2013-05-14T08:12:06-05:00 2012-06-30 470757164 ALEGENT CREIGHTON HEALTH 12809 W DODGE ROAD OMAHA NE 68154 990 2011-07-01 470648586 ALEGENT HEALTH FOUNDATION MERCY HOSPITAL ALEG 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 SCOTT M WOOTEN 4023434323 2013-05-13 1 ANGELA LEA P01051055 4023434413 2011 2016-02-25 16:41:14Z ALEGENT HEALTH FOUNDATION SCOTT M WOOTEN 12809 WEST DODGE ROAD OMAHA NE 68154 3817954 0 X WWW.ALEGENTCREIGHTON.COM X 1982 NE SUPPORT THE HEALTHCARE MINISTRY OF ALEGENT HEALTH 8 8 10 71 0 0 1084639 1919032 822421 1035500 955112 697362 4692 15482 2866864 3667376 775941 378165 0 0 545223 604982 0 0 995154 292028 478478 1613192 1461625 1253672 2205751 15730371 15792860 2059562 345030 13670809 15447830 X FAITHFUL TO THE HEALING MINISTRY OF JESUS CHRIST, OUR MISSION IS TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. OUR COMMITMENT TO HEALING CALLS US TO:CREATE CARING AND COMPASSIONATE ENVIRONMENTS RESPECT THE DIGNITY OF EVERY PERSON CARE FOR THE RESOURCES ENTRUSTED TO US AS RESPONSIBLE STEWARDS COLLABORATE WITH OTHERS TO IMPROVE THE HEALTH OF OUR COMMUNITIES ATTEND ESPECIALLY TO THE NEEDS OF THOSE WHO ARE POOR AND DISADVANTAGED ACT WITH INTEGRITY IN ALL ENDEAVORS TO ACHIEVE THIS MISSION, WE PLEDGE TO BE CREATIVE, VISIONARY LEADERS COMMITTED TO HOLISTIC HEALTHCARE IN THE REGION. 0 0 322567 322567 963015 ALEGENT HEALTH FOUNDATION DISTRIBUTED $322,567 TO ALEGENT CREIGHTON HEALTH SERVICE LINES, LAKESIDE HOSPITAL AND MIDLANDS HOSPITAL DURING FISCAL YEAR 2012. THE FOUNDATION PROVIDED SUPPORT IN FOUR PRIMARY AREAS: (1) MISSION INTEGRATION PROGRAMS FOR HEALTHIER COMMUNITIES AND FAITH-BASED HEALTH EDUCATION PROGRAMS; (2) PROFESSIONAL DEVELOPMENT AND SCHOLARSHIPS; (3) GENERAL OPERATING SUPPORT; AND (4) BEHAVIORAL SERVICE PROGRAMS AND EQUIPMENT. 17759 17759 51775 ALEGENT HEALTH FOUNDATION DISTRIBUTED $17,759 TO BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL-COUNCIL BLUFFS IN FISCAL YEAR 2012. THE FOUNDATION PROVIDED SUPPORT IN THREE PRIMARY AREAS: (1) PROFESSIONAL DEVELOPMENT; (2) ORTHOPEDICS EQUIPMENT; AND (3) ONCOLOGY SERVICES PATIENT ASSISTANCE PROGRAMS. 9323 9323 20710 ALEGENT HEALTH FOUNDATION SUPPORTS THE HEALTHCARE MINISTRY OF ALEGENT CREIGHTON HEALTH SYSTEM. THE FOUNDATION DISTRIBUTED $9,323 TO IMMANUEL MEDICAL CENTER AND RELATED FACILITIES DURING FISCAL YEAR 2012. THE FOUNDATION PROVIDED SUPPORT IN THREE PRIMARY AREAS: (1) CAPITAL CONSTRUCTION AND RENOVATION PROJECTS; (2) GENERAL OPERATING SUPPORT; AND (3) REHABILITATION CENTER EQUIPMENT AND PROGRAMS. 28547 28516 0 IN ADDITION TO SUPPORTING ALEGENT CREIGHTON HEALHT, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM AND ALEGENT HEALTH-IMMANUEL MEDICAL CENTER ; ALEGENT HEALTH FOUNDATION ALSO GRANTS SCHOLARSHIPS TO QUALIFIED RECIPIENTS AND ACTIVELY ENCOURAGES, RECEIVES AND MANAGES INDIVIDUAL GIFTS, BEQUEST, MEMORIAL, PLANNED OR DEFERRED GIFTS AND CONTRIBUTIONS SUCH AS REAL ESTATE AND OTHER PROPERTY. 28547 28516 378196 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 0 1 X 5 0 1 10 1 0 0 0 0 0 1 1 0 0 0 0 X 8 8 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X SCOTT M WOOTEN SENIOR VPCFO 4023434323 12809 W DODGE ROAD OMAHA NE 68154 X JOANNE JARVIS 2.00 X X 0 0 0 DAN MCKINNEY MD 2.00 X 0 0 0 THOMAS BELFORD 2.00 X 0 0 0 THERESA BARRON-MCKEAGNEY PHD 2.00 X 0 0 0 MATHEW GRONSTAL 2.00 X 0 0 0 PATRICK TUCKER 2.00 X 0 0 0 BILL BEAVERS 2.00 X X 0 0 0 ALLEN DVORAK MD 2.00 X X 0 0 0 PAUL STRAWHECKER 60.00 X 0 80348 330709 RICHARD HACHTEN II 2.00 X 0 1726160 297951 SCOTT WOOTEN 2.00 X 0 707918 134300 0 2514426 762960 0 0 1 0 0 159991 282598 1476443 49385 1919032 ADMIN REIMBURSEMENT 900099 1035500 1035500 1035500 384735 384735 312627 0 312627 312627 312627 154990 159991 142824 12166 12166 11070 7754 3316 3316 3667376 1035500 0 712844 350215 350215 27950 27950 526655 21066 505589 37522 1501 36021 40805 1632 39173 31 31 48526 48526 75637 3025 72612 30884 30884 2961 2961 12808 12808 6398 6398 9564 9564 PURCHASED SERVICES 183608 183608 TAXES AND LICENSES 65041 65041 OTHER 43020 43020 1461625 378196 88275 995154 944352 780877 122871 77759 54676 45112 14731343 14966871 15730371 15792860 6934 5948 2052628 339082 2059562 345030 X 4961093 5709134 5128053 6157033 3581663 3581663 13670809 15447830 15730371 15792860 X 2205751 -428730 X 0 1 1 X 0 X 2687943 2801079 2085015 1084639 1372827 10031503 2687943 2801079 2085015 1084639 1372827 10031503 317039 9714464 188347 102384 264036 379184 384735 1318686 4692 35485 40177 11390366 6242499 0.85290 0.81050 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 1 31 0 0 0 31 0 8709716 1489425 90735 27950 523230 9738696 7799364 743105 945736 13283 765206 8709716 6884246 892471 606317 19993 563677 7799364 7744172 1259786 -901726 7750 1210236 6884246 0.37000 0.63000 0 0 26803 15860 10943 96068 61899 34169 45112 INTERCOMPANY LIABILITIES 339082 339082 3667376 1461625 2205751 -417922 -10808 -428730 1777021 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE HELD TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF ALEGENT CREIGHTON HEALTH, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM & ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. PART XI, LINE 8 - OTHER ADJUSTMENTS: TEMPORARY NET ASSETS RELEASED FROM RESTRICTIONS -10,808. PART X, LINE 2 - ALL RELATED ENTITIES HAVE BEEN RECOGNIZED AS NOT-FOR-PROFIT CORPORATIONS BY THE INTERNAL REVENUE SERVICE AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE, EXCEPT THE PARTNERSHIP SPECIFICALLY LISTED. ALEGENT RECOGNIZES 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 2012 AND 2011, MANAGEMENT DETERMINED THAT THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS. JEWELS OF AUTUMN 186440 104559 81881 0 46481 2834 15745 500 4837 EVENING WITH FRIENDS 67091 27442 39649 0 14341 0 13860 0 5116 1 61450 27990 33460 0 1766 6122 28551 0 2671 314981 159991 154990 62588 8956 58156 500 12624 142824 12166 1 AH-BERGAN MERCY HEALTH SYSTEM 7500 MERCY ROAD OMAHA NE 68124 470484764 501(C)(3) 17759 FURTHER EXEMPT PURPOSE AH-IMMANUEL MEDICAL CENTER 6901 NORTH 72ND STREET OMAHA NE 68122 470376615 501(C)(3) 9323 FURTHER EXEMPT PURPOSE ALEGENT CREIGHTON HEALTH 12809 WEST DOGDE ROAD OMAHA NE 68154 470757164 501(C)(3) 322567 FURTHER EXEMPT PURPOSE 3 0 SCHOLARSHIPS 31 27950 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: ALEGENT HEALTH FOUNDATION PROVIDES GRANTS TO ONLY RELATED 501(C)(3) ORGANIZATIONS WHICH SUPPORT THE SAME MISSION AND PURPOSE AS ALEGENT HEALTH FOUNDATION. SCHEDULE I, PART I, LINE 1: THE STEVEN L. CARPER MEMORIAL SCHOLARSHIP IS AWARDED TO STUDENTS WHO MEET THE ELIGIBILITY OF BEING ENROLLED STUDENTS OF THE IMMANUEL SCHOOL OF RESPIRATORY THERAPY CARE. A COMMITTEE WITHIN THE IMMANUEL SCHOOL OF RESPIRATORY THERAPY CARE SHALL SELECT RECIPIENTS OF THESE AWARDS. THE COMMITTEE CHOSEN MAY ESTABLISH REASONABLE CRITERIA FOR THE GRANT WITH ACADEMIC EXCELLENCE AS THE DETERMINING FACTOR. ELIGIBILITY FOR THE GLEN B. EICH EDUCATION FUND FOR RADIOLOGY CONTINUING EDUCATION IS LIMITED TO INDIVIDUALS EMPLOYED IN THE RADIOLOGY FIELD AT IMMANUEL MEDICAL CENTER. A COMMITTEE WITHIN THE IMMANUEL RADIOLOGY DEPARTMENT SHALL SELECT RECIPIENTS OF THESE SCHOLARSHIPS. THE COMMITTEE CHOSEN MAY ESTABLISH REASONABLE CRITERIA FOR THE GRANT FACTOR. HANS M. LINK HEALTHCARE EDUCATION SCHOLARSHIPS ARE FOR STUDENTS PURSUING AN EDUCATION IN HEALTHCARE FIELDS INCLUDING: NURSING, OCCUPATIONAL, PHYSICAL, RESPIRATORY OR RECREATIONAL THERAPY; MEDICAL RECORDS; RADIOLOGICAL TECHNOLOGY; MEDICAL TECHNOLOGY; NURSE PRACTITIONER OR PHYSICIAN'S ASSISTANT. RECIPIENTS MUST ATTEND AN ACCREDITED SCHOOL, BE CONSIDERED FULL TIME STUDENTS BY THE CRITERIA OF THEIR RESPECTIVE SCHOOLS, AND HAVE AN INTEREST AND DESIRE TO SERVE HEALTHCARE NEEDS. APPLICANTS MUST ALREADY BE ACCEPTED INTO THE SCHOOL OR HEALTH DEGREE PROGRAM TO BE ELIGIBLE. STUDENTS PURSUING DOCTORAL DEGREES ARE INELIGIBLE. APPLICANTS WILL BE SELECTED BASED ON SEVERAL CRITERIA INCLUDING BUT NOT LIMITED TO: FINANCIAL NEED, ACADEMIC PERFORMANCE, AND SUBMITTED LETTERS OF RECOMMENDATION. PREFERENCE WILL BE GIVEN TO APPLICANTS WHO ARE PERSONALLY AFFILIATED WITH IMMANUEL MEDICAL CENTER AND THE IMMANUEL HEALTH SYSTEMS OR WHO HAVE FAMILY MEMBERS WHOM ARE AFFILIATED. THE MARY HEUERMANN SCHOLARSHIP IS NOT AVAILABLE BY APPLICATION. THIS IS A DISCRETIONARY SCHOLARSHIP FOR APPLICANTS THAT MERIT, BUT DID NOT RECEIVE THE HANS M. LINK OR HEALTHCARE EDUCATION SCHOLARSHIP. A COMMITTEE OF IMMANUEL MEDICAL CENTER REPRESENTATIVES WILL AWARD SCHOLARSHIPS AT THEIR DISCRETION. PREFERENCE WILL BE GIVEN TO APPLICANTS WHO ARE PERSONALLY AFFILIATED WITH IMMANUEL MEDICAL CENTER AND THE IMMANUEL HEALTH SYSTEMS OR WHO HAVE FAMILY MEMBERS WHOM ARE AFFILIATED. BARBARA K. GOODRICH IMMANUEL AUXILIARY NURSING SCHOLARSHIP IS AVAILABLE TO IMMANUEL MEDICAL CENTER EMPLOYEES WHO ARE ENROLLED IN AN ACCREDITED EDUCATIONAL INSTITUTION ON A FULL-TIME BASIS, AS DETERMINED BY THE SCHOOL. THE APPLICANT MUST BE PURSUING A DEGREE IN A NURSING SPECIFIC PROGRAM AND MAINTAIN A GPA OF AT LEAST 3.2 ON A 4.0 SCALE. THIS SCHOLARSHIP IS A NON-NEED BASED, MERIT SCHOLARSHIP. THE FOLLOWING CRITERIA WILL BE USED TO SELECT RECIPIENTS OF THIS SCHOLARSHIP: COMMITMENT TO NURSING AND PROFESSIONAL DEVELOPMENT, DEMONSTRATION OF OUTSTANDING CHARACTER AND VALUES, VOLUNTEERISM AND COMMUNITY INVOLVEMENT, AND POTENTIAL TO CONTRIBUTE TO IMMANUEL MEDICAL CENTER, THE OMAHA COMMUNITY AND THE PROFESSIONAL PRACTICE OF NURSING. WILLIAM D. VANN AND FAMILY PHYSICAL & OCCUPATIONAL THERAPY AWARD IS AVAILABLE TO STUDENTS WHO ARE FULL-TIME, PART-TIME, OR ON-CALL EMPLOYEES OF ALEGENT HEALTH AND ANY UNDERGRADUATE STUDENTS WHO HAVE ACHIEVED JUNIOR STANDING OR HIGHER WITH A MINIMUM GRADE POINT AVERAGE OF 2.50 STUDYING ONE OF THE FOLLOWING HEALTHCARE FIELDS: OCCUPATIONAL, PHYSICAL, RESPIRATORY, OR RECREATIONAL THERAPY AT AN ACCREDITED EDUCATIONAL INSTITUTION IN OMAHA AND SURROUNDING AREAS, BE CONSIDERED FULL OR PART-TIME STUDENTS BY THE CRITERIA OF THEIR RESPECTIVE SCHOOL, AND HAVE AN INTEREST AND DESIRE TO SERVE HEALTH CARE NEEDS. APPLICANTS MUST ALREADY BE ACCEPTED INTO THE SCHOOL OR HEALTH DEGREE PROGRAM TO BE ELIGIBLE. STUDENTS PURSUING DOCTORAL DEGREES ARE INELIGIBLE. APPLICANTS WILL BE SELECTED BASED ON SEVERAL CRITERIA INCLUDING BUT NOT LIMITED TO: FINANCIAL NEED, ACADEMIC PERFORMANCE, AND LETTERS OF RECOMMENDATION SUBMITTED. PREFERENCE WILL BE GIVEN TO APPLICANTS WHO ARE PERSONALLY AFFILIATED WITH THE IMMANUEL MEDICAL CENTER AND THE IMMANUEL HEALTH SYSTEMS OR WHO HAVE FAMILY MEMBERS WHOM ARE AFFILIATED. LAKESIDE CHARITABLE COUNCIL AWARDS SCHOLARSHIPS ANNUALLY TO RECOGNIZE THE GIFT OF TIME GIVEN BY TEEN VOLUNTEERS. ANY HIGH SHCOOL SENIOR WHO HAS VOLUNTEERED A MINIMUM OF 100 HOURS IN THE PAST YEAR IS ELIGIBLE TO APPLY FOR A $250 SCHOLARSHIP. APPLICANTS MUST BE PERMANENT RESIDENTS OF NEBRASKA AND HIGH SCHOOL SENIORS ATTENDING OMAHA, MILLARD OR ELKHORN SCHOOL DISTRICT. APPLICANTS MUST CURRENTLY BE AN ACTIVE VOLUNTEER AT ALEGENT HEALTH LAKESIDE HOSPITAL. A MINIMUM OF SIX MONTHS SERVICE AS A VOLUNTEER AT ALEGENT HEALTH LAKESIDE HOSPITAL IS REQUIRED. APPLICANTS OF THE MERCY HOSPITAL PROFESSIONAL DEVELOPMENT AND MAGNET SCHOLARSHIP MUST BE CURRENTLY WORKING FOR ALEGENT HEALTH-MERCY HOSPITAL, COUNCIL BLUFFS FOR A MINIMUM OF A YEAR AND IN GOOD STANDING. ONLY STAFF NURSES AND NURSE LEADERS AT MERCY THAT HAVE A RECOMMENDATION FROM THEIR SUPERVISOR ARE ELIGIBLE FOR THE SCHOLARSHIP. APPLICANTS WILL BE SELECTED BASED ON SEVERAL CRITERIA INCLUDING, BUT NOT LIMITED TO: FINANCIAL NEED, ACADEMIC PERFORMANCE, AND LETTERS OF RECOMMENDATION SUBMITTED. APPLICANTS OF THE MIDLANDS HOSPITAL TEEN SCHOLARSHIP MUST BE IN THE HIGH SCHOOL GRADUATING CLASS OF 2012. STUDENTS MUST ALSO BE AN ACTIVE MIDLANDS HOSPITAL VOLUNTEER IN GOOD STANDING AT THE TIME OF THE APPLICATION. APPLICANTS WILL BE SELECTED BASED ON SEVERAL CRITERIA INCLUDING BUT NOT LIMITED TO: APPLICATION RESPONSES, ACADEMIC PERFORMANCE, AND LETTERS OF RECOMMENDATION. SELECTION WILL BE WEIGHTED BASED ON THE APPLICANTS CONTRIBUTIONS OF TIME AND TALENT TO ALEGENT HEALTH MIDLANDS HOSPITAL AND THE COMMUNITY. THE SISTER INGEBORD SCHOLARSHIP IS OFFERED TO ENCOURAGE AND PROVIDE OPPORTUNITIES FOR CONTINUING PROFESSIONAL EDUCATION AND DEVELOPMENT FOR ALEGENT HEALTH-IMMANUEL MEDICAL CENTER EMPLOYEES. ONLY ALEGENT HEALTH-IMMANUEL MEDICAL CENTER EMPLOYEES IN GOOD STANDING WITH SIX MONTHS OR MORE OF FULL TIME OR PART TIME SERVICE MAY APPLY FOR THE SCHOLARHSIP. FULL TIME EMPLOYEES MAY RECEIVE A MAXIMUM AWARD OF $500 AND PART TIME EMPLOYEES MAY RECEIVE A MAXIMUM AWARD OF $250. APPLICANTS MUST INCLUDE A LETTER OF REFERENCE COMPLETED BY A SUPERVISOR OR DEPARTMENT OPERATIONS DIRECTOR. 1 1 0 0 0 1 1 0 0 PAUL STRAWHECKER 0 73509 0 0 0 6839 0 329991 0 1317 0 411656 0 0 RICHARD HACHTEN II 0 689659 0 431112 0 605389 0 282350 0 17083 0 2025593 0 462847 SCOTT WOOTEN 0 364536 0 214452 0 128930 0 115000 0 21907 0 844825 0 48613 PART I, LINES 4A-B THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS AS EXECUTIVES OF ALEGENT CREIGHTON HEALTH DURING THE 2011 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 - $346,579 THE FOLLOWING REPORTABLE INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2011 CALENDAR YEAR. AMOUNTS DEFERRED FROM THE PLAN WERE INCLUDED IN COLUMN C OF THE SCHEDULE J: RICHARD HACHTEN II - $141,223 SCOTT WOOTEN - $58,678 PAUL STRAWHECKER - $4,227. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED A PAY OUT FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT CREIGHTON HEALTH (A RELATED ORGANIZATION) DURING THE 2011 CALENDAR YEAR. AMOUNTS PAID OUT WERE INCLUDED IN TAXABLE WAGES FOR THE INDIVIDUAL AND REPORTED IN COLUMN E OF THE SCHEDULE J: RICHARD HACHTEN II - $116,268 SCOTT WOOTEN - $48,613. PART I, LINE 6 COMPENSATION FOR MEMBERS OF MANAGEMENT OF ALEGENT CREIGHTON HEALTH AND RELATED ENTITIES IS DETERMINED AT A SYSTEM LEVEL. SCOTT WOOTEN, RICHARD HACHTEN II AND PAUL STRAWHECKER ARE MEMBERS OF ALEGENT CREIGHTON HEALTH MANAGEMENT AND ARE ELIGIBLE FOR AN ANNUAL INCENTIVE BONUS. INCENTIVE AWARDS ARE BASED ON FOUR INDIVIDUAL PERFORMANCE MEASURES WHICH ARE LINKED TO FOUR SYSTEM PERFORMANCE GOALS. FOR EACH MANAGER, 75% OF THE INCENTIVE AWARD WILL BE DETERMINED BY SYSTEM PERFORMANCE GOALS AND 25% DETERMINED BY INDIVIDUAL PERFORMANCE MEASURES. ONE OF THE FOUR SYSTEM PERFORMANCE GOALS IS DEPENDENT ON THE FINANCIAL RESULTS OF THE ENTIRE ALEGENT CREIGHTON HEALTH SYSTEM FOR THE FISCAL YEAR. SUPPLEMENTAL INFORMATION PART III ALEGENT CREIGHTON HEALTH GOVERNANCE OF EXECUTIVE COMPENSATION: ACTING AS PRUDENT STEWARDS OF ITS FINANCIAL RESOURCES, THE ALEGENT CREIGHTON HEALTH BOARD COMPENSATION COMMITTEE RECOMMENDS AND THE BOARD EXECUTIVE COMMITTEE APPROVES EXECUTIVE COMPENSATION PHILOSOPHY, POLICY AND GUIDELINES. IT DOES SO WITH THE OBJECTIVE OF ATTRACTING AND RETAINING TOP EXECUTIVE TALENT TO ENSURE ALEGENT CREIGHTON HEALTH IS ABLE TO FULFILL ITS FAITH-BASED MISSION AND ACHIEVE ITS VISION OF BECOMING WORLD-CLASS. THE ALEGENT CREIGHTON HEALTH COMPENSATION COMMITTEE FOLLOWS A THOROUGH AND INTENTIONAL PROCESS THAT INCLUDES CONSULTATION WITH INDEPENDENT, EXPERT COUNSEL AND CAREFULLY COMPARES COMPENSATION LEVELS TO MARKET-BASED COMPENSATION OF SIMILAR SIZED, NON-PROFIT AND FOR-PROFIT HEALTH SYSTEMS AND ALSO UTILIZES A BLEND OF NON-PROFIT AND GENERAL INDUSTRY DATA FOR EXECUTIVE ROLES WHERE THE RECRUITING MARKET IS ARGUABLY BROADER THAN THE NON-PROFIT SECTOR. TOTAL COMPENSATION INCLUDES BASE COMPENSATION, AND ALSO INCLUDES PERFORMANCE-BASED INCENTIVE COMPENSATION FOR ACHIEVING BOARD-SET GOALS FOR CLINICAL QUALITY, PATIENT SAFETY AND SATISFACTION, PHYSICIAN PERCEPTION, STRATEGIC AND FACILITY PLANNING AND FINANCIAL PERFORMANCE. IT MAY ALSO INCLUDE OTHER CASH PAYMENTS SUCH AS ONE-TIME RELOCATION COSTS, AND/OR CASH PAYMENTS FOR DEFERRED COMPENSATION. ADDITIONALLY, COMPENSATION FOR NON EXECUTIVE LEVEL MANAGEMENT POSITIONS WITHIN THE ALEGENT CREIGHTON HEALTH SYSTEM ARE DETERMINED BY THE ALEGENT CREIGHTON 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 CREIGHTON HEALTH EXECUTIVES HAVE A PROVISION IN THEIR COMPENSATION AGREEMENT THAT PROVIDES FOR POTENTIAL SEVERANCE PAYMENTS IN THE EVENT OF TERMINATION WITHOUT CAUSE OR CHANGE OF CONTROL. THE AMOUNT OF SEVERANCE AN EXECUTIVE MAY OR MAY NOT RECEIVE IF TERMINATED ACCORDING TO THE COMPENSATION AGREEMENT IS INCLUDED AS DEFERRED COMPENSATION IN COLUMN C. X 1.0+ CT. CUSHION DIAMOND 1 5500 FMV X JACKSON HOLE SKI PACKAGE 1 4000 FMV X RITZ CARLTON & AMERICAN EXPRESS GIFT CARDS 1 3500 FMV X ORLANDO VACATION, $500 GC, $500 TEETH WHITENING 1 3400 FMV X BILLBOARD FOR 30 DAYS AND PRODUCTION 1 3200 FMV X VACATION FOR 2-4 AT MARRIOTT CANYON VILLAS 1 2500 FMV X 2 BLEED POSTERS FOR 4 WEEKS 1 1500 FMV X 30 MINUTE HELICOPTER RIDE FOR 2 PEOPLE 1 1200 FMV X NONPAREIL ADVERTISING 1 1000 FMV X PAINTING "HAPPY DAYS" 1 750 FMV X LUXURY SUITE FOR 18 1 675 FMV X SILENT AUCTION ITEM DONATIONS-MISC 1 655 FMV X TEETH BLEACHING FOR TWO 1 600 FMV X APPLE IPAD 2 TABLET 1 600 FMV X INSPIRON DUO 1 600 FMV X 3 MONTH MEMBERSHIP 1 560 FMV X 3 MONTH MEMBERSHIP 1 560 FMV X FIRE STATION BIRTHDAY PARTY 1 545 FMV X JOHNSON LAKE CABIN WEEKEND TRIP 1 500 FMV X GIFT CERTIFICATES 1 500 FMV X FOLDOVER CALFSKIN CLUTCH PURSE 1 450 FMV X MISCELLANEOUS AUCTION ITEMS 1 420 FMV X FREE DESIGN CONSULTATION 1 400 FMV X COLLEGE WORLD SERIES TKTS (4) 1 400 FMV X (2) MEN'S BASKETBALL SEASON 1 380 FMV X NECKLACE & EARRINGS 1 375 FMV X PAINTING "BLUE PITCHER" 1 350 FMV X US OLYMPIC SWIM TRIALS BOX 1 350 FMV X HOODIES,SHIRTS JACKETS 1 310 FMV X SERVICE GUARD CERTIFICATE 1 300 FMV X PRIVATE TOUR FOR 20 1 300 FMV X (2) ONE NIGHT STAY W/FOOD 1 300 FMV X SHERATON DES MOINES-ONE NT 1 300 FMV X SHERATON DES MOINE-ONE NT 1 300 FMV X AUTO DETAIL 1 300 FMV X 4 ROUNDS OF GOLF W/CART 1 260 FMV X 2 GC $129 EACH 1 258 FMV X PERSONAL CHEF SERVICE 1 250 FMV X AUTOGRAPHED CUBS JERSEY 1 250 FMV X 1 YEAR SUPPLY OF DAIRY PROD 1 250 FMV X PAPIO BAY SEASON PASS 1 240 FMV X (2) 6 MONTH MEMBERSHIPS 1 240 FMV X 4 NE FOOTBALL TICKETS AND 1 PARKING PASS 1 239 FMV X ROUND OF GOLF FOR 4 1 220 FMV X ITEMS FOR CABIN FEVER GIFT BASKET 1 211 FMV X AKSARBEN RACE PHOTO 1 200 FMV X RUN FOR THE ROSES-RUNNING BASKET 1 200 FMV X (2) MEN'S SOCCER SEASON TKTS 1 200 FMV X CREAM COLORED NATIVITY AND PEWTER NATIVITY SETS 1 200 FMV X WINE GIFT BASKET AND GIFT CERTIFICATES 1 200 FMV X DONATED ITEMS FOR SILENT AUCTION 1 195 FMV X ONE NIGHT STAY CERTIFICATE 1 189 FMV X 18 HOLES OF GOLF W/CART FOR 4 PLAYERS 1 186 FMV X SONY CYBERSHOT DIGITAL CAMERA & BEST BUY GC 1 179 FMV X SNOCONE,POPCORN,COTTON CDY 1 175 FMV X FREE SESSION & 8X10 1 171 FMV X KENTUCKY DERBY BASKET 1 170 FMV X BASKETBALL AND FOOTBALL TICKETS 1 168 FMV X (2) WOMENS SOCCER SEASON TKTS 1 160 FMV X (4) WEEKLY GROUNDS PASSES 1 160 FMV X 2 TICKET TO THIS IS OPERA 1 158 FMV X DAISY, DAISY, LADY BUG WATERCOLOR, GOLD FRAME 1 150 FMV X BIRTHDAY PARTY FOR 10 1 150 FMV X HEART HEALTHY 1 150 FMV X VISIT FROM SANTA 1 150 FMV X MARGARITA FIESTA PARTY 1 150 FMV X 2 TICKETS SESSION 17 1 137 FMV X HAND CRAFTED CEDAR CHEST 1 135 FMV X 4 CU MEN'S B-BALL TICKETS 1 135 FMV X GARDEN TREASURES 1 130 FMV X $130 GIFT CERTIFICATE 1 130 FMV X ONE NIGHT STAY CERTIFICATE 1 130 FMV X ONE NIGHT STAY CERTIFICATE 1 129 FMV X ONE NIGHT STAY CERTIFICATE 1 125 FMV X GIFT BASKET FACIAL PRODUCTS 1 125 FMV X 14 PC. WURSTHUT KNIFE SET 1 125 FMV X 2 OPERA TICKETS 1 120 FMV X WINE & WOMEN FASHION PARTY 1 120 FMV X POKER & MARTINI PARTY 1 120 FMV X HUSKER FOOTBALL TICKETS 1 112 FMV X GIFT BASKET 1 110 FMV X MULHALLS GIFT CARD 1 100 FMV X 4 FREE OIL CHANGES 1 100 FMV X FRAMED PHOTOGRAPH-FARM 1 100 FMV X LADIES PERSONAL CARE 1 100 FMV X HENRY DOORLY ZOO GIFT CARD 1 100 FMV X LEGENDS RIVALRY PHOTO 1 100 FMV X 12 VISIT CARD TO LAKESIDE WELLNESS CENTER 1 100 FMV X 2 $50 GIFT CERTIFICATES 1 100 FMV X FOUR $25 GIFT CERTIFICATES & CREIGHTON BASKETBALL 1 100 FMV X PEARL & CRYSTAL CROSS NECKLACE 1 95 FMV X 4 ROUNDS GOLF & 2 PAPIO PARK WRISTBANDS 1 92 FMV X HOME PARTY BASKET 1 90 FMV X 2 TICKETS TO "DRACULA" PRESENTATION 1 90 FMV X 5 BOOKS (W/BOOK STAND & OTHER THINGS) 1 88 FMV X FLORAL ARRNAGEMENT 1 85 FMV X HOMEMADE AFGHAN BLANKET 1 75 FMV X ANN NYE MINI-HEART W/STAND 1 75 FMV X FRAMED PHOTOGRAPH-CHERRIES 1 75 FMV X TRIPLE CROWN DRINK KIT 1 75 FMV X 4 STORM CHASER TKTS W/PARKING 1 75 FMV X GIFT CARD & PASTRY & NOBBIES GIFT CARD 1 75 FMV X FALL WREATH 1 75 FMV X OUTDOOR BIRDFEEDER AND BIRD SEED 1 70 FMV X MASSAGE ENVY GIFT CARD 1 70 FMV X GIFT CARD/T-SHIRT 1 69 FMV X ONE HOUR MASSAGE & MULHALLS 1 65 FMV X WHOLE SMOKED SALMON 1 65 FMV X RED CUT GLASS SHAKER & MARTINI GLASSES 1 62 FMV X GIFTS & THINGS COFFEE BASKET 1 60 FMV X PEGGY KARR "AKSARBEN" PLATE 1 60 FMV X NOBBIES GIFT CARD, BOOKS 1 60 FMV X CHILD'S FIRE ENGINE AND HEROS 1 55 FMV X 4 ADMISSION TICKETS TO ZOO 1 54 FMV X (4) OMAHA ZOO PASSES 1 54 FMV X BORSHIEMS HEART PAPERWT 1 50 FMV X VARIETY GIFT BASKET 1 50 FMV X WIRE HORSE/HORSE PRINT 1 50 FMV X WINE STOPPER & WINE 1 50 FMV X BISTRO BASKET 1 50 FMV X JEWELRY TRAYS, NECKLACE 1 50 FMV X HOMERUN DERBY PORCH TICKETS, WALMART GC, ZOO GC 1 50 FMV X FLEMINGS GIFT CARD 1 50 FMV X FLEMINGS GIFT CARD 1 50 FMV X GIFT BASKET 1 50 FMV X GIFT BASKET 1 50 FMV X OMAHA BEEF TKTS (8) 1 50 FMV X $45 GIFT CERTIFICATE 1 45 FMV X SPA PEDICURE CERTIFICATE 1 45 FMV X THERMAL TOTE 1 42 FMV X PORTFOLIO/GAS GIFT CARD & OIL CHANGES 1 40 FMV X $40 GIFT CERTIFICATE (W/DOME CAKE SET) 1 40 FMV X 6 ONE FREE COMBO MEAL CARDS 1 30 FMV X $25 GIFT CERTIFICATE 1 25 FMV X LUSH GREEN PLANT 1 25 FMV X $25 GIFT CARD 1 25 FMV X $25 GIFT CERTIFICATE 1 25 FMV X $25 GIFT CERTIFICATE 1 25 FMV X $25 GIFT CERTIFICATE 1 25 FMV X ICE CREAM CAKE 8" & SNO CONES, ETC. 1 22 FMV X (2) ACTIVITY WRISTBANDS 1 20 FMV X SOARING WINGS WINE (2) 1 20 FMV X $20 GIFT CERTIFICATE & HAMPTON 1 20 FMV X $20 GIFT CERTIFICATE & HAMPTON 1 20 FMV X $20 GIFT CERTIFICATE & KATINAS 1 20 FMV X DILLY BAR GIFT CERTIFICATE & 4 ZOO PASS 1 10 FMV X $10 GIFT CERTIFICATE 1 10 FMV 0 0 1 0 FORM 990, PART VI, SECTION A, LINE 6 ALEGENT HEALTH FOUNDATION HAS ONE MEMBER, ALEGENT CREIGHTON HEALTH. FORM 990, PART VI, SECTION A, LINE 7A ALEGENT CREIGHTON HEALTH MAY DESIGNATE ITS BOARD CHAIR AND/OR ITS CHIEF EXECUTIVE OFFICER, OR HIS/HER DESIGNEE, TO SERVE EX OFFICIO WITHOUT VOTE, AS SPONSORSHIP ADVISOR TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B IN ADDITION TO ALL THE RIGHTS AND POWERS GRANTED BY LAW WITH RESPECT TO THE GOVERNANCE OF THIS CORPORATION, THE MEMBER SHALL HAVE THE RIGHT TO: A. INITIATE AND APPROVE ANY AMENDMENTS TO THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION. B. INITIATE AND APPROVE JOINT VENTURES IN WHICH CORPORATION PROPOSES TO PARTICIPATE PURSUANT TO GUIDELINES ESTABLISHED FROM TIME TO TIME BY THE MEMBER. C. APPROVE AND REMOVE, WITH OR WITHOUT CAUSE, ALL MEMBERS OF THE BOARD OF DIRECTORS. D. INITIATE AND APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF CORPORATION. E. INITIATE AND APPROVE THE DISSOLUTION, LIQUIDATION, MERGER OR CONSOLIDATION OF CORPORATION. F. INITIATE AND APPROVE THE INCORPORATION OR DISSOLUTION OF AFFILIATED ENTITIES OF CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 TAX RETURNS FOR ENTITIES OF THE ALEGENT CREIGHTON HEALTH SYSTEM ARE PREPARED BY THE SYSTEM TAX DEPARTMENT. FOLLOWING THE PREPARATION OF ALEGENT HEALTH FOUNDATION FORM 990 BY ALEGENT CREIGHTON HEALTH INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE ALEGENT CREIGHTON HEALTH TAX DIRECTOR 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 CREIGHTON HEALTH TAX DIRECTOR AND THE BOARD IS NOTIFIED OF THE DATE THE TAX RETURN WILL BE FILED. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY - ALEGENT HEALTH FOUNDATION HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF ALEGENT CREIGHTON HEALTH, THE PARENT CORPORATION OF THE ALEGENT CREIGHTON HEALTH SYSTEM. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY THE ALEGENT CREIGHTON HEALTH COMPLIANCE OFFICER AND REPORTED TO THE CONFLICTS OF INTEREST COMMITTEE. THE CONFLICTS OF INTEREST COMMITTEE REVIEWS THE INVESTIGATION AND MAKES RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE MAKES THE FINAL DETERMINATION OF WHETHER OR NOT THERE IS A DISQUALIFYING EVENT AND COMMUNICATES IT TO THE ALEGENT HEALTH FOUNDATION 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 C, LINE 19 THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE TO THE PUBLIC ON OUR WEBSITE AT WWW.ALEGENTCREIGHTON.COM. ALEGENT HEALTH FOUNDATION 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: RICHARD HACHTEN II AND SCOTT WOOTEN ARE EXECUTIVES OF THE ALEGENT CREIGHTON HEALTH SYSTEM AND AVERAGE HOURS PER WEEK WORKED FOR AFFILIATE ORGANIZATIONS IS 60. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -417,922. TEMPORARY NET ASSETS RELEASED FROM RESTRICTIONS -10,808. TOTAL TO FORM 990, PART XI, LINE 5: -428,730. 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