WELL OMAHA: A COALITION FOUNDED BY ACH AND THE COUNTY HEALTH DEPARTMENT THAT SERVES AS CONVENER OF BUSINESS, HEALTHCARE AND COMMUNITY LEADERS TO REVIEW HEALTH TRENDS AND CATALYZE COMMUNITY ACTION TO ADDRESS HEALTH ISSUES. ALEGENT CREIGHTON HEALTH SERVES ON THE BOARD OF DIRECTORS, IS A MEMBER AT THE HIGHEST LEVEL AND LEASES STAFF TO LIVE WELL OMAHA. - LIVE WELL POTTAWATTAMIE COUNTY: AN EMERGING COALITION TO ADDRESS OBESITY IN POTTAWATTAMIE COUNTY. ACH PROVIDES STRATEGIC PLANNING, GRANT WRITING AND STAFF SUPPORT. - OMAHA BY DESIGN: A COALITION THAT SUPPORT HEALTHY AND SUSTAINABLE COMMUNITY DEVELOPMENT AND LAND USE - VIOLENCE PREVENTION: A PARTNERSHIP WITH CATHOLIC HEALTH INITIATIVES, WOMEN'S CENTER FOR ADVANCEMENT, UNIVERSITY OF NEBRASKA-OMAHA AND CREIGHTON UNIVERSITY TO IMPLEMENT A CAMPUS BASED VIOLENCE PREVENTION PLAN KNOWN AS "GREEN DOT". ALEGENT CREIGHTON HEALTH ALSO SUPPORTS ECPR TRAINING TO PROVIDE COMMUNITY CAPACITY AND SKILLS TO ADDRESS THE TRAUMA ASSOCIATED WITH VIOLENCE. - METRO AREA CONTINUUM OF CARE FOR THE HOMELESS: BOARD SERVICE AND FINANCIAL SUPPORT TO THIS COALITION ADDRESSING HOMELESSNESS IN THE SERVICE AREA. - HOPE MEDICAL COALITION: BOARD SERVICE AND ANNUAL OPERATING SUBSIDY. ALEGENT CREIGHTON HEALTH'S HOSPITALS AND PHYSICIANS PROVIDE SPECIALTY CARE TO PATIENTS UNABLE TO AFFORD MEDICAL SERVICES. - PARTICIPATION IN AND FUNDING OF MATERNAL HEALTH, BREASTFEEDING, SUBSTANCE ABUSE, CANCER, DIABETES AND OTHER COMMUNITY HEALTH COALITIONS - MENTAL HEALTH COALITIONS INCLUDING NATIONAL ALLIANCE ON MENTAL ILLNESS, NEBRASKA, NEBRASKA ASSOCIATION OF BEHAVIORAL HEALTH CARE ORGANIZATIONS, AND THE JUVENILE JUSTICE PROVIDER FORUM BEHAVIORAL HEALTH COMMITTEE. Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 30.42%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, Line 3 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: "THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICES REVENUE, PROVISION FOR BAD DEBTS, AND ALLOWANCES FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH ENTITIES, THE PROVISION FOR BAD DEBTS IS PRESENTED ON THE CONSOLIDATED STATEMENT OF OPERATIONS AS A DEDUCTION FROM PATIENT SERVICES REVENUES (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) SINCE CHI ACCEPTS AND TREATS ALL PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY." Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 THE ALEGENT CREIGHTON HEALTH SYSTEM DOES NOT CONSIDER MEDICARE SHORTFALLS TO BE COMMUNITY BENEFIT, PER THE RECOMMENDATION OF THE CATHOLIC HEALTH ASSOCIATION. THE MEDICARE CHARGES REPORTED ON LINES 5 AND 6 ARE FROM MEDICARE COST REPORTS WHICH USED A COST TO CHARGE RATIO. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b THE ALEGENT CREIGHTON HEALTH SYSTEM'S SELF PAY BILLING AND BAD DEBT POLICY HAS A CLEARLY DELINEATED PROCESS AND GUIDELINES FOR COLLECTIONS AGENCIES TO FOLLOW, INCLUDING EXPLICIT INSTRUCTIONS TO ADHERE TO THE SAME FINANCIAL ASSISTANCE GUIDELINES AS ALEGENT CREIGHTON HEALTH. ALL OF CATHOLIC HEALTH INITIATIVES' HOSPITALS' CONTRACTS WITH THIRD PARTY COLLECTION AGENCIES INCLUDE THE FOLLOWING STANDARDS: * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL REQUEST BENCH OR ARREST WARRANTS AS A RESULT OF NON-PAYMENT; * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL SEEK LIENS THAT WOULD REQUIRE THE SALE OR FORECLOSURE OF A PRIMARY RESIDENCE; AND * NO CATHOLIC HEALTH INITIATIVES' COLLECTION AGENCY MAY SEEK COURT ACTION WITHOUT HOSPITAL APPROVAL. FINALLY, COLLECTION AGENCIES ARE TRAINED ON THE CATHOLIC HEALTH INITIATIVES MISSION, CORE VALUES AND STANDARD OF CONDUCT TO MAKE SURE ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT. Community Served by Needs Assessment Schedule H, Part V Section B, Line 3 (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - ACH SERVED AS A KEY MEMBER OF THE STEERING COMMITTEE FOR A TRI-COUNTY CHNA LED BY LOCAL HEALTH DEPARTMENTS; THE FOLLOWING LEADERS PARTICIPATED IN SURVEY CREATION, FOCUS GROUPS AND DISSEMINATING RESULTS. INPUT FROM THE GREATER COMMUNITY WAS ALSO OBTAINED IN THE CHNA PROCESS VIA SURVEY AND KEY INFORMANT INTERVIEWS WITH OVERSAMPLES TO INTENTIONALLY HEAR FROM UNDERSERVED POPULATIONS OF BLACK/AFRICAN AMERICAN RESIDENTS AND HISPANIC RESIDENTS. COMMUNITY REPRESENTATIVES AND THOSE WITH SPECIAL KNOWLEDGE OR EXPERTISE AS TO THE HEALTH NEEDS OF THE SERVICE AREA PARTICIPATED IN FIVE FOCUS GROUPS WITH 88 KEY INFORMANTS. ALEGENT CREIGHTON HEALTH: * BETH LLEWELLYN-VICE PRESIDENT MISSION INTEGRATION * MIKKI FROST -DIRECTOR COMMUNITY BENEFIT AND HEALTHIER COMMUNITIES DOUGLAS COUNTY HEALTH DEPARTMENT: * ADI POUR -HEALTH DIRECTOR LIVE WELL OMAHA: * KERRI PETERSON -EXECUTIVE DIRECTOR METHODIST HEALTH SYSTEM: * KEN KLAASMEYER- VICE PRESIDENT * RUTH FREED-FOUNDATION POTTAWATTAMIE HEALTH DEPARTMENT/VNA: * KRIS STAPP-VISITING NURSES ASSOCIATION SARPY/CASS COUNTY HEALTH DEPARTMENT: * DIANE KELLY-DIRECTOR THE NEBRASKA MEDICAL CENTER: * LESLIE UTTECHT - COMMUNITY RELATIONS LIAISON * TADD PULLIN- VICE PRESIDENT MARKETING, PLANNING AND NETWORK OPERATIONS PRC IS A NATIONALLY RECOGNIZED CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING CHNAS SINCE 1994. THIS CHNA IS AN UPDATE TO THE CHNAS CONDUCTED BY PRC IN 2002 AND 2008 THAT WERE USED TO DEVELOP A COMMUNITY REPORT CARD, DIALOGUE AND PRIORITIES THROUGH THE LIVE WELL OMAHA COALITION. ; Other Hospital Facilities included in Needs Assessment Schedule H, Part V Section B, Line 4 (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - ALEGENT CREIGHTON HEALTH INVESTED IN THE CHNA AND SERVED AS AN EQUAL PARTNER WITH THE TWO OTHER HEALTH SYSTEMS SERVING THE SAME MSA; THE NEBRASKA MEDICAL CENTER AND METHODIST HEALTH SYSTEM. CHILDREN'S HOSPITAL AND MEDICAL CENTER CONDUCTED A SEPARATE ASSESSMENT FOCUSED ON CHILDREN. ; Availability of Needs Assessment Schedule H, Part V Section B, Line 5c (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - THE CHNA RESULTS WERE SHARED WITH THE COMMUNITY AT AN ANNUAL HEALTH SUMMIT FACILITATED BY LIVE WELL OMAHA - A 35 MEMBER HEALTHY COMMUNITY COLLABORATION, AND CONTINUES TO BE A KEY FINANCIAL SUPPORTER AND MEMBER OF THE BOARD OF THE DIRECTORS OF THE ORGANIZATION. IN ADDITION, THE DATA IS SHARED ON AN EASILY ACCESSIBLE, PUBLIC WEBSITE WWW.DOUGLASCOHEALTH.ORG THAT IS PARTIALLY FUNDED BY ALEGENT CREIGHTON HEALTH AND OTHER AREA HOSPITALS INCLUDING THE NEBRASKA MEDICAL CENTER AND METHODIST HEALTH SYSTEM TO SHARE TRI-COUNTY HEALTH DATA AND BEST PRACTICES. ; Needs not addressed in Needs Assessment Schedule H, Part V Section B, Line 7 (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - TWO HEALTH NEEDS IDENTIFIED IN THE PRIMARY DATA WILL NOT BE ADDRESSED BY THE HOSPITAL: 1) ORAL HEALTH; AND 2) SEXUALLY TRANSMITTED DISEASES. CURRENTLY, ACH DOES NOT OFFER ANY ORAL HEALTH CARE OR FUTURE PLANS TO PROVIDE DIRECT ORAL HEALTH CARE. OTHER ORGANIZATIONS SUCH AS CREIGHTON SCHOOL OF DENTISTRY AND BUILDING HEALTHY FUTURES ARE TAKING ON THIS ISSUE. SEXUALLY TRANSMITTED DISEASE IS ALSO AN ISSUE THAT IS COVERED BY OTHER KEY ORGANIZATIONS SUCH AS THE DOUGLAS COUNTY HEALTH DEPARTMENT, FEDERALLY QUALIFIED HEALTH CENTERS, THE NEBRASKA AIDS PROJECT, ETC. THE FINAL LIST OF HEALTH PRIORITIES SELECTED BY THE COMMUNITY IS BEING ADDRESSED BY ACH IN EITHER SYSTEM-WIDE OR INDIVIDUAL HOSPITAL IMPLEMENTATION STRATEGIES.; Used federal poverty guidelines (FPG) to determine eligibility Schedule H, Part V Section B, Line 10 (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - ALEGENT HEALTH-IMMANUEL MEDICAL CENTER BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES; Used FPG to determine eligibility for providing discounted care criteria Schedule H, Part V Section B, Line 11 (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - ALEGENT HEALTH-IMMANUEL MEDICAL CENTER BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES; Other factors included in calculating amounts charges to patients Schedule H, Part V Section B, Line 12h (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - SIZE OF FAMILY IS ALSO USED IN THE CALCULATION.; Other ways hospital publicized Financial Assistance Policy Schedule H, Part V Section B, Line 14g (1) ALEGENT HEALTH IMMANUEL MEDICAL CENTER - INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENTCREIGHTON.COM AND THROUGH BROCHURES PROVIDED AT THE MAIN PATIENT REGISTRATION AREAS. LETTERS AND BILLING STATEMENTS SENT OUT TO PATIENTS INCLUDE A STATEMENT THAT FINANCIAL ASSISTANCE MAY BE AVAILABLE AND HOW TO OBTAIN ADDITIONAL INFORMATION. COUNSELORS OF THE ALEGENT CREIGHTON HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY TO PATIENTS.; Needs assessment. Schedule H, Part VI, Line 2 THE PROCESS TO DEVELOP ASSESSMENTS OF THE COMMUNITY HEALTH NEEDS (CHNA) IS COLLABORATIVE IN NATURE AND INVOLVES HEALTH DEPARTMENTS, EXISTING HEALTH COALITIONS, COMMUNITY MEMBERS AND HOSPITAL LEADERSHIP, AND IS SUPPORTED BY ALEGENT CREIGHTON HEALTH'S COMMUNITY BENEFIT AND HEALTHIER COMMUNITIES DEPARTMENT STAFF. EACH ALEGENT CREIGHTON HEALTH HOSPITAL PARTICIPATES IN THE CHNA PROCESS FOR THE COUNTY IN WHICH THE FACILITY IS LOCATED AT LEAST EVERY 3 YEARS IN PARTNERSHIP WITH THE LOCAL HEALTH DEPARTMENTS. THE ASSESSMENT VARIES IN EACH COMMUNITY BUT INCLUDES REVIEW OF PRIMARY DATA (SUCH AS SURVEYS, KEY INFORMANT INTERVIEWS, FOCUS GROUPS) AND SECONDARY DATA (SUCH AS COUNTY HEALTH RANKINGS, BRFRSS, YRBS, CENSUS DATA ETC) LEADERSHIP FROM ALEGENT CREIGHTON HEALTH PARTICIPATE IN MULTIPLE INTERNAL AND EXTERNAL VENUES TO GARNER COMMUNITY INPUT, PRIORITIZE COMMUNITY HEALTH NEEDS AND DEVELOP COMMUNITY HEALTH IMPROVEMENT PLANS. THE CHNA REPORT FOR EACH COMMUNITY IS MADE AVAILABLE TO THE PUBLIC BY POSTING THE REPORT ON THE ALEGENT CREIGHTON HEALTH EXTERNAL WEBSITE AND BY MAKING IT AVAILABLE IN COMMUNITY VENUES. THE CHNAS ARE INTEGRATED INTO THE GOVERNANCE AND PLANNING FOR ALEGENT CREIGHTON HEALTH ON TWO LEVELS- * REPORTING INTO THE COMMITTEE OF THE BOARD OF DIRECTORS CHARGED WITH HEALTH PLANNING OVERSIGHT * INTO THE ANNUAL STRATEGIC PLANNING AND BUDGETING PROCESSES OF ALEGENT CREIGHTON HEALTH. * IMPLEMENTATION PLANS APPROVED BY BOARD OF DIRECTORS. PARTICULAR TO THE COUNTY IN WHICH IMMANUEL MEDICAL CENTER RESIDES, ALEGENT CREIGHTON HEALTH PARTNERS WITH LOCAL HEALTH DEPARTMENTS, LIVE WELL OMAHA AND COMPETING HEALTH SYSTEMS TO RETAIN PROFESSIONAL RESEARCH CONSULTANTS TO CONDUCT A CHNA FOR THE OMAHA/COUNCIL BLUFFS METROPOLITAN SERVICE AREA. THE CHNA COVERS FOUR COUNTIES SERVED BY THE ALEGENT CREIGHTON HEALTH OMAHA AND COUNCIL BLUFFS HOSPITALS. THE CHNA REPORTS DATA AT THE COUNTY LEVEL AND FOR DOUGLAS COUNTY, BY FOUR QUADRANTS WITHIN THE COUNTY. ALEGENT CREIGHTON HEALTH LEADERS SERVE ON THE CHNA STEERING COMMITTEE AND PARTICIPATE IN KEY INFORMANT INTERVIEWS CONDUCTED AT HOSPITAL LOCATIONS. THE CHNA IS SHARED IN MULTIPLE VENUES WITH THE PUBLIC, INCLUDING AT THE LIVE WELL OMAHA SUMMIT. ALEGENT CREIGHTON HEALTH IS ONE OF THE FOUNDERS OF LIVE WELL OMAHA. IN ADDITION, ALEGENT CREIGHTON HEALTH HAS JOINED WITH LOCAL HEALTH SYSTEMS AND HEALTH DEPARTMENTS TO FUND THE WEB BASED COMMUNITY HEALTH DASHBOARD. (HTTP://WWW.DOUGLASCOHEALTH.ORG/). THE CHNA PROCESS FOR THE HOSPITAL INCLUDED BOTH QUANTITATIVE AND QUALITATIVE SOURCES. QUANTITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH (THE PRC COMMUNITY HEALTHY SURVEY) AND SECONDARY RESEARCH (VITAL STATISTICS AND OTHER EXISTING HEALTH-RELATED DATA). THESE QUANTITATIVE COMPONENTS ALLOW FOR TRENDING AND COMPARISON TO BENCHMARK DATA AGAINST THE STATE AND NATIONAL LEVELS. QUALITATIVE DATA INPUT INCLUDES PRIMARY RESEARCH GATHERED THROUGH A SERIES OF KEY INFORMANT INTERVIEWS. THE SURVEY INSTRUMENT USED FOR THE CHNA IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, WITH THE FINAL SURVEY QUESTIONS DEVELOPED BY THE SPONSORS AND PRC, SIMILAR TO PREVIOUS CHNAS USED IN THE REGION ALLOWING FOR DATA TRENDING. A TELEPHONE INTERVIEW METHODOLOGY-ONE THAT INCORPORATES BOTH LANDLINES AND CELL PHONE INTERVIEWS-WAS EMPLOYED FOR THE CHNA. THE CHNA CONSISTED OF STRATIFIED RANDOM SAMPLE OF 2,000 INDIVIDUALS AGE 18 AND OLDER IN THE SERVICE AREA, INCLUDING 1,000 INTERVIEWS IN DOUGLAS COUNTY; 400 IN SARPY COUNTY; 200 IN CASS COUNTY AND 400 IN POTTAWATTAMIE COUNTY. IN ADDITION, TO BETTER REPRESENT RACIAL/ETHNIC GROUPS, TWO OVERSAMPLES WERE APPLIED IN DOUGLAS COUNTY (100 ADDITIONAL INTERVIEWS WITH BLACK/AFRICAN AMERICAN RESIDENTS AND 100 ADDITIONAL INTERVIEWS WITH HISPANIC RESIDENTS). IN ALL, 2,200 INTERVIEWS WERE COMPLETED THROUGHOUT THE SERVICE AREA. AS PART OF THE CHNA, THERE WERE FIVE FOCUS GROUPS AND 88 KEY INFORMANT INTERVIEWS WHICH INCLUDED PHYSICIANS, OTHER HEALTH PROFESSIONALS, MEDIA, AGENCIES SERVING VULNERABLE POPULATIONS AND INDIVIDUAL COMMUNITY MEMBERS. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE; SIGNS ARE POSTED IN CLINICS AND HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND HOSPITALS. INFORMATION ON THE ALEGENT CREIGHTON HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICIES ARE LOCATED SEVERAL PLACES ON THE SYSTEM'S WEBSITE- WWW.ALEGENTCREIGHTON.COM. ALL EFFORTS ARE MADE TO ESTABLISH WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SERVICE IF POSSIBLE, OTHERWISE AS SOON AS POSSIBLE FOLLOWING SERVICE. ALEGENT CREIGHTON HEALTH REPRESENTATIVES HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH ALEGENT CREIGHTON HEALTH'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME. Community information. Schedule H, Part VI, Line 4 ALEGENT CREIGHTON HEALTH SYSTEM SERVES THE NINE COUNTIES OF GREATER OMAHA COMBINED STATISTICAL AREA (CSA), WITH AN ESTIMATED POPULATION OF OVER 925,858, RANKING 56TH OUT OF 166 CSAS IN TOTAL POPULATION. THE CSA CONSISTS OF 3 IOWA AND 6 NEBRASKA COUNTIES ON BOTH SIDES OF THE MISSOURI RIVER AND COVERS 4407 SQUARE MILES. LOCATED IN DOUGLAS COUNTY, THE CITY OF OMAHA HAS A POPULATION OF 419,041. NEARLY 1.3 MILLION PEOPLE LIVE WITHIN A 60-MILE RADIUS OF OMAHA. CHARACTERIZED BY STEADY GROWTH, THE CSA GREW BY 14.9 PERCENT BETWEEN 2000 AND 2011; THE 2016 PROJECTED POPULATION IS MORE THAN 946,000, A 7.3 PERCENT INCREASE. APPROXIMATELY 36 PERCENT OF THE POPULATION IS 25 YEARS OF AGE OR YOUNGER WITH A MEDIAN AGE OF 35.2 YEARS COMPARED TO A U.S. MEDIAN AGE OF 37.6. 50.6% OF THE POPULATION IS FEMALE. RACIAL MINORITIES COMPRISE ABOUT 17.4 PERCENT OF GREATER OMAHA'S POPULATION, INCLUDING AN AFRICAN-AMERICAN POPULACE OF 7.8 PERCENT AND A GROWING HISPANIC POPULATION OF 9.8 PERCENT. IN 2012, GREATER OMAHA WAS PREDICTED TO HAVE 387,514 TOTAL HOUSING UNITS AND HOUSING UNITS ARE PROJECTED TO INCREASE ANOTHER 5 PER CENT BY 2017. THE MEDIAN HOUSEHOLD INCOME IS $56,445 WHICH SURPASSES THE NATIONAL AVERAGE OF $53,046, WITH A PER CAPITA INCOME OF $27,307. GREATER OMAHA IS A WELL-EDUCATED COMMUNITY. NEARLY 91 PERCENT OF ADULTS, AGE 25 AND OLDER, ARE HIGH SCHOOL GRADUATES AND 32 PERCENT HAVE A BACHELOR'S DEGREE OR HIGHER, COMPARED TO 27.9 PERCENT NATIONALLY. GREATER OMAHA OFFERS A LARGE AND DIVERSE WORKFORCE FOR EMPLOYERS OF ALL SIZES AND INDUSTRIES. THE GREATER OMAHA POPULATION NOT ONLY POSSESSES THE EDUCATION AND DEMOGRAPHIC QUALITIES THAT EMPLOYERS ARE LOOKING FOR, BUT ALSO THE NATIONALLY RECOGNIZED MIDWEST WORK ETHIC THAT IS SIMPLY PART OF THE FABRIC OF THE REGION. OMAHA IS HOME TO MANY MAJOR COMPANIES AND LARGE EMPLOYERS, INCLUDING FIVE FORTUNE 500 COMPANIES, MAKING IT FOURTH IN THE NATION FOR NUMBER OF SUCH COMPANIES PER CAPITA. RECENT RECOGNITIONS FOR THE GREATER OMAHA AREA INCLUDE: AMONG THE 10 BEST CITIES FOR PROFESSIONAL WOMEN, AMONG THE 10 BEST CITIES FOR CONSUMER BANKING; AMONG THE 10 BEST CITIES TO RAISE A FAMILY; AND AMONG THE BEST CITIES FOR JOB SEEKERS. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 ALEGENT CREIGHTON HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT AND HOSPITAL SPECIFIC COMMUNITY BENEFIT INVESTMENTS TO ADDRESS COMMUNITY HEALTH NEEDS OF THE PARTICULAR SERVICE AREA. EXAMPLES OF HOW ALEGENT CREIGHTON HEALTH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY INCLUDE: * FINANCIAL ASSISTANCE AND UNPAID COSTS OF MEDICAID * COMMUNITY HEALTH IMPROVEMENT SERVICES: - COMMUNITY EDUCATION, CLASSES AND PROGRAMS (CHILDBIRTH, DIABETES, ONCOLOGY, PHYSICAL ACTIVITY, HEALTHY EATING AND COOKING, HEALTH CAREERS, CANCER, SPORTS MEDICINE ETC) - SUPPORT GROUPS (CANCER, BEREAVEMENT, YOUTH ETC) - COMMUNITY HEALTH FAIRS AND SCREENINGS - IMMUNIZATION CLINICS - PARISH NURSING PROGRAM AND FAITH COMMUNITY OUTREACH - SCHOOL BASED HEALTHCARE SERVICES * HEALTH PROFESSIONAL EDUCATION: - CLINICAL PRECEPTORSHIPS FOR HEALTHCARE PROFESSIONALS - SCHOLARSHIPS AND MENTORSHIPS - AFFILIATION WITH AND SUPPORT OF CREIGHTON UNIVERSITY SCHOOL OF MEDICINE - PHYSICIAN RESIDENCY AND FELLOWSHIP PROGRAMS TRAINING MORE THAN 200 RESIDENTS AND FELLOWS ANNUALLY * RESEARCH-PARTICIPATION IN THE MISSOURI VALLEY CANCER CONSORTIUM * FINANCIAL AND IN-KIND CONTRIBUTIONS: - SUPPORT OF THE FEDERALLY QUALIFIED HEALTHCARE CENTERS (AND HOPE MEDICAL COALITION WHICH PROVIDES ACCESS TO MEDICAL SERVICES SPECIFICALLY FOR THE UNDERSERVED - CORPORATE SPONSORSHIPS - TANZANIA AND DOMINICAN REPUBLIC HEALTH MINISTRIES - STAFF SERVICE ON HEALTH RELATED BOARD AND COALITIONS * SUBSIDIZED HEALTHCARE SERVICE INCLUDING BEHAVIORAL HEALTH, NICU, HOME HEALTH AND HOSPICE (SEE CONTINUATION #1) PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 (CONTINUATION #1) * COMMUNITY BUILDING ACTIVITIES: - COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE - STRATEGIC PLANNING AND CONSULTING SERVICES FOR COMMUNITY - HEALTH COALITIONS: LIVE WELL OMAHA-A COALITION FOUNDED BY ACH AND THE COUNTY HEALTH DEPARTMENT THAT SERVES AS CONVENER OF BUSINESS, HEALTHCARE AND COMMUNITY LEADERS TO REVIEW HEALTH TRENDS AND CATALYZE COMMUNITY ACTION TO ADDRESS HEALTH ISSUES. ACH SERVES ON THE BOARD OF DIRECTORS, IS A MEMBER AT THE HIGHEST LEVEL AND LEASES STAFF TO LIVE WELL OMAHA. LIVE WELL OMAHA KIDS-A COALITION FUNDED AND STAFFED FOR SEVEN YEARS BY ACH TO ADDRESS CHILDHOOD OBESITY. LIVE WELL POTTAWATTAMIE-AN EMERGING COALITION TO ADDRESS OBESITY IN POTTAWATTAMIE COUNTY. ACH PROVIDES STRATEGIC PLANNING, GRANT WRITING AND STAFF SUPPORT. - VIOLENCE PREVENTION-A PARTNERSHIP WITH CATHOLIC HEALTH INITIATIVES, WOMEN'S CENTER FOR ADVANCEMENT, UNIVERSITY OF NEBRASKA-OMAHA AND CREIGHTON UNIVERSITY TO IMPLEMENT A CAMPUS BASED VIOLENCE PREVENTION PLAN KNOWN AS "GREEN DOT". - METRO AREA CONTINUUM OF CARE FOR THE HOMELESS- BOARD SERVICE AND FINANCIAL SUPPORT TO THIS COALITION ADDRESSING HOMELESSNESS IN THE SERVICE AREA. - HOPE MEDICAL COALITION-BOARD SERVICE AND ANNUAL OPERATING SUBSIDY. ACH HOSPITALS AND PHYSICIANS PROVIDE SPECIALTY CARE TO PATIENTS UNABLE TO AFFORD MEDICAL SERVICES. - PARTICIPATION IN AND FUNDING OF MATERNAL HEALTH, BREASTFEEDING, SUBSTANCE ABUSE, CANCER, DIABETES AND OTHER COMMUNITY HEALTH COALITIONS -MENTAL HEALTH COALITIONS INCLUDING NATIONAL ALLIANCE ON MENTAL ILLNESS, NEBRASKA ASSOCIATION OF BEHAVIORAL HEALTH CARE ORGANIZATIONS, AND THE JUVENILE JUSTICE PROVIDER FORUM BEHAVIORAL HEALTH COMMITTEE. * THE PRIMARY CARE PHYSICIAN CLINICS THAT ARE PART OF THE PARENT CORPORATION PROVIDE ACCESS TO CARE THROUGH THE SYSTEM'S FINANCIAL ASSISTANCE POLICY AND PARTICIPATE IN MEDICAL STUDENT PRECEPTORSHIPS THAT ADVANCE THE HEALTHCARE PROVIDER EDUCATION PROCESS. * ALEGENT CREIGHTON HEALTH HAS OPEN MEDICAL STAFFS * ALEGENT CREIGHTON HEALTH IS ONE OF THREE HEALTH SYSTEMS THAT FUND THE OPERATIONS OF A COALITION THAT EXISTS TO PROVIDE ACCESS FOR THE PATIENTS OF THREE AREA FEDERALLY QUALIFIED HEALTHCARE CENTERS TO SPECIALTY PHYSICIAN SERVICES AND HOSPITAL BASED DIAGNOSTICS AND TREATMENT * ALEGENT CREIGHTON HEALTH IS THE SOLE COMPREHENSIVE MENTAL HEALTH PROVIDER IN THE OMAHA MSA AREA * ALEGENT CREIGHTON HEALTH IS A JOINT VENTURE PARTNER IN A NOT-FOR-PROFIT HOSPICE INPATIENT HOSPITAL AND PROVIDES THE MANAGEMENT SUPPORT CONTRACT. * ALEGENT HEALTH BUDGETS FOR AN EMERGENCY FUND AS A SUBSET OF OTHER COMMUNITY DONATIONS TO RESPOND TO CRISIS OR UNPLANNED FUNDING NEEDS OF A VITAL COMMUNITY SERVICE, WHICH HAS FIRST USED IN FY2011 WITH THE ECONOMIC DOWNTURN. * BOARD OF DIRECTORS- ALEGENT HEALTH-IMMANUEL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF OUR LOCAL COMMUNITY WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. * EMERGENCY DEPARTMENT- ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 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-IMMANUEL MEDICAL CENTER, 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-IMMANUEL MEDICAL CENTER 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. Affiliated health care system Schedule H, Part VI, Line 6 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE PART OF CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES (CHI) IS A NATIONAL FAITH-BASED NONPROFIT HEALTH CARE ORGANIZATION WITH HEADQUARTERS IN ENGLEWOOD, COLORADO. CHI'S EXEMPT PURPOSE IS TO SERVE AS AN INTEGRAL PART OF ITS NATIONAL SYSTEM OF HOSPITALS AND OTHER CHARITABLE ENTITIES, WHICH ARE DESCRIBED AS MARKET-BASED ORGANIZATIONS, OR MBOS. AN MBO IS A DIRECT PROVIDER OF CARE OR SERVICES WITHIN A DEFINED MARKET AREA THAT MAY BE AN INTEGRATED HEALTH SYSTEM AND/OR A STAND-ALONE HOSPITAL OR OTHER FACILITY OR SERVICE PROVIDER. CHI SERVES AS THE PARENT CORPORATION OF ITS MBOS WHICH ARE COMPRISED OF 73 HOSPITALS; 40 LONG-TERM CARE, ASSISTED- AND RESIDENTIAL-LIVING FACILITIES; TWO COMMUNITY HEALTH-SERVICES ORGANIZATIONS; TWO ACCREDITED NURSING COLLEGES; AND HOME HEALTH AGENCIES. TOGETHER, THESE FACILITIES PROVIDED $762 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2013 FISCAL YEAR, INCLUDING SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. CHI PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARED SERVICES" FOR THE MBOS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES - INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN -- PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE MBOS. THE COST SAVINGS ACHIEVED THROUGH CHI'S CENTRALIZATION ENABLE MBOS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. ALEGENT HEALTH-IMMANUEL MEDICAL CENTER OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, TO SERVE THE HEALTH CARE NEEDS OF THE OMAHA, NE COMMUNITIES. State filing of community benefit report Schedule H, Part VI, Line 7 IA, NE true ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 501(C)(3) 57308 0 N/A N/A GENERAL SUPPORT RONCALLI CATHOLIC HIGH SCHOOL 6401 SORENSEN PKWY OMAHA NE 68152 470486481 501(C)(3) 5500 0 N/A N/A GENERAL SUPPORT 2 0 FINANCIAL ASSISTANCE/CHARITY CARE 4502 0 19362843 BOOK REDUCTION OR WRITE OFF OF PATIENT SERVICES SCHOLARSHIPS 8 4750 0 N/A N/A SCHOLARSHIPS SCHEDULE I, PART III SISTER INGEBORG BLOMBERG SCHOLARSHIP: SCHOLARSHIPS ARE PROVIDED BY THE IMMANUEL MEDICAL CENTER AUXILIARY TO PROVIDE CONTINUING EDUCATION FOR ALGENT HEALTH-IMMANUEL MEDICAL CENTER EMPLOYEES FOR THEIR PERSONAL GROWTH AND/OR PROFESSIONAL DEVELOPMENT. ALL PERMANENT, FULL-TIME AND PART-TIME EMPLOYEES IN GOOD STANDING WHO HAVE SIX MONTHS OR MORE OF SERVICE WITH ALEGENT HEALTH-IMMANUEL MEDICAL CENTER MAY APPLY FOR THE SCHOLARSHIPS. PAYMENT FOR TUITION, LAB FEES, BOOKS AND REGISTRATION EXPENSES WILL BE MADE DIRECTLY TO THE INSTITUTION UPON RECEIPT OF A STATEMENT OF COSTS FROM THE INSTITUTION. THE AWARDING OF THE SISTER INGEBORG BLOMBERG SCHOLARSHIP SHALL BE SUBJECT TO THE FOLLOWING CRITERIA: 1. APPLICATION IS MADE PRIOR TO MAKING A COMMITMENT TO THE SCHOOL 2. THE SCHOOL AND COURSE ARE OF RECOGNIZED STANDING 3. THE EMPLOYEE CONTINUES TO MAINTAIN HIS/HER REGULARLY SCHEDULED WORKING HOURS 4. THE EMPLOYEE SHALL SIGN AN AUTHORIZATION ALLOWING THE AUXILIARY TO RECEIVE WRITTEN CERTIFICATION OF PERFORMANCE FROM THE INSTITUTION 5. IT IS EVIDENT THAT THE COURSE, OR COURSES ARE MUTUALLY BENEFICIAL TO THE EMPLOYEE AND TO ALEGENT HEALTH-IMMANUEL MEDICAL CENTEER 6. THE EMPLOYEE IS EXPECTED TO REMAIN EMPLOYED AT ALEGENT HEALTH-IMMANUAL MEDICAL CENTEER FOR AT LEASTONE YEAR AFTER RECEIVING THE SISTER INGEBORG BLOMBERG SCHOLARSHIP. ALEGENT HEALTH-IMMANUEL MEDICAL CENTER OCCASSIONALLY DISTRIBUTES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS. THESE DISTRIBUTIONS ARE MONITORED TO ENSURE THEY ARE BEING USED AS SPECIFIED BY THE ORGANIZATION. FINANCIAL ASSISTANCE/CHARITY CARE SCHEDULE I, PART II ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 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. Procedures for monitoring use of grant funds 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. X X true true true true false false false true true false false ANN SCHUMACHER 55917 203910 23533 85815 15798 57609 19300 70381 5362 19555 119910 437270 5110 18636 ANTHONY HATCHER 0 399807 0 0 0 32728 0 15000 0 16780 0 464315 0 0 ARUN SHARMA MD 395614 0 0 0 33340 0 17500 0 24638 0 471092 0 0 0 BECKI HILL MD 327473 0 10000 0 15621 0 12500 0 14358 0 379952 0 0 0 BETH LLEWELLYN 33879 123543 15386 56108 10514 38341 53227 194099 2130 7766 115136 419857 3179 11591 CHRISTOPHER CRISCUOLO MD 322335 0 0 0 23092 0 12500 0 20838 0 378765 0 0 0 FRANK EMSICK 30720 112027 10052 36655 7801 28446 431 1570 4092 14921 53096 193619 0 0 HUDSON HSIEH MD 278303 0 0 0 34960 0 14966 0 23113 0 351342 0 0 0 JANE CARMODY 57297 208939 23134 84359 9549 34823 11896 43378 2510 9154 104386 380653 4299 15675 JASON YUNGTUM 42335 154376 1137 4147 2038 7433 122589 447036 4625 16869 172724 629861 0 0 JOAN NEUHAUS 82773 301843 55039 200706 26404 96284 361083 1316735 1248 4553 526547 1920121 11487 41887 JOHN HARRIS MD 0 473461 0 0 0 16361 0 7500 0 21988 0 519310 0 0 KENNETH LAWONN 70726 257912 46220 168546 21783 79434 322023 1174295 4391 16013 465143 1696200 10173 37096 LARRY BROWN MD 0 316479 0 0 0 26324 0 18641 0 27066 0 388510 0 0 MARTIN HICKEY MD 0 0 0 0 40889 149105 0 0 0 0 40889 149105 40889 149105 MARTIN M MANCUSO MD 0 347042 0 0 0 61035 0 7500 0 16329 0 431906 0 0 MICHAEL EGGER MD 325516 0 0 0 27290 0 17500 0 26761 0 397067 0 0 0 MYLES GART MD 39642 144558 0 0 3662 13355 2167 7904 290 1058 45761 166875 0 0 NANCY WALLACE 45408 165585 22412 81728 14118 51483 72370 263906 2373 8653 156681 571355 4128 15053 PATRICIA MASEK 28006 102126 13250 48319 11527 42033 13924 50776 3449 12577 70156 255831 2715 9899 PAUL EBMEIER 0 211292 0 110956 0 79842 0 1063 0 16707 0 419860 0 22752 PAUL EDGETT 0 440982 0 214258 0 79137 0 64715 0 21785 0 820877 0 57444 PAUL STRAWHECKER 40231 146708 14317 52207 5133 18719 3442 12550 3562 12988 66685 243172 1027 3746 RICHARD II HACHTEN 184201 671711 140745 513244 147686 538555 640903 2337132 3501 12768 1117036 4073410 126090 459805 RICHARD ROLSTON MD 97350 355001 58361 212822 16330 59548 369218 1346398 4719 17209 545978 1990978 8755 31925 RICK MILLER MD 51912 189302 36652 133656 18862 68783 240210 875954 6188 22566 353824 1290261 7851 28629 SCOTT WOOTEN 82273 300017 57211 208628 29117 106178 338082 1232859 4316 15739 510999 1863421 12628 46050 SHEREE KEELY 29507 107601 11363 41437 6920 25233 10709 39051 2457 8959 60956 222281 2660 9698 Housing allowance or residence for personal use Schedule J, Part I, Line 1a AS PART OF THE EXECUTIVE COMPENSATION ARRANGEMENT, EXECUTIVES ARE PROVIDED WITH A SET SUM, APPROXIMATELY 30 - 40% OF THEIR BASE SALARY, WHICH CAN BE USED TO ELECT VARIOUS BENEFITS. SOME OF THE BENEFITS AVAILABLE FOR ELECTION INCLUDE HEALTH CLUB DUES, AUTOMOBILE ALLOWANCE, HOUSING ALLOWANCE, FINANCIAL PLANNING FEES AND LEGAL FEES. PAYMENT FOR THESE BENEFITS ARE EITHER MADE DIRECTLY BY ALEGENT CREIGHTON HEALTH OR REIMBURSED TO THE EXECUTIVE AFTER THE APPROPRIATE SUBSTANTIATION FOR THE EXPENSE IS PROVIDED. THE AMOUNT PAID FOR THESE BENEFITS IS INCLUDED IN THE EXECUTIVE'S WAGES AS TAXABLE INCOME. Health or social club dues or initiation fees Schedule J, Part I, Line 1a SEE ABOVE DISLCOSURE FOR 1A. Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 ACTING AS PRUDENT STEWARDS OF ITS FINANCIAL RESOURCES, THE ALEGENT CREIGHTON HEALTH BOARD COMPENSATION COMMITTEE RECOMMENDS AND THE BOARD EXECUTIVE COMMITTEE APPROVES EXECUTIVE COMPENSATION PHILOSOPHY, POLICY AND GUIDELINES. IT DOES SO WITH THE OBJECTIVE OF ATTRACTING AND RETAINING TOP EXECUTIVE TALENT TO ENSURE ALEGENT CREIGHTON HEALTH IS ABLE TO FULFILL ITS FAITH-BASED MISSION AND ACHIEVE ITS VISION OF BECOMING WORLD-CLASS. THE ALEGENT CREIGHTON HEALTH COMPENSATION COMMITTEE FOLLOWS A THOROUGH AND INTENTIONAL PROCESS THAT INCLUDES CONSULTATION WITH INDEPENDENT, EXPERT COUNSEL AND CAREFULLY COMPARES COMPENSATION LEVELS TO MARKET-BASED COMPENSATION OF SIMILAR SIZED, NON-PROFIT AND FOR-PROFIT HEALTH SYSTEMS AND ALSO UTILIZES A BLEND OF NON-PROFIT AND GENERAL INDUSTRY DATA FOR EXECUTIVE ROLES WHERE THE RECRUITING MARKET IS ARGUABLY BROADER THAN THE NON-PROFIT SECTOR. TOTAL COMPENSATION INCLUDES BASE COMPENSATION, AND ALSO INCLUDES PERFORMANCE-BASED INCENTIVE COMPENSATION FOR ACHIEVING BOARD-SET GOALS FOR CLINICAL QUALITY, PATIENT SAFETY AND SATISFACTION, PHYSICIAN PERCEPTION, STRATEGIC AND FACILITY PLANNING AND FINANCIAL PERFORMANCE. IT MAY ALSO INCLUDE OTHER CASH PAYMENTS SUCH AS ONE-TIME RELOCATION COSTS, AND/OR CASH PAYMENTS FOR DEFERRED COMPENSATION. Severance or change-of-control payment Schedule J, Part I, Line 4a THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS AS EXECUTIVES OF ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2012 CALENDAR YEAR AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE AS COMPENSATION ON SCHEDULE J: RICHARD HACHTEN - $444,672 MARTIN HICKEY, MD - $189,994 SEVERANCE PAID TO RICHARD HACHTEN IN CALENDAR YEAR 2012 RELATES TO A CORRECTION MADE TO REPORT ADDITIONAL SEVERANCE OWED TO HIM FROM A PREVIOUS SEPARATION OF SERVICE. THE ADDITIONAL SEVERANCE WAS REPORTED ON A CORRECTED W-2C AND APPLICABLE TAXES WERE SUBMITTED TO THE IRS. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b THE FOLLOWING REPORTABLE INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2012 CALENDAR YEAR. THE FOLLOWING AMOUNTS DEFERRED FROM THE PLAN WERE INCLUDED IN COLUMN C OF THE SCHEDULE J: RICHARD HACHTEN II - $155,803 SCOTT WOOTEN - $64,619 JANE CARMODY - $23,850 NANCY WALLACE - $20,943 RICK MILLER, MD - $42,174 KENNETH LAWONN - $107,846 JOAN NEUHAUS - $63,430 SHEREE KEELY - $25,941 ELIZABETH LLEWELLYN - $31,429 PATRICIA MASEK - $26,283 ANN SCHUMACHER - $51,778 RICHARD ROLSTON - $67,114 JASON YUNGTUM - $24,139 PAUL STRAWHECKER - $15,992 SCHEDULE J, LINE 4B - THE FOLLOWING REPORTABLE INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2012 CALENDAR YEAR. THE FOLLOWING AMOUNTS FROM THE PLAN WERE PAID OUT AND INCLUDED IN TAXABLE WAGES. THE AMOUNTS WERE INCLUDED IN COLUMN B(III) OF THE SCHEDULE J: RICHARD HACHTEN II - $141,223 SCOTT WOOTEN - $58,678 JANE CARMODY - $19,974 NANCY WALLACE - $19,182 RICK MILLER, MD - $36,480 RICHARD ROLSTON, MD - 40,680 KENNETH LAWONN - $47,270 JOAN NEUHAUS - $53,374 SHEREE KEELY - $12,358 ELIZABETH LLEWELLYN - $14,770 PATRICIA MASEK - $12,614 PAUL STRAWHECKER - $4,772 PAUL EBMEIER - $22,752 ANN SCHUMACHER - $23,746 Compensation contingent on net earnings of the organization Schedule J, Part I, Line 6a COMPENSATION FOR MEMBERS OF MANAGEMENT OF ALEGENT CREIGHTON HEALTH AND RELATED ENTITIES IS DETERMINED AT A SYSTEM LEVEL. MEMBERS OF ALEGENT CREIGHTON HEALTH MANAGEMENT ARE ELIGIBLE FOR AN ANNUAL INCENTIVE BONUS. INCENTIVE AWARDS ARE BASED ON FOUR INDIVIDUAL PERFORMANCE MEASURES WHICH ARE LINKED TO FOUR SYSTEM PERFORMANCE GOALS. FOR EACH MANAGER, 75% OF THE INCENTIVE AWARD WILL BE DETERMINED BY SYSTEM PERFORMANCE GOALS AND 25% DETERMINED BY INDIVIDUAL PERFORMANCE MEASURES. ONE OF THE FOUR SYSTEM PERFORMANCE GOALS IS DEPENDENT ON THE FINANCIAL RESULTS OF THE ENTIRE ALEGENT CREIGHTON HEALTH SYSTEM FOR THE FISCAL YEAR. Compensation contingent on net earnings of a related organization Schedule J, Part I, Line 6b SEE DISCLOSURE OF 6A. POTENTIAL SEVERANCE PAYMENTS SCHEDULE J, PART II THE ALEGENT CREIGHTON HEALTH EXECUTIVES HAVE A PROVISION IN THEIR COMPENSATION AGREEMENT THAT PROVIDES FOR POTENTIAL SEVERANCE PAYMENTS IN THE EVENT OF TERMINATION WITHOUT CAUSE OR CHANGE OF CONTROL. THE AMOUNT OF SEVERANCE AN EXECUTIVE MAY OR MAY NOT RECEIVE IF TERMINATED ACCORDING TO THE COMPENSATION AGREEMENT IS INCLUDED AS DEFERRED COMPENSATION IN COLUMN C. X USGA MEGA PACKAGE #2 1 3900 MARKET VALUE X USGA MEGA PACKAGE #1 1 3900 MARKET VALUE X OKOBOJI 1 2200 MARKET VALUE X CHICAGO CUBS 1 1170 MARKET VALUE X CELINE DION 1 1150 MARKET VALUE X MAN BASKET 1 1026 MARKET VALUE X SECURITY SOLUTIONS, INC. - BASIC SYSTEM INSTALL 1 845 MARKET VALUE X THE PUPPY 1 750 MARKET VALUE X UPSTREAM BEER MAKING EXPERIENCE 1 750 MARKET VALUE X OMAHA SYMPHONY 1 710 MARKET VALUE X RUFF WATERS- TREE AND PLANTING 1 650 MARKET VALUE X IPAD 1 640 MARKET VALUE X PLAYERS CLUB GOLF FOURSOME AND HOTEL 1 605 MARKET VALUE X STAYCATION 1 520 MARKET VALUE X VERA BRADLEY COMFORTER SET AND BREAKFAST TRAY 1 460 MARKET VALUE X USGA TWO TICKETS/WEEK PASS 1 446 MARKET VALUE X FIRE PIT, SNACKS AND ACCESSORIES 1 415 MARKET VALUE X DR. RUMA'S ART 1 400 MARKET VALUE X DESIGNER VASE 1 300 MARKET VALUE X SHADOW RIDGE COUNTRY CLUB - FOURSOME OF GOLF 1 275 MARKET VALUE X FRAMED NEBRASKA PHOTOGRAPH - SUNRISE AND OMAHA WORLD HERALD NEBRASKA PHOTOGRAPHY BOOK 1 275 MARKET VALUE X SNORE & ROAR HOTEL AND ZOO PACKAGE 1 260 MARKET VALUE X TASTE OF OMAHA #1 1 254 MARKET VALUE X THE WHISTLING GOURMET - PERSONAL CHEF SERVICE 1 250 MARKET VALUE X TWO COLLEGE WORLD SERIES TICKETS - CLUB LEVEL, 1ST BASELINE 1 250 MARKET VALUE X TAILGATING COLEMAN GRILL 1 250 MARKET VALUE X SHORELINE GOLF OUTING FOR FOUR WITH CART 1 250 MARKET VALUE X GLASS AND TILE MIRROR 1 250 MARKET VALUE X LAP QUILT 1 250 MARKET VALUE X SPARTINA PURSE AND SCARF 1 245 MARKET VALUE X BEACH CHAIRS, SUMMER BAG & HAT 1 220 MARKET VALUE X PRIMAVERA GLASS ON COPPER PEDASTAL 1 220 MARKET VALUE X (2) TICKETS ADDAMS FAMILY PLAY AND SPENCER'S GIFT CARD 1 220 MARKET VALUE X WEIGHT MANAGEMENT BASKET 1 190 MARKET VALUE X TASTE OF OMAHA #2 1 185 MARKET VALUE X MOTHER - DAUGHTER BASKET 1 185 MARKET VALUE X WINE TRIO 1 180 MARKET VALUE X OMAHA STORM CHASERS & TEXAS ROADHOUSE 1 180 MARKET VALUE X COMMUNITY PLAYHOUSE TICKETS FOR TWO AND $100 SULLIVAN'S GIFT CARD 1 180 MARKET VALUE X LIED LODGE AND CONFERENCE CENTER AT ARBOR DAY FARM - ONE NIGHT STAY, BREAKFAST FOR TWO WITH TREE AD 1 175 MARKET VALUE X TUSSEY'S WINE AND DINE FOR FOUR 1 170 MARKET VALUE X RED NECK BASKET & ALPINE INN 1 170 MARKET VALUE X BALLET BIRTHDAY PARTY, PRINCESS COSTUME AND ACCESSORIES 1 160 MARKET VALUE X BRONCO TICKETS - 2 PRE-SEASON TICKETS 1 160 MARKET VALUE X YMCA CAMP, ESTES PARK LODGE - 2 NIGHT STAY 1 160 MARKET VALUE X CABELA'S GIFT CARD 1 150 MARKET VALUE X FRAMED PHOTOGRAPH - MOUNTAIN REFLECTION 1 150 MARKET VALUE X PORSCHE GT-2 CLUB COUPE RACING 1 150 MARKET VALUE X SALON TEEZ -CUT, COLOR AND HAIR PRODUCTS 1 150 MARKET VALUE X TASTE OF OMAHA #3 1 145 MARKET VALUE X GONE FISHIN' BASKET 1 130 MARKET VALUE X CAMPING BASKET 1 130 MARKET VALUE X MOM, I''''M BORED SUMMER FAMILY BASKET 1 127 MARKET VALUE X NEBRASKA BASKET 1 125 MARKET VALUE X M & M GUY - BROWN 1 125 MARKET VALUE X SIGNATURE FACIAL BY GINA LEISE 1 125 MARKET VALUE X TEEN BASKET 1 125 MARKET VALUE X FIFTH AVENUE PURSE BY THIRTY ONE 1 125 MARKET VALUE X HAPPY EVERYTHING PLATE 1 120 MARKET VALUE X CHRISTMAS BASKET 1 120 MARKET VALUE X FAMILY FUN CENTER & SORTINO'S PIZZA 1 115 MARKET VALUE X POSTER - ALBERT EINSTEIN 1 115 MARKET VALUE X MOCHA CROSSBODY CLUTCH AND BRACELET 1 115 MARKET VALUE X HARLEY MUGS BASKET 1 110 MARKET VALUE X WENNINGHOFF SPRING BASKET, $20 GIFT CARD & WEATHER STATION 1 110 MARKET VALUE X ARTISAN APPLE SMOKED BACON WITH PAN AND PRESS 1 105 MARKET VALUE X 2009 EGELHOFF CABERNET SAUVIGNON AND 2011 EGELHOFF RIESLING 1 105 MARKET VALUE X SPA BATH SET 1 102 MARKET VALUE X WINE SUITCASE 1 100 MARKET VALUE X ARTISAN CHOCOLATE BASKET 1 100 MARKET VALUE X WOODEN WINE CORK LETTERS 1 100 MARKET VALUE X BABY BASKET 1 100 MARKET VALUE X DOG BASKET 1 100 MARKET VALUE X FRAMED FISHING PRINT FROM BASS PRO 1 100 MARKET VALUE X HANDY TOOLS 1 100 MARKET VALUE X GARDEN ART 1 100 MARKET VALUE X CUSTOM DESIGNED FAMILY TREE WITH FRAME 1 100 MARKET VALUE X ART BY TERRY WEBBER 1 100 MARKET VALUE X FRAMED CHRIST THE REDEEMER PRINT 1 100 MARKET VALUE X 2 MONTH MEMBERSHIP TO VICTORY BOXING CLUB AND COMMUNITY CENTER 1 100 MARKET VALUE X ALPACA FARM TOUR FOR CHILDREN 1 100 MARKET VALUE X LOLIA BATH SET 1 100 MARKET VALUE X BLUE GLITZ PURSE, SCARF AND BRACELET 1 100 MARKET VALUE X TOTE WITH ZEBRA ACCESSORIES 1 100 MARKET VALUE X SIGNATURE DRINK #1 - STRAWBERRY HEAVEN 1 100 MARKET VALUE X SIGNATURE DRINK #2 - STRAWBERRY HEAVEN 1 100 MARKET VALUE X AQUA TOTS SWIM SCHOOL 1 95 MARKET VALUE X TAKE ME OUT TO THE BALLGAME BASKET 1 95 MARKET VALUE X PRINCESS CHAIR AND ACCESSORIES 1 90 MARKET VALUE X LUCKY BUCKET BREWERY BASKET AND TOUR 1 90 MARKET VALUE X PURSE, SCARF AND $25 GIFT CERTIFICATE 1 90 MARKET VALUE X STEADMAN PHOTOGRAPHY PACKAGE 1 85 MARKET VALUE X MIKASA FLUTES, SET OF EIGHT 1 80 MARKET VALUE X GIFTS CARDS TO THREE LOCAL RESTAURANTS 1 80 MARKET VALUE X ZEBRA THEMED BASKET 1 80 MARKET VALUE X DOG THEMED QUILT AND DOG 1 80 MARKET VALUE X VERA BRADLEY COOLER TOTE AND TUMBLER 1 80 MARKET VALUE X TANNING & NAIL SPA GIFT CERTIFICATES 1 76 MARKET VALUE X WINE RACK 1 75 MARKET VALUE X C. WHITE PHOTOGRAPHY GIFT CERTIFICATE 1 75 MARKET VALUE X OWEN'S MOWING SERVICE 1 75 MARKET VALUE X SANTA AND ELF CHRISTMAS VISIT 1 75 MARKET VALUE X SILVER ZEBRA PRINT WINE TOTE 1 70 MARKET VALUE X MARGARITA AND SALSA BASKET 1 70 MARKET VALUE X TASTE OF ITALIAN, OMAHA STYLE 1 70 MARKET VALUE X FAMILY GAME BASKET AND PIZZA 1 70 MARKET VALUE X TEAVANA GIFT SET WITH TEA SET 1 70 MARKET VALUE X POSTER - LOVE IS GREAT 1 70 MARKET VALUE X SANDALS AND DAVID AUBREY BRACELET 1 70 MARKET VALUE X HOMEMADE JAMS FOR A YEAR BASKET 1 60 MARKET VALUE X HAND KNIT WRAP 1 60 MARKET VALUE X AROMATHERAPY BATH SET 1 60 MARKET VALUE X CHOCOLATIER BLUE - CHOCOLATES AND GIFT CARD 1 52 MARKET VALUE X BEYOND THE VINE GIFT CARD AND MOLESKIN WINE JOURNAL 1 50 MARKET VALUE X 11-WORTH CAF? GIFT CERTIFICATE 1 50 MARKET VALUE X DEFY GRAVITY GIFT CERTIFICATE WITH BACKPACK 1 50 MARKET VALUE X CHILD'S SOCCER BASKET 1 50 MARKET VALUE X GIFT CERTIFICATE FOR HARLEY MUGS BASKET 1 50 MARKET VALUE X HANDCRAFTED METAL SIGN 1 50 MARKET VALUE X (2) AKSARBEN THEATER TICKETS & JONES BROS. 1 50 MARKET VALUE X 11-WORTH CAF?' GIFT CERTIFICATES 11-WORTH CAF? GIFT CARD WITH BOXING MEMBERSHIP 1 50 MARKET VALUE X ROBE AND ACCESSORIES 1 50 MARKET VALUE X RAINY DAY TEA TIME BASKET 1 50 MARKET VALUE X RHINESTONE BRACELET WITH BEAR 1 50 MARKET VALUE X HANGING WINE RACK WITH GLASSES 1 40 MARKET VALUE X MIKASA CHEERS FLUTES, SET OF FOUR 1 40 MARKET VALUE X OMAHA STEAKS GIFT CERTIFICATE WITH BARBEQUE GRILL SET 1 40 MARKET VALUE X FROG AND BLANKET 1 40 MARKET VALUE X SURH LUCHTEL NAPA VALLEY WINE 1 35 MARKET VALUE X IOWA PLATE 1 30 MARKET VALUE X JULIE SETTERHOLM COPPER NECKLACE 1 30 MARKET VALUE X FRAMED VERSE FOR 35 YEAR OLD 1 25 MARKET VALUE false false false Number of contributions or items contributed. Schedule M, part I, column (b), Line other=USGA MEGA PACKAGE #2 Number of contributions or items contributed. Schedule M, part I, column (b), Line other=USGA MEGA PACKAGE #1 Number of contributions or items contributed. Schedule M, part I, column (b), Line other=OKOBOJI Number of contributions or items contributed. Schedule M, part I, column (b), Line other=CHICAGO CUBS Number of contributions or items contributed. Schedule M, part I, column (b), Line other=CELINE DION PAYMENTS TO VENDORS FORM 990, PART V, LINE 1C PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE MADE BY ALEGENT CREIGHTON HEALTH, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. ALEGENT CREIGHTON HEALTH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY ALEGENT CREIGHTON HEALTH ON BEHALF OF ALEGENT HEALTH-IMMANUEL MEDICAL CENTER ARE REPORTED TO THE IRS. EMLOYEES OF ALEGENT HEALTH-IMMANUEL MEDICAL CENTER FORM 990, PART V, LINE 2A THE EMPLOYEES LISTED IN PART I, LINE 5 AND PART V, LINE 2A ARE EMPLOYED BY ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT CREIGHTON HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. Family/business relationships amongst interested persons Form 990, Part VI, Section A, Line 2 PAUL EDGETT III AND SR. PHYLLIS HUGHES - BUSINESS RELATIONSHIP Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE SOLE MEMBER OF THE CORPORATION SHALL BE IMMANUEL HEALTH SYSTEMS (IHS). IMMANUEL HEALTH SYSTEMS SHALL NOT HAVE ANY VOTING RIGHTS AS A MEMBER OF THE CORPORATION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a THE BUSINESS AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY OR UNDER THE DIRECTION OF THE ALEGENT CREIGHTON HEALTH BOARD OF DIRECTORS, AND THE CORPORATION HEREBY DELEGATES TO THE ALEGENT CREIGHTON HEALTH BOARD OF DIRECTORS, TO THE EXTENT PERMITTED BY LAW, COMPLETE GOVERNANCE AUTHORITY OVER IT, SUBJECT ONLY TO THE APPROVAL POWERS OF THE ALEGENT CREIGHTON HEALTH CORPORATE MEMBERS SET FORTH IN THE ARTICLES OF INCORPORATION AND BYLAWS. DIRECTORS SHALL BE APPOINTED BY THE ALEGENT CREIGHTON HEALTH BOARD IMMEDIATELY FOLLOWING THE APPOINTMENT AND RATIFICATION BY ALEGENT CREIGHTON HEALTH CORPORATE MEMBERS OF THE ALEGENT CREIGHTON HEALTH DIRECTORS PURSUANT TO THE ARTICLES OF INCORPORATION AND BYLAWS OF ALEGENT CREIGHTON HEALTH. THE ALEGENT CREIGHTON HEALTH BOARD SHALL APPOINT DIRECTORS SUCH THAT, AT ALL TIMES, ALL OF THE PERSONS SERVING AS ALEGENT CREIGHTON HEALTH DIRECTORS ALSO SHALL BE SERVING AS DIRECTORS OF THE CORPORATION. Decisions requiring approval by members or stockholders 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 CAPITAL 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 CREIGHTON 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 CREIGHTON HEALTH SYSTEM CREDIT, AND THE TAKING OF ALL ACTIONS NECESSARY OR APPROPRIATE TO OBTAIN FUNDING OR OTHERWISE MAKE ARRANGEMENTS TO PREPAY SUCH NOTES INCLUDING WITHOUT LIMITATION INCURRENCE OF INDEBTEDNESS NECESSARY OR APPROPRIATE TO PREPAY THE NOTES OUTSTANDING. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b THE ORGANIZATION'S ACCOUNTING PERSONNEL WORK WITH THE CHI TAX DEPARTMENT TO PREPARE THE FORM 990 AND THE FINANCE STAFF CONSULTS WITH EXECUTIVE MANAGEMENT REGARDING THE ITEMS OF INTEREST (I.E. CONFLICTS, POLITICAL ACTIVITIES, ETC.) OF WHICH THEY WOULD HAVE FIRSTHAND KNOWLEDGE. AFTER COMPLETION OF THE FORM 990, A DRAFT COPY IS REVIEWED BY FINANCE AND EITHER THE DIRECTOR OF FINANCE OR CFO FOR ANY POTENTIAL ERRORS, OMISSIONS, OR CLARIFICATIONS NEEDED FOR PROPER PRESENTATION. AFTER FINAL CHANGES ARE MADE TO THE FORM 990, THE FINAL RETURN IS THEN PROVIDED TO THE BOARD MEMBERS PRIOR TO THE BOARD MEETING DATE. AT THE NEXT BOARD MEETING, THE FORM 990 IS AN AGENDA ITEM WHEREBY THE BOARD HAS AN OPPORTUNITY TO ASK QUESTIONS OR OBTAIN CLARIFICATION OF THE FORM 990 INFORMATION. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Conflict of interest policy Form 990, Part VI, Section B, Line 12c WRITTEN CONFLICT OF INTEREST POLICY - ALEGENT HEALTH-IMMANUEL MEDICAL CENTER HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF ALEGENT CREIGHTON HEALTH, THE PARENT CORPORATION OF THE ALEGENT CREIGHTON HEALTH SYSTEM. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY THE ALEGENT CREIGHTON HEALTH COMPLIANCE OFFICER AND REPORTED TO THE CONFLICTS OF INTEREST COMMITTEE. THE CONFLICTS OF INTEREST COMMITTEE REVIEWS THE INVESTIGATION AND MAKES RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE MAKES THE FINAL DETERMINATION OF WHETHER OR NOT THERE IS A DISQUALIFYING EVENT AND COMMUNICATES IT TO THE BOARD OF DIRECTORS. AT ANY TIME A BOARD MEMBER OR KEY EMPLOYEE MAY DECLARE A CONFLICT OF INTEREST AND RECUSE HIS/HERSELF FROM THE DISCUSSION. THE INDIVIDUAL IS ALSO REQUIRED TO DISCLOSE ANY KNOWN OR POSSIBLE CONFLICTS OF INTEREST THAT ARISE DURING THE CALENDAR YEAR. Process used to establish compensation of top management official Form 990, Part VI, Section B, Line 15a THE GOVERNING BOARD OF ALEGENT CREIGHTON HEALTH ENGAGED THE SERVICES OF AN INDEPENDENT CONSULTING FIRM THAT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT THAT IS QUALIFIED TO AND REGULARLY PERFORMS EXECUTIVE AND OFFICER COMPENSATION STUDIES. THE CONSULTING FIRM CONDUCTED A REVIEW AND ANALYSIS OF THE TOTAL COMPENSATION PAID TO THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, BASED ON COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS AND DETERMINED THAT THE COMPENSATION WAS REASONABLE. THE CONSULTING FIRM ISSUED AN OPINION LETTER AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PAID TO EMPLOYEES IDENTIFIED AS DISQUALIFIED PERSONS. THE OPINION LETTER SETTING FORTH THE FINDINGS WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS WERE MAINTAINED. THIS PROCESS WAS USED FOR THE FOLLOWING EMPLOYEES: PRESIDENT AND CHIEF EXECUTIVE OFFICER SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER CHIEF EXECUTIVE OFFICER ALEGENT CREIGHTON CLINIC SENIOR VICE PRESIDENT AND CHIEF OPERATIONS OFFICER SENIOR VICE PRESIDENT STRATEGY AND TECHNOLOGY VICE PRESIDENT OPERATIONS (BERGAN MERCY & MERCY) VICE PRESIDENT OPERATIONS (IMMANUEL) VICE PRESIDENT OPERATIONS (LAKESIDE) VICE PRESIDENT OPERATIONS (MIDLANDS) MEDICAL DIRECTORS Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b SEE DISCLOSURE FOR 15A. WRITTEN POLICY FOR JOINT VENTURE AGREEMENTS FORM 990, PART VI, LINE 16A ALEGENT CREIGHTON HEALTH HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, ALEGENT CREIGHTON HEALTH'S SYSTEM-WIDE JOINT VENTURE MODEL INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSE IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNER'S RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.ALEGENTCREIGHTON.COM. ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 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. Other changes in net assets or fund balances Form 990 , Part XI, Line 9 JOINT OPERATING AGREEMENT - CAPITAL - 1540000; NET ASSETS RELEASED FROM RESTRICTIONS - -88504; ALEGENT CREIGHTON CLINIC 12809 WEST DODGE ROAD OMAHA NE 68154 HEALTHCARE NE 501(C)(3) 3 ACH true ALEGENT CREIGHTON HEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 HEALTHCARE NE 501(C)(3) 3 NA true ALEGENT HEALTH - BERGAN MERCY HEALTH SYS 7500 MERCY ROAD OMAHA NE 68124 HEALTHCARE NE 501(C)(3) 3 ACH true ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH STREET MISSOURI VALLEY IA 51555 HEALTHCARE IA 501(C)(3) 3 AHIMC true ALEGENT HEALTH FOUNDATION 12809 WEST DODGE ROAD OMAHA NE 68154 FUNDRAISING NE 501(C)(3) 7 ACH true ALEGENT HEALTH IMMANUEL MEDICAL CENTER 6901 NORTH 72ND STREET OMAHA NE 68122 HEALTHCARE NE 501(C)(3) 3 ACH true ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE 104 W 17TH STREET SCHUYLER NE 68661 HEALTHCARE NE 501(C)(3) 3 AHIMC true ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 HEALTHCARE IA 501(C)(3) 3 AHBMHS true ALVERNA APARTMENTS 300 SE 8TH AVENUE LITTLE FALLS MN 56345 LTERM CARE MN 501(C)(3) 9 CHI true APPLETREE COURT 601 OAK STREET BRECKENRIDGE MN 56520 SENIOR HOMES MN 501(C)(3) 9 SFH true BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVENUE DES MOINES IA 50314 LTERM CARE IA 501(C)(3) 9 CHI-IA CORP true BORNEMANN HEALTH CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 HEALTHCARE PA 501(C)(3) 11 - Type I CHI true CARRINGTON HEALTH CENTER 800 NORTH 4TH STREET CARRINGTON ND 58421 HEALTHCARE ND 501(C)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 9 NA true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 FUNDRAISING CO 501(C)(3) 7 CHIC true CATHOLIC HEALTH INITIATIVES INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 11 - Type I CHI true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 FUNDRAISING CO 501(C)(3) 9 CHI true CATHOLIC HEALTH INITIATIVES-COLORADO 188 INVERNESS DRIVE WEST SUITE 500 ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES-IOWA CORP DBA MERCY MEDICAL CENTER-DES MOINES 1111 6TH AVENUE DES MOINES IA 50314 HEALTHCARE IA 501(C)(3) 3 CHI true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PARKWAY ROSEBURG OR 97470 PHYSICIANS OR 501(C)(3) 9 MMC true CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 SURGERY CNTR KS 501(C)(3) 3 CHI true CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PARKWAY SOUTH FARGO ND 58104 HEALTHCARE ND 501(C)(3) 9 CHI true CHI KENTUCKY INC 3900 OLYMPIC BLVD SUITE 400 ERLANGER KY 41018 HEALTHCARE KY 501(C)(3) 11 - Type I CHI true CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 9 CHI NHC true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 11 - Type I CHI true CHI NEBRASKA 6940 O STREET LINCOLN NE 68510 HEALTHCARE NE 501(C)(3) 11 - Type I CHI true COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 DIALYSIS OH 501(C)(2) N/A GSH true COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION MISSOURI VALLEY IA 631 N 8TH STREET MISSOURI VALLEY IA 51555 FUNDRAISING IA 501(C)(3) 11 - Type I AHCMH true CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DRIVE LEXINGTON KY 40509 LTACH KY 501(C)(3) 3 SJHS true COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HOME HEALTH PA 501(C)(3) 11 - Type II NA true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVENUE ENUMCLAW WA 98022 HEALTHCARE WA 501(C)(3) 3 FHS true FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 HEALTHCARE KY 501(C)(3) 3 KOH true FLAGET MEMORIAL HOSPITAL FOUNDATION 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 FUNDRAISING KY 501(C)(3) 11 - Type I FH true FRANCISCAN FOUNDATION 1717 SOUTH J STREET TACOMA WA 98405 FUNDRAISING WA 501(C)(3) 9 FHS true FRANCISCAN HEALTH SYSTEM 1717 SOUTH J STREET TACOMA WA 98405 HEALTHCARE WA 501(C)(3) 3 CHI true FRANCISCAN MEDICAL GROUP 1708 SOUTH YAKIMA AVENUE TACOMA WA 98405 HEALTHCARE WA 501(C)(3) 9 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE 3601 SOUTH CHICAGO AVENUE SOUTH MILWAUKEE WI 53172 HEALTHCARE WI 501(C)(3) 9 CHI true GETTYSBURG MEDICAL CENTER 606 EAST GARFIELD AVENUE GETTYSBURG SD 57442 HEALTHCARE SD 501(C)(3) 3 SMHC true GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 MINISTRIES CO 501(C)(3) 11 - Type I CHI true GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 EDUCATION OH 501(C)(3) 2 GSH true GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 FUNDRAISING OH 501(C)(3) 11 - Type I GSH true GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST STREET KEARNEY NE 68847 FUNDRAISING NE 501(C)(3) 7 GSH true ST LUKE'S MEDICAL GROUP FKA GREATER HOUSTON HEALTH NETWORK 6624 FANNIN HOUSTON TX 77030 PHY PRACTICES TX 501(C)(3) 3 SLHS true HEALTH SET 4200 WEST CONEJOS PLACE 436 DENVER CO 80204 LOW INC.CARE CO 501(C)(3) 7 CHIC true HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 FUNDRAISING MN 501(C)(3) 11 - Type I SFMC true HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 HEALTHCARE WA 501(C)(3) 3 FHS true HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL 7601 OSLER DRIVE TOWSON MD 21204 HEALTHCARE MD 501(C)(3) 9 SJMC true HOUSE OF MERCY 1111 6TH AVENUE DES MOINES IA 50314 SHELTER IA 501(C)(3) 7 CHI-IA CORP true JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 539 S 4TH STREET LOUISVILLE KY 40202 HEALTHCARE KY 501(C)(3) 3 KOH true JEWISH PHYSICIAN GROUP INC 539 S 4TH STREET LOUISVILLE KY 40202 HEALTHCARE KY 501(C)(3) 9 JHSMH true KENTUCKYONE HEALTH INC FKA JH PROPERTIES INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 HEALTHCARE KY 501(C)(3) 9 CHI true LAKEWOOD HEALTH CENTER 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 HEALTHCARE MN 501(C)(3) 3 CHI true LINUS OAKES INC 2700 STEWART PARKWAY ROSEBURG OR 97470 SENIOR LIVING OR 501(C)(3) 9 MMC true LISBON AREA HEALTH SERVICES 905 MAIN STREET LISBON ND 58054 HEALTHCARE ND 501(C)(3) 3 CHI true MEMORIAL HEALTH CARE SYSTEM FOUNDATION 2525 DE SALES AVENUE CHATTANOOGA TN 37404 FUNDRAISING TN 501(C)(3) 7 MHCS true MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVENUE CHATTANOOGA TN 37404 HEALTHCARE TN 501(C)(3) 3 CHI true MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD ROAD SUITE 500 CHATTANOOGA TN 37411 HEALTHCARE TN 501(C)(3) 9 MHCS true MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVENUE DES MOINES IA 50314 AUXILIARY IA 501(C)(3) 11 - Type I CHI-IA CORP true MERCY CLINICS INC 1111 6TH AVENUE DES MOINES IA 50314 PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP true MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVENUE DES MOINES IA 50314 EDUCATION IA 501(C)(3) 2 CHI-IA CORP true MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVENUE DES MOINES IA 50314 FUNDRAISING IA 501(C)(3) 7 CHI-IA CORP true MERCY FOUNDATION INC 2700 STEWART PARKWAY ROSEBURG OR 97470 FUNDRAISING OR 501(C)(3) 7 MMC true MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 FUNDRAISING NE 501(C)(3) 11 - Type I AHMH true MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 FUNDRAISING ND 501(C)(3) 11 - Type III - FI MHVC true MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DRIVE COUNCIL BLUFFS IA 51503 FUNDRAISING IA 501(C)(3) 11 - Type I AHBMHS true MERCY HOSPITAL OF DEVILS LAKE 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 FUNDRAISING ND 501(C)(3) 7 CHI true MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY MEDICAL CENTER 1301 15TH AVENUE WEST WILLISTON ND 58801 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 HEALTHCARE IA 501(C)(3) 3 CHI-IA CORP true MERCY MEDICAL CENTER INC 2700 STEWART PARKWAY ROSEBURG OR 97470 HEALTHCARE OR 501(C)(3) 3 CHI true MERCY MEDICAL FOUNDATION 1301 15TH AVENUE WEST WILLISTON ND 58801 FUNDRAISING ND 501(C)(3) 11 - Type I MMC true MERCY PROFESSIONAL PRACTICE ASSOCIATES INC 1111 6TH AVENUE DES MOINES IA 50314 PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP true MLIFECARES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 PROPERTY MGMT MO 501(C)(3) 11 - Type I SJRMC true MNMCH INC 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE KS 501(C)(3) 3 SJRMC true MT ST JOSEPH INC 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 NURSING CARE OR 501(C)(3) 11 - Type I CHI true NEBRASKA HEART HOSPITAL 7500 SOUTH 91ST STREET LINCOLN NE 68526 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true OAKES COMMUNITY HOSPITAL 314 SOUTH 8TH STREET OAKES ND 58474 HEALTHCARE ND 501(C)(3) 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH STREET OAKES ND 58474 FUNDRAISING ND 501(C)(3) 11 - Type I OCH true PUEBLO STEPUP 1925 EAST ORMAN AVE SUITE G52 PUEBLO CO 81004 COMMUNITY CO 501(C)(3) 7 CHIC true SET OF COLORADO SPRINGS INC 2864 S CIRCLE DRIVE SUITE 450 COLORADO SPRINGS CO 80906 LTERM CARE CO 501(C)(3) 7 CHIC true SAINT CLARE'S COMMUNITY CARE 25 POCONO ROAD DENVILLE NJ 07834 HEALTHCARE NJ 501(C)(3) 11 - Type II SCHS true SAINT CLARE'S FOUNDATION 25 POCONO ROAD DENVILLE NJ 07834 FUNDRAISING NJ 501(C)(3) 7 SCHS true SAINT CLARE'S HEALTH SERVICES INC 25 POCONO ROAD DENVILLE NJ 07834 MANAGEMENT NJ 501(C)(3) 7 CHI true SAINT CLARE'S HOSPITAL 25 POCONO ROAD DENVILLE NJ 07834 HEALTHCARE NJ 501(C)(3) 3 SCHS true SAINT ELIZABETH FOUNDATION 555 SOUTH 70TH STREET LINCOLN NE 68510 FUNDRAISING NE 501(C)(3) 7 SERMC true SAINT ELIZABETH HEALTH SERVICES 555 SOUTH 70TH STREET LINCOLN NE 68510 HEALTHCARE NE 501(C)(3) 3 SERMC true SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 SOUTH 70TH STREET LINCOLN NE 68510 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER 2620 WEST FAIDLEY GRAND ISLAND NE 68803 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 FUNDRAISING NE 501(C)(3) 7 SFMC true SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL STREET BEREA KY 40403 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH HEALTH SYSTEM INC 424 LEWIS HARGETT CIRCLE 160 LEXINGTON KY 40503 HEALTHCARE KY 501(C)(3) 3 CHI true SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON KY 40741 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH MEDICAL FOUNDATION INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 PHY PRACTICES KY 501(C)(3) 3 SJHS true SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DRIVE MOUNT STERLING KY 40353 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH'S HOSPITAL FOUNDATION 30 WEST 7TH STREET DICKINSON ND 58601 FUNDRAISING ND 501(C)(3) 11 - Type I SJHHC true SAMARITAN BEHAVIORAL HEALTH 2222 PHILADELPHIA DRIVE DAYTON OH 45406 HEALTHCARE OH 501(C)(3) 3 SHP true SAMARITAN HEALTH FOUNDATION 2222 PHILADELPHIA DRIVE DAYTON OH 45406 FUNDRAISING OH 501(C)(3) 7 SHP true SAMARITAN HEALTH PARTNERS 110 NORTH MAIN STREET DAYTON OH 45402 HEALTHCARE OH 501(C)(3) 11 - Type I CHI true SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH STREET SCHUYLER NE 68661 FUNDRAISING NE 501(C)(3) 11 - Type I AHMHS true SJMGROUP 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 PHYS PRACTICE MO 501(C)(3) 9 SJRMC true SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE MO 501(C)(3) 3 CHI true SL AUGUSTA CORP PO BOX 20269 HOUSTON TX 77225 TITLE HOLDING TX 501(C)(2) N/A SL PROPERTIES true ST JOSEPH HEALTH MINISTRIES 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 HEALTHCARE PA 501(C)(3) 11 - Type I CHI true ST LUKE'S MEDICAL TOWER CORPORATION 6624 FANNIN SUITE 1100 HOUSTON TX 77030 PROPERTY MGMT TX 501(C)(3) 11 - Type I SL PROPERTIES true ST ANTHONY HOSPITAL 1601 SE COURT AVENUE PENDLETON OR 97801 HEALTHCARE OR 501(C)(3) 3 CHI true ST ANTHONY HOSPITAL FOUNDATION 1601 SE COURT AVENUE PENDLETON OR 97801 FUNDRAISING OR 501(C)(3) 11 - Type I SA HOSPITAL true ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DRIVE MORRILTON AR 72110 HEALTHCARE AR 501(C)(3) 3 SVIMC true ST CATHERINE HOSPITAL 401 EAST SPRUCE STREET GARDEN CITY KS 67846 HEALTHCARE KS 501(C)(3) 3 CHI true ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION 401 EAST SPRUCE STREET GARDEN CITY KS 67846 FUNDRAISING KS 501(C)(3) 11 - Type I SCH true ST DOMINIC OF ONTARIO OREGON 351 SW 9TH STREET ONTARIO OR 97914 HEALTHCARE OR 501(C)(4) N/A CHI true ST FRANCIS HOME 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 LTERM CARE MN 501(C)(3) 9 CHI true ST FRANCIS LIFE CARE CORPORATION 19 POCONO ROAD DENVILLE NJ 07834 ELDERLY CARE NJ 501(C)(3) 9 SCHS true ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 HEALTHCARE MN 501(C)(3) 3 CHI true ST FRANCIS OF BAKER CITY 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE OR 501(C)(3) 3 CHI true ST JOHN'S MERCY REGIONAL FOUNDATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 FUNDRAISING MO 501(C)(3) 7 SJRMC true ST JOSEPH COMMUNITY HEALTH 300 CENTRAL AVENUE SW ALBUQUERQUE NM 87102 COMMUNITY NM 501(C)(3) 11 - Type I CHI true ST JOSEPH HOSPITAL FOUNDATION INC ONE SAITN JOSEPH DRIVE LEXINGTON KY 40504 FUNDRAISING KY 501(C)(3) 11 - Type I SJHS true ST JOSEPH MEDICAL CENTER FOUNDATION 2500 BERNVILLE ROAD PO BOX 316 READING PA 19603 FUNDRAISING PA 501(C)(3) 11 - Type I SJRHN true ST JOSEPH MEDICAL CENTER FOUNDATION 7601 OSLER DRIVE TOWSON MD 21204 FUNDRAISING MD 501(C)(3) 7 SJMC true ST JOSEPH MEDICAL CENTER INC 7601 OSLER DRIVE TOWSON MD 21204 HEALTHCARE MD 501(C)(3) 3 CHI true ST JOSEPH MEDICAL GROUP 2500 BERNVILLE ROAD PO BOX 316 READING PA 19603 HEALTHCARE PA 501(C)(3) 9 BHC true ST JOSEPH PHYSICIAN ENTERPRISE INC 7601 OSLER DRIVE TOWSON MD 21204 PHYSICIANS MD 501(C)(3) 11 - Type I SJMC true ST JOSEPH REGIONAL HEALTH NETWORK 2500 BERNVILLE ROAD PO BOX 316 READING PA 19603 HEALTHCARE PA 501(C)(3) 3 CHI true ST JOSEPH'S AREA HEALTH SERVICES 600 PLEASANT AVENUE PARK RAPIDS MN 56470 HEALTHCARE MN 501(C)(3) 3 CHI true ST JOSEPH'S HOSPITAL AND HEALTH CENTER 30 WEST 7TH STREET DICKINSON ND 58601 HEALTHCARE ND 501(C)(3) 3 CHI true ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - 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