2012-05-14T14:00:48-05:00 2011-06-30 KPMG LLP TWO CENTRAL PARK PLAZA SUITE 1501 OMAHA NE 681021626 990 2010-07-01 470376615 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER ALEG 4023434323 6901 NORTH 72ND STREET OMAHA NE 681221799 SCOTT M WOOTEN 4023434315 2012-05-14 1 LORRAINE A EGGER 4023481450 2010 2016-02-24 21:20:13Z SCOTT M WOOTEN 12809 WEST DODGE OMAHA NE 68154 297603514 0 X WWW.ALEGENT.COM X 1904 NE TO PROVIDE HIGH QUALITY CARE FOR THE BODY, MIND AND SPIRIT OF EVERY PERSON. 12 11 1957 411 196055 35036 696247 521944 243544887 217799831 12933425 42502007 22688240 27955969 279862799 288779751 17167842 21450502 0 0 123464854 115924692 0 0 70618 129299651 111456033 269932347 248831227 9930452 39948524 511697918 593611626 122419898 146737325 389278020 446874301 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 22792428 7112957 71419281 ALEGENT HEALTH IMMANUEL MEDICAL CENTER MENTAL HEALTH PHYSICIANS ARE UNIQUE IN THEIR CARE-GIVING APPROACH TO EMOTIONAL AND BEHAVIORAL PROBLEMS OF CHILDREN, ADOLESCENTS, ADULTS AND SENIORS. PHYSICIANS PROVIDE THE MOST APPROPRIATE CARE AT THE LEVEL OF SERVICE THAT EACH PATIENT NEEDS. OUTPATIENT AND INPATIENT BEHAVIORAL SERVICE PROGRAMS ARE PROVIDED. RECENTLY, IMMANUEL MEDICAL CENTER BUILT A RESIDENTIAL TREATMENT CENTER. THIS NEW STATE OF THE ART FACILITY FEATURES 20 PRIVATE ROOMS FOR BOYS AND GIRLS BETWEEN THE AGES OF SIX AND EIGHTEEN YEARS OF AGE. 16261968 3838749 38543846 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER REHABILITATION CENTER PROVIDES COMPREHENSIVE INPATIENT AND OUTPATIENT PROGRAMS FOR INDIVIDUALS OF ALL AGES. THE REHABILITATION CENTER IS THE REGION'S MOST COMPREHENSIVE CENTER FOR PHYSICAL MEDICINE AND REHABILITATION, OFFERING PATIENTS SOME OF THE MOST ADVANCED REHABILITATIVE TECHNOLOGY. IMMANUEL REHABILITATION CENTER HAS RECEIVED THE HIGHEST LEVEL OF ACCREDITATION AWARDED BY THE JOINT COMMISSION AND BY THE COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES (CARF). AT EVERY LEVEL OF CARE, A TEAM OF LICENSED AND CERTIFIED REHABILITATION PROFESSIONALS ARE AVAILABLE. EACH ONE OF THE REHABILITATION PROGRAMS ARE DESIGNED TO MAXIMIZE INDEPENDENCE AND QUALITY OF LIFE. 6014957 1577562 15839875 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER CANCER SUPPORT TEAM IS COMPRISED OF A GROUP OF HEALTHCARE PROFESSIONALS WHO WORK TOGETHER IN A VARIETY OF WAYS TO HELP THE PATIENT AND FAMILY COPE WITH CANCER. EACH ONE OF THE PHYSICIANS ARE EQUIPPED TO DIAGNOSE AND AGGRESSIVELY TREAT CANCER AND GET PATIENTS BACK TO THEIR LIFE AS SOON AS POSSIBLE. INDIVIDUAL TEAM MEMBERS INCLUDE CANCER SUPPORT SERVICE SPECIALISTS, MEDICAL SOCIAL WORKERS, CANCER REHABILITATION SPECIALISTS, PASTORAL SERVICES, DIETITIANS, ONCOLOGY NURSE NAVIGATORS, HOSPICE & HOME CARE SERVICES, INPATIENT NURSING SERVICES, RADIATION ONCOLOGY, AND VOLUNTEER SERVICES. 161746114 8921234 89684625 ALEGENT HEALTH-IMMANUEL MEDICAL CENTER PROVIDES ADDITIONAL SERVICES INCLUDING BUT NOT LIMITED TO: WEIGHT MANAGEMENT, A 24 HOUR EMERGENCY DEPARTMENT, INPATIENT HOSPITAL FACILITIES, PROCEDURE CENTER, ORTHOPEDIC SERVICES, DIGESTIVE HEALTH CENTER, FAMILY LIFE CENTER, RADIOLOGY, UROLOGY, DIAGNOSTIC SERVICES AND PHYSICAL THERAPY. PATIENTS ARE AT THE CENTER OF EVERYTHING DONE AT ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. 161746114 8921234 89684625 206815467 1 1 0 1 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 1 X 81 0 1 1957 1 1 1 0 0 0 0 1 1 0 0 0 0 X 12 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X SCOTT M WOOTEN SENIOR VPCFO 4023434323 12809 W DODGE ROAD OMAHA NE 68154 X LESLIE ANDERSEN 4.00 X 0 0 0 SR LILLIAN MURPHY RSM 4.00 X 0 0 0 ANTHONY HATCHER DO 6.00 X X 0 430677 31545 JOHN HEWITT 6.00 X X 0 0 0 MARTIN MANCUSO MD 4.00 X 0 18500 0 ANTOINETTE HARDY-WALLER RN 4.00 X 0 17500 0 RICHARD VIERK 4.00 X 0 26500 0 MICHAEL DEFREECE 6.00 X X 0 0 0 PAUL EDGETT III 4.00 X 0 0 0 ERIC GURLEY 4.00 X 0 0 0 H KEITH SCHMODE 4.00 X 0 18500 0 GUILLERMO HUERTA MD 4.00 X 0 0 0 RICHARD HACHTEN II 14.00 X 244390 805089 278627 MARTIN HICKEY MD 14.00 X 168661 555623 205555 KENNETH LAWONN 14.00 X 103281 340240 134712 SCOTT WOOTEN 14.00 X 125929 414850 136617 JOAN NEUHAUS 14.00 X 109208 359763 324164 JANE CARMODY 14.00 X 60191 198287 376202 RICK MILLER MD 14.00 X 25157 82877 368614 LARRY BROWN MD 1.00 X 0 380851 51034 RICHARD ROLSTON MD 14.00 X 0 0 0 PAUL EBMEIER 14.00 X 78442 258410 52953 SHEREE KEELY 14.00 X 41766 137589 39094 ELIZABETH LLEWELLYN 14.00 X 50649 166857 43049 PATRICIA MASEK 14.00 X 43144 142133 65673 FRANK EMSICK 14.00 X 48796 160754 47892 ANN SCHUMACHER 60.00 X 75665 249260 75876 NANCY WALLACE 14.00 X 52699 173603 357417 ARUN SHARMA MD 60.00 X 454051 0 28167 MICHAEL EGGER MD 60.00 X 310593 0 37967 THOMAS FRANCO MD 60.00 X 434690 0 37009 MICHAEL COY MD 60.00 X 325023 0 24545 HUDSON HSIEH MD 60.00 X 308535 0 33281 WAYNE SENSOR X 525920 1732539 13511 THEODORE SCHWAB X 54074 178136 1258 FRED HOSLER MD X 187787 618625 7239 MARK KESTNER MD X 128958 424831 7402 MARGARET BREEN X 63826 210264 5445 AMY PROTEXTER X 58058 191259 9793 PATRICIA NADLE X 57654 189932 4772 MICHAEL ANDERSON X 37349 123038 0 4174496 8606487 2799413 71 1 1 0 CASSLING DIAGNOSTIC IMAGING INC 13808 F STREET OMAHA NE 68137 DIAGNOSTIC IMAGING SERVICES 1378053 NORTHWEST ANESTHESIA PC 6901 N 72ND STREET OMAHA NE 68122 ANESTHESIA SERVICES 725107 GRAHAM CONSTRUCTION INC 13210 CENTENNIAL RD 1 OMAHA NE 68138 CONSTRUCTION SERVICES 640002 BAXTER-KENWORTHY ELECTRIC INC 4600 S 76TH CIRCLE OMAHA NE 68127 ENGINEERING SERVICES 532937 DOUBLE D EXCAVATING INC 8615 VERNON AVE OMAHA NE 68134 CONSTRUCTION SERVICES 335081 28 58500 57002 364167 42275 42275 521944 NET PATIENT SVC REVENU 621500 209792089 209792089 REIMBURSABLE-AFFILIATE 621990 5586624 5586624 HOSPITAL PHARMACY 446110 1627122 1627122 FOOD & NUTRITION 722320 678068 33293 644775 HEALTH EDUCATION 611710 108914 108914 7014 7014 217799831 -284207 -284207 2225750 512324 1713426 1713426 1713426 23876137 26876708 7966631 23876137 18910077 42786214 42786214 43987 57002 75127 -31140 -31140 11450 6300 5150 5150 373324 263381 109943 109943 JOA SETTLEMENTS 812300 19785000 19785000 REIMBURSED SERVICES 621990 2810432 2810432 MISCELLANEOUS OPERATIN 561499 2584340 162762 2421578 978818 978818 26158590 288779751 215487627 196055 72574125 9384 9384 21441118 21441118 1832560 1557676 274884 90137059 73707806 16362552 66701 3779637 3593288 186349 15123483 9948109 5175374 5051953 4763995 284041 3917 4076 285 3791 17274 17274 3858651 2275781 1582870 29431 29431 30753569 30375610 377959 7829395 7829395 137429 69474 67955 38283 38283 5460429 5460429 20113625 14911923 5201702 616541 616541 PURCHASED SERVICES 17382840 10739530 6643310 BAD DEBTS 9871449 9871449 EQUITY NET LOSS 8277518 8277518 MANAGEMENT ALLOCATIONS 5790803 6448 5784355 MISCELLANEOUS 867463 867463 407257 407257 248831227 206815467 41945142 70618 414057 735745 20155527 50158053 25509809 21437399 4008795 3227004 230776 230776 312071795 171474826 145013597 140596969 280079981 317547773 20583830 59638068 15701546 39839 511697918 593611626 8555178 5794560 7539 666106 111165217 132888865 2691964 7387794 122419898 146737325 X 385378337 442337788 2109683 2745513 1790000 1791000 389278020 446874301 511697918 593611626 X 39948524 17647757 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 X 17274 106741 17274 106741 248813953 484963523 248831227 485070264 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 136554 176941 262701 106741 682937 250000 250000 250000 250000 1000000 1500000 2938870 5001 464742 6642 183950 3218021 2665977 126695 298938 9996 142744 2938870 2688014 800115 -448721 3875 369556 2665977 0.39000 0.61000 0 1 1 1800312 1800312 145719602 67849819 77869783 479327 338930 140397 153273987 98961366 54312621 10798567 4324711 6473856 140596969 INVESTMENT IN MCH HEALTH SYSTEM 6876791 C INVESTMENT IN ALEGENT HEALTH 50159388 C INVESTMENT IN PRAIRIE HEALTH VENTURES, LLC 2594875 C AMHS HERITAGE, LLC 7014 C 59638068 3RD PARTY PAYER SETTLEMENTS 4062939 INTERCOMPANY LIABILITY 3324855 7387794 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. 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. IMMANUEL REHAB INPATIENT 2011 100989 57002 43987 36425 13244 10500 1600 13358 100989 57002 43987 36425 13244 10500 1600 13358 75127 -31140 1 1 X 0 0 1 1 1 0 1 1 7728 9293093 2105841 7187252 0.03010 2286 45181226 32005558 13175668 0.05510 10014 54474319 34111399 20362920 0.08520 14205 245950 18166 227784 0.00100 72 499273 89680 409593 0.00170 0 0 302804 125604 177200 0.00070 301 224026 83 223943 0.00090 14578 1272053 233533 1038520 0.00430 24592 55746372 34344932 21401440 0.08950 14 3024 3024 0.00000 7 260218 260218 0.00110 5542 5542 0.00000 21 268784 268784 0.00110 1 2978216 1320429 44603698 49170122 -4566424 X 1 1 1 1 ALEGENT HEALTH IMMANUEL MEDICAL CENTER

6901 NORTH 72ND STREET OMAHA NE 68122

X X X ALEGENT HEALTH IMMANUEL MEDICAL CENTER 1 1 0 0 1 X X X X 1 1 X X X X X X X 1 X X 1 X X X X X X 1 X 0 0 1 AH IMMANUEL FONTENELLE HOME

6809 NORTH 68TH PLAZA OMAHA NE 68152

SKILLED NURSING FACILITY PART I, LINE 3C: ALEGENT HEALTH-IMMANUEL MEDICAL CENTER IS PART OF THE ALEGENT HEALTH SYSTEM. THE AMOUNT OF FINANCIAL ASSISTANCE WRITE-OFF FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM IS 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 ALEGENT HEALTH'S FINANCIAL ASSISTANCE POLICY.THE APPLICATION PROCESS REQUIRES THAT THE PATIENT COMPLETE A PERSONALFINANCIAL APPLICATION AND PROVIDE VERIFICATION DOCUMENTS. VERIFICATIONINCLUDES 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 METHOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WERE WORKSHEETS 1 - 8 PROVIDED WITH THE SCHEDULE H INSTRUCTIONS. THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE TOTAL COMMUNITY BENEFIT EXPENSE FOR CHARITY CARE AND MEDICAID. PART I, L7 COL(F): BAD DEBT OF $9,871,449 INCLUDED IN THE FUNCTIONAL EXPENSE TOTAL PART IX, LINE 25 IS NOT INCLUDED IN THE TOTAL OPERATING EXPENSE USED TO CALCULATE THE TABLE 7 PERCENTAGES. THE DENOMINATOR USED TO CALCULATE THE COST TO CHARGE RATIO WAS $238,959,778. PART II: AS A RESULT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN 2006, WHICH POINTED TO CHILDHOOD OBESITY AS A SERIOUS HEALTH NEEDS ISSUE ACROSS ALL OMAHA MSA COUNTIES SERVED, THE ALEGENT HEALTH SYSTEM PARTNERED WITH THE COMMUNITY AND MADE A MULTI-YEAR COMMITMENT TO IMPACT CHILDHOOD OBESITY THROUGH COMMUNITY BASED BEST PRACTICE INTERVENTIONS. THIS INITIATIVE HAS HAD A PRIMARY FOCUS OF IMPACT IN DOUGLAS COUNTY, BUT THE FUNDING TO UNDERWRITE HAS COME FROM THE FISCAL PERFORMANCE OF ALL ALEGENT HEALTH HOSPITALS. THE COMMUNITY COALITION KNOWN AS LIVE WELL OMAHA KIDS (LWOK) IS STAFFED AND FUNDED BY ALEGENT HEALTH. AN EXECUTIVE COMMITTEE, WHICH CONSISTS OF COMMUNITY LEADERS AND POLICY MAKERS, HAS IMPLEMENTED AN ECOLOGICAL APPROACH THAT IMPROVES PROGRAMS, POLICIES AND PROMOTES PHYSICAL ACTIVITY AND HEALTHY EATING HABITS AT THE INDIVIDUAL AND ORGANIZATIONAL LEVELS. MORE THAN 200 VOLUNTEERS HAVE PARTICIPATED IN THE PLANNING AND IMPLEMENTATION OF LWOK INITIATIVES. A PORTION OF THIS INVESTMENT IN LWOK IS ALLOCATED TO ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. 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 IS DETERMINED BY USING THE COST TO CHARGE RATIO FROM MEDICARE COST REPORTS PER ENTITY AND MULTIPLYING THE RATIO BY THE ACTUAL BAD DEBT CHARGES PER ENTITY.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 USED A COST TO CHARGE RATIO. PART III, LINE 9B: THE ALEGENT HEALTH'S SELF PAY BILLING AND BAD DEBT POLICY HAS A CLEARLY DELINEATED PROCESS FOR COLLECTION AGENCIES TO FOLLOW, INCLUDING EXPLICIT INSTRUCTIONS THAT ENSURE THE CHARITY CARE PATIENTS WHO HAVE BEEN IDENTIFIED DO NOT GO TO COLLECTIONS. ALEGENT HEALTH IMMANUEL MEDICAL CENTER PART V, SECTION B, LINE 11H: SIZE OF FAMILY IS ALSO USED IN THE CALCULATION. ALEGENT HEALTH IMMANUEL MEDICAL CENTER 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. PART VI, LINE 2: THE ALEGENT HEALTH SYSTEM APPROACHES COMMUNITY NEEDS ASSESSMENT AS A CORPORATE ACTIVITY THAT DEVELOPS AND INTEGRATES COUNTY BASED HEALTH PROFILES FOR EACH OF THE COUNTIES WHERE THE LICENSED HOSPITALS ARE LOCATED. THE PROCESS TO DEVELOP THE ASSESSMENTS IS COLLABORATIVE IN NATURE AND INVOLVES HEALTH DEPARTMENTS, EXISTING HEALTH COALITIONS, COMMUNITY MEMBERS AND HOSPITAL LEADERSHIP, AND IS SUPPORTED BY THE ALEGENT HEALTH PLANNING AND COMMUNITY BENEFIT DEPARTMENT STAFF. THE ALEGENT HEALTH PLANNING DEPARTMENT CONDUCTS MARKET ASSESSMENTS THAT IDENTIFY THE OMAHA METROPOLITAN STATISTICAL AREA'S POPULATION AND DEMOGRAPHIC CHARACTERISTICS. ADDITIONALLY, IN COOPERATION WITH LOCAL HEALTH DEPARTMENTS AND COALITIONS, THE ALEGENT HEALTH COMMUNITY BENEFIT/HEALTHIER COMMUNITY DEPARTMENT CONDUCTS AN ANNUAL REVIEW OF THE DOCUMENTED COMMUNITY HEALTH NEEDS AND PLANS OF EACH OF THE COMMUNITIES IT SERVES. THIS ASSESSMENT PROCESS INVOLVES SUMMARIZING EXISTING DATA AND RESEARCH FROM LOCAL HEALTH DEPARTMENT REPORTS AND LOCAL COALITION REPORTS INTO A COMPREHENSIVE SUMMARY GRID INCORPORATING A MULTITUDE OF FACTORS INCLUDING-DEMOGRAPHICS, HEALTH STATUS METRICS, BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY DATA, DOCUMENTED HEALTH ISSUES, QUALITATIVE INFORMATION FROM QUALITATIVE AND COMMUNITY BASED PROCESSES AND IDENTIFICATION OF ALEGENT HEALTH'S PARTICIPATION AND SPECIFIC STRATEGIC ACTION PLANS. THE PROFILES ARE INTEGRATED INTO THE GOVERNANCE AND PLANNINGFOR ALEGENT HEALTH ON TWO LEVELS:I. REPORTING TO THE COMMITTEE OF THE BOARD OF DIRECTORS CHARGED WITHHEALTH PLANNING OVERSIGHTII. INTO THE ANNUAL STRATEGIC PLANNING PROCESSES OF ALEGENT HEALTH.PARTICULAR TO DOUGLAS COUNTY, WITHIN WHICH THE IMMANUEL MEDICAL CENTER RESIDES, NEEDS ASSESSMENT AND REPORTING OF THOSE NEEDS IS LED BY LIVE WELL OMAHA (LWO), A MEMBERSHIP BASED COALITION. LWO HAS BEEN IN EXISTENCE FOR 14 YEARS AND ALEGENT HEALTH WAS A FOUNDING MEMBER AND IS THE LARGEST FINANCIAL CONTRIBUTOR. THE ALEGENT HEALTH SYSTEM CONTINUES TO PROVIDE LEADERSHIP AND FUNDING FOR LWO COALITION WHICH INCLUDES HEALTHCARE PROVIDERS, PUBLIC HEALTH SERVICE PROVIDERS, INSURERS, BUSINESSES AND ACADEMIA WHO PARTICIPATE IN A COLLABORATIVE COMMUNITY HEALTH NEEDS ASSESSMENT CONSISTING OF PRIMARY AND SECONDARY DATA AND KEY INFORMANT INTERVIEWS. THE ASSESSMENT IS SHARED WITH THE PUBLIC THROUGH A REPORT CARD, AT AN ANNUAL COMMUNITY SUMMIT AND ON A COMMUNITY WEBSITE. THE COMMUNITY HEALTH NEEDS ASSESSMENT IS USED BY THE COMMUNITY TO ASSESS HEALTH NEEDS AND IDENTIFY PARTNERSHIP OPPORTUNITIES FOR INTERVENTION. PART VI, LINE 3: THERE ARE SEVERAL FINANCIAL ASSISTANCE ACCESS POINTS THROUGHOUT A PATIENT'S CARE CYCLE. BILLS CONTAIN FINANCIAL ASSISTANCE VERBIAGE; SIGNS ARE POSTED IN CLINICS AND HOSPITALS, AND THERE IS INFORMATION ON FINANCIAL ASSISTANCE POSTED AT REGISTRATION POINTS THROUGHOUT THE CLINICS AND HOSPITALS. INFORMATION ON THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY IS LOCATED AT 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, PATIENTSARE ASSISTED IN THE APPLICATION PROCESS FOR FINANCIAL ASSISTANCE CONSISTENT WITH THE ALEGENT HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. PART VI, LINE 4: THE ALEGENT HEALTH SYSTEM, WHICH INCLUDES IMMANUEL MEDICAL CENTER, SERVES THE EIGHT-COUNTY GREATER OMAHA METROPOLITAN STATISTICAL AREA (MSA), WITH AN ESTIMATED POPULATION OF 865,350, RANKING 60TH OUT OF 366 MSAS IN TOTAL POPULATION. THE MSA CONSISTS OF 3 IOWA AND 5 NEBRASKA COUNTIES ON BOTH SIDES OF THE MISSOURI RIVER. MORE THAN 1.2 MILLION PEOPLE LIVE WITHIN A 60-MILE RADIUS OF OMAHA. CHARACTERIZED BY STEADY GROWTH, THE MSA GREW BY 12.8 PERCENT BETWEEN 2000 AND 2010; THE 2015 PROJECTED POPULATION IS MORE THAN 900,000, A 5.5 PERCENT INCREASE. MORE THAN 36 PERCENT OF THE POPULATION IS 24 YEARS OF AGE OR YOUNGER WITH A MEDIAN AGE OF 34.9 YEARS COMPARED TO A U.S. MEDIAN AGE OF 37.1. 50.5% OF THE POPULATION IS FEMALE. RACIAL MINORITIES COMPRISE ABOUT 18 PERCENT OF GREATER OMAHA'S POPULATION, INCLUDING AN AFRICAN-AMERICAN POPULACE OF 7.9 PERCENT AND APPROXIMATELY 9.0 PERCENT HISPANIC. IN 2010 GREATER OMAHA HAD OVER 360,000 HOUSING UNITS. THE MEDIAN HOUSEHOLD INCOME WAS $56,271 WHICH SURPASSES THE NATIONAL AVERAGE OF $51,517, WITH A PER CAPITA INCOME OF $27,876. GREATER OMAHA IS A WELL-EDUCATED COMMUNITY. MORE THAN 91 PERCENT OF ADULTS, AGE 25 AND OLDER, ARE HIGH SCHOOL GRADUATES AND 32.7 PERCENT HAVE A BACHELOR'S DEGREE OR HIGHER. PART VI, LINE 6: THE PRIMARY CARE PHYSICIAN CLINICS THAT ARE PART OF THE ALEGENT HEALTH SYSTEM PARTICIPATE IN MEDICAL STUDENT PRECEPTORSHIPS THAT ADVANCE THE HEALTHCARE PROVIDER EDUCATION PROCESS. THE ALEGENT HEALTH SYSTEM HAS OPEN MEDICAL STAFFS AND IS ONE OF 3 HEALTH SYSTEMS THAT FUND THE OPERATIONS OF A COALITION THAT EXISTS TO PROVIDE ACCESS FOR THE PATIENTS OF 3 AREA FEDERALLY QUALIFIED COMMUNITY HEALTH CENTERS TO SPECIALTY PHYSICIAN SERVICES AND HOSPITAL BASED DIAGNOSTICS AND TREATMENT. THE ALEGENT HEALTH SYSTEM IS THE SOLE COMPREHENSIVE ACUTE MENTAL HEALTH PROVIDER IN THE OMAHA MSA AREA. THE ALEGENT HEALTH SYSTEM IS A JOINT VENTURE PARTNER IN A NOT-FOR-PROFIT HOSPICE INPATIENT HOSPITAL AND PROVIDES THE MANAGEMENT SUPPORT CONTRACT. THE ALEGENT HEALTH SYSTEM BUDGETS FOR AN EMERGENCY FUND AS A SUBSET OF OTHER COMMUNITY DONATIONS TO RESPOND TO CRISIS OR UNPLANNED FUNDING NEEDS OF A VITAL COMMUNITY SERVICE, WHICH WAS FIRST USED IN FY2010 WITH THE ECONOMIC DOWNTURN. THE ALEGENT HEALTH SYSTEM HAS A CURRENT COMMITMENT TO SET ASIDE UP TO 6% OF ITS EBIDA IN A GIVEN FISCAL YEAR FOR COLLABORATIVE INITIATIVES TO IMPROVE THE HEALTH OF THE COMMUNITIES SERVED, WHICH IS THE CATALYST FUND.BOARD OF DIRECTORS - THE ALEGENT HEALTH SYSTEM IS GOVERNED BY A BOARD OF DIRECTORS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF OUR LOCAL COMMUNITY WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. EMERGENCY DEPARTMENT - ALEGENT HEALTH IMMANUEL MEDICAL CENTER HOSPITAL 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.IN ADDITION, ALEGENT HEALTH IMMANUEL MEDICAL CENTER, TOGETHER WITH UNRELATED HOSPITALS IN THE AREA, WORK CLOSELY WITH LOCAL FIRE AND RESCUE DEPARTMENTS TO ENSURE THAT AMBULANCES TAKE PATIENTS TO THE APPROPRIATE HOSPITAL. THIS IS GENERALLY THE HOSPITAL THAT IS CLOSET GEOGRAPHICALLY WITH EXCEPTIONS BASED ON PATIENT PREFERENCE, PATIENT'S PHYSICIAN PREFERENCE, AND CAPACITY OR THE AVAILABILITY OF SPECIALIZED FACILITIES OR PROGRAMS RELATED TO THE PATIENT'S CONDITION. FINALLY, ALEGENT HEALTH IMMANUEL MEDICAL CENTER MAINTAINS DETAILED PROCEDURES REGARDING WHEN AND UNDER WHAT CIRCUMSTANCES A PATIENT CAN BE TRANSFERRED. UNDER THIS POLICY, NO PATIENT WILL BE TRANSFERRED BASED ON RACE, CREED, RELIGION OR ABILITY TO PAY.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 IMMANUEL MEDICAL CENTER'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 HOSPITALS ARE INVOLVED IN SHARED BUDGET DECISION MAKING TO MEET THE PRIORITIZED COMMUNITY HEALTH NEEDS IN COLLABORATION WITH COMMUNITY PARTNERS. THE CORPORATE FUNCTION IS FUNDED FROM THE OPERATIONS OF THE INDIVIDUAL HOSPITALS TO LEVERAGE EXPERTISE AND TIME THAT IS FOCUSED ON PROMOTING HEALTH. 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. PART VI, LINE 7: THE ALEGENT HEALTH SYSTEM FILES REPORTS WITH THE NEBRASKA HOSPITAL ASSOCIATION (NEBRASKA) AND IOWA HOSPITAL ASSOCIATION (IOWA). 1 X CHARITY CARE 7728 21426618 BOOK REDUCE OR WRITE OFF OF PATIENT SERVICES HOSPITALITY HOUSE SUBSIDIES 37 12000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MOST DISBURSEMENTS IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS ARE MADE DIRECTLY IN THE ACTIVE CONDUCT OF THE ACTIVITIES CONSTITUTING THE EXEMPT PURPOSE OR FUNCTION OF THE ORGANIZATION. OTHERWISE, DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES OR SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. SISTER INGEBORG BLOMBERG SCHOLARSHIP: SCHOLARSHIPS ARE PROVIDED BY THE IMMANUEL MEDICAL CENTER AUXILIARY TO PROVIDE CONTINUING EDUCATION FOR ALEGENT HEALTH-IMMANUEL MEDICAL CENTER EMPLOYEES FOR THEIR PERSONAL GROWTH AND/OR PROFESSIONAL DEVELOPMENT. ALL PERMANENT, FULL-TIME AND PART-TIME EMPLOYEES IN GOOD STANDING WHO HAVE SIX MONTHS OR MORE OF SERVICE WITH ALEGENT HEALTH-IMMANUEL MEDICAL CENTER MAY APPLY FOR THE SCHOLARSHIPS. PAYMENT FOR TUITION, LAB FEES, BOOKS AND REGISTRATION EXPENSES WILL BE MADE DIRECTLY TO THE INSTITUTION UPON RECEIPT OF A STATEMENT OF COSTS FROM THE INSTITUTION. THE AWARDING OF THE SISTER INGEBORG BLOMBERG SCHOLARSHIP SHALL BE SUBJECT TO THE FOLLOWING CRITERIA: 1. APPLICATION IS MADE PRIOR TO MAKING A COMMITMENT TO THE SCHOOL 2. THE SCHOOL AND COURSE ARE OF RECOGNIZED STANDING 3. THE EMPLOYEE CONTINUES TO MAINTAIN HIS/HER REGULARLY SCHEDULED WORKING HOURS 4. THE EMPLOYEE SHALL SIGN AN AUTHORIZATION ALLOWING THE AUXILIARY TO RECEIVE WRITTEN CERTIFICATION OF PERFORMANCE FROM THE INSTITUTION 5. IT IS EVIDENT THAT THE COURSE, OR COURSES, ARE MUTUALLY BENEFICIAL TO THE EMPLOYEE AND TO ALEGENT HEALTH-IMMANUEL MEDICAL CENTER 6. THE EMPLOYEE IS EXPECTED TO REMAIN EMPLOYED AT ALEGENT HEALTH-IMMANUEL MEDICAL CENTER FOR AT LEAST ONE YEAR AFTER RECEIVING THE SISTER INGEBORG BLOMBERG SCHOLARSHIP. OTHER INFORMATION: PART IV: ALEGENT HEALTH-IMMANUEL MEDICAL CENTER OCCASSIONALLY DISTRIBUTES FUNDS TO OTHER 501(C)(3) ORGANIZATIONS. THESE DISTRIBUTIONS ARE MONITORED TO ENSURE THEY ARE BEING USED AS SPECIFIED BY THE ORGANIZATION. SCHEDULE I, PART III - ALEGENT HEALTH-IMMANUEL MEDICAL CENTER RECOGNIZES THE RIGHT TO QUALITY HEALTHCARE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, OR ABILITY TO PAY. BUSINESS OFFICE STAFF HELPS PATIENTS SEEK LOCAL, STATE, AND FEDERAL REIMBURSEMENT AT NO CHARGE WHEN NO OTHER SOURCE OF PAYMENT IS AVAILABLE. FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS WITH DEMONSTRATED INABILITY TO PAY FOR MEDICALLY NECESSARY SERVICES. THESE FUNDS ARE DIRECTLY USED TO OFFSET THE PATIENTS ACCOUNTS RECEIVABLE. HOSPITALITY HOUSE SUBSIDIES ARE ESTABLISHED FOR THE DISBURSEMENT OF ALEGENT HEALTH IMMANUEL AUXILIARY MONIES FOR PATIENT ASSISTANCE THAT IS COMPLIANT WITH ALEGENT HEALTH POLICIES AND PROCEDURES, INTERNAL REVENUE SERVICES (IRS) REGULATIONS AND OTHER APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND REGULATIONS. X 1 1 X X X X X 1 1 0 1 0 1 1 0 0 ANTHONY HATCHER DO 0 403550 0 0 0 27127 0 14700 0 18657 0 464034 0 0 RICHARD HACHTEN II 154819 510015 59734 196782 29837 98292 61693 203236 3501 11533 309584 1019858 0 0 MARTIN HICKEY MD 82142 270603 32526 107151 53993 177869 42983 141597 5250 17296 216894 714516 28517 93943 KENNETH LAWONN 66193 218061 24667 81262 12421 40917 28065 92455 3676 12108 135022 444803 0 0 SCOTT WOOTEN 79039 260380 29596 97499 17294 56971 27931 92015 4304 14179 158164 521044 0 0 JOAN NEUHAUS 74561 245623 22653 74627 11994 39513 75487 248677 1135 3740 185830 612180 0 0 JANE CARMODY 14425 47521 44923 147990 843 2776 87198 287255 458 1508 147847 487050 0 0 RICK MILLER MD 24225 79805 0 0 932 3072 89226 293935 1440 4743 115823 381555 0 0 LARRY BROWN MD 0 342647 0 8758 0 29446 0 27733 0 25249 0 433833 0 0 PAUL EBMEIER 58525 192798 13004 42839 6913 22773 7708 25394 5055 16654 91205 300458 0 0 SHEREE KEELY 28514 93933 6891 22701 6361 20955 6805 22417 2622 8637 51193 168643 0 0 ELIZABETH LLEWELLYN 33722 111093 8601 28334 8326 27430 8437 27793 1801 5934 60887 200584 0 0 PATRICIA MASEK 31025 102208 7263 23928 4856 15997 12104 39873 3355 11051 58603 193057 0 0 FRANK EMSICK 35158 115826 8550 28167 5088 16761 6679 22003 4722 15557 60197 198314 0 0 ANN SCHUMACHER 56599 186453 10601 34921 8465 27886 12634 41619 5652 18620 93951 309499 0 0 NANCY WALLACE 39765 130996 6539 21540 6395 21067 80660 265718 3064 10095 136423 449416 0 0 ARUN SHARMA MD 421384 0 0 0 32667 0 7350 0 23757 0 485158 0 0 0 MICHAEL EGGER MD 284536 0 0 0 26057 0 17150 0 24232 0 351975 0 0 0 THOMAS FRANCO MD 264681 0 152485 0 17524 0 17158 0 22004 0 473852 0 0 0 MICHAEL COY MD 293738 0 0 0 31285 0 17150 0 10514 0 352687 0 0 0 HUDSON HSIEH MD 289844 0 0 0 18691 0 14700 0 22148 0 345383 0 0 0 WAYNE SENSOR 394 1298 0 0 525526 1731241 0 0 3303 10880 529223 1743419 524852 1729017 THEODORE SCHWAB 0 0 0 0 54074 178136 293 965 454 1494 54821 180595 54074 178136 FRED HOSLER MD 591 1947 0 0 187196 616678 0 0 1705 5618 189492 624243 184971 609349 MARK KESTNER MD 1181 3895 0 0 127777 420936 188 617 1551 5108 130697 430556 126126 415497 MARGARET BREEN 0 0 0 0 63826 210264 158 521 1110 3656 65094 214441 63827 210264 AMY PROTEXTER 0 0 0 0 58058 191259 462 1524 1818 5989 60338 198772 58058 191259 PATRICIA NADLE 13961 45993 11635 38329 32058 105610 0 0 1273 4192 58927 194124 29691 97813 MICHAEL ANDERSON 0 0 0 0 37349 123038 0 0 0 0 37349 123038 37349 123038 PART I, LINE 1A AS PART OF THE EXECUTIVE COMPENSATION ARRANGEMENT, EXECUTIVES ARE PROVIDED WITH A SET SUM, APPROXIMATELY 30 - 40% OF THEIR BASE SALARY, WHICH CAN BE USED TO ELECT VARIOUS BENEFITS. SOME OF THE BENEFITS AVAILABLE FOR ELECTION INCLUDE HEALTH CLUB DUES, AUTOMOBILE ALLOWANCE, FINANCIAL PLANNING FEES AND LEGAL FEES. PAYMENT FOR THESE BENEFITS ARE EITHER MADE DIRECTLY BY ALEGENT HEALTH OR REIMBURSED TO THE EXECUTIVE AFTER THE APPROPRIATE SUBSTANTIATION FOR THE EXPENSE IS PROVIDED. THE AMOUNT PAID FOR THESE BENEFITS IS INCLUDED IN THE EXECUTIVE'S WAGES AS TAXABLE INCOME. PART I, LINES 4A-B THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS AS EXECUTIVES OF ALEGENT HEALTH (A RELATED ORGANIZATION) DURING THE 2010 CALENDAR YEAR AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE AS COMPENSATION ON SCHEDULE J: MARTIN HICKEY, MD - $122,460 THEODORE SCHWAB - $232,210 WAYNE SENSOR - $2,253,869 FRED HOSLER, MD - $794,319 MARGARET BREEN - $274,090 AMY PROTEXTER - $249,317 MICHAEL ANDERSON - $160,387 MARK KESTNER, MD - $541,623 PATRICIA NADLE - $127,504. SCHEDULE J, LINE 4B - THE FOLLOWING REPORTABLE INDIVIDUALS PARTICIPATED IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN FROM ALEGENT HEALTH (A RELATED ORGANIZATION) DURING THE 2010 CALENDAR YEAR. AMOUNTS DEFERRED FROM THE PLAN WERE INCLUDED IN COLUMN C OF THE SCHEDULE J: RICHARD HACHTEN II - $116,268 SCOTT WOOTEN - $48,613 JANE CARMODY - $3,877 NANCY WALLACE - $13,759 RICK MILLER, MD - $9,841 LARRY BROWN, MD - $12,411 KENNETH LAWONN - $39,892 JOAN NEUHAUS - $41,947 SHEREE KEELY - $10,915 ELIZABETH LLEWELLYN - $12,916 PATRICIA MASEK - $10,956 FRANK EMSICK - $11,534 PAUL EBMEIER - $20,451 ANN SCHUMACHER - $19,981 MARTIN HICKEY, MD - $50,630. PART I, LINE 5 PHYSICIANS EMPLOYED BY ALEGENT HEALTH-IMMANUEL MEDICAL CENTER ARE ELIGIBLE FOR QUARTERLY PRODUCTIVITY BONUSES BASED ON INDIVIDUAL QUALITY MANAGEMENT, WHICH INCLUDES CORE MEASURES, REVENUE, PHYSICIAN REFFERAL AND ATTENDANCE AT MEETINGS. THE CORE MEASURES USED TO DETERMINE THE PHYSICIAN BONUSES ARE NATIONALLY ACCEPTED MEASURES OF PHYSICIAN PRODUCTIVITY. PART I, LINE 6 COMPENSATION FOR MEMBERS OF MANAGEMENT OF ALEGENT HEALTH AND RELATED ENTITIES IS DETERMINED AT A SYSTEM LEVEL. MEMBERS OF ALEGENT HEALTH MANAGEMENT ARE ELIGIBLE FOR AN ANNUAL INCENTIVE BONUS. INCENTIVE AWARDS ARE BASED ON FOUR INDIVIDUAL PERFORMANCE MEASURES WHICH ARE LINKED TO FOUR SYSTEM PERFORMANCE GOALS. FOR EACH MANAGER, 75% OF THE INCENTIVE AWARD WILL BE DETERMINED BY SYSTEM PERFORMANCE GOALS AND 25% DETERMINED BY INDIVIDUAL PERFORMANCE MEASURES. ONE OF THE FOUR SYSTEM PERFORMANCE GOALS IS DEPENDENT ON THE FINANCIAL RESULTS OF THE ENTIRE ALEGENT HEALTH SYSTEM FOR THE FISCAL YEAR. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: ALEGENT HEALTH GOVERNANCE OF EXECUTIVE COMPENSATION: ACTING AS PRUDENT STEWARDS OF ITS FINANCIAL RESOURCES, THE ALEGENT HEALTH BOARD COMPENSATION COMMITTEE RECOMMENDS AND THE BOARD EXECUTIVE COMMITTEE APPROVES EXECUTIVE COMPENSATION PHILOSOPHY, POLICY AND GUIDELINES. IT DOES SO WITH THE OBJECTIVE OF ATTRACTING AND RETAINING TOP EXECUTIVE TALENT TO ENSURE ALEGENT HEALTH IS ABLE TO FULFILL ITS FAITH-BASED MISSION AND ACHIEVE ITS VISION OF BECOMING WORLD-CLASS. THE ALEGENT HEALTH COMPENSATION COMMITTEE FOLLOWS A THOROUGH AND INTENTIONAL PROCESS THAT INCLUDES CONSULTATION WITH INDEPENDENT, EXPERT COUNSEL AND CAREFULLY COMPARES COMPENSATION LEVELS TO MARKET-BASED COMPENSATION OF SIMILAR SIZED, NON-PROFIT AND FOR-PROFIT HEALTH SYSTEMS AND ALSO UTILIZES A BLEND OF NON-PROFIT AND GENERAL INDUSTRY DATA FOR EXECUTIVE ROLES WHERE THE RECRUITING MARKET IS ARGUABLY BROADER THEN THE NON-PROFIT SECTOR. TOTAL COMPENSATION INCLUDES BASE COMPENSATION, AND ALSO INCLUDES PERFORMANCE-BASED INCENTIVE COMPENSATION FOR ACHIEVING BOARD-SET GOALS FOR CLINICAL QUALITY, PATIENT SAFETY AND SATISFACTION, PHYSICIAN PERCEPTION, STRATEGIC AND FACILITY PLANNING AND FINANCIAL PERFORMANCE. IT MAY ALSO INCLUDE OTHER CASH PAYMENTS SUCH AS ONE-TIME RELOCATION COSTS. SCHEDULE J, PART II: THE ALEGENT HEALTH EXECUTIVES HAVE A PROVISION IN THEIR COMPENSATION AGREEMENT THAT PROVIDES FOR POTENTIAL SEVERANCE PAYMENTS IN THE EVENT OF TERMINATION WITHOUT CAUSE OR CHANGE OF CONTROL. THE AMOUNT OF SEVERANCE AN EXECUTIVE MAY OR MAY NOT RECEIVE IF TERMINATED ACCORDING TO THE COMPENSATION AGREEMENT IS INCLUDED AS DEFERRED COMPENSATION IN COLUMN C. X HUSKER HELICOPTER 1 1250 SELLING PRICE X NEBRASKA HUSKERS SKYBOX TICKETS 1 1000 SELLING PRICE X DISMAL RIVER GOLF CLUB PACKAGE 1 1600 SELLING PRICE X VALET PARKING FOR ONE YEAR 1 300 SELLING PRICE X CHAMPIONS RUN GOLF/TOMMIE FRAZIER 1 650 SELLING PRICE X CHAMPIONS RUN GOLF WITH MATT DAVISON AND DR. PAUL 1 400 SELLING PRICE X THE PERSONICS 1 3000 SELLING PRICE X LAKE OF THE OZARKS, OSAGE BEACH VACATION 1 2500 SELLING PRICE X JOSH GROBAN CONCERT 1 400 SELLING PRICE X GOODRICH DIAMONDS 1 1500 SELLING PRICE X TICKETS FOR TWO TO THE KEITH URBAN CONCERT 1 345 SELLING PRICE X HOTEL, DINNER AT SPENCER'S WITH A WINE AND CHOC 1 350 SELLING PRICE X DINNER PARTY FOR EIGHT 1 1500 SELLING PRICE X ROCKY MOUNTAIN GETAWAY YMCA OF THE ROCKIES 1 500 SELLING PRICE X LINDY FREED JEWELRY 1 700 SELLING PRICE X WINE TASTING AND CHEESE FOR SIX 1 800 SELLING PRICE X GOLF/FRAZIER/WOOTEN 1 100 SELLING PRICE X GOLF/FRAZIER/WOOTEN 1 100 SELLING PRICE X VALET PARKING FOR ONE YEAR 1 300 SELLING PRICE X THE LEGEND OF PASTOR FOGELSTROM'S WATCH 1 250 SELLING PRICE X U2 CONCERT AND AIRFARE 1 1060 SELLING PRICE X LAWN MOWING SERVICES 1 50 SELLING PRICE X FUSED GLASS, DRAPED BOWL 1 70 SELLING PRICE X FRAMED PICTURE OF WEST HIGHLAND TERRIOR 1 145 SELLING PRICE X LANDSCAPE DESIGN CONSULTATION 1 150 SELLING PRICE X BEE A HONEY GIFT BASKET 1 50 SELLING PRICE X HIGHLANDER PICNIC BASKET 1 170 SELLING PRICE X STRING OF PURLS YARN AND KNITTING GIFT CERTIFICATE 1 40 SELLING PRICE X FRAMED PHOTOGRAPH OF ALASKA MOUNTAINS 1 80 SELLING PRICE X HANDCRAFTED ILLUMINATED GERMAN NATIVITY 1 220 SELLING PRICE X SIMON PEARCE GLASS THETFORD BOWL 1 95 SELLING PRICE X DEE-SIGN AND NORTHWEST FLORAL GIFT CERTIFICATE 1 50 SELLING PRICE X FLORAL ARRANGEMENT FROM NORTHWEST FLORIST AND GIFT 1 130 SELLING PRICE X "BON APPETIT" GLASS CLOCHE WITH MARBLE BASE 1 180 SELLING PRICE X 2 PLAQUES OF A 3D GERBER DAISY 1 80 SELLING PRICE X MULHALL'S GIFT CERTIFICATE 1 200 SELLING PRICE X HAND-CRAFTED CUSTOMIZABLE METAL SIGN 1 50 SELLING PRICE X GARDENING BUCKET WITH METAL FLOWER 1 80 SELLING PRICE X LEWIS ART GALLERY GIFT CERTIFICATE 1 200 SELLING PRICE X ALL SEASONS FLORAL 1 20 SELLING PRICE X THE MAIDS OF NORTHWEST OMAHA 1 204 SELLING PRICE X MULHALL'S GARDEN BASKET AND GIFT CERTFICATE 1 650 SELLING PRICE X BEATRIZ BALL METALWARE BOWL WITH SALAD SERVERS 1 180 SELLING PRICE X TUDY'S GARDEN SERVICE AND CONSULTATION 1 100 SELLING PRICE X TOMMYGLASS ART BY DR. TOM RUMA #1 1 300 SELLING PRICE X WENNINGHOFF FARMS SPRING BASKET AND GIFT CERTIFI 1 90 SELLING PRICE X TREE 1 750 SELLING PRICE X GARDEN ART 1 150 SELLING PRICE X RUSSELL SPEEDER'S CAR WASH 1 145 SELLING PRICE X PAMPERED CHEF COLLECTION 1 96 SELLING PRICE X PEGGY KARR HEALING PLATE 1 80 SELLING PRICE X M & M GREEN GUY 1 125 SELLING PRICE X M & M BLUE GUY 1 125 SELLING PRICE X FRAMED PHOTOGRAPH 1 250 SELLING PRICE X SALSA AND CHIPS BASKET 1 75 SELLING PRICE X UNION PACIFIC RAILROAD TOOLS 1 30 SELLING PRICE X TOMMYGLASS ART BY DR. TOM RUMA #2 1 300 SELLING PRICE X PEAR COLLECTION 1 72 SELLING PRICE X HANDMADE QUILT 1 50 SELLING PRICE X HOWARD BUFFET BOOKS 1 515 SELLING PRICE X WINE PICNIC PACKAGE 1 95 SELLING PRICE X M'S PUB GIFT CERTIFICATE 1 50 SELLING PRICE X LIED LODGE AND CONFERENC CENTER AT ARBOR DAY FARM 1 175 SELLING PRICE X SGT. PEFFER'S GIFT CERTIFICATE 1 25 SELLING PRICE X RUNNER'S GRANOLA GIFT BASKET 1 50 SELLING PRICE X DINNER AT DARIO'S BRASSERIE / DUNDEE THEATER 1 60 SELLING PRICE X FINICKY FRANK'S GIFT CERTIFICATE 1 25 SELLING PRICE X WINE AND DINE FOR FOUR AT TUSSEY'S 1 140 SELLING PRICE X TOO FAR NORTH WINE AND WINE TASTING FOR ONE 1 35 SELLING PRICE X WINESTYLES - WINE TASTING FOR TWELVE 1 200 SELLING PRICE X 7 M GRILL GIFT CERTIFICATE 1 50 SELLING PRICE X EDIBLE ARRANGEMENTS GIFT CERTIFICATE 1 45 SELLING PRICE X OMAHA COMMUNITY PLAYHOUSE AND JOHNNY'S ITALIAN 1 180 SELLING PRICE X NOTHING BUNDT CAKES GIFT CERTIFICATE 1 40 SELLING PRICE X SEASONAL DELIGHTS BASKET FOR SPRING AND FALL 1 75 SELLING PRICE X HEALING GROUNDS GIFT BASKET 1 30 SELLING PRICE X BOTTLE OF PAUL HOBBS CABERNET SAUVIGNON 1 300 SELLING PRICE X PASHMINA SCARF 1 72 SELLING PRICE X VERA BRADLEY GRAY TOTE AND MATCHING WALLET 1 145 SELLING PRICE X PRINCESS HAT AND MITTEN KIT 1 70 SELLING PRICE X YOGA BASKET 1 250 SELLING PRICE X NECKLACE, BRACELET AND EARRINGS BY VIVA BEADS 1 54 SELLING PRICE X GOLF VEST 1 135 SELLING PRICE X VERA BRADLEY SIDE BY SIDE PURSE AND CARD KEEPER 1 81 SELLING PRICE X NITESWEATZ PAJAMAS 1 120 SELLING PRICE X AMAZON KINDLE WITH GIFT CARD 1 165 SELLING PRICE X SONY INTERNET TV BLUE RAY DISC PLAYER 1 400 SELLING PRICE X SCHLITTERBAHN KC WATERPARK IN KANSAS CITY 1 190 SELLING PRICE X PAMPER YOUR PET - DOG GROOMING BY PUCCI'S 1 43 SELLING PRICE X BALLET BIRTHDAY PARTY AND TUTU WITH HEADBAND 1 100 SELLING PRICE X PRIVATE SANTA PARTY 1 75 SELLING PRICE X HAND KNIT BABY SWEATER AND HAT 1 90 SELLING PRICE X REMOTE CONTROL HELICOPTER - TIGER 1 55 SELLING PRICE X REMOTE CONTROL HELICOPTER - TACTICAL 1 55 SELLING PRICE X POOL MEMBERSHIP TO MAPLE VILLAGE COUNTRY CLUB 1 475 SELLING PRICE X LINDSAY ERNST PHOTOGRAPHY SESSION AND 1 - 11X14 1 175 SELLING PRICE X THOMAS THE TRAIN PEDAL ENGINE 1 390 SELLING PRICE X EXTRA LARGE ELMO 1 150 SELLING PRICE X OLD FASHIONED GAME ASSORTMENT 1 90 SELLING PRICE X LORALEE AMANDAS PHOTOGRAPHY SESSION 1 175 SELLING PRICE X PUMP IT UP BOUNCE PARTY 1 264 SELLING PRICE X GIRLS' NIGHT OUT IN BENSON 1 105 SELLING PRICE X GIRL-THEMED BASKET 1 50 SELLING PRICE X DOG TREATS BASKET 1 15 SELLING PRICE X I-PAD 1 500 SELLING PRICE X MOTORCYCLE RIDE THROUGH THE LOESS HILLS 1 200 SELLING PRICE X DINNER FOR TWO AT ANTHONY'S AND A SCENIC AIRPLANE 1 250 SELLING PRICE X HENRY DOORLY ZOO GUIDED TOUR 1 50 SELLING PRICE X PACIFIC SPRINGS GOLF OUTING FOR FOUR WITH CART 1 180 SELLING PRICE X PORSCHE GT-2 CLUB COUPE RACING 1 150 SELLING PRICE X CWS TICKETS AND ROSENBLATT BOOK 1 95 SELLING PRICE X UNO MAV HOCKEY TICKETS 1 136 SELLING PRICE X KIM'S LOTTI BISCOTTI 1 75 SELLING PRICE X GOLF PACKAGE FOR 4 AT PACIFIC SPRINGS WITH COOLER 1 200 SELLING PRICE X DEER CREEK GOLF OUTING FOR FOUR WITH CART 1 320 SELLING PRICE X KANSAS CITY ROYALS BASEBALL TICKETS 1 64 SELLING PRICE X DISCOVERY FLIGHT AND SASM 1 64 SELLING PRICE X SIGNED FOOTBALL 1 175 SELLING PRICE X CABELA'S GIFT CERTIFICATE 1 100 SELLING PRICE X GOLF OUTING FOR FOUR AT SHADOW RIDGE COUNTRY CLUB 1 500 SELLING PRICE X FOUR TICKETS FOR A NEBRASKA CORNHUSKER FOOTBALL 1 1000 SELLING PRICE X DENVER BRONCO'S TICKETS 1 150 SELLING PRICE X MEMBERSHIP TO IMMANUEL/LAKESIDE WELLNESS CENTER 1 420 SELLING PRICE X MATRIX HAIR CARE PRODUCTS BASKET 1 65 SELLING PRICE X SALON AURA- COLOR, CUT & STYLE GIFT CERTIFICATE 1 90 SELLING PRICE X SALON AURA- PEDICURE/MANICURE GIFT CERTIFICATE 1 58 SELLING PRICE X SALON AURA GIFT CERTIFICATE - FACIAL & BROW WAX 1 55 SELLING PRICE X DESSERT OF THE MONTH FOR ONE YEAR 1 120 SELLING PRICE X T'EEZ SALON 1 120 SELLING PRICE X CLAUDE'S BEAUTORIUM - SALON SERVICES & GIFT BASKET 1 150 SELLING PRICE X MARY KAY BASKET 1 288 SELLING PRICE X MAKIN WAVES HAIR AND TANNING SALON 1 90 SELLING PRICE X CRABTREE & EVELYN 1 94 SELLING PRICE X WEIGHT MANAGEMENT BASKET 1 150 SELLING PRICE X DIAMOND 1 6000 SELLING PRICE X APPLE IPOD TOUCH 1 300 SELLING PRICE 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 PAUL EDGETT III AND ANTOINETTE HARDY-WALLER - BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE CORPORATION SHALL BE IMMANUEL HEALTH SYSTEMS (IHS). IMMANUEL HEALTH SYSTEMS SHALL NOT HAVE ANY VOTING RIGHTS AS A MEMBER OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE BUSINESS AND AFFAIRS OF THE CORPORATION SHALL BE MANAGED BY OR UNDER THE DIRECTION OF THE ALEGENT BOARD OF DIRECTORS, AND THE CORPORATION HEREBY DELEGATES TO THE ALEGENT BOARD OF DIRECTORS, TO THE EXTENT PERMITTED BY LAW, COMPLETE GOVERNANCE AUTHORITY OVER IT, SUBJECT ONLY TO THE APPROVAL POWERS OF THE ALEGENT CORPORATE MEMBERS SET FORTH IN THE ARTICLES OF INCORPORATION AND BYLAWS. DIRECTORS SHALL BE APPOINTED BY THE ALEGENT BOARD IMMEDIATELY FOLLOWING THE APPOINTMENT AND RATIFICATION BY ALEGENT CORPORATE MEMBERS OF THE ALEGENT DIRECTORS PURSUANT TO THE ARTICLES OF INCORPORATION AND BYLAWS OF ALEGENT. THE ALEGENT BOARD SHALL APPOINT DIRECTORS SUCH THAT, AT ALL TIMES, ALL OF THE PERSONS SERVING AS ALEGENT DIRECTORS ALSO SHALL BE SERVING AS DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE FOLLOWING ACTIONS SHALL BE EFFECTIVE ONLY IF APPROVED BY THE ALEGENT BOARD AND BY BOTH IMMANUEL HEALTH SYSTEMS (IHS) AND CATHOLIC HEALTH INITIATIVES (CHI) IN THEIR CAPACITIES AS ALEGENT CORPORATE MEMBERS: A. ADOPTION OR AMENDMENT OF THE UNIFIED PHILOSOPHY AND MISSION OF THE CORPORATION; B. SALE, LEASE, TRANSFER, ENCUMBRANCE OR DISPOSITION OF THE TANGIBLE PROPERTY OR INVESTMENTS OF THE CORPORATION HAVING A FAIR MARKET VALUE IN ANY INDIVIDUAL TRANSACTION IN EXCESS OF $3 MILLION OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS, PROVIDED THAT TRANSFERS OF INVESTMENTS BETWEEN THE CORPORATION AND ANOTHER PARTICIPANT SHALL NOT REQUIRE THE APPROVAL OF CHI AND IHS; AND PROVIDED FURTHER THAT APPROVAL OF CHI AND IHS SHALL NOT BE REQUIRED FOR ANY TRANSFER OF ASSETS TO CHI BY THE CORPORATION PURSUANT TO THE TERMS OF THE ALEGENT FINANCING AGREEMENT(AFA); C. INCURRENCE, ASSUMPTION OR GUARANTY BY THE CORPORATION IN ANY INDIVIDUAL TRANSACTION OF LONG-TERM INDEBTEDNESS, INCLUDING CAPITAL LEASES, OUTSTANDING FOR MORE THAN 365 DAYS, IN EXCESS OF THE GREATER OF $2 MILLION OR 2% OF THE TOTAL LONG-TERM INDEBTEDNESS OF ALL THE PARTICIPANTS, OR SUCH GREATER AMOUNT AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS; D. MERGER, DISSOLUTION, CONSOLIDATION OR SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION EXCEPT FOR A MERGER IN WHICH (I) THE CORPORATION IS THE SURVIVING ENTITY, AND (II) THE TOTAL BOOK VALUE OF THE ASSETS OF THE MERGING ENTITY DOES NOT EXCEED 2% OF THE TOTAL BOOK VALUE OF THE ASSETS OF ALL THE PARTICIPANTS, OR SUCH GREATER VALUE AS MAY BE DETERMINED FROM TIME TO TIME BY CHI AND IHS; AND E. NOTWITHSTANDING ANY OTHER PROVISIONS IN THE BYLAWS TO THE CONTRARY. THE ACTIONS THAT CAN BE TAKEN WITHOUT THE APPROVAL OF IHS AND CHI INCLUDE, WITHOUT LIMITATION: (I) TERMINATION OF THE AFA IN ACCORDANCE WITH ITS TERMS. (II) FORMATION OF THE UNIFIED ALEGENT HEALTH SYSTEM (AS THAT TERM IS DEFINED IN THE AFA) (III) PREPAYMENT BY THE CORPORATION OF THE FULL AMOUNTS OUTSTANDING ON ITS NOTES TO CHI UNDER THE AFA, FOR PURPOSES OF EXERCISING THE RIGHTS OF TERMINATION OF THE AFA, OR FORMATION OF THE UNIFIED ALEGENT HELATH SYSTEM CREDIT, AND THE TAKING OF ALL ACTIONS NECESSARY OR APPROPRIATE TO OBTAIN FUNDING OR OTHERWISE MAKE ARRANGEMENTS TO PREPAY SUCH NOTES INCLUDING WITHOUT LIMITATION INCURRENCE OF INDEBTEDNESS NECESSARY OR APPROPRIATE TO PREPAY THE NOTES OUTSTANDING. FORM 990, PART VI, SECTION B, LINE 11 TAX RETURNS FOR ENTITIES OF THE ALEGENT HEALTH SYSTEM ARE PREPARED BY THE SYSTEM TAX DEPARTMENT. FOLLOWING THE PREPARATION OF ALEGENT HEALTH-IMMANUEL MEDICAL CENTER FORM 990 BY INTERNAL TAX STAFF, THE RETURN IS REVIEWED BY THE TAX DIRECTOR, EXTERNAL TAX ADVISOR AND THE CHIEF FINANCIAL OFFICER. THE FINAL TAX RETURN IS POSTED ON THE ELECTRONIC DIRECTOR'S PORTAL TO BE REVIEWED BY THE BOARD OF DIRECTORS AND PRESENTED AT THE FINANCE AND AUDIT COMMITTEE OF THE BOARD. THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR ARE PRESENT AT THE FINANCE AND AUDIT COMMITTEE MEETING TO ANSWER ANY QUESTIONS THE COMMITTEE MAY HAVE. ADDITIONALLY, THE BOARD OF DIRECTORS ARE REFERRED TO THE ALEGENT HEALTH TAX DIRECTOR IF THEY HAVE QUESTIONS AND THE BOARD IS NOTIFIED THAT THE FINAL FORM 990, WILL BE FILED ON MAY 15, 2012. FORM 990, PART VI, SECTION B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICY - ALEGENT HEALTH-IMMANUEL MEDICAL CENTER HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF ALEGENT HEALTH, THE PARENT CORPORATION OF THE ALEGENT HEALTH SYSTEM. ANNUAL COMPLETION OF THE DISCLOSURE STATEMENT IS REQUIRED BY THE BOARD OF DIRECTORS. STATED DISCLOSURES ARE INVESTIGATED BY THE ALEGENT HEALTH COMPLIANCE OFFICER AND REPORTED TO THE CONFLICTS OF INTEREST COMMITTEE. THE CONFLICTS OF INTEREST COMMITTEE REVIEWS THE INVESTIGATION AND MAKES RECOMMENDATIONS TO THE GOVERNANCE COMMITTEE. THE GOVERNANCE COMMITTEE MAKES THE FINAL DETERMINATION OF WHETHER OR NOT THERE IS A DISQUALIFYING EVENT AND COMMUNICATES IT TO THE BOARD OF DIRECTORS. AT ANY TIME A BOARD MEMBER OR KEY EMPLOYEE MAY DECLARE A CONFLICT OF INTEREST AND RECUSE HIS/HERSELF FROM THE DISCUSSION. THE INDIVIDUAL IS ALSO REQUIRED TO DISCLOSE ANY KNOWN OR POSSIBLE CONFLICTS OF INTEREST THAT ARISE DURING THE CALENDAR YEAR. FORM 990, PART VI, SECTION B, LINE 15 THE GOVERNING BOARD ENGAGED THE SERVICES OF AN INDEPENDENT CONSULTING FIRM THAT HOLDS ITSELF OUT TO THE PUBLIC AS A COMPENSATION CONSULTANT THAT IS QUALIFIED TO AND REGULARLY PERFORMS EXECUTIVE AND OFFICER COMPENSATION STUDIES. THE CONSULTING FIRM CONDUCTED A REVIEW AND ANALYSIS OF THE TOTAL COMPENSATION PAID TO THE CEO AND OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION, BASED ON COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS AND DETERMINED THAT THE COMPENSATION WAS REASONABLE. THE CONSULTING FIRM ISSUED AN OPINION LETTER AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PAID TO EMPLOYEES IDENTIFIED AS DISQUALIFIED PERSONS. THE OPINION LETTER SETTING FORTH THE FINDINGS WAS REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE GOVERNING BOARD. CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENTS WERE MAINTAINED. THIS PROCESS WAS USED FOR THE FOLLOWING EMPLOYEES: PRESIDENT AND CHIEF EXECUTIVE OFFICER SENIOR VICE PRESIDENT AND CHIEF FINANCIAL OFFICER CHIEF EXECUTIVE OFFICER ALEGENT HEALTH CLINIC SENIOR VICE PRESIDENT ALEGENT HEALTH SYSTEM CHIEF OPERATIONS OFFICER SENIOR VICE PRESIDENT STRATEGY AND TECHNOLOGY (F/K/A CIO) VICE PRESIDENT OPERATIONS (BERGAN MERCY & MERCY) VICE PRESIDENT OPERATIONS (IMMANUEL) VICE PRESIDENT OPERATIONS (LAKESIDE) VICE PRESIDENT OPERATIONS (MIDLANDS) MEDICAL DIRECTORS FORM 990, PART VI, SECTION C, LINE 19 THE CONFLICT OF INTEREST POLICY IS MADE AVAILABLE TO THE PUBLIC ON THE WEBSITE AT WWW.ALEGENT.COM. ALEGENT HEALTH-IMMANUEL MEDICAL CENTER DOES NOT MAKE THE FINANCIAL STATEMENTS OR GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC. HOWEVER, THE ARTICLES OF INCORPORATION ARE AVAILABLE AT WWW.SOS.STATE.NE.US. PART VII, SECTION A: EXECUTIVES OF THE ALEGENT HEALTH SYSTEM HOURS WORKED ARE SPLIT OUT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. THE FOLLOWING EMPLOYEES ARE EXECUTIVES OF THE ALEGENT HEALTH SYSTEM: RICHARD HACHTEN II, SCOTT WOOTEN, KENNETH LAWONN, JOAN NEUHAUS, RICHARD ROLSTON, MD, RICK MILLER, MD, JANE CARMODY, SHEREE KEELY, ELIZABETH LLEWELLYN, PATRICIA MASEK, FRANK EMSICK, MARTIN HICKEY, MD, PAUL EBMEIER AND NANCY WALLACE. THEREFORE, THEIR AVERAGE NUMBER OF HOURS WORKED PER WEEK FOR THE AFFILIATE ORGANIZATIONS ARE 46. LARRY BROWN, MD IS ALSO AN EXECUTIVE OF THE ALEGENT HEALTH SYSTEM, HOWEVER HIS HOURS ARE SPLIT BETWEEN TWO AFFILIATED ORGANIZATIONS. AVERAGE HOURS PER WEEK FOR AFFILIATE ORGANIZATIONS IS 60. ANTHONY HATCHER, MD IS AN EMPLOYED PHYSICIAN OF THE ALEGENT HEALTH SYSTEM AND HIS HOURS ARE SPLIT BETWEEN THE FILING ORGANIZATION AND AFFILIATE ORGANIZATIONS OF THE SYSTEM. AVERAGE HOURS PER WEEK FOR AFFILIATE ORGANIZATIONS ARE 54. A BOARD OF DIRECTOR LISTED IN PART VII IS COMPENSATED FOR HIS SERVICES PROVIDED TO A SUPPORTING ORGANIZATION OF THE FILING ORGANIZATION. REASONABLE EFFORTS TO OBTAIN THE BOARD OF DIRECTOR'S COMPENSATION FROM THE SUPPORTING ORGANIZATION WAS CONDUCTED PRIOR TO THE FILING OF THIS TAX RETURN. HOWEVER, WE WERE UNABLE TO OBTAIN THE INFORMATION FROM THE SUPPORTING ORGANIZATION. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 28,162,311. JOA CAPITAL EXPENDITURES -17,406,000. TRANSFERS TO OTHER ALEGENT AFFILIATES -39,359,000. CHANGE IN UNRESTRICTED ASSETS OF ALEGENT 45,395,000. OTHER MISCELLANEOUS CHANGES 218,616. CHANGE IN TEMP. RESTRICTED ASSETS OF ALEGENT 454,000. TRANSFERS FROM OTHER AFFILIATED ENTITIES 181,830. CHANGE IN PERM. RESTRICTED ASSETS OF ALEGENT 1,000. TOTAL TO FORM 990, PART XI, LINE 5: 17,647,757. FORM 990, PART I, LINE 5 AND PART V, LINE 2A: THE EMPLOYEES LISTED IN PART I, LINE 5 AND PART V, LINE 2A ARE EMPLOYED BY ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. HOWEVER, THROUGH A COMMON PAY AGENT AGREEMENT, THE EMPLOYEES ARE PAID BY ALEGENT HEALTH AND PAYROLL EXPENSES ARE ALLOCATED TO ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. FORM 990, PART V, LINE 1C: PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF THE ALEGENT HEALTH SYSTEM ARE MADE BY ALEGENT HEALTH, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT HEALTH-IMMANUEL MEDICAL CENTER. ALEGENT HEALTH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY ALEGENT HEALTH ON BEHALF OF ALEGENT HEALTH-IMMANUEL MEDICAL CENTER ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 16: ALEGENT HEALTH HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER, ALEGENT HEALTH'S SYSTEM-WIDE JOINT VENTURE MODEL INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSE IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNER'S RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. 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