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ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM (EIN 47-0484764)
Tax period
2010-07-01 to 2011-06-30
Filed
2013-06-26
IRS object ID
201301779349300935
Schema version
2010v3.4
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)
Timestamp2013-06-26T16:30:25-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

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 PLAZASUITE 1501AddressLine1
CityOMAHACity
StateNEState
ZIP Code68102ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN470484764EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1ALEGENT HEALTH- BERGAN MERCY HEALTH SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlALEGNameControl
Phone4023434323Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line17500 MERCY ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68124ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameSCOTT M WOOTENName
TitleSENIOR VP/CFOTitle
Phone4023434323Phone
Date Signed2013-06-26DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameLORRAINE A EGGERName
Phone4023481450Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Amended ReturnXAmendedReturn
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 Receipts544015718GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.ALEGENT.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1961YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees3557TotalNbrEmployees
Total Nbr Volunteers643TotalNbrVolunteers
Total Gross UBI6300799TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year7217626ContributionsGrantsPriorYear
Contributions Grants Current Year5756620ContributionsGrantsCurrentYear
Program Service Revenue Prior Year489519489ProgramServiceRevenuePriorYear
Program Service Revenue CY509669237ProgramServiceRevenueCY
Investment Income Prior Year8837616InvestmentIncomePriorYear
Investment Income Current Year14017887InvestmentIncomeCurrentYear
Other Revenue Prior Year8782526OtherRevenuePriorYear
Other Revenue Current Year9852200OtherRevenueCurrentYear
Total Revenue Prior Year514357257TotalRevenuePriorYear
Total Revenue Current Year539295944TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year45561805GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY49176970GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year215854278SalariesEtcPriorYear
Salaries Etc Current Year211500809SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year465738TotalFundrsngExpCurrentYear
Other Expense Prior Year255705725OtherExpensePriorYear
Other Expenses Current Year256319452OtherExpensesCurrentYear
Total Expenses Prior Year517121808TotalExpensesPriorYear
Total Expenses Current Year516997231TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-2764551RevenuesLessExpensesPriorYear
Revenues Less Expenses CY22298713RevenuesLessExpensesCY
Total Assets BOY621960900TotalAssetsBOY
Total Assets EOY689310700TotalAssetsEOY
Total Liabilities BOY188123787TotalLiabilitiesBOY
Total Liabilities EOY192738088TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY433837113NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY496572612NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
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
Expense376801929Expense
Grants41888769Grants
Revenue200134856Revenue
DescriptionBERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS PROVIDE A LARGE RANGE OF HOSPITAL SERVICES INCLUDING BUT NOT LIMITED TO: EMERGENCY DEPARTMENT, INPATIENT HOSPITAL FACILITIES, PROCEDURE CENTER, ORTHOPEDIC SERVICES, DIGESTIVE HEALTH CENTER, FAMILY LIFE CENTER, RADIOLOGY, UROLOGY AND PHYSICAL THERAPY. PATIENTS ARE AT THE CENTER OF EVERYTHING DONE AT BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense24728518Expense
Grants2749050Grants
Revenue129805356Revenue
DescriptionBERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS OFFER A WIDE RANGE OF CARDIOVASCULAR SERVICES IN THE REGION, USING A TEAM APPROACH TO ADDRESS THE TOTAL NEEDS OF THE CARDIOVASCULAR PATIENT. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM PROVIDES A COMPREHENSIVE RANGE OF CARDIAC SERVICES, INCLUDING BUT NOT LIMITED TO: VASCULAR AND CARDIAC SURGERY, HEART SCANS AND HEART CHECKS, CARDIAC REHABILITATION, VASCULAR ULTRASOUND, NUCLEAR STRESS TESTS, DUAL SOURCE CT SCANNER AND ANGIOPLASTY. IN 2006, MERCY HOSPITAL OPENED A NEW STATE-OF-THE-ART CARDIAC CATHETERIZATION LAB, ALLOWING PHYSICIANS TO PERFORM PROCEDURES SUCH AS HEART CATHETERIZATIONS, CORONARY INTERVENTIONS INCLUDING BALLOON ANGIOPLASTY AND STENTING, AS WELL AS IMPLANTATION OF PACEMAKERS AND DEFIBRILLATORS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense21828336Expense
Grants2426639Grants
Revenue10746956Revenue
DescriptionBERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS OFFER EXPECTANT MOMS THE MOST COMFORTABLE AND COMPREHENSIVE MATERNITY SERVICES AVAILABLE WITH SPACIOUS, HOME-LIKE SETTINGS AND FAMILY-FRIENDLY GUEST SLEEPING ACCOMMODATIONS. BOTH OF THE MATERNITY CENTER LOCATIONS ARE BACKED BY THE SUPPORT OF BOTH FULL-SERVICE HOSPITALS.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense19002671Expense
Grants2112512Grants
Revenue157091648Revenue
DescriptionBERGAN MERCY MEDICAL CENTER IS EQUIPPED WITH THE LATEST TECHNOLOGIES IN THE DIAGNOSTIC CENTER. THE CENTER IS COMPLETELY DIGITAL, SO PATIENTS ARE NEVER WAITING ON FILMS. FEMALE PATIENTS CAN COUNT ON EXPERT IMAGING TESTS INCLUDING ULTRASOUND, BONE DENSITY TESTING, STEREOTACTIC BREAST BIOPSY AND DIGITAL MAMMOGRAPHY. THERE ARE A WIDE RANGE OF AVAILABLE TESTS AT THE DIAGNOSTIC CENTER THAT INCLUDE THE FOLLOWING: DIGITAL MAMMOGRAPHY, MRI AND OPEN MRI, CT, PET CT AND CARDIAC CT, 64-SLICE CT, FLUOROSCOPY, PULMONARY FUNCTION TESTING, ULTRASOUND, CARDIOVASCULAR IMAGING, PHLEBOTOMY, NUCLEAR MEDICINE, DIGITAL IMAGING, EEG, EKG AND EMG, STRESS TESTING AND ARTERIOGRAM.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp19002671TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt2112512TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev157091648TotalOfOtherProgramServiceRev
Total Program Service Expense442361454TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest1ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
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 Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
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 Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With1096225NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees3557NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
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 Body1Form990ProvidedToGoverningBody
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 Venture1InvestmentInJointVenture
Written Policy Or Procedure0WrittenPolicyOrProcedure
States Where Copy Of Return Is FiledIAStatesWhereCopyOfReturnIsFiled
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
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (44 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
SR LILLIAN MURPHY RSM
DIRECTOR4.00X000
MICHAEL DEFREECE
VICE CHAIR6.00X000X
PAUL EDGETT III
DIRECTOR4.00X000
ERIC GURLEY
DIRECTOR4.00X000
H KEITH SCHMODE
DIRECTOR4.00X0185000
MARTIN MANCUSO MD
DIRECTOR4.00X0185000
RICHARD VIERK
DIRECTOR4.00X0265000
ANTOINETTE HARDY-WALLER RN
DIRECTOR4.00X0175000
GUILLERMO HUERTA MD
DIRECTOR4.00X000
LESLIE ANDERSEN
DIRECTOR4.00X000
ANTHONY HATCHER DO
SECRETARY/TREASURER6.00X043067731545X
JOHN HEWITT
CHAIR6.00X000X
RICHARD HACHTEN II
PRESIDENT & CEO29.00790318817392278627X
KENNETH LAWONN
SVP STRATEGY AND TECHNOLOGY29.00218025225496134712X
SCOTT WOOTEN
SVP/CFO29.00265835274944136617X
JOAN NEUHAUS
SVP-COO29.00230538238433324164X
RICHARD ROLSTON MD
AHC-PRESIDENT & CEO29.00000X
RICK MILLER MD
SVP-CHIEF QUALITY OFFICER29.005310754927388614X
JANE CARMODY
SVP-CHIEF NURSING OFFICER29.00127062131416376202X
LARRY BROWN MD
AHC-INTERIM CEO1.00038085151034X
MARTIN HICKEY MD
SVP/CEO CLINICS29.00356044368240205555X
MARIE KNEDLER
COO-MERCY HOSPITAL & BMMC29.00181596187818153276X
SHEREE KEELY
VP-BEHAVIORAL HEALTH SVC29.00881679118839094X
ELIZABETH LLEWELLYN
VP-MISSION INTEGRATION29.0010692111058543049X
PATRICIA MASEK
VP-MEDICAL AFFAIRS29.00910799419865673X
FRANK EMSICK
VP-CONSTRUCTION29.0010301010654047892X
PAUL EBMEIER
COO-AHC29.0016559017126252953X
NANCY WALLACE
VP-HUMAN RESOURCES29.00111246115056357417X
JOSEPH HOAGBIN MD
MEDICAL DIRECTOR60.00267360029289X
ENEH OKORUWA MD
PHYSICIAN60.00454287033561X
SRIRAMAMURTHY RAVIPATI MD
PHYSICIAN60.00394864037873X
UMAJYOTHI INDUKURI MD
PHYSICIAN60.00366457013012X
CHAKRAVARTHI PURETI MD
PHYSICIAN60.00403279012250X
ANTONIO SAQUETON JR MD
PHYSICIAN60.00368482029404X
WAYNE SENSOR
FORMER CEO1110213114824613511X
THEODORE SCHWAB
FORMER SVP/CIO1141501180601258X
FRED HOSLER MD
FORMER SVP/CMO3964154099977239X
MARGARET BREEN
FORMER SVP-HUMAN RESOURCES1347371393535445X
DAVID TEW
FORMER COO-BMMC88492915231338X
AMY PROTEXTER
FORMER SVP MARKETING & COMM1225591267589793X
ANN JONES
FORMER VP-ONCOLOGY SVC000X
PATRICIA NADLE
FORMER SVP/CNO1217081258784772X
MARK KESTNER MD
FORMER SVP-CMO2722312815587402X
MICHAEL ANDERSON
FORMER VP-BEHAVIORAL HS78843815440X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7582615TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs6402940TotalReportableCompFrmRltdOrgs
Total Other Compensation2892571TotalOtherCompensation
Number Individuals GT100 K85NumberIndividualsGT100K
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
CASSLING DIAGNOSTIC
13808 F STREETOMAHANE68137DIAGNOSTIC IMAGING SERVICES2703571
ARUP LABORATORIES
500 CHIPETA WAYSALT LAKE CITYUT84108LABORATORY RESEARCH1209423
DELTA CONSTRUCTION SERVICES INC
1105 S 24TH STREETOMAHANE68108CONSTRUCTION1112058
CAPITAL EXPRESS
3326 S 67TH STREETOMAHANE68106COURIER SERVICE797002
PROFESSIONAL ANESTHESIA SERVICES
7500 MERCY ROAD 424OMAHANE68124ANESTHESIA SERVICES770757
FieldValueIRS element (for citing)
Number Of Contractors GT100 K46NumberOfContractorsGT100K
Membership Dues111800MembershipDues
Fundraising Events55264FundraisingEvents
Related Organizations48210RelatedOrganizations
Government Grants5388122GovernmentGrants
All Other Contributions153224AllOtherContributions
Total Contributions5756620TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenueExclusionExclusionAmount
NET PATIENT SERV REV6215004856117994829514032660396
REIMBURSABLE AFFILIATE9000991482719414827194
PHARMACY44611075917392915093$4,676,646
FOOD SERVICE7223201638286196906$1,441,380
HEALTH EDUCATION PRGMS611710219219
FieldValueIRS element (for citing)
Total Program Service Revenue509669237TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column63463TotalRevenueColumn
Exclusion$63,463ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real3114094Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real1372538Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real1741556Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column1741556TotalRevenueColumn
Exclusion$1,741,556ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities14005430Securities
Other2853847Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other2904853Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities14005430Securities
Other-51006Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column13954424TotalRevenueColumn
Exclusion$13,954,424ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events46626GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events55264CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses58990FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column-12364TotalRevenueColumn
Exclusion-$12,364ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Gaming7950GrossIncomeGaming
Gaming Direct Expenses7776GamingDirectExpenses

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column174TotalRevenueColumn
Exclusion$174ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory596881GrossSalesOfInventory
Cost Of Goods Sold375617CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column221264TotalRevenueColumn
Exclusion$221,264ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountUnrelated Business RevenueUnrelatedBusinessRevenue
REIMBURSED SERVICES9000995641475$5,641,475
CHILD CARE6244101472384$1,472,384
MISC OPERATING REVENUE900003738881$259,307479574

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column48830TotalRevenueColumn
Unrelated Business Revenue48830UnrelatedBusinessRevenue
FieldValueIRS element (for citing)
Total Other Revenue7901570TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column539295944TotalRevenueColumn
Related Or Exempt Function Income497778816RelatedOrExemptFunctionIncome
Unrelated Business Revenue6300799UnrelatedBusinessRevenue
Exclusion$29,459,709ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total44141Total
Program Services44141ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total49132829Total
Program Services49132829ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total4039476Total
Program Services3029607ProgramServices
Management And General1009869ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total163174617Total
Program Services130098177ProgramServices
Management And General32751983ManagementAndGeneral
Fundraising324457Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total6978429Total
Program Services5479046ProgramServices
Management And General1499383ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total28079616Total
Program Services18719197ProgramServices
Management And General9266815ManagementAndGeneral
Fundraising93604Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total9228671Total
Program Services7663410ProgramServices
Management And General1559197ManagementAndGeneral
Fundraising6064Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total30390Total
Management And General30390ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total24689Total
Program Services24689ProgramServices

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6578094Total
Program Services3965430ProgramServices
Management And General2612664ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total38527Total
Program Services38527ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total87642582Total
Program Services85984510ProgramServices
Management And General1657751ManagementAndGeneral
Fundraising321Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total13230256Total
Program Services13230256ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total418685Total
Program Services181235ProgramServices
Management And General236329ManagementAndGeneral
Fundraising1121Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total77375Total
Program Services77375ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total6696835Total
Program Services6696835ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total38782970Total
Program Services28652183ProgramServices
Management And General10130787ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total155131Total
Program Services120004ProgramServices
Management And General35127ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PURCHASED SERVICES31116842177263491335032240171
BAD DEBTS2926791729267917
JOA SETTLEMENT1978500019785000
MANAGEMENT ALLOCATIONS1119698311196983
EQUITY NET LOSS IN ALEG82775188277518

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2999658Total
Program Services2970236ProgramServices
Management And General29422ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total516997231Total
Program Services442361454ProgramServices
Management And General74170039ManagementAndGeneral
Fundraising465738Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1044159BOY
EOY822390EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY20019456BOY
EOY50019633EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY50919748BOY
EOY48373165EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY2975000BOY
EOY2894000EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY9130447BOY
EOY9918036EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY111548BOY
EOY2830EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis577239927LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec283038458LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY296800596BOY
EOY294201469EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY192439888BOY
EOY232670177EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY16108779BOY
EOY50409000EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY32411279BOY
EOY0EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY621960900BOY
EOY689310700EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY13061612BOY
EOY9849102EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY526305BOY
EOY74131EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY171451063BOY
EOY176961161EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY3084807BOY
EOY5853694EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY188123787BOY
EOY192738088EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY428915113BOY
EOY491195612EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY3131000BOY
EOY3586000EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1791000BOY
EOY1791000EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY433837113BOY
EOY496572612EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY621960900BOY
EOY689310700EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses22298713ReconcilationRevenueExpenses
Reconcilation Other Changes40436786ReconcilationOtherChanges
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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures0PoliticalExpenditures
Volunteer Hours0VolunteerHours
Amt Of4955 Tax0AmtOf4955Tax
Amt Of4955 Tax On Managers0AmtOf4955TaxOnManagers
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations1GrantsOtherOrganizations
Grants Other Organizations$24,689GrantsOtherOrganizationsAmount
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities
Total Lobbying Expenditures IIB24689TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance3961188BeginningOfYearBalance
Contributions6001Contributions
Investment Earnings Or Losses464742InvestmentEarningsOrLosses
Grants Or Scholarships6642GrantsOrScholarships
Other Expenditures183950OtherExpenditures
End Of Year Balance4241339EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance3665977BeginningOfYearBalance
Contributions149013Contributions
Investment Earnings Or Losses298938InvestmentEarningsOrLosses
Grants Or Scholarships9996GrantsOrScholarships
Other Expenditures142744OtherExpenditures
End Of Year Balance3961188EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance2688014BeginningOfYearBalance
Contributions1800115Contributions
Investment Earnings Or Losses-448721InvestmentEarningsOrLosses
Grants Or Scholarships3875GrantsOrScholarships
Other Expenditures369556OtherExpenditures
End Of Year Balance3665977EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance0.33000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.67000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs1EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R1AreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis3341409OtherCostOrOtherBasis
Book Value3341409BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis253295896OtherCostOrOtherBasis
Depreciation101285190Depreciation
Book Value152010706BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis1800544OtherCostOrOtherBasis
Depreciation1081039Depreciation
Book Value719505BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis298119550OtherCostOrOtherBasis
Depreciation172412068Depreciation
Book Value125707482BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis20682528OtherCostOrOtherBasis
Depreciation8260161Depreciation
Book Value12422367BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings294201469TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (2 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENT IN HOSPICE OF SWIA250000C
INVESTMENT IN ALEGENT HEALTH50159000C
FieldValueIRS element (for citing)
Total Of Book Value Program Related50409000TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
PAYABLE UNDER DEFERRED COMP PLANS$56,587
3RD PARTY PAYER SETTLEMENT$3,673,356
INTERCOMPANY RECEIVABLE$2,123,751
FieldValueIRS element (for citing)
Total Of Amounts5853694TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM.
PART X, LINE 2 - ENTITIES OF THE ALEGENT HEALTH SYSTEM RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. SUCH TAX POSITIONS, WHICH ARE MORE THAN 50% LIKELY OF BEING REALIZED, ARE MEASURED AT THEIR HIGHEST VALUE. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGEMENT OCCURS. DURING 2011 AND 2010, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS.

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1CANDLE LIGHT BALLNameOfEvent1
Gross Receipts Event1101890GrossReceiptsEvent1
Charitable Contributions Event155264CharitableContributionsEvent1
Gross Revenue Event146626GrossRevenueEvent1
Cash Prizes Event16500CashPrizesEvent1
Non Cash Prizes Event119281NonCashPrizesEvent1
Food And Beverage Event131209FoodAndBeverageEvent1
Entertainment Event12000EntertainmentEvent1
Gross Receipts Total101890GrossReceiptsTotal
Charitable Contributions Total55264CharitableContributionsTotal
Gross Revenue Total Events46626GrossRevenueTotalEvents
Cash Prizes Total Events6500CashPrizesTotalEvents
Non Cash Prizes Total Events19281NonCashPrizesTotalEvents
Food And Beverage Total Events31209FoodAndBeverageTotalEvents
Entertainment Total Events2000EntertainmentTotalEvents
Direct Expense Summary Events58990DirectExpenseSummaryEvents
Net Income Summary-12364NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care0FPGReferenceFreeCare
FPG Reference Discounted Care0FPGReferenceDiscountedCare
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served15287PersonsServed
Total Community Benefit Expense16748872TotalCommunityBenefitExpense
Direct Offsetting Revenue1048583DirectOffsettingRevenue
Net Community Benefit Expense15700289NetCommunityBenefitExpense
Percent Of Total Expense0.03220PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served15287PersonsServed
Total Community Benefit Expense16748872TotalCommunityBenefitExpense
Direct Offsetting Revenue1048583DirectOffsettingRevenue
Net Community Benefit Expense15700289NetCommunityBenefitExpense
Percent Of Total Expense0.03220PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Persons Served6499PersonsServed
Total Community Benefit Expense424612TotalCommunityBenefitExpense
Direct Offsetting Revenue34196DirectOffsettingRevenue
Net Community Benefit Expense390416NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Persons Served140PersonsServed
Total Community Benefit Expense159884TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense159884NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense9151473TotalCommunityBenefitExpense
Direct Offsetting Revenue7526728DirectOffsettingRevenue
Net Community Benefit Expense1624745NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense588785TotalCommunityBenefitExpense
Direct Offsetting Revenue244231DirectOffsettingRevenue
Net Community Benefit Expense344554NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Persons Served956PersonsServed
Total Community Benefit Expense445707TotalCommunityBenefitExpense
Direct Offsetting Revenue162DirectOffsettingRevenue
Net Community Benefit Expense445545NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Persons Served7595PersonsServed
Total Community Benefit Expense10770461TotalCommunityBenefitExpense
Direct Offsetting Revenue7805317DirectOffsettingRevenue
Net Community Benefit Expense2965144NetCommunityBenefitExpense
Percent Of Total Expense0.00600PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served22882PersonsServed
Total Community Benefit Expense27519333TotalCommunityBenefitExpense
Direct Offsetting Revenue8853900DirectOffsettingRevenue
Net Community Benefit Expense18665433NetCommunityBenefitExpense
Percent Of Total Expense0.03820PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense4293TotalCommunityBuildingExpense
Net Community Building Expense4293NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Persons Served13PersonsServed
Total Community Building Expense505980TotalCommunityBuildingExpense
Net Community Building Expense505980NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense10776TotalCommunityBuildingExpense
Net Community Building Expense10776NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Persons Served13PersonsServed
Total Community Building Expense521049TotalCommunityBuildingExpense
Net Community Building Expense521049NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$8,347,210BadDebtExpenseAmount
Amount Attributable To2234045AmountAttributableTo
Amount Reimbursed By Medicare98079114AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare127814917CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-29735803MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities3NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (3 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24HoursEr OtherErOther
AH BERGAN MERCY MEDICAL CTR
17500 MERCY ROADOMAHANE68124XXX
AH MERCY HOSPITAL
2800 MERCY DRIVECOUNCIL BLUFFSIA51503XXX
AH LASTING HOPE RECOVERY CTR
3415 S 25TH AVENUEOMAHANE68131XXX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (3 entries)

Hospital Facility NumberHospitalFacilityNumberEligibility Criteria ExplainedEligibilityCriteriaExplainedUses FPG FreeUsesFPGFreeUses FPG DiscountedUsesFPGDiscountedExplains BasisExplainsBasisIncome LevelIncomeLevelAsset LevelAssetLevelUninsured DiscountUninsuredDiscountOther FactorsOtherFactorsExplains Application MethodExplainsApplicationMethodIncludes Publicity MeasuresIncludesPublicityMeasuresPosted On WebsitePostedOnWebsiteAttached To InvoicesAttachedToInvoicesPosted In Emergency RoomPostedInEmergencyRoomPosted In Admission OfficePostedInAdmissionOfficeProvided On AdmissionProvidedOnAdmissionAvailable On RequestAvailableOnRequestOther PublicityOtherPublicityActions On NonpaymentActionsOnNonpaymentPermit Report To Credit AgencyPermitReportToCreditAgencyPermit LawsuitPermitLawsuitCollection ActivitiesCollectionActivitiesReport To Credit AgencyReportToCreditAgencyLawsuitLawsuitNotify Upon AdmissionNotifyUponAdmissionNotify Before DischargeNotifyBeforeDischargeNotified All PatientsNotifiedAllPatientsDocumented DeterminationDocumentedDeterminationNondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicyAverage Negotiated RatesAverageNegotiatedRatesAmounts Generally BilledAmountsGenerallyBilledGross ChargesGrossCharges
ALEGENT HEALTH BERGAN MERCY MEDICAL CTR
11001XXXX11XXXXXXX1XX1XXXXXX1X00
ALEGENT HEALTH MERCY HOSPITAL
21001XXXX11XXXXXXX1XX1XXXXXX1X00
ALEGENT HEALTH LASTING HOPE RECOVERY CTR
31001XXXX11XXXXXXX1XX1XXXXXX1X00

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities3NumberOfOtherFacilities

Other Facilities OtherFacilities (3 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
ALEGENT HEALTH HOSPICE
7070 SPRING STREETOMAHANE68106LICENSED HOSPICE
ALEGENT HEALTH AT HOME
7070 SPRING STREETOMAHANE68106HOME HEALTH AGENCY
ALEGENT HEALTH HOSPICE
703 ROSARY DRIVECORNINGIA50041LICENSED HOSPICE

Form990 Schedule H Part VI Form990ScheduleHPartVI (20 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: BERGAN MERCY HEALTH SYSTEM IS PART OF THE ALEGENT HEALTH SYSTEM. THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM ARE BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT (HUD) VERY LOW INCOME GUIDELINES, WHICH ARE UPDATED YEARLY.ALL EFFORTS ARE MADE TO ESTABLISH WHETHER PATIENTS ARE ELIGIBLE FOR FINANCIAL ASSISTANCE PRIOR TO SERVICE IF POSSIBLE, OTHERWISE AS SOON AS POSSIBLE FOLLOWING SERVICE. REPRESENTATIVES OF THE ALEGENT HEALTH SYSTEM HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH ALEGENT HEALTH'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME.PART I, LINE 6A: THE ALEGENT HEALTH SYSTEM PRODUCES A PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY AND PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE, AND ON ITS PUBLIC WEBSITE AT WWW.ALEGENT.COM.
PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS 1 - 8 PROVIDED WITH THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE TOTAL COMMUNITY BENEFIT EXPENSE FOR CHARITY CARE.
PART I, LINE 7G: ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM PROVIDES SUBSIDIZED HEALTH TO THE BROADER COMMUNITY VIA A NEONATIVE INTENSIVE CARE UNIT, HOME HEALTH AND HOSPICE CARE, AND BEHAVIORAL HEALTH SERVICES.
PART I, L7 COL(F): BAD DEBT OF $29,267,917 INCLUDED IN THE FUNCTIONAL EXPENSE TOTAL PART IX, LINE 25 IS NOT INCLUDED IN THE TOTAL OPERATING EXPENSE USED TO CALCULATE THE TABLE 7 PERCENTAGES. THE DENOMINATOR USED TO CALCULATE THE COST TO CHARGE RATIO IS $487,729,314.
PART II: 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 COUNTIES SERVED, THE ALEGENT HEALTH SYSTEM PARTNERED WITH THE COMMUNITY AND MADE A MULTI-YEAR COMMITMENT TO IMPACT CHILDHOOD OBESITY THROUGH COMMUNITY BASED BEST PRACTICE INTERVENTIONS. THIS INITIATIVE HAS HAD A PRIMARY FOCUS OF IMPACT IN DOUGLAS COUNTY, BUT THE FUNDING TO UNDERWRITE HAS COME FROM THE FISCAL PERFORMANCE OF ALL ALEGENT HEALTH HOSPITALS. THE COMMUNITY COALITION KNOWN AS LIVE WELL OMAHA KIDS (LWOK) IS STAFFED AND FUNDED BY ALEGENT HEALTH. EXECUTIVE COMMITTEE, WHICH CONSISTS OF COMMUNITY LEADERS AND POLICY MAKERS, HAVE IMPLEMENTED AN ECOLOGICAL APPROACH THAT IMPROVES PROGRAMS, POLICIES AND PROMOTES PHYSICAL ACTIVITY AND HEALTHY EATING HABITS AT THE INDIVIDUAL AND ORGANIZATIONAL LEVELS. MORE THAN 200 VOLUNTEERS HAVE PARTICIPATED IN THE PLANNING AND IMPLEMENTATION OF LWOK INITIATIVES. A PORTION OF THIS INVESTMENT IN LWOK IS ALLOCATED TO THE ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM.
PART III, LINE 4: THE AUDITED FOOTNOTES FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATIONS WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS.BAD DEBT EXPENSE (AT COST) FOR ENTITIES OF ALEGENT HEALTH ARE DETERMINED BY USING THE COST TO CHARGE RATIO FROM MEDICARE COST REPORTS PER ENTITY AND MULTIPLYING THE RATIO BY THE ACTUAL BAD DEBT CHARGES PER ENTITY.TO DETERMINE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST)ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CAREPOLICY, REPRESENTATIVES OF THE ALEGENT HEALTH SYSTEM DETERMINE IF ANACCOUNT NEEDS TO BE MOVED FROM BAD DEBT TO CHARITY WHEN A PATIENT EITHERCOMES FORWARD AND COMPLETES A CHARITY APPLICATION, WHICH IS APPROVED OR IF IT IS DETERMINED THAT THE PATIENT HAS NO OTHER RESOURCES TO PAY THEACCOUNT BALANCE.
PART III, LINE 8: THE ALEGENT HEALTH SYSTEM DOES NOT CONSIDER MEDICARE SHORTFALLS TO BE COMMUNITY BENEFIT, PER THE RECOMMENDATION OF THE CATHOLIC HEALTH ASSOCIATION. THE MEDICARE CHARGES REPORTED ON LINE 5 AND 6 ARE FROM MEDICARE COST REPORTS WHICH USE A COST TO CHARGE RATIO.
PART III, LINE 9B: ALEGENT HEALTH'S SELF PAY BILLING AND BAD DEBT POLICY HAS A CLEARLY DELINEATED PROCESS FOR COLLECTION AGENCIES TO FOLLOW, INCLUDING EXPLICIT INSTRUCTIONS THAT ENSURE THE CHARITY CARE PATIENTS WHO HAVE BEEN IDENTIFIED DO NOT GO TO COLLECTIONS.
PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION.ALEGENT HEALTH BERGAN MERCY MEDICAL CTR
PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION.ALEGENT HEALTH MERCY HOSPITAL
PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION.ALEGENT HEALTH LASTING HOPE RECOVERY CTR
PART V, SECTION B, LINE 13G: INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENT.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 HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY TO PATIENTS.ALEGENT HEALTH BERGAN MERCY MEDICAL CTR
PART V, SECTION B, LINE 13G: INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENT.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 HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY TO PATIENTS.ALEGENT HEALTH MERCY HOSPITAL
PART V, SECTION B, LINE 13G: INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE AT WWW.ALEGENT.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 HEALTH SYSTEM ALSO DISSEMINATE INFORMATION ON THE FINANCIAL ASSISTANCE POLICY TO PATIENTS.ALEGENT HEALTH LASTING HOPE RECOVERY CTR
PART VI, LINE 2: THE ALEGENT HEALTH SYSTEM APPROACHES COMMUNITY NEEDS ASSESSMENT AS A CORPORATE ACTIVITY THAT DEVELOPS AND INTEGRATES COUNTY BASED HEALTH PROFILES FOR EACH OF THE COUNTIES WHERE THE LICENSED HOSPITALS ARE LOCATED. THE PROCESS TO DEVELOP THE ASSESSMENTS IS COLLABORATIVE IN NATURE AND INVOLVES HEALTH DEPARTMENTS, EXISTING HEALTH COALITIONS, COMMUNITY MEMBERS AND HOSPITAL LEADERSHIP, AS IS SUPPORTED BY THE ALEGENT HEALTH PLANNING AND COMMUNITY BENEFIT DEPARTMENT STAFF. THE ALEGENT HEALTH PLANNING DEPARTMENT CONDUCTS MARKET ASSESSMENTS THAT IDENTIFY THE OMAHA METROPOLITAN STATISTICAL AREA'S POPULATION AND DEMOGRAPHIC CHARACTERISTICS. ADDITIONALLY, IN COOPERATION WITH LOCAL HEALTH DEPARTMENTS AND COALITIONS, THE ALEGENT HEALTH COMMUNITY BENEFIT/HEALTHIER COMMUNITY DEPARTMENT CONDUCTS AN ANNUAL REVIEW OF THE DOCUMENTED COMMUNITY HEALTH NEEDS AND PLANS OF EACH OF THE COMMUNITIES IT SERVES. THIS ASSESSMENT PROCESS INVOLVES SUMMARIZING EXISTING DATA AND RESEARCH FROM LOCAL HEALTH DEPARTMENT REPORTS AND LOCAL COALITION REPORTS INTO A COMPREHENSIVE SUMMARY GRID INCORPORATING A MULTITUDE OF FACTORS INCLUDING- DEMOGRAPHICS, HEALTH STATUS METRICS, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY DATA, DOCUMENTED HEALTH ISSUES, QUALITATIVE INFORMATION FROM QUALITATIVE AND COMMUNITY BASED PROCESSES AND IDENTIFICATION OF ALEGENT HEALTH'S PARTICIPATION AND SPECIFIC STRATEGIC ACTION PLANS. THE PROFILES ARE INTEGRATED INTO THE GOVERNANCE AND PLANNING FOR ALEGENT HEALTH ON TWO LEVELS: I. REPORTING TO THE COMMITTEE OF THE BOARD OF DIRECTORS CHARGED WITH HEALTH PLANNING OVERSIGHTII. INTO THE ANNUAL STRATEGIC PLANNING PROCESSES OF ALEGENT HEALTH. PARTICULAR TO DOUGLAS COUNTY, WHICH BERGAN MERCY MEDICAL CENTER RESIDES, NEEDS ASSESSMENT AND REPORTING OF THOSE NEEDS IS LED BY LIVE WELL OMAHA, A MEMBERSHIP BASED COALITION. LIVE WELL OMAHA HAS BEEN IN EXISTENCE FOR 14 YEARS AND ALEGENT HEALTH WAS A FOUNDING MEMBER AND IS THE LARGEST FINANCIAL CONTRIBUTOR. THE ALEGENT HEALTH SYSTEM CONTINUES TO PROVIDE LEADERSHIP AND FUNDING FOR LIVE WELL OMAHA COALITION WHICH INCLUDES HEALTHCARE PROVIDERS, PUBLIC HEALTH, SERVICE PROVIDERS, INSURERS, BUSINESSES AND ACADEMIA WHO PARTICIPATE IN A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT CONSISTING OF PRIMARY AND SECONDARY DATA AND KEY INFORMANT INTERVIEWS. THE ASSESSMENT IS SHARED WITH THE PUBLIC THROUGH A REPORT CARD, AT AN ANNUAL COMMUNITY SUMMIT AND ON A COMMUNITY WEBSITE. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS USED BY THE COMMUNITY TO ASSESS HEALTH NEEDS AND IDENTIFY PARTNERSHIP OPPORTUNITIES FOR INTERVENTION.
PART VI, LINE 3: THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE; SIGNS ARE POSTED IN CLINICS AND HOSPITAL, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND HOSPITALS. ADDITIONALLY, INFORMATION ON THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICIES ARE LOCATED AT WWW.ALEGENT.COM.REPRESENTATIVES OF THE ALEGENT HEALTH SYSTEM HELP PATIENTS SEEK REIMBURSEMENT FROM LOCAL, STATE AND FEDERAL PROGRAMS AT NO CHARGE TO THE PATIENT. AFTER THESE EFFORTS AND RESOURCES HAVE BEEN EXHAUSTED, PATIENTS ARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCECONSISTENT WITH THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY.
PART VI, LINE 4: ALEGENT HEALTH (SYSTEM) SERVES THE OMAHA METROPOLITAN STATISTICAL AREA (MSA), WITH AN ESTIMATED POPULATION OF 865,350, RANKING 60TH OUT OF 366 MSAS IN TOTAL POPULATION. THE MSA CONSISTS OF 3 IOWA AND 5 NEBRASKA COUNTIES ON BOTH SIDES OF THE MISSOURI RIVER. MORE THAN 1.2 MILLION PEOPLE LIVE WITHIN A 60-MILE RADIUS OF OMAHA. CHARACTERIZED BY STEADY GROWTH, THE MSA GREW BY 12.8 PERCENT BETWEEN 2000 AND 2010; THE 2015 PROJECTED POPULATION IS MORE THAN 900,000, A 5.5 PERCENT INCREASE. MORE THAN 36 PERCENT OF THE POPULATION IS 24 YEARS OF AGE OR YOUNGER WITH A MEDIAN AGE OF 34.9 YEARS COMPARED TO A U.S. MEDIAN AGE OF 37.1. 50.5% OF THE POPULATION IS FEMALE. RACIAL MINORITIES COMPRISE ABOUT 18 PERCENT OF GREATER OMAHA'S POPULATION, INCLUDING AN AFRICAN-AMERICAN POPULACE OF 7.9 PERCENT AND APPROXIMATELY 9.0 PERCENT HISPANIC. IN 2010 GREATER OMAHA HAD OVER 360,000 HOUSING UNITS. THE MEDIAN HOUSEHOLD INCOME IS $56,271 WHICH SURPASSES THE NATIONAL AVERAGE OF $51,517, WITH A PER CAPITA INCOME OF $27,876. GREATER OMAHA IS A WELL-EDUCATED COMMUNITY. MORE THAN 91 PERCENT OF ADULTS, AGE 25 AND OLDER, ARE HIGH SCHOOL GRADUATES AND 32.7 PERCENT HAVE A BACHELOR'S DEGREE OR HIGHER.
PART VI, LINE 6: THE PRIMARY CARE PHYSICIAN CLINICS THAT ARE PART OF THE ALEGENT HEALTH SYSTEM PARTICIPATES IN MEDICAL STUDENT PRECEPTORSHIPS THAT ADVANCE THE HEALTHCARE PROVIDER EDUCATION PROCESS. THE ALEGENT HEALTH SYSTEM HAS OPEN MEDICAL STAFFS AND THE ALEGENT HEALTH SYSTEM IS ONE OF 3 HEALTH SYSTEMS THAT FUND THE OPERATIONS OF A COALITION THAT EXISTS TO PROVIDE ACCESS FOR THE PATIENTS OF 3 AREA FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS TO SPECIALTY PHYSICIAN SERVICES AND HOSPITAL BASED DIAGNOSTICS AND TREATMENT. THE ALEGENT HEALTH SYSTEM IS THE SOLE COMPREHENSIVE ACUTE MENTAL HEALTH PROVIDER IN THE OMAHA MSA AREA. THE ALEGENT HEALTH SYSTEM IS A JOINT VENTURE PARTNER IN A NOT-FOR-PROFIT HOSPICE INPATIENT HOSPITAL AND PROVIDES THE MANAGEMENT SUPPORT CONTRACT. THE ALEGENT HEALTH SYSTEM BUDGETS FOR AN EMERGENCY FUND AS A SUBSET OF OTHER COMMUNITY DONATIONS TO RESPOND TO CRISIS OR UNPLANNED FUNDING NEEDS OF A VITAL COMMUNITY SERVICE, WHICH WAS FIRST USED IN FY2010 WITH THE ECONOMIC DOWNTURN. THE ALEGENT HEALTH SYSTEM HAS A CURRENT COMMITMENT TO SET ASIDE UP TO 6% OF ITS EBIDA IN A GIVEN FISCAL YEAR FOR COLLABORATIVE INITIATIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED, WHICH IS THE CATALYST FUND. BOARD OF DIRECTORS - THE ALEGENT HEALTH SYSTEM IS GOVERNED BY A BOARD OF DIRECTORS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF OUR LOCAL COMMUNITY WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. EMERGENCY DEPARTMENT - ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM HOSPITALS HAVE FULL-TIME EMERGENCY DEPARTMENTS THAT ARE OPEN TO THE PUBLIC AND PROVIDE MEDICAL SCREENING EXAMINATIONS AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITY OF THE HOSPITALS REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE, AND/OR ABILITY TO PAY. THE HOSPITALS ARE IN COMPLIANCE WITH THE FEDERAL EMTALA REGULATIONS.IN ADDITION, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM, TOGETHER WITH UNRELATED HOSPITALS IN THE AREA, WORKS CLOSELY WITH LOCAL FIRE AND RESCUE DEPARTMENTS TO ENSURE THAT AMBULANCES TAKE PATIENTS TO THE APPROPRIATE HOSPITAL. THIS IS GENERALLY THE HOSPITAL THAT IS CLOSEST GEOGRAPHICALLY WITH EXCEPTIONS BASED ON PATIENT PREFERENCE, PATIENT'S PHYSICIAN PREFERENCE, AND CAPACITY OR THE AVAILABILITY OF SPECIALIZED FACILITIES OR PROGRAMS RELATED TO THE PATIENT'S CONDITION. FINALLY, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM MAINTAINS DETAILED PROCEDURES REGARDING WHEN AND UNDER WHAT CIRCUMSTANCES A PATIENT CAN BE TRANSFERRED. UNDER THIS POLICY, NO PATIENT WILL BE TRANSFERRED BASED ON RACE, CREED, RELIGION OR ABILITY TO PAY.MEDICAL STAFF - ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM MAINTAINS AN OPEN MEDICAL STAFF. ALL QUALIFIED MDS, DOS, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITALS. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM'S POLICY ON PHYSICIAN CREDENTIALING IS THAT NO INDIVIDUAL IS TO BE DENIED MEDICAL STAFF APPOINTMENT BASED ON SEX, RACE, CREED, COLOR OR NATIONAL ORIGIN. THE STANDARDS A PHYSICIAN MUST MEET FOR APPOINTMENT RELATE TO (1) EDUCATIONAL QUALIFICATIONS AND LICENSING; (2) PROFESSIONAL COMPETENCE, (3) CHARACTER, (4) ETHICAL STANDING, AND (5) ABILITY TO RELATE TO AND WORK WITH OTHERS. APPLICATIONS ARE REVIEWED AT SEVERAL LEVELS WITHIN THE ORGANIZATION. PHYSICIANS WHO HAVE BEEN GRANTED STAFF PRIVILEGES AUTOMATICALLY BECOME MEMBERS OF THE MEDICAL STAFF AT THE HOSPITAL(S) FOR WHICH PRIVILEGES HAVE BEEN GRANTED.
PART VI, LINE 7: THE SENIOR LEADERSHIP OF THE INDIVIDUAL HOSPITALS ARE ENGAGED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS THAT IS CONDUCTED FROM THE CORPORATE OFFICES OF THE ALEGENT HEALTH SYSTEM (SEE PART VI-2/COMMUNITY NEEDS ASSESSMENT). THE HOSPITALS ARE INVOLVED IN SHARED BUDGET DECISION MAKING TO MEET THE PRIORITIZED COMMUNITY HEALTH NEEDS IN COLLABORATION WITH COMMUNITY PARTNERS. THE CORPORATE FUNCTION IS FUNDED FROM THE OPERATIONS OF THE INDIVIDUAL HOSPITALS TO LEVERAGE EXPERTISE AND TIME THAT IS FOCUSED ON PROMOTING HEALTH VERSUS ADDRESSING ACUTE CARE NEEDS. THE INDIVIDUAL HOSPITALS BECOME MORE INVOLVED IN SPECIFIC STRATEGIC RESPONSES THROUGH THE SERVICES THEY PROVIDE AND THEIR PARTICIPATION IN THE COALITIONS ACROSS THE ALEGENT HEALTH SERVICE AREA.
THE ALEGENT HEALTH SYSTEM FILES REPORTS WITH THE NEBRASKA HOSPITAL ASSOCIATION (NEBRASKA) AND IOWA HOSPITAL ASSOCIATION (IOWA). ADDITIONALLY, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND ALEGENT HEALTH MERCY HOSPITAL, CORNING REPORT TO CATHOLIC HEALTH INITIATIVES, LOCATED IN COLORADO.PART VI, LINE 7:

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HARBOR HOUSEBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68154ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient364003095EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant17490AmountOfCashGrant
Purpose Of GrantGENERAL SUPPORTPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part III Form990ScheduleIPartIII (3 entries)

Type Of GrantTypeOfGrantNumber Of RecipientsNumberOfRecipientsAmount Of Cash GrantAmountOfCashGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
SCHOLARSHIPS2411788
MERCY FUND DISTRIBUTIONS4213801
CHARITY CARE1528749107240BOOKREDUCE OR WRITE OFF OF PATIENT SERVICES.

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. THE BERGAN MERCY AUXILIARY TEEN SCHOLARSHIP PROGRAM WAS SET UP IN 1986 BY BERGAN MERCY. THE PURPOSE OF THE SCHOLARSHIP PROGRAM IS TO PROVIDE COLLEGE SCHOLARSHIPS TO TEEN VOLUNTEERS WHO HAVE VOLUNTEERED THEIR SERVICES AT BERGAN MERCY MEDICAL CENTER. IN ORDER TO RECEIVE A SCHOLARSHIP IN THIS PROGRAM, THE APPLICANT MUST BE AN ACTIVE VOLUNTEER THROUGHOUT ALL THE YEARS THEY DO SERVICE, INCLUDING THEIR SENIOR YEAR. IF A STUDENT IS TO DROP OUT OF THE PROGRAM OR IS TO BE DISMISSED, THEY ARE NOT ELIGIBLE FOR THE SCHOLARSHIPS. MERCY FUND DISTRIBUTIONS ARE ESTABLISHED FOR THE DISBURSEMENT OF ALEGENT HEALTH BERGAN MERCY AUXILIARY MONIES FOR PATIENT ASSISTANCE THAT IS COMPLIANT WITH ALEGENT HEALTH POLICIES AND PROCEDURES, INTERNAL REVENUE SERVICE (IRS) REGULATIONS AND OTHER APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND REGULATIONS.
OTHER INFORMATION:PART IV:ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM RECOGNIZES THE RIGHT TO QUALITY HEALTHCARE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, OR ABILITY TO PAY. BUSINESS OFFICE STAFF HELP 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. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM OCCASIONALLY DISTRIBUTES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS. THESE DISTRIBUTIONS ARE MONITORED TO ENSURE THEY ARE BEING USED AS SPECIFIED BY THE ORGANIZATION.

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
ANTHONY HATCHER DO
040355000027127014700018657046403400
RICHARD HACHTEN II
32681933801512609813041833740134895913023313469573917643927942959730274415283816
KENNETH LAWONN
1397331445215207353857262192711859245612757759802528502929479600
SCOTT WOOTEN
1668511725686247764618365073775858963609839086939733388434532400
JOAN NEUHAUS
157396162787478224945925320261871593521648112397247939228740572300
RICK MILLER MD
511395289100196820361883541948073039314324450025287700
JANE CARMODY
3045131495948329808117791840184073190379966100031210132279500
LARRY BROWN MD
034264608758029447027733025249043383300
MARTIN HICKEY MD
1734031793436866371014113978117883907359384411084114624578634735466019962261
MARIE KNEDLER
1371981418982970030718146981520266279685509068937925694326574700
SHEREE KEELY
60192622551454715045134281388814364148575535572310806611176800
ELIZABETH LLEWELLYN
71188736271815718779175761817917810184203803393312853413293800
PATRICIA MASEK
65494677381533315858102521060225550264267081732512371012794900
FRANK EMSICK
742217676418049186681074011108141001458399681031012707813143300
PAUL EBMEIER
123546127778274512839114593150931627216830106721103719253419912900
NANCY WALLACE
8394386818138031427613500139621702721761066469669028798729785200
JOSEPH HOAGBIN MD
25586000011500022050093340298744000
ENEH OKORUWA MD
3696510312270534090148380205350489660000
SRIRAMAMURTHY RAVIPATI MD
364410000304540171500239450435959000
UMAJYOTHI INDUKURI MD
364843000161404900090910380448000
CHAKRAVARTHI PURETI MD
3829950002028401225009420416471000
ANTONIO SAQUETON JR MD
347571000209110126950177380398915000
WAYNE SENSOR
832860001109381114738600697272111117185115545711079561145913
THEODORE SCHWAB
000011415011806061864000114768118700114150118060
FRED HOSLER MD
12471291003951684087060036003723400015413720390471403848
MARGARET BREEN
000013473713935333434523432423137414142121134737139353
DAVID TEW
000088492915236586800089150922038849291523
AMY PROTEXTER
0000122559126758977101038373969127373131737122559126758
PATRICIA NADLE
29472304822456125403676756999300268727781243951286566267864826
MARK KESTNER MD
249525810026973627897739640932743385275901285352266251275372
MICHAEL ANDERSON
00007884381544000078843815447884381544

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. 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, LINES 4A-BTHE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS AS EXECUTIVES OF ALEGENT HEALTH (A RELATED ORGANIZATION) DURING THE 2010 CALENDAR YEAR AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE AS COMPENSATION ON SCHEDULE J: DAVID TEW - $180,015 THEODORE SCHWAB - $232,210 WAYNE SENSOR - $2,253,869 FRED HOSLER, MD - $794,319 MARGARET BREEN - $274,090 AMY PROTEXTER - $249,317 MARK KESTNER, MD - $541,623 MARTIN HICKEY, MD - $122,460 PATRICIA NADLE - $127,504 MICHAEL ANDERSON - $160,387 RICHARD HACHTEN - $558,231 PART I, LINE 4B: THE FOLLOWING REPORTABLE INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT HEALTH (A RELATED ORGANIZATION) DURING THE 2010 CALENDAR YEAR. AMOUNTS DEFERRED FROM THE PLAN WERE INCLUDED IN COLUMN C OF THE SCHEDULE J FOR THE FOLLOWING INDIVIDUALS: RICHARD HACHTEN II - $116,268 SCOTT WOOTEN - $48,613 JANE CARMODY - $3,877 NANCY WALLACE - $13,759 RICK MILLER, MD - $9,841 LARRY BROWN, MD - $12,411 KENNETH LAWONN - $39,892 JOAN NEUHAUS - $41,947 MARIE KNEDLER - $22,238 SHEREE KEELY - $10,915 ELIZABETH LLEWELLYN - $12,916 PATRICIA MASEK - $10,956 FRANK EMSICK - $11,534 PAUL EBMEIER - $20,451 MARTIN HICKEY, MD - $50,630.
PART I, LINE 5PHYSICIANS EMPLOYED BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM ARE ELIGIBLE FOR QUARTERLY PRODUCTIVITY BONUSES BASED ON INDIVIDUAL QUALITY MANAGEMENT, WHICH INCLUDE CORE MEASURES, REVENUE, PHYSICIAN REFFERAL AND ATTENDANCE AT MEETINGS. THE CORE MEASURES USED TO DETERMINE THE PHYSICIAN BONUSES ARE NATIONALLY ACCEPTED MEASURES OF PHYSICIAN PRODUCTIVITY.
PART I, LINE 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 MEASURES. 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 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. 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 L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonMICHAEL DEFREECE-BOARD MEMBERNamePerson
FieldValueIRS element (for citing)
RelationshipH-CARD,LLC - OFFICERRelationship
Amount Of Transaction159604AmountOfTransaction
Description Of TransactionSUPPLIER PAYMENT NETWORKDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
FORM 990, PART V, LINE 1C: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 HEATLH-BERGAN MERCY HEALTH SYSTEM. ALEGENT HEALTH FILES THE FORM 1099S AND COMPILES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY ALEGENT HEALTH ON BEHALF OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM ARE REPORTED TO THE IRS.
ANTOINETTE HARDY-WALLER AND PAUL EDGETT III - BUSINESS RELATIONSHIP.FORM 990, PART VI, SECTION A, LINE 2
THE SOLE MEMBER OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM IS CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES DOES NOT HAVE ANY VOTINGS RIGHTS AS A MEMBER OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. INSTEAD CATHOLIC HEALTH INITIATIVES ELECTS 50% OF THE DIRECTORS OF ALEGENT HEALTH.FORM 990, PART VI, SECTION A, LINE 6
THE BUSINESS AND AFFAIRS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM ARE MANAGED BY OR UNDER THE DIRECTION OF THE ALEGENT HEALTH BOARD OF DIRECTORS, AND ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM DELEGATES TO THE ALEGENT BOARD OF DIRECTORS, TO THE EXTENT PERMITTED BY LAW, COMPLETE GOVERNANCE AUTHORITY OVER IT, SUBJECT ONLY TO THE APPROVAL POWERS OF THE ALEGENT CORPORATE MEMBERS SET FORTH IN THE ARTICLES OF INCORPORATION AND BYLAWS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. DIRECTORS SHALL BE APPOINTED BY THE ALEGENT BOARD IMMEDIATELY FOLLOWING THE APPOINTMENT AND RATIFICATION BY ALEGENT CORPORATE MEMBERS OF THE ALEGENT DIRECTORS PURSUANT TO THE ARTICLES OF INCORPORATION AND BYLAWS OF ALEGENT. THE ALEGENT BOARD SHALL APPOINT DIRECTORS SUCH THAT, AT ALL TIMES , ALL OF THE PERSONS SERVING AS ALEGENT DIRECTORS ALSO SHALL BE SERVING AS DIRECTORS OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM.FORM 990, PART VI, SECTION A, LINE 7A
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 HEALTH SYSTEM (AS THAT TERM IS DEFINED IN THE AFA) (III) PREPAYMENT BY THE CORPORATION OF THE FULL AMOUNTS OUTSTANDING ON ITS NOTES TO CHI UNDER THE AFA, FOR PURPOSES OF EXERCISING THE RIGHTS OF TERMINATION OF THE AFA, OR FORMATION OF THE UNIFIED ALEGENT HEALTH SYSTEM CREDIT, AND THE TAKING OF ALL ACTIONS NECESSARY OR APPROPRIATE TO OBTAIN FUNDING OR OTHERWISE MAKE ARRANGEMENTS TO PREPAY SUCH NOTES INCLUDING WITHOUT LIMITATION INCURRENCE OF INDEBTEDNESS NECESSARY OR APPROPRIATE TO PREPAY THE NOTES OUTSTANDING.FORM 990, PART VI, SECTION A, LINE 7B
TAX RETURNS FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM ARE PREPARED BY THE SYSTEM TAX DEPARTMENT. FOLLOWING THE PREPARATION OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM FORM 990 BY INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE TAX DIRECTOR, EXTERNAL TAX ADVISOR AND THE CHIEF FINANCIAL OFFICER. THE FINAL TAX RETURN IS POSTED ON THE ELECTRONIC DIRECTOR'S PORTAL TO BE REVIEWED BY THE BOARD OF DIRECTORS AND PRESENTED AT THE FINANCE AND AUDIT COMMITTEE OF THE BOARD. THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR ARE PRESENT AT THE FINANCE AND AUDIT COMMITTEE MEETING TO ANSWER ANY QUESTIONS THE COMMITTEE MAY HAVE. ADDITIONALLY, THE BOARD OF DIRECTORS ARE REFERRED TO THE ALEGENT HEALTH TAX DIRECTOR IF THEY HAVE QUESTIONS AND THE BOARD IS NOTIFIED THAT THE FINAL FORM 990, WILL BE FILED ON MAY 15, 2012.FORM 990, PART VI, SECTION B, LINE 11
FORM 990, PART VI, SECTION B, LINE 12CWRITTEN CONFLICT OF INTEREST POLICY - ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF ALEGENT HEALTH, THE PARENT CORPORATION OF THE ALEGENT HEALTH SYSTEM. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY THE ALEGENT HEALTH COMPLIANCE OFFICER AND REPORTED TO THE CONFLICTS OF INTEREST COMMITTEE. THE CONFLICTS OF INTEREST COMMITTEE REVIEWS THE INVESTIGATION AND MAKES RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE MAKES THE FINAL DETERMINATION OF WHETHER OR NOT THERE IS A DISQUALIFYING EVENT AND COMMUNICATES IT TO THE BOARD OF DIRECTORS. AT ANY TIME A BOARD MEMBER OR KEY EMPLOYEE MAY DECLARE A CONFLICT OF INTEREST AND RECUSE HIS/HERSELF FROM THE DISCUSSION. THE INDIVIDUAL IS ALSO REQUIRED TO DISCLOSE ANY KNOWN OR POSSIBLE CONFLICTS OF INTEREST THAT ARISE DURING THE CALENDAR YEAR.
FORM 990, PART VI, SECTION B, LINE 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. THIS PROCESS WAS USED FOR THE FOLLOWING EMPLOYEES: PRESIDENT AND CHIEF EXECUTIVE OFFICER SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER CHIEF EXECUTIVE OFFICER ALEGENT HEALTH CLINIC SENIOR VICE PRESIDENT ALEGENT HEALTH SYSTEM CHIEF OPERATIONS OFFICER SENIOR VICE PRESIDENT STRATEGY AND TECHNOLOGY (F/K/A CIO) VICE PRESIDENT OPERATIONS (BERGAN MERCY & MERCY) VICE PRESIDENT OPERATIONS (IMMANUEL) VICE PRESIDENT OPERATIONS (LAKESIDE) VICE PRESIDENT OPERATIONS (MIDLANDS) MEDICAL DIRECTORS
FORM 990, PART VI, SECTION C, LINE 19THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.ALEGENT.COM. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM DOES NOT MAKE THE FINANCIAL STATEMENTS OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE ARTICLES OF INCORPORATION ARE AVAILABLE AT WWW.SOS.STATE.NE.US.
PART VII, SECTION A:EXECUTIVES OF THE ALEGENT HEALTH SYSTEM HOURS WORKED ARE SPLIT OUT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. THE FOLLOWING EMPLOYEES ARE EXECUTIVES OF THE ALEGENT HEALTH SYSTEM: RICHARD HACHTEN II, SCOTT WOOTEN, KENNETH LAWONN, JOAN NEUHAUS, RICHARD ROLSTON, MD, RICK MILLER, MD, JANE CARMODY, MARIE KNEDLER, SHEREE KEELY, ELIZABETH LLEWELLYN, PATRICIA MASEK, FRANK EMSICK, PAUL EBMEIER, MARTIN HICKEY, MD AND NANCY WALLACE. THEREFORE, THEIR AVERAGE NUMBER OF HOURS WORKED PER WEEK FOR THE AFFILAITE ORGANIZATIONS ARE 31. LARRY BROWN, MD IS ALSO AN EXECUTIVE OF THE ALEGENT HEALTH SYSTEM, HOWEVER HIS HOURS ARE SPLIT BETWEEN TWO AFFILIATED ORGANIZATIONS. AVERAGE HOURS PER WEEK FOR AFFILAITE ORGANIZATIONS IS 60. ANTHONY HATCHER, MD IS AN EMPLOYED PHYSICIAN OF THE ALEGENT HEALTH SYSTEM AND HIS HOURS ARE SPLIT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. AVERAGE HOURS PER WEEK FOR AFFILIATE ORGANIZATIONS ARE 54.
FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 19,624,748. PRIOR PERIOD ADJUSTMENTS: -3,257,775. OTHER MISCELLANEOUS CHANGES 172,813. CHANGES IN UNRESTRICTED ASSETS OF ALEGENT HEALTH 45,395,000. TRANSFERS TO AFFILIATED ENTITIES -39,359,000. JOA CAPITAL ADJUSTMENT 17,406,000. TEMP RESTRICTED CHANGES IN ALEGENT HEALTH 455,000. TOTAL TO FORM 990, PART XI, LINE 5: 40,436,786.CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART I, LINE 5 AND PART V, LINE 2A:THE EMPLOYEES LISTED IN PART I, LINE 5 AND PART V, LINE 2A ARE EMPLOYED BY ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM.
FORM 990, PART VI, SECTION B, LINE 16:ALEGENT HEALTH HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, ALEGENT HEALTH'S SYSTEM-WIDE JOINT VENTURE MODEL INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSE IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNER'S RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S LENGTH, WITH PRICES SET AT FAIR MARKET VALUE.
PART VII, SECTION A, SCHEDULE J, PART I, LINE 4A AND SCHEDULE J, PART IITHE AMENDMENT OF THE JUNE 30, 2011 FORM 990 IS DUE TO A CORRECTION OF SEVERANCE PAYMENTS TO MR. RICHARD HACHTEN II. ON APRIL 17, 2009, MR. HACHTEN WAS SEPARATED FROM EMPLOYMENT AS THE PRESIDENT FOR "GOOD REASON," AS DESCRIBED IN HIS EMPLOYMENT AGREEMENT WITH ALEGENT HEALTH. ON OCTOBER 19, 2009, MR. HACHTEN WAS REHIRED BY ALEGENT HEALTH AS THE CEO/PRESIDENT. AT THE TIME OF HIS SEPARATION, MR. HACHTEN WAS ENTITLED TO RECEIVE SEVERANCE PAY AND RETIREMENT BENEFITS. MR. HACHTEN'S 2010 TAXABLE INCOME SHOULD HAVE INCLUDED ADDITIONAL SEVERANCE PAY ACCORDING TO HIS EMPLOYMENT AGREEMENT WITH ALEGENT HEALTH, THEREFORE, HE WAS ISSUED AMENDED W-2C'S TO CORRECTLY REPORT TAXABLE INCOME. THE FORM 990 HAS BEEN AMENDED TO REFLECT THE COMPENSATION REPORTED ON THE FORM W-2C FOR MR. HACHTEN. THE AMENDMENT AFFECTS PAGES 7, 8, 61 AND 64 OF THIS FORM 990. PART VI, SECTION B, LINE 11: THE AMENDED FORM 990 HAS BEEN PROVIDED TO THE FINANCE COMMITTEE AND BOARD OF DIRECTORS THROUGH AN ELECTRONIC PORTAL FOR REVIEW PRIOR TO FILING. THE TAX DIRECTOR AND CHIEF FINANCIAL OFFICER WERE PRESENT AT THE COMMITTEE AND BOARD OF DIRECTOR'S MEETING TO ANSWER QUESTIONS ABOUT THE AMENDMENT.REASON FOR AMENDED FORM 990

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)

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ALEGENT HEALTH-IMMANUEL MEDICAL CENTER
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ALEGENT HEALTH
12809 WEST DODGE ROADOMAHANE68154470757164LICENSED HOSPITAL/ADIMINSTRATIVE SUPPORTNE501(C)(3)L30N/A
ALEGENT HEALTH CLINIC
12809 WEST DODGE ROADOMAHANE68154470765154CLINICAL SERVICESNE501(C)(3)L3ALEGENT HEALTH0
ALEGENT HEALTH FOUNDATION
12809 WEST DODGE ROADOMAHANE68154470648586SUPPORT OF ALEGENT HEALTH AND AFFILIATES EXEMPT ACTIVITIESNE501(C)(3)L7ALEGENT HEALTH0
ALEGENT HEALTH-MERCY HOSPITAL CORNING IA
603 ROSARY DRIVECORNINGIA50841420782518LICENSED HOSPITALIA501(C)(3)L3ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM1
MERCY HEALTH CARE FOUNDATION CORNING IA
603 ROSARY DRIVECORNINGIA50841421461064SUPPORT OF ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IA EXEMPT ACTIVITIESIA501(C)(3)L11 IALEGENT HEALTH-MERCY HOSPITAL CORNING IA0
ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE
104 WEST 17TH STREETSCHUYLERNE68661470399853LICENSED HOSPITALNE501(C)(3)L3ALEGENT HEALTH-IMMANUEL MEDICAL CENTER0
SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC
104 WEST 17TH STREETSCHUYLERNE68661363630014SUPPORT OF ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER EXEMPT ACTIVITIESNE501(C)(3)L11 IALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE0
ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MO VALLEY IA
631 NORTH 8TH STREETMISSOURI VALLEYIA51555420776568LICENSED HOSPITALIA501(C)(3)L3ALEGENT HEALTH-IMMANUEL MEDICAL CENTER0
COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION MISSOURI VALLEY IA
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 IA0
MERCY HOSPITAL FOUNDATION
800 MERCY DRIVECOUNCIL BLUFFSIA51503421178204SUPPORT OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEMIA501(C)(3)L11 IALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM1

Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
AVANTAS LLC
11128 JOHN GALT BLVD STE 400OMAHANE68137392045003STAFFING OF NURSESNEN/ARELATED-286204071301400$103,44610.95000
LAKESIDE AMBULATORY SURGICAL CENTER LLC
17030 LAKESIDE HILLS PLZ STE 206OMAHANE68130204267902AMBULATORY SURGICAL CENTERNEN/AN/A000.00000
LAKESIDE ENDOSCOPY CENTER LLC
17001 LAKESIDE HILLS PLAZA STE 201OMAHANE68130205544496ENDOSCOPY SERVICESNEN/AN/A000.00000
OMAHA AMBULATORY INVESTMENT COMPANY LLC
12809 WEST DODGE ROADOMAHANE68154061786989PARENT HOLDING COMPANY ASCNEN/AN/A000.00000
ALEGENT HEALTH NORTHWEST IMAGING CENTER LLC
3606 N 156TH STREET STE 104OMAHANE68154061786985DIAGNOSTIC TESTING FACILITYNEN/AN/A000.00000
PRAIRIE HEALTH VENTURES LLC
421 SOUTH 9TH STREET STE 102LINCOLNNE68508204962103PROFESSIONAL TECH SERVICESNEN/AN/A000.00000
BERGAN MERCY SURGERY CENTER LLC
7710 MERCY ROAD STE 100OMAHANE68124208671994AMBULATORY SURIGICAL CENTERNEN/AN/A000.00000
NEBRASKA SPINE LLC
6901 N 72ND STREET STE 20300OMAHANE68122270263191SPINE HOSPITALNEN/AN/A000.00000

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SERVICES INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line112809 WEST DODGE ROADAddressLine1
CityOMAHACity
StateNEState
ZIP Code68164ZIPCode
FieldValueIRS element (for citing)
EIN470802396EIN
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 Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
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 Orgs0RentalOfFacilitiesFrOtherOrgs
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

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1AVANTAS LLCBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeDTransactionType
Amount Involved2894000AmountInvolved
Method Of Amt DeterminationFAIR MARKET VALUEMethodOfAmtDetermination