ALEGENT HEALTH MERCY HOSPITAL: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- ALEGENT HEALTH MERCY HOSPITAL (EIN 42-0782518)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2013-06-26
- IRS object ID
- 201321779349301102
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-06-26T16:30:25-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEGENT CREIGHTON HEALTH | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420782518 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEGENT HEALTH-MERCY HOSPITAL CORNING IA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | ALEG | NameControl |
| Phone | 4023434323 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 368 | AddressLine1 |
| City | CORNING | City |
| State | IA | State |
| ZIP Code | 50841 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT M WOOTEN | Name |
| Title | SENIOR VP/CFO | Title |
| Phone | 4023434323 | Phone |
| Date Signed | 2013-06-26 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ANGELA LEA | Name |
| Phone | 4023434323 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | X | AmendedReturn |
| Name Of Principal Officer Person | SCOTT M WOOTEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19321709 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.ALEGENT.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1953 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 170 | TotalNbrEmployees |
| Total Nbr Volunteers | 23 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 658918 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 324315 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 18140286 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16198015 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1398 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1317 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 178999 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2337031 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 18979601 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18860678 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 472122 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 472036 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7661222 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7942235 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8763285 | OtherExpensePriorYear |
| Other Expenses Current Year | 9951477 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 16896629 | TotalExpensesPriorYear |
| Total Expenses Current Year | 18365748 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2082972 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 494930 | RevenuesLessExpensesCY |
| Total Assets BOY | 14162658 | TotalAssetsBOY |
| Total Assets EOY | 15016429 | TotalAssetsEOY |
| Total Liabilities BOY | 959603 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1318444 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 13203055 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 13697985 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 13147697 | Expense |
| Grants | 264297 | Grants |
| Revenue | 10320207 | Revenue |
| Description | ALEGENT HEALTH MERCY HOSPITAL, CORNING SUPPORTS THE MISSION BY CONTINUALLY MAKING SERVICES MORE CONVENIENT AND ACCESSIBLE WHILE MAINTAINING A LEVEL OF EFFICIENCY. THE HOSPITAL OFFERS THE FOLLOWING SERVICES TO PATIENTS: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, DIAGNOSTIC IMAGING SERVICES, CARDIOVASCULAR SERVICES, CHEMOTHERAPY AND ELECTROENCEPHALOGRAMS (EEGS) PHYSICAL THERAPY. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 852228 | Expense |
| Grants | 138525 | Grants |
| Revenue | 5408936 | Revenue |
| Description | ALEGENT HEALTH MERCY HOSPITAL, CORNING HAS STRIVED TO IMPROVE THE HEALTH STATUS OF CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS IN THIS RURAL COMMUNITY. MERCY HOSPITAL-CORNING IS PROUD TO OFFER HEALTHCARE SERVICES CLOSE TO HOME WITHIN THE COMMUNITY. ALEGENT HEALTH MERCY HOSPITAL, CORNING PROVIDES A VARIETY OF DIAGNOSTIC SERVICES TO THE COMMUNITY, SUCH AS CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3074117 | Expense |
| Grants | 69214 | Grants |
| Revenue | 2702544 | Revenue |
| Description | ALEGENT HEALTH MERCY HOSPITAL, CORNING PROVIDES SEVERAL SPECIALTY CLINICS EACH WEEK THROUGH VISITING SPECIALISTS IN THE FOLLOWING AREAS: AUDIOLOGY, EAR, NOSE AND THROAT, CARDIOVASCULAR SERVICES, DERMATOLOGY, GASTROENTEROLOGY, GENERAL SURGERY/WOUND CARE, GYNECOLOGY/OBSTETRICS, ONCOLOGY, OPTHALMOLOGY, ORTHOPEDIC SURGERY, PODIATRY, UROLOGY, SPEECH AND OCCUPATIONAL THERAPY AND PSYCHIATRY. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 17074042 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Info In Schedule O Part V | X | InfoInScheduleOPartV |
| Number Forms Transmitted With1096 | 34 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 170 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCOTT M WOOTEN SENIOR VPCFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4023434323 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 WEST DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68154 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| RICHARD HOGAN | |||||||
| PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| DOUG LEONARD | |||||||
| VICE-PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| KARL MCCARTY | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| JANE RYCHNOVSKY | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| LINDA SHEARER | |||||||
| SECRETARY | 2.00 | X | X | 0 | 0 | 0 | |
| RODNEY TRIPLETT | |||||||
| DIRECTOR/NETWORK EXEC | 2.00 | X | X | 0 | 136049 | 31108 | |
| MICHAEL GRUNDMAN | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| DENISE MCNITT | |||||||
| DIRECTOR | 2.00 | X | 0 | 132634 | 27505 | ||
| RANDY ALLMAN | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| D RANDALL PRITZA MD | |||||||
| DIRECTOR | 2.00 | X | 0 | 579930 | 33752 | ||
| TIM MAXA | |||||||
| DIRECTOR | 2.00 | X | 0 | 0 | 0 | ||
| SCOTT WOOTEN | |||||||
| AH SVP/CFO | 2.00 | X | 0 | 540779 | 136617 | ||
| DEBRA GOLDSMITH | |||||||
| EX-OFFICIO/ADMINISTRATOR | 60.00 | X | 107987 | 0 | 27388 | ||
| RICHARD HACHTEN II | |||||||
| AH PRESIDENT & CEO | 2.00 | X | 0 | 1607710 | 278627 | ||
| MAEN HADDADIN MD | |||||||
| PHYSICIAN | 60.00 | 529227 | 0 | 34423 | X | ||
| STEPHEN GRUBA MD | |||||||
| PHYSICIAN | 60.00 | 179287 | 0 | 18327 | X | ||
| BETHEL KOPP MD | |||||||
| PHYSICIAN | 60.00 | 350847 | 0 | 23866 | X | ||
| JOSEPH PICCOLO | |||||||
| PHYSICIAN | 60.00 | 177507 | 0 | 26905 | X | ||
| CAROLINE AMAO MD | |||||||
| PHYSICIAN | 60.00 | 175166 | 0 | 27418 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1520021 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2997102 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 665936 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| REHABVISIONS | |||||
| 11623 ARBOR ST | OMAHA | NE | 68144 | REHAB SERVICES | 268050 |
| DON SABO | |||||
| 713 CENTER STREET | STANTON | IA | 51573 | PHYSICIAN SERVICES | 229040 |
| SHARED MEDICAL SERVICES | |||||
| 209 LIMESTONE PASS | COLLEGE GROVE | WI | 53527 | DIAGNOSTIC IMAGING | 114185 |
| CASSLING | |||||
| 13808 F STREET | OMAHA | NE | 68137 | DIAGNOSTIC IMAGING | 102736 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Membership Dues | 708 | MembershipDues |
| Related Organizations | 284818 | RelatedOrganizations |
| Government Grants | 23417 | GovernmentGrants |
| All Other Contributions | 15372 | AllOtherContributions |
| Total Contributions | 324315 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SVC REVENU | 621500 | 16010374 | 16010374 |
| AFFILIATE REVENUE | 900099 | 155647 | 155647 |
| HEALTH PROMOTIONS | 611710 | 31994 | 31994 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16198015 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1317 | TotalRevenueColumn |
| Exclusion | $1,317 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1200 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 1030 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 170 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 170 | TotalRevenueColumn |
| Exclusion | $170 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 448430 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 448430 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 4325 | GrossIncomeFundraisingEvents |
| Fundraising Direct Expenses | 86 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4239 | TotalRevenueColumn |
| Exclusion | $4,239 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 13241 | GrossSalesOfInventory |
| Cost Of Goods Sold | 11485 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1756 | TotalRevenueColumn |
| Exclusion | $1,756 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| OTHER OPERATING REVENU | 900099 | 2223295 | 2223295 | |
| CAFETERIA | 722320 | 97194 | $97,194 | |
| REIMBURSED SERVICES | 900099 | 10377 | 10377 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2330866 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18860678 | TotalRevenueColumn |
| Related Or Exempt Function Income | 18431687 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $104,676 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 915 | Total |
| Program Services | 915 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 471121 | Total |
| Program Services | 471121 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169199 | Total |
| Management And General | 169199 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6361765 | Total |
| Program Services | 5852824 | ProgramServices |
| Management And General | 508941 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 276461 | Total |
| Program Services | 254344 | ProgramServices |
| Management And General | 22117 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 748503 | Total |
| Program Services | 688623 | ProgramServices |
| Management And General | 59880 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 386307 | Total |
| Program Services | 355402 | ProgramServices |
| Management And General | 30905 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2454 | Total |
| Program Services | 2454 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 350010 | Total |
| Program Services | 350010 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64052 | Total |
| Program Services | 58928 | ProgramServices |
| Management And General | 5124 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2728793 | Total |
| Program Services | 2510490 | ProgramServices |
| Management And General | 218303 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 396653 | Total |
| Program Services | 396653 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27135 | Total |
| Program Services | 24964 | ProgramServices |
| Management And General | 2171 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10029 | Total |
| Program Services | 9227 | ProgramServices |
| Management And General | 802 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15660 | Total |
| Program Services | 15660 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 908627 | Total |
| Program Services | 908627 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27084 | Total |
| Program Services | 24917 | ProgramServices |
| Management And General | 2167 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PURCHASED SERVICES | 3328476 | 3062198 | 266278 |
| BAD DEBTS | 2019758 | 2019758 | |
| MISCELLANEOUS | 32223 | 29645 | 2578 |
| MEMBERSHIP & DUES | 30601 | 28153 | 2448 |
| TAXES & LICENSES | 5605 | 5157 | 448 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4317 | Total |
| Program Services | 3972 | ProgramServices |
| Management And General | 345 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18365748 | Total |
| Program Services | 17074042 | ProgramServices |
| Management And General | 1291706 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 811559 | BOY |
| EOY | 969940 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1872 | BOY |
| EOY | 1846 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1951070 | BOY |
| EOY | 2069439 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 443843 | BOY |
| EOY | 381327 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17854150 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10564327 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7867424 | BOY |
| EOY | 7289823 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3086890 | BOY |
| EOY | 4304054 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14162658 | BOY |
| EOY | 15016429 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 252003 | BOY |
| EOY | 398680 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 355556 | BOY |
| EOY | 350953 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 352044 | BOY |
| EOY | 568811 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 959603 | BOY |
| EOY | 1318444 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13203055 | BOY |
| EOY | 13697985 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13203055 | BOY |
| EOY | 13697985 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14162658 | BOY |
| EOY | 15016429 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 494930 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Political Expenditures | 0 | PoliticalExpenditures |
| Volunteer Hours | 0 | VolunteerHours |
| Amt Of4955 Tax | 0 | AmtOf4955Tax |
| Amt Of4955 Tax On Managers | 0 | AmtOf4955TaxOnManagers |
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 1 | GrantsOtherOrganizations |
| Grants Other Organizations | $2,454 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 2454 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 20338 | BeginningOfYearBalance |
| Contributions | 27073 | Contributions |
| Investment Earnings Or Losses | -26565 | InvestmentEarningsOrLosses |
| End Of Year Balance | 20846 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 982 | BeginningOfYearBalance |
| Contributions | 19356 | Contributions |
| End Of Year Balance | 20338 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 3471 | BeginningOfYearBalance |
| Other Expenditures | 2489 | OtherExpenditures |
| End Of Year Balance | 982 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 1 | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | 1 | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7500 | OtherCostOrOtherBasis |
| Book Value | 7500 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6770533 | OtherCostOrOtherBasis |
| Depreciation | 2882546 | Depreciation |
| Book Value | 3887987 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10758956 | OtherCostOrOtherBasis |
| Depreciation | 7485175 | Depreciation |
| Book Value | 3273781 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 317161 | OtherCostOrOtherBasis |
| Depreciation | 196606 | Depreciation |
| Book Value | 120555 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7289823 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTERCOMPANY RECEIVABLE | Description |
| Book Value | 4304054 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4304054 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | AMOUNTS DUE TO 3RD PARTY PAYORS | Description |
| Amount | $568,811 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 568811 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF MERCY HEALTH CARE FOUNDATION AND ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA. |
| 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 H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 0 | FPGReferenceFreeCare |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 819 | PersonsServed |
| Total Community Benefit Expense | 262904 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 262904 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01610 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 819 | PersonsServed |
| Total Community Benefit Expense | 262904 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 262904 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01610 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 277 | PersonsServed |
| Total Community Benefit Expense | 32060 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1563 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 30497 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 11 | PersonsServed |
| Total Community Benefit Expense | 19691 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 19691 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 342676 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 221069 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 121607 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00740 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 26916 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11164 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15752 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 324 | PersonsServed |
| Total Community Benefit Expense | 20643 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 20636 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 612 | PersonsServed |
| Total Community Benefit Expense | 441986 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 233803 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 208183 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01280 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 1431 | PersonsServed |
| Total Community Benefit Expense | 704890 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 233803 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 471087 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02890 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 9000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 9000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1800 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1800 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 196 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 196 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 49650 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 49650 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00300 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 493 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 493 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 61139 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 61139 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,244,373 | BadDebtExpenseAmount |
| Amount Attributable To | 237 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7289950 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9631300 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2341350 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEGENT HEALTH MERCY HOSPITAL CORNING | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 603 ROSARY DRIVE | AddressLine1 |
| City | CORNING | City |
| State | IA | State |
| ZIP Code | 50841 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEGENT HEALTH MERCY HOSPITAL CORNING | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 0 | UsesFPGFree |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Uninsured Discount | X | UninsuredDiscount |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| AH CORNING RURAL HEALTH CLINIC | ||||
| 601 ROSARY DRIVE | CORNING | IA | 50841 | RURAL HEALTH CLINIC |
| AH BEDFORD RURAL HEALTH CLINIC | ||||
| 618 COURT AVE | BEDFORD | IA | 50833 | RURAL HEALTH CLINIC |
| AH LENOX RURAL HEALTH CLINIC | ||||
| 810 1/2 E VAN BUREN ST | LENOX | IA | 50851 | RURAL HEALTH CLINIC |
| AH MERCY HOSP SKILLED NURSING FACILITY | ||||
| 603 ROSARY DRIVE | CORNING | IA | 50841 | SKILLED NURSING FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 3C: ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA IS PART OF THE ALEGENT HEALTH SYSTEM. THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM WILL BE BASED ON A FINANCIAL ASSISTANCE SLIDING FEE SCHEDULE UTILIZING A DERIVATIVE OF THE CURRENT US DEPT 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 THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONAL FINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATION INCLUDES EMPLOYMENT VERIFICATION AND OBTAINING DOCUMENTATION OF THE APPLICANT'S FINANCIAL CONDITION SUCH AS FEDERAL TAX RETURN, PAY STUB, NET WORTH AND/OR LIQUID ASSETS AND REASONABLE HOUSEHOLD OR BUSINESS EXPENSES. FINANCIAL ASSISTANCE MAY STILL BE GRANTED IN CERTAIN CIRCUMSTANCES INVOLVING A CATASTROPHIC OCCURRENCE RESULTING IN MEDICAL BILLS GROSSLY EXCEEDING THE PATIENT'S ABILITY TO PAY, AND IN THESE SITUATIONS, THE PATIENT'S RESPONSIBILITY WILL BE LIMITED TO 20% OF THE FAMILY'S GROSS ANNUAL INCOME.PART I, LINE 6A: 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 WERE USED TO CALCULATE TOTAL COMMUNITY BENEFIT EXPENSE FOR CHARITY CARE. | ||
| PART I, LINE 7G: ALEGENT HEALTH-MERCY HOSPITAL PROVIDES SUBSIDIZED HEALTH TO THE BROADER COMMUNITY THROUGH RURAL COMMUNITY SUPPORT CLINICS, RURAL HEALTH CLINICS, EMERGENCY AND TRAUMA CARE. | ||
| PART I, L7 COL(F): BAD DEBT OF $2,019,758 INCLUDED IN THE FUNCTIONAL EXPENSE TOTAL PART IX, LINE 25 IS NOT INCLUDED IN THE TOTAL OPERATING EXPENSE USED TO CALCULATE THE TABLE 7 PERCENTAGES. | ||
| PART II: ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA LEADERSHIP PARTICIPATES IN COMMUNITY TOBACCO AND ECONOMIC DEVELOPMENT COALITIONS. THROUGH A CONTRACT WITH THE STATE, ALEGENT HEALTH MERCY HOSPITAL, CORNING AND FAMILY HOME CARE SERVE AS THE LOCAL HEALTH DEPARTMENT FOR COLFAX COUNTY, IOWA. THE HOSPITAL ALSO PROMOTES COMMUNITY BUILDING AND PHYSICAL ACTIVITY THROUGH ITS SUPPORT OF SCHOOL RECESS RESEARCH AND FUNDING OF ENHANCEMENTS TO THE LOCAL SWIMMING POOL. | ||
| PART III, LINE 4: THE AUDITED FOOTNOTES FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM DO NOT CONTAIN FOOTNOTES RELATED TO BAD DEBT EXPENSE. BAD DEBT EXPENSE IS IDENTIFIED ON THE CONSOLIDATED STATEMENT OF OPERATIONS WHICH IS CONSISTENT WITH THE REPORTING PRACTICE OF OTHER HEALTH CARE ORGANIZATIONS.BAD DEBT EXPENSE (AT COST) FOR ENTITIES OF ALEGENT HEALTH ARE DETERMINED BY USING THE COST TO CHARGE RATIO FROM MEDICARE COST REPORTS PER ENTITY AND MULTIPLYING THE RATIO BY THE ACTUAL BAD DEBT CHARGES PER ENTITY.TO DETERMINE THE AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE (AT COST) ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, REPRESENTATIVES OF THE ALEGENT HEALTH SYSTEM DETERMINE IF AN ACCOUNT NEEDS TO BE MOVED FROM BAD DEBT TO CHARITY WHEN A PATIENT EITHER COMES FORWARD AND COMPLETES A CHARITY APPLICATION, WHICH IS APPROVED OR IF IT IS DETERMINED THAT THE PATIENT HAS NO OTHER RESOURCES TO PAY THE ACCOUNT BALANCE. | ||
| PART III, LINE 8: 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: THE ALEGENT HEALTH SYSTEM'S SELF PAY BILLING AND BAD DEBT POLICY HAS A CLEARLY DELINEATED PROCESS FOR COLLECTION AGENCIES TO FOLLOW, INCLUDING EXPLICIT INSTRUCTIONS TO ADHERE TO THE SAME FINANCIAL ASSISTANCE GUIDELINES AS ALEGENT HEALTH, WHICH ENSURE THAT NO CHARITY CARE PATIENTS GO INTO COLLECTIONS. | ||
| PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION. | ALEGENT HEALTH MERCY HOSPITAL, CORNING | |
| 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, CORNING | |
| PART VI, LINE 2: THROUGH A CONTRACT WITH THE STATE, ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA SERVES AS THE LOCAL HEALTH DEPARTMENT FOR ADAMS AND TAYLOR COUNTY, IA AND LEADS THE COMMUNITY HEALTH NEEDS ASSESSMENT, COMMUNITY PLANNING AND IMPLEMENTATION EVERY 2 YEARS AS REQUIRED BY STATE LAW. THE ALEGENT HEALTH SYSTEM SUPPORTS THIS LOCAL PROCESS AS A CORPORATE ACTIVITY THAT DEVELOPS AND INTEGRATES COUNTY BASED HEALTH PROFILES FOR EACH OF THE COUNTIES WHERE ONE OF OUR LICENSED HOSPITALS ARE LOCATED. THE PROCESS TO DEVELOP THE ASSESSMENT 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 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 (BRFSS) 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 OVERSIGHT AND;II. INTO THE ANNUAL STRATEGIC PLANNING PROCESSES OF ALEGENT HEALTH. | ||
| 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 HOSPITALS, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT CLINICS AND HOSPITALS. INFORMATION ON THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICIES ARE LOCATED SEVERAL PLACES ON 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 ASSISTANCE CONSISTENT WITH THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. | ||
| PART VI, LINE 4: ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA SERVES ADAMS AND TAYLOR COUNTIES IN IOWA. CORNING IS LOCATED IN THE ROLLING HILLS OF SOUTHWEST IOWA. THE ADAMS COUNTY ESTIMATED POPULATION AS OF 2010 WAS 4,029, A DECREASE OF OVER 10 PERCENT FROM 2000 AND THE TAYLOR COUNTY ESTIMATED POPULATION AS OF 2010 WAS 6,317, A DECREASE OF 9.2 PERCENT FROM 2000. THERE ARE APPROXIMATELY 955 SQUARE MILES COMBINED. CENSUS ESTIMATES SHOW THAT ADAMS (98.1%) AND TAYLOR (96.1%) COUNTIES RACIAL AND ETHNIC MAKEUP IS PREDOMINANTLY WHITE. THE MEDIAN HOUSEHOLD INCOME IN ADAMS COUNTY IS $40,368, AND IN TAYLOR COUNTY IS $40,300 COMPARED TO $48,872 FOR THE STATE OF IOWA. IN ADAMS COUNTY, THE CORNING SCHOOLS PROVIDE FREE OR REDUCED LUNCH TO 53.6% OF THE STUDENTS AND THE PRESCOTT SCHOOLS TO 65.0% OF THEIR STUDENTS. THE NUMBER OF STUDENTS RECEIVING FREE OR REDUCED LUNCH IN TAYLOR COUNTY RANGES FROM 49.9% IN THE BEDFORD SCHOOL DISTRICT, 53.6% IN THE LENOX SCHOOL DISTRICT TO 78.6% IN THE CLEARFIELD SCHOOL DISTRICT. | ||
| PART VI, LINE 6: ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA FURTHER PROMOTES THE HEALTH OF ITS COMMUNITY THROUGH FINANCIAL AND IN-KIND DONATIONS.BOARD OF DIRECTORS - THE BOARD OF DIRECTORS MANAGES THE AFFAIRS OF ALEGENT HEALTH-MERCY HOSPITAL, CORNING. THE NUMBER OF DIRECTORS IS NOT LESS THAN FIVE AND NO MORE THAN FIFTEEN. ALEGENT HEALTH-MERCY HOSPITAL, CORNING'S BOARD OF DIRECTORS IS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF THE 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-MERCY HOSPITAL, CORNING HAS A FULL-TIME EMERGENCY DEPARTMENT THAT IS OPEN TO THE PUBLIC AND PROVIDES MEDICAL SCREENING EXAMINATIONS AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITY OF THE HOSPITAL REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE, AND/OR ABILITY TO PAY. THE HOSPITAL IS IN COMPLIANCE WITH THE FEDERAL EMTALA REGULATIONS.MEDICAL STAFF - THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. ALL QUALIFIED MDS, DOS, OTHER HEALTHCARE PRACTITIONERS, AND MID-LEVEL PRACTITIONERS ARE ELIGIBLE TO APPLY FOR PRIVILEGES AT THE HOSPITAL. ALEGENT HEALTH-MERCY HOSPITAL, CORNING'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. | ||
| 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 HOSPITAL IS 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|---|---|---|
| CHARITY CARE | 819 | 470521 | BOOK | REDUCE OR WRITE OFF OF PATIENT SERVICES. | |
| ROSE ANN AUXILIARY SCHOLARSHIPS | 3 | 600 |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IOWA 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. SCHEDULE I, PART I, LINE 2: THE ORGANIZATION MAKES GRANTS TO OTHER 501(C)(3) ORGANIZATIONS AND THE FUNDS ARE ONLY PROVIDED FOR CHARITABLE PURPOSES. |
| OTHER INFORMATION: | PART IV: | THE ROSE ANN AUXILIARY SCHOLARSHIP IS PROVIDED TO FUND THE SECOND SEMESTER OF STUDY TO ELIGIBLE HIGH SCHOOL SENIORS ENTERING THE HEALTH CARE FIELD. APPLYING STUDENTS MUST INDICATE A HEALTH CARE MAJOR AND COLLEGE OR INSTITUTION THEY PLAN TO ATTEND ACCOMPANIED BY A LETTER STATING REASONS WHY THEY SHOULD RECEIVE THE SCHOLARSHIP AND PERSONAL INFORMATION TO HELP THE SELECTION COMMITTE IN MAKING THEIR DECISION. AFTER THE SCHOLARSHIP IS GRANTED, STUDENTS MUST PROVIDE GRADES FOR THEIR FIRST SEMESTER AND PROOF OF ENROLLMENT FOR A SECOND SEMESTER. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RODNEY TRIPLETT | |||||||||||||
| 0 | 106049 | 0 | 15434 | 0 | 14566 | 0 | 10891 | 0 | 22721 | 0 | 169661 | 0 | 0 |
| DENISE MCNITT | |||||||||||||
| 0 | 107418 | 0 | 13483 | 0 | 11733 | 0 | 9660 | 0 | 18471 | 0 | 160765 | 0 | 0 |
| D RANDALL PRITZA MD | |||||||||||||
| 0 | 530528 | 0 | 35000 | 0 | 14402 | 0 | 13934 | 0 | 22799 | 0 | 616663 | 0 | 0 |
| SCOTT WOOTEN | |||||||||||||
| 0 | 339420 | 0 | 127094 | 0 | 74265 | 0 | 119946 | 0 | 18483 | 0 | 679208 | 0 | 0 |
| RICHARD HACHTEN II | |||||||||||||
| 0 | 664833 | 0 | 256516 | 0 | 686361 | 0 | 264929 | 0 | 15034 | 0 | 1887673 | 0 | 558231 |
| MAEN HADDADIN MD | |||||||||||||
| 466068 | 0 | 39123 | 0 | 24036 | 22428 | 14700 | 0 | 22428 | 0 | 566355 | 22428 | 0 | 0 |
| STEPHEN GRUBA MD | |||||||||||||
| 149593 | 0 | 18115 | 0 | 11579 | 0 | 13075 | 0 | 6041 | 0 | 198403 | 0 | 0 | 0 |
| BETHEL KOPP MD | |||||||||||||
| 306958 | 0 | 31269 | 0 | 12620 | 0 | 12993 | 0 | 12580 | 0 | 376420 | 0 | 0 | 0 |
| JOSEPH PICCOLO | |||||||||||||
| 158436 | 0 | 0 | 0 | 19071 | 0 | 10115 | 0 | 17797 | 0 | 205419 | 0 | 0 | 0 |
| CAROLINE AMAO MD | |||||||||||||
| 170255 | 0 | 0 | 0 | 4911 | 0 | 9852 | 0 | 20168 | 0 | 205186 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINES 4A-B | 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 COLUMN C OF THE SCHEDULE J: RICHARD HACHTEN II - $116,268 SCOTT WOOTEN - $48,613. | |
| PART I, LINE 5 | PHYSICIANS EMPLOYED BY ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA ARE COMPENSATED BASED ON THEIR INDIVIDUAL REVENUES LESS EXPENSES. ABSENT EXTENUATING CIRCUMSTANCES, THERE IS NO GUARANTEED BASE SALARY OR MINIMUM SALARY PAST THEIR INITIAL START-UP PERIOD. | |
| PART I, LINE 6 | COMPENSATION FOR MEMBERS OF MANAGEMENT OF ALEGENT HEALTH AND RELATED ENTITIES IS DETERMINED AT A SYSTEM LEVEL. MEMBERS OF MANAGEMENT INCLUDE RICHARD HACHTEN II, SCOTT WOOTEN, DEBRA GOLDSMITH, DENISE MCNITT AND RODNEY TRIPLETT. 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 NET FINANCIAL RESULTS OF THE ENTIRE ALEGENT HEALTH SYSTEM FOR THE FISCAL YEAR. | |
| PART III | 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. THE COMPENSATION COMMITTEE 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. ADDITIONALLY, COMPENSATION FOR NON EXECUTIVE LEVEL MANAGEMENT POSITIONS WITHIN THE ALEGENT HEALTH SYSTEM ARE DETERMINED BY THE ALEGENT HEALTH HUMAN RESOURCE DEPARTMENT. THE HUMAN RESOURCE DEPARTMENT COMPARES MANAGEMENT COMPENSATION LEVELS TO SIMILAR POSITIONS WITHIN THE GEOGRAPHICAL AREA IN ORDER TO DETERMINE REASONABLE COMPENSATION. SCHEDULE J, PART II: THE ALEGENT HEALTH EXECUTIVES HAVE A PROVISION IN THEIR COMPENSATION AGREEMENT THAT PROVIDES FOR POTENTIAL SEVERANCE PAYMENTS IN THE EVENT OF TERMINATION WITHOUT CAUSE OR CHANGE OF CONTROL. THE AMOUNT OF SEVERANCE AN EXECUTIVE MAY OR MAY NOT RECEIVE IF TERMINATED ACCORDING TO THE COMPENSATION AGREEMENT IS INCLUDED AS DEFERRED COMPENSATION IN COLUMN C. PART I, LINES 4A-B: THE FOLLOWING REPORTABLE INDIVIDUAL RECEIVED SEVERANCE PAYMENTS FROM 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: RICHARD HACHTEN II - $558,231 | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | LINDA SHEARER AND MICHAEL GRUNDMAN - BUSINESS RELATIONSHIP. RICHARD HOGAN AND MICHAEL GRUNDMAN - BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 6 | ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM IS THE SOLE MEMBER OF ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IOWA. | |
| FORM 990, PART VI, SECTION A, LINE 7A | ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM APPOINTS INDIVIDUALS TO SERVE ON THE BOARD OF DIRECTORS. THE BOARD, OR A NOMINATING COMMITTEE OF THE BOARD, PRESENT A SLATE OF NOMINEES AND THEIR CREDENTIALS TO THE MEMBER FOR APPROVAL. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM MAY REJECT ANY NOMINEE OR APPOINT INDIVIDUALS DIRECTLY TO THE BOARD OF DIRECTORS, OR REQUEST ADDITIONAL NOMINEES BY GIVING WRITTEN NOTICE OF SUCH ACTIONS TO THE CHAIRMAN OF THE BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE POWERS, DUTIES AND RIGHTS RESERVED TO ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM WILL BE, BUT ARE NOT LIMITED TO, THE FOLLOWING: A. TO AMEND, REVISE OR ALTER THE ARTICLES OF INCORPORATION OR THE BYLAWS; B. TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, MEMBERS OF THE BOARD OF DIRECTORS; C. TO APPROVE ANY MERGER OR CONSOLIDATION INTO OR WITH ANY OTHER CORPORATION, ORGANIZATION OR ASSOCIATION, AND TO APPROVE THE DISSOLUTION OR OTHERWISE WRAPPING UP OF THE AFFAIRS; D. TO APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL, OF THE ASSETS; E. TO APPROVE THE INCORPORATION OR DISSOLUTION OF AFFILIATED ENTITIES ORGANIZATIONS OR ASSOCIATIONS; AND F. TO RECEIVE THE ANNUAL REPORT OF THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IA IS PART OF THE ALEGENT HEALTH SYSTEM. TAX RETURNS FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM ARE PREPARED BY THE SYSTEM TAX DEPARTMENT. FOLLOWING THE PREPARATION OF ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IA FORM 990 BY ALEGENT HEALTH INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE ALEGENT HEALTH TAX DIRECTOR, EXTERNAL TAX ADVISOR AND THE CHIEF FINANCIAL OFFICER. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED A WEB LINK THAT DIRECTS THEM TO THE FINAL TAX RETURN AND ALL REQUIRED SCHEDULES. QUESTIONS ARE REFERRED TO THE ALEGENT HEALTH TAX DIRECTOR AND THE BOARD IS NOTIFIED OF THE DATE THE TAX RETURN WILL BE FILED. | |
| WRITTEN CONFLICT OF INTEREST POLICY - ALEGENT HEALTH MERCY HOSPITAL, CORNING, IOWA HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF ALEGENT HEALTH. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY THE ALEGENT HEALTH COMPLIANCE OFFICER AND REPORTED TO THE CONFLICTS OF INTEREST COMMITTEE. THE CONFLICTS OF INTEREST COMMITTEE REVIEWS THE INVESTIGATION AND MAKES RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE MAKES THE FINAL DETERMINATION OF WHETHER OR NOT THERE IS A DISQUALIFYING EVENT AND COMMUNICATES IT TO THE ALEGENT HEALTH MERCY HOSPITAL, CORNING, IOWA 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 12C | |
| THE GOVERNING BOARD OF ALEGENT HEALTH ENGAGED THE SERVICES OF AN INDEPENDENT CONSULTING FIRM THAT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT THAT IS QUALIFIED TO AND REGULARLY PERFORMS EXECUTIVE AND OFFICER COMPENSATION STUDIES. THE CONSULTING FIRM CONDUCTED A REVIEW AND ANALYSIS OF THE TOTAL COMPENSATION PAID TO THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, BASED ON COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS AND DETERMINED THAT THE COMPENSATION WAS REASONABLE. THE CONSULTING FIRM ISSUED AN OPINION LETTER AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PAID TO EMPLOYEES IDENTIFIED AS DISQUALIFIED PERSONS. THE OPINION LETTER SETTING FORTH THE FINDINGS WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS WERE MAINTAINED. THIS PROCESS WAS USED FOR THE SENIOR VICE PRESIDENT, CHEIF FINANCIAL OFFICER, PRESIDENT & CHEIF EXECUTIVE OFFICER. | FORM 990, PART VI, SECTION B, LINE 15 | |
| THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.ALEGENT.COM. ALEGENT HEALTH MEMORIAL HOSPITAL, CORNING, IOWA DOES NOT MAKE THE FINANCIAL STATEMENTS OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. HOWEVER, ARTICLES OF INCORPORATION ARE AVAILABLE AT WWW.SOS.STATE.IA.US. | FORM 990, PART VI, SECTION C, LINE 19 | |
| RICHARD HACHTEN II AND SCOTT WOOTEN ARE EXECUTIVES OF THE ALEGENT HEALTH SYSTEM AND AVERAGE HOURS PER WEEK FOR AFFILAITE ORGANIZATIONS IS 60. RODNEY TRIPLETT, DENISE MCNITT, AND D. RANDALL PRITZA ARE EMPLOYED BY AFFILIATED ORGANIZATIONS OF THE ALEGENT HEALTH SYSTEM AND THE AVERAGE HOURS PER WEEK FOR THOSE AFFILIATED ORGANIZATIONS ARE 60. | PART VII, SECTION A: | |
| REASON FOR AMENDED FORM 990: THE 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. ACCORDING TO INTERNAL REVENUE CODE SECTION 457(F), MR. HACHTEN'S 2010 TAXABLE INCOME SHOULD HAVE REFLECTED ADDITIONAL SEVERANCE OWED TO HIM ACCORDING TO HIS EMPLOYMENT AGREEMENT. THEREFORE, HE WAS ISSUED AN AMENDED W-2C TO CORRECTLY REPORT TAXABLE INCOME. ALEGENT HEALTH HAS AMENDED THE FORM 990 TO REFLECT THE COMPENSATION REPORTED ON THE FORM W-2C FOR MR. HACHTEN. THE AMENDMENT AFFECTS PAGES 7, 8, 47, AND 51 OF THIS FORM 990. | PART VII, SECTION A, SCHEDULE J, PART I, LINE 4A AND SCHEDULE J, PART II | |
| THE EMPLOYEES LISTED IN PART I, LINE 5 AND PART V, LINE 2A ARE EMPLOYED BY ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IA. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IA. | FORM 990, PART I, LINE 5 AND PART V, LINE 2A: | |
| PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT HEALTH SYSTEM ARE MADE BY ALEGENT HEALTH, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IOWA. 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-MERCY HOSPITAL, CORNING, IA ARE REPORTED TO THE IRS. | FORM 990, PART V, LINE 1C: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (11 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| ALEGENT HEALTH | |||||||||||
| 12809 WEST DODGE ROAD | OMAHA | NE | 68154 | 470757164 | LICENSED HOSPITAL/ADMINISTRATIVE SUPPORT | NE | 501(C)(3) | L3 | N/A | 0 | |
| ALEGENT HEALTH CLINIC | |||||||||||
| 12809 WEST DODGE ROAD | OMAHA | NE | 68154 | 470765154 | CLINICAL SERVICES | NE | 501(C)(3) | L3 | 0 | ALEGENT HEALTH | |
| ALEGENT HEALTH FOUNDATION | |||||||||||
| 12809 WEST DODGE ROAD | OMAHA | NE | 68154 | 470648586 | SUPPORT OF ALEGENT HEALTH AND AFFILIATES EXEMPT ACTIVITIES | NE | 501(C)(3) | L7 | 0 | ALEGENT HEALTH | |
| ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM | |||||||||||
| 7500 MERCY ROAD | OMAHA | NE | 68124 | 470484764 | LICENSED HOSPITAL | NE | 501(C)(3) | L3 | 0 | ALEGENT HEALTH | |
| ALEGENT HEALTH-IMMANUEL MEDICAL CENTER | |||||||||||
| 6901 N 72ND STREET | OMAHA | NE | 68122 | 470376615 | LICENSED HOSPITAL | NE | 501(C)(3) | L3 | 0 | ALEGENT HEALTH | |
| MERCY HEALTH CARE FOUNDATION | |||||||||||
| 603 ROSARY DRIVE | CORNING | IA | 50841 | 421461064 | SUPPORT OF ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA EXEMPT ACTIVITIES | IA | 501(C)(3) | L11 I | 1 | ALEGENT HEALTH-MERCY HOSPITAL CORNING IA | |
| AH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA | |||||||||||
| 631 NORTH 8TH STREET | MISSOURI VALLEY | IA | 51555 | 420776568 | LICENSED HOSPITAL | IA | 501(C)(3) | L3 | 0 | ALEGENT HEALTH-IMMANUEL MEDICAL CENTER | |
| COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION | |||||||||||
| 631 NORTH 8TH STREET | MISSOURI VALLEY | IA | 51555 | 421294399 | SUPPORT OF ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IA | IA | 501(C)(3) | L11 I | 0 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MO VALLEY IA | |
| ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER | |||||||||||
| 104 W 17TH STREET | SCHUYLER | NE | 68661 | 470399853 | LICENSED HOSPITAL | NE | 501(C)(3) | L3 | 0 | ALEGENT HEALTH-IMMANUEL MEDICAL CENTER | |
| SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC | |||||||||||
| 104 W 17TH STREET | SCHUYLER | NE | 68661 | 363630014 | SUPPORT OF ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER EXEMPT ACTIVITIES | NE | 501(C)(3) | L11 I | 0 | ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER | |
| MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS | |||||||||||
| 800 MERCY DRIVE | COUNCIL BLUFFS | IA | 51503 | 421178204 | SUPPORT OF ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM | IA | 501(C)(3) | L11 I | 0 | ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM | |
Form990 Schedule R Part III Form990ScheduleRPartIII (8 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| AVANTAS LLC | |||||||||||
| 11128 JOHN GALT BLVD STE 400 | OMAHA | NE | 68137 | 392045003 | STAFFING OF NURSES | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| LAKESIDE AMBULATORY SURGICAL CENTER LLC | |||||||||||
| 17030 LAKESIDE HILLS PLZ STE 206 | OMAHA | NE | 68130 | 204267902 | AMBULATORY SURGICAL CENTER | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| LAKESIDE ENDOSCOPY CENTER LLC | |||||||||||
| 17001 LAKESIDE HILLS PLZ STE 201 | OMAHA | NE | 68130 | 205544496 | ENDOSCOPY SERVICES | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| OMAHA AMBULATORY INVESTMENT COMPANY LLC | |||||||||||
| 12809 WEST DODGE ROAD | OMAHA | NE | 68154 | 061786989 | PARENT HOLDING COMPANY ASC | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| AH NORTHWEST IMAGING CENTER LLC | |||||||||||
| 3606 N 156TH STREET STE 104 | OMAHA | NE | 68154 | 061786985 | DIAGNOSTIC TESTING FACILITY | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| PRAIRIE HEALTH VENTURES LLC | |||||||||||
| 421 S 9TH STREET STE 102 | LINCOLN | NE | 68508 | 204962103 | PROFESSIONAL TECH SERVICES | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| BERGAN MERCY SURGERY CENTER LLC | |||||||||||
| 7710 MERCY ROAD STE 100 | OMAHA | NE | 68124 | 208671994 | AMBULATORY SURGICAL CENTER | NE | N/A | RELATED | 0 | 0 | 0.00000 |
| NEBRASKA SPINE LLC | |||||||||||
| 6901 N 72ND STREET STE 20300 | OMAHA | NE | 68122 | 270263191 | SPINE HOSPITAL | NE | N/A | RELATED | 0 | 0 | 0.00000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12809 W DODGE ROAD | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 68164 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470802396 | EIN |
| Primary Activity | MANAGED CARE SERVICES | PrimaryActivity |
| Legal Domicile State | NE | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 0 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HEALTH CARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 284818 | AmountInvolved |
| Method Of Amt Determination | BOOK VALUE | MethodOfAmtDetermination |