009e67f1 - foundation center990s.foundationcenter.org/990_pdf_archive/470/470484764/470484… ·...

turn of Organization Exempt From Income 10 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (eaepl black lung

benefit trail or private foundation) " Tie organization may have to use a copy of this return to sanity stale reporting requirements

Farm 990 2001 oepartment of the 7rmury Internet RNlIIYO $HViU

A For the 2001 calendar year, or tax year period beginning JUL 1 Z U U 1 i+!pB Check a pi.. C Name of organization r~ applicable

use IRS LEGENT HEALTH-0 NOU~ss labeior ERGAN MERCY HEALTH SYSTEM 1.0

=hahce Stt Number and street (or P 0 box it mail is not delivered to street address) ~ r~;"~'i~°~ sa-,fi=7500 MERCY ROAD

ioswc

97-0489764 Room/suite I E Telephone number

" 4021 343-9315 a L-jai m lions City or town, state or country, and ZIP a 4 F r~a~cnq oemm ~1 trio U aim ~0 �̂m'"`° -OMAHA , NE 68124 EXTENSION C EpP~ai°°° " Section 501(c)(3) organizations and 4947( .

must attach a completed Schedule A (Form Lo S4 web site No-WWW .ALEGENT .ORG

RETURil OiV I o aP=y, nonexempt charitable trusts H and I aye not applicable to section 527 organizations or 990-EZ) H I n I h 9 ~ r ~X N

Organization type unawonryorc)" ~X 501(c)( 3 )1 Pn.Mnol ~ 4947(x)(1) or 0 52

Check here " = it tie organisation's grass receipts are normally nod more than $25 000 The

organization need not file a return with the IRS but d the organization received a Farm 990 Package in the mail it should file a return without financial data Same states require a complete return

H(d) Is (his a separate return filed by an or-

I Enter 4-d M Check 10,

Sch B (F it the organization is not requueo to aliacn i0 990-EZ of 990-PF) L Gross receipts Add lines 6b, 8b 9b, and 10b to line 12 . 278,436

Part 1 Revenue Expenses and Changes in Net Assets or Fund Balances t Contributions grtts, grants, and similar amounts received

a Direct public support 1 a 1 6 5,040

D Indirect public support 16 82,785

c Government coninbutions(prants) ic 57 715

G Total (add lines 1a through 1c) (cash E 305,540 . noncashE )

2 Program service revenue including government fees and contracts (tram Part VII, line 93) 3 Membership dues and assessments d Interest on savings and temporary cash investments 5 Orvidends and interest from securities 6 a Gross rents SEE STATEMENT 1 6, 1,883,708

0 Less rental expenses 6b d e Net rental income or (lass) (subtract line 6D from line 6a)

7 Other investment income (describe L m 8 a Gross amount from sate of assets older A Secunlies B Other

man inventory Ba 201,065 b Less cost or other basis and sales expenses B6 1 , 375 , 524 c Gain or (loss) (attach schedule) < 7 6 9 412 . Bc <1 , 174 , 459 d Net gain or (toss) (combine line Bc, columns (A) and (B)) STMT 2 STMT 3

9 Special events and acirvitias (attach schedule) a Gross revenue (not including $ 0 " 01 contributions

reported on line ia) I 9a ~ 136,128

M

0 N

0 Z

O W Z

U o ,~ VI

,~V Y n M w

18 Excess or (deficit) tai the year (subtract line 17 from line tY)

19 Net assets or fund balances at beginning of year (tram line 73 column (A)) 20 Other changes in net assets or land balances (attach explanation) SEE STATEMENT 7 21 Net asses or tune balances at end of year (combine lines 18, 19, and 20)

n LHA For Paperrork Reduction Act Native, see the separate Instructions

533,917 . 387,071 . Form 990 (YOOtV,

I

D Employer identification number

(a) s t is a group return of a iliales es o H(6) II Yes' enter number of affiliates ll~ H(c) Are all affiliates included N/A = Yes Ll No

(it 'NO' attach a list )

other t an funOraismg expenses I 96 I 3 ~ r y c e e I s trot events (suhiracl line 9b from line 9a) SEE STATEMENT

1 a Gross sales of inventory I returns and allowances 10a 628,0

,~ o ~~lskjcoslofpo~~{yy"~d 0 STATEMENT 6 too 453 , 0

e ross profit of (lass) fro ~ s of inventory (attach schedule) (subtract line 10b from line 1Oa) STMT

11 er.1re 11 no

103) r 12 T i es 1d 3 4 5 6c 1 Bd 9c tOc and 71

rogram services (from line 44, column (B)) 14 Management and general (from line 44, column (C)) 15 Fundraising (from line 44 column (D)) 16 Payments to affiliates (attach schedule)

is 305,590 . 2 270,717,891 . 3 169 f 446 . a 604,961 . 5 1,248 , 964o

k 1,883 708 . 7

3a <1,943 , 871 .>

3c 98 , 191 .

Oe 175,071 . i, 2 .591,150 .

HEALTH- -04R4764 Form 990 (200 1

Part II on line (B) Program (C) Management (D) Fundraising al

I (A) Total servires 2nd nnnera l

d

and allocations $ services 44 JJJ~V

Form 990(2001) 01 02 02

and

22 Grants and allocations (attach schedule) cash s 5 3 , 815 . �� ,cas � s 22 53 , 815 . 5 3 , 815 . TATEMENT 9

23 Specific assistance to individuals (attach schedule) 23 141, 189 . 141, 189 . STATEMENT 10 6 24 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of ottice(s, directors etc 25 601 , 003 . 0 . 601 , 003 . 0 . 26 Other salaries anawages 26 103, 113, 787 . 95,661,790 . 7,951,997 . 0 . 27 Pension pan contributions 27 3, 6 9 3 516 . 3, 381, 772 . 261 , 744 . 0 . 28 Other employee benefits 28 14 512 278 . 12,863,046 . 1,649,232 . 0 . 29 Payroll taxes 29 7 494 , 949 . 6 989,696 . 505, 303 . 0 . 30 Professional fundraising teas 30 0 . 0 . 0 . 31 Accounting fees 31 749,845 . 0 . 749 845 . 0 . 32 Legal tees 32 691,642 . 0 . 691,642 . 0 . 33 Supplies 33 49, 867, 682 . 49, 503, 986 . 363, 696 . 0 . 3e Telephone 34 1,093 396 . 647 800 . 445,596 . 0 . 35 Postage andshipping 35 918 191 . 764,441 . 153,750 . 0 . 35 Occupancy 36 8,716 569 . 7,961,981 . 1,255, 083 . 0 . 37 Equipment renal and maintenance 37 1 , 118 515 . 1 , 118 , 515 . 0 . 0 . 38 Printing and publications 38 0 . 0 . 0 . 39 Travel 39 1,227 , 631 . 881,050 . 346,581 . 0 . 40 Conferences, conventions, and meetings 40 314 259 . 314 , 259 . 0 . --6- . 41 Interest g 41 2,032 759 . 2,002 102 . 30,657 . 0 . 42 Depreciation, depletion, et~ ~aP1laAch~eure) 28) az 18, 011 , 820 . 15, 888, 574 . 2, 123, 246 . 03 Other expenses not covered above (itemize)

a 43a b 436 e 43c d 430

. e SEE STATEMENT 8 43e 51 707 095 . 46 859 542 . 4 , 684 , 854 . 162 , 699 44 Total functional wpensn (add ines 22 through Q)

OqanIS"IIonS rnTplatinp column! (B) (D) carry these totals ,o �n6 �.,s as 66,009,936 .244,533,008 . 21,319,229 . 162,699 .

Joint Costs Check " E:1 d you are following SOP 98.2 Are any point casts from a combined educational campaign and fundraising solicitation reported in (B) Program services ~ E] Yes EXI No It'Yes' enter (j) the aggregate amount o1 these lomt costs $ , (it) the amount allocated to Program services E iii the amount allocated to Management and general $ and rv the amount allocated to Fundraisin g $ Part III Statement of Program Service Accomplishments What is the organization's primary exempt purDOSe7 1 HEALTHCARE DELIVERY SYSTEM Pro ramService Nlorganizations must describe weir eaernpipurposaetliie~arn~ISIna dear end concise manner State NenumDeroI fLmISServN pubu[ationsissuM etc Discuss

~Venses

~~~ ~~~iwemmU that lm not m'ssurd0lB (Section 501(cam) and 1C1 organizations end C9O(a)l11 nonatemP1 chenleble trusts must also enter ape amount of grants end ~~ for ~~~~ ~a z ~ i wemmU (a) orps and a9d7(a)p)

allocations to others ) vests om options. toy amers 1

a SEE STATEMENT 34

94 .533,008 . b

c

17]071 01 02 02

GENT HEALTH- Form 990(200t) SGAN MERCY HEALTH SYSTEM "-0484764

Part IV Balance Sheets

Note Where required, attached schedules and amounts within the description column (R) (B) should be (or end-of-year amounts only Beginning of year End of year

45 Cash -nonHnterest-6eanng 4,936,390 . 45 3 , 996,293 .

46 Savings and temporary cash investments 30,052,073 . 46 23,703 , 131 .

47 a Accounts recervabie a7a 111 155 978 . b Hess allowance tordoubtful accounts 476 64 760 159 . 69, 226, 787 . aye 46, 395 829 .

48 a Pledges receivable 48a h Less allowance for doubtful accounts CBS 48c

49 Grants receivable 49 50 Hecervables from officers, directors, hostess

and key employees 50 51 a Other notes one loans receivable (SEE S1Tff . ~ 20 , 676 , 229 .

h Less allowance tordoubtful accounts S1h 21,516,339 . Sic 20,676 229 .

52 Inventories for sale or use 4 , 859,312 . 52 6 276 , 15 9 . 53 Prepaid expenses and deferred charges 53 5a Investments-securities STMT 11 STMT 12 " EJ Cosy CK FMV 43, 686, 498 . 54 40,583,939 .

SS a Investments - land buildings, and equipment basis 55a

D Less accumulated depreciation 550 =s

56 Investments -other SEE STATEMENT 13 0 . 56 13,600 .

57 a Land, buildings and equipment basis (S1MT .28 57a 270, 056 545 .

d Hess accumulated depreciation 57h 160, 677 876 . 95,285, 938 . sic 109, 378, 669 .

58 other assets (describe " SEE STATEMENT 14 ~ 19 112 , 746 . se 48 , 778 , 456 .

59 Total assets addlines a5throu gh 58 musteq ual une7a 283 176 083 . 59 299 802 295 .

60 Accounts payable and accrued expenses 9 , 781 , 581 . 60 5 , 548 , 232 .

61 Grants payable 51 62 Deferred revenue 17 , 167 . 52 1 1 , 534 .

= 63 Loans from officers, directors, trustees . and key employees 63 a '° 64 a Tax-exempt bond liabilities 64a

J oMortgages andother notes payable (SEE STMT. 29) 65,295,466 . 6ao 62,895,897 .

65 Other liabilities (descrioe 10' SEE STATEMENT 15 1 25 069 830 . 65 26 959 611 .

. fib Total liabilities ( add lines so throug h 65 95 , 114 , 044 . 6s 95 , 415 , 224

Organizations teal follow SFAS 117, check here 1 ~ and complete lines 67 through

69 and lines 73 and 74 67 Unrestricted 187 909 039 . 67 204, 379, 894 .

A 68 Temporarily restricted 153,000 . 68 7, 177 .

m 69 Permanently restricted 69 °c Organizations that do hat follow SFAS 117, cheek here ~ 0 and complete lines

70 through 74 70 Capital sock, gust principal, or current funds 70 71 Paid-in or capital surplus, or land, building, and equipment fund 71

a 72 Retained earnings, endowment, accumulated income of other funds 72

2 73 Total net assets or fund balances (add lines 67 through 69 OH lines 70 through 72, column (A) must equal line 19,column (B)must equal line 21) 188 062 039 . 73 204 387 071 .

74 Total liabilities and net assets / fund balances (add lines 66 and 73) 283,176 , 083, 74 2-99 , 80-2 , 295 .

Form 990 is available tar public inspection and for some people serves as the primary or sole source of information about a particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore please make sole the return is complete and accurate and fully describes, in Part III the organization's programs and accomplishments

STEM -0489769 Pag e a 'art IV-B Reconciliation of Expenses per Audited

Financial Statements With Expenses per Return

a Total expenses and losses per audited financial statements " a 276465000 .

D Amounts included on line a but not on line 17, Form 990

(1) Donated services and use of tacnilies $

(2) Prior yeas adjustments reported an line 20 Form 990 S

(3) Losses reported on line 20, Form 990 $

(4) Other (specify) STMT 17 $ 10,874,289 .

Add amounts on lines (7 ) through (C) " D 110 , 8 7 9 , 2 89 . c Line aminus line G " t 265590711 . d Amounts included an line 17 Form

990 but not on line a

(1) Investment expenses not included on line 6b Farm 990 f

(2) Other (specify) STMT 19 $ 419,225 .

Addamounts onlines (1) and (2) " 0 919 225 . e Total expenses per line 17 Foam 990

(unecpwsuned) ~ e 266009936 . ployees (List each one even it not compensated ~ Title and average nouns (C) Compensation (Uca~i~o~~~o~s ~o (E) Expense per week devoted to (II oat Opid, enter ��P 1°n ,°,°°,� account an0 (A) Name and address

SEE -STATEMENT -26

---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

75 Did any officer director, trustee, or key employee receive aggregate compensation of more than E100 OOO from your organization and all related

$1NT .

REGENT HEALTH- Form 990 2000 RGAN MERCY HEALTH Part IV-A Reconciliation of Revenue per Audited

Financial Statements with Revenue per Return

a Total revenue,gams,and other support peraudited financial statements ~ a 285956000 .

b Amounts included on line a but not on line 12 Form 990

(1) Net unrealized pains on investments $

(2) Doomed services and use of facilities $

(3) Recovenes of poor year grants

(4) Other (specify) STMT 16 f 11,189,172 . Ado amounts on lines (1) through (4) " D 11 , 189,172 .

c Line a minus line b " C 1 274766828 . d Amounts included on line 12 Form

990 but not on line a

(1) Investment expenses not included on line 6b, Form 990 $

(2) Other (specify) STMT 18 s 1,034,223 . nddamounts onlines (i)and(2) " d 1 034 223 .

e Total revenue per line 12, Form 990 (linecplus line d) ll~ e 275801051 .

Part V List of Officers . Directors . Trustees, and Kev I

No 76 Did the organization engage in any activity not previously reported to the IRS If Yes' attach a detailed description o1 each activity 76 77 Were any changes made in the organizing or governing documents bud not reported to the IRS? ( SEE ATTACHMENT) 77 X

It *Yes .' attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of $1000 or more during the year covered by this return? 783 X

D I1 Yes ; has it tiled a tax return on Farm 990-T for this years 7BU X 79 Was (here a liquidation, dissolution, termination, or substantial contraction during the years 79

If Yes; attach a statement 80 a Is the organization related (other khan by association with a statewide or nationwide organization) through common membership,

governing bodies, trustees, officers, etc , to any other exempt or nonexempt orpanixalion7 Boa X h It'ves'enter lhename oftheorganization " -- SEE STATEMENT 20

exempt OH 0 nonexempt and check whether it is

Localedat " 6901 NORTH 72ND STREET, OMAHA, NEBRASKA ZiP .4 . 68122

1i ED 92 Section 4947(a)(i) nonerempf charitable trusts fling Form 990 in lieu of Form 1041- Check here N/A Form 990 120011

_EGENT HEALTH- Form 990(2001) ORGAN MERCY HEALTH SYSTEM 7-

81 a Enter direct or indirect political expenditures See line 81 instructions 81a 0 . h Did the organization file Form 1120-POL for this years B1b X

82 a Did the organization receive donated services or the use of materials equipment or facilities at no charge or at substantially less than fair rental value? (SAE PART V) 82a X

b II 'Yes ' you may indicate the value of these items here Do not include this amount as revenue in Part I of as an expense in Pan II (See instructions in Part III ) 82b

83 a Did the organization comply with the public inspection requirements for returns and exemption applications? B3a X h Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b X

84 a Did the organization solicit any contributions or gifts that were not tax deductiDle9 84a X b 11 Yes; did the organization include wild every solicitation an express statement that such contributions or gifts were not

tax deductible? B46 X, &5 501(c)(4), (S), or (6) organizations a Were substantially all dues nondeductible by members N/A BSa

6 Die the organization make only in-house lobbying expenditures o1 E2,000 or less N/A 85b It Yes' was answered to either 85a or 85b, do not complete BSc through 85h below unless the organization received a waiver for proxy tax owed for the poor year

c Dues assessments, and similar amounts from members 85c N / A d Section 162(e) lobbying and political expenditures 85d N/A e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices BSe N ~A 1 Taxable amount at lobbying and political expenditures (line BSA less BSe) 851 N/A g Does the organization elect to pay the section 6033(e) tax on the amount in BSn N / A BS A If section 6033(e)(1)(A) dues notices were sent does the organization agree to add the amount in 85t to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following lax years N / A B5h 85 501(c)(7) organizations Enter a Initiation lees and capital contributions included on line 12 B6a N / A

D Gloss receipts, included online 12, for public use of club facilities B6b N/A 87 501(c)(12) organizations Enter a Gross income from members or shareholders 87a N/A

b Gross income from other sources (DO not net amounts due or paid 1o ether sources against amounts due or received from them ) B76 N / A

BB At any time during the year did the organization own a 50% or greater interest in a taxable corporation or partnership of an entry disregarded as separate from the organization under Regulations sections 3017701-2 and 301 770t-39 II Yes; complete Part IX 88 X

89 a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 . 0 . , section 4912 . 0 . , section 4955 . 0 .

h 501(c)(3) and 507(c)(4) orgenrzehons Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction tram a poor year If 'Yes' attach a statement explaining each transaction 89111 X

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 991 2, 4955, and 4958 . 0 .

d Enter Amount of tax on line 89c, above, reimbursed by the organization to. 0 . 90 a Lisp the sates with which a copy of this return is filed 11~ NONE

h Number of employees employed in the pay penod that includes March 12, 2001 SEE STMT . 30 ~ 90h 2569

91 inenooksaieincaieof DWIGHT YOUNGMAN, CFO Telephone no 1 902 -343-431

HEALTH-MERCY HEALTH SY 6 Form 990

Note Enter gross amounts unless otherwise "'" indicated (p) E Business

93 Program service revenue code a SEE STATEMENT 21 h t a e f Medicare/Medicaid payments q Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary

cash investments 96 Dividends and interest from securities 97 Net renal income or (loss) from real estate

a debt-financed property

b not debt-financed property 98 Net rental income or (loss) from personal properly 99 Other investment income 100 Gain or (loss) from sales of assets

other than inventory 101 Not income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue

a MISCELLANEOUS b SYSTEM MGMT ALLOCATION CHILD CARE

a MEDICAL TRANSCRIPTION e

104 Subtotal (add columns (8), (D), and (E)) 105 Total (add line 104 columns (B) (D), and (E)) Note Line 105 plus line id. Part l, should equal the amount on line

Related of exempt function income

031 534 . 142 .

" 275,995,511 .

Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See Specific Instructions on page 32)

Line No Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization s " exempt purposes (other than by providing funds for such purposes)

EE STATEMENT

of I Nature of activities Name, address, arid'EIN of income

Use Only r~~ ~f p ' SUITE 1501, TWO CENTRAL

u"6' '~~~`~' ~"d OMAHA NE 68102 o t 02 02 LP . 4 a

iss income e.uvo~ o zwwn 512 513 o. III) E~d~ 101

Amount ,~o~ Amount

141 604,961 .

9

SOecluc instructions on pope 33

(a) Did the organization, during the year, receive any funds directly or indirectly, If (b) Did the organization, during the yeas, pay premiums, directly or mduecty, on a

Nlfrelum incluCln officer) . buaC on

Please n Sign Here 1 SgnaWre t liter

Paid Preparers i ,_ _' signature ~YvA`

Preparer's F�� io, KPMG L

SCHEDULER organization Exempt Under Section 501(c)(0 OMB NO 15a100<7

(Form 990 or 990-EZ) (Except Private Foundation) and Section 501(e), 507(I), 501(k), 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

2001 DepanmmtaltheTreuury Supplementary Information-(See separate instructions .) imemei R~enue seNim " MUST be completed by the above organizations and attached la their Form 990 or 990-EZ

Name oltneorganization ALEGENT HEALTH- Employer identification number BERGAN MERCY HEALTH SYSTEM 47 0984769

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page t otihe instructions Lisp each one If there are none enter 'None ') (a) Name and address of each emplo yee aid (b) Title and average hours (n) c.^~^o~~, .^ " to (e) Expense

per week devoted to (e) Compensation =I-d= account and oil mare than E50 000 nnahnn ..m .... . ...., ., Anwanroc

HYSICIAN

0

HYSICIAN

0

HYSICIAN ENEH E . OKORUWA, M .D .

715 HARMONY . CO BLUFFS 51503

WILLIAM J . BUSSEY,_ M .D . PHYSICIAN

800 MERCY DRIVE . CO BLUFFS, IA 51503140 231 .880-121 .509 .1 0 .

GROSS, IWERSEN, KRATOCHVIL 6 KLEIN, PC

7710 MERCY ROAD, OMAHA, NE 68124 PHYSICIANS 50,958 .

Total number of others receiving aver $50,000 for professional services ~ 0 LHA For Papenrork Reduction Act Notice, see the Instructions for Form 990 and Form 990 EZ Schedule A (Form 990 or 990-E2) 2001

231 01 (2 7901

JOSEPH E . HOAGBIN, M .D .

800 MERCY DRIVE . CO BLUFFS, IA 5150

SRIRAMAM RAVIPATI, M .D .

254,615 .1 25,027 .1 0 .

SAMUEL HS CHOY, M .D . PHYSICIAN

800 MERCY DRIVE, CO BLUFFS IA 5150390 239,470 . 32,177 . 0 . Total number of other employees paid over E50 000 . 477 Part II Compensation of the Five Highest Paid Independent Contractors for Professional Services

(See page 2 of the instructions List each one (whether individuals of bans) If there are none, enter'NOne')

(a) Name and address of each independent contractor paid more than E50 000 (b) Type of service (c) Compensation

PROFESSIONAL- ANESTHESIA- SERVICES

11440 W . CENTER RD ., OMAHA, NE 68144 PHYSICIANS ~ 288 .276 .

PULMONARY MEDICINE SPECIALISTS PC

7

BERGAN CARDIOLOGY SPECIALISTS

7710 MERCY ROAD OMAHA NE 68124 PHYSICIANS 102,833 .

NEUROPHYSIOLOGY CONSULTANTS, LLC

11123 N 72 ST . OMAHA . NE 68122 PHYSICIANS 77,250 .

HEALTH-MERCY HEALTH SYSTEM 7-0989769 Schedule A (Form 990 or

Part I 1 Statements About Activities (See page 2 of the instructions ) No

D Lending of money or other extension o1 credits

cFurnishing olgoods,services,orfacnities? (SEE STMT . 32)

d Payment 01 compensation (or payment of reimbursement of expenses if more than $7 000) SEE PART V, FORM

e transfer of any part of its income or assets ( SEE STMT . 32 )

6 of the instructions

13 E::] An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (7) lines 5 through 12 above or (2) section 501(c)(4) (5) or (6) if they meet the test of section 509(a)(2) (See section 509(a)(3) )

Provide the following information about tie supported organizations (See page S of the instructions )

(6) Line number from above (a) Name(s) of suppohed organixation(s)

Section 509fa1141 (See nape 6 of the 14 Schedule A (Farm 990 or 990 EZ) 2001

177111 01 07 02

1 During the year, has the organisation attempted to influence national state or local legislation including any attempt to influence public opinion on a legislative matter or reterendum9 11'Ves' enter the total expenses paid or incurred in connection with the

lobbying actrviles " E 88,985 . $ 11,666 . (Must equal amounts on line 38, Part VI-A,

orline lofPart Vl-B) (LINE 38a) (LINE 38b) Organizations that made an election under section 501(h) by tiling Form 5768 must complete Part VI-A Other organizations checking

'Yes ; must complete Part VI-0 AND attach a statement giving a detailed description of the lobbying activities 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors

trustees, directors, officers creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director trustee, majority owner, or principal beneficiary? (If the answer to any question is "Yes," attach a detailed statement explaining the transactions)

a Sale exchange or leasing of property?

3 Does tie organization make grants for scholarships, fellowships, student loans etc 7 (See Note below ) 4 Do you have a section 403(h) annuity plan for your employees? ( SEE STMT . 31 )

Note Attach a statement to exploit how the organization determines that individuals or organizations receiving grants or loans from itinlurtheranceof itschantableprograms 'quality" toreceive payments SEE STATEMENT

The organization is not a private foundation because it is (Please check only ONE applicable box ) 5 [-] Achurch,convention olchurches or association olchurches Section 170(b)(1)(A)(i) 6 E::] A school Section 170(b)(1)(A)(n) (Also complete Part V ) 7 ~X A hospital of a cooperative hospital service organization Section 170(b)(I)(A)(ni) B [-] A Federal state or local government or governmental unit Section 170(b)(1)(A)(v)

9 0 A medical research organization operated in conjunction with a hospital Section 170(b)(7)(A)(ni) Enter the hospital's name, city,

and state 10 D An organization operated for the benefit of a college or unrversAy owned or operated by a governmental and Section 770(b)(t)JA)(rv)

(Also complete the Support Schedule in Part IV-A ) 11a ~ An organization that normally receives a substantial part of its support from a governmental unit or from the general public

Section 170(b)(7)(A)(vi) (Also complete the Support Schedule in Part IV-A ) 11b 0 A community gust Section 170(b)(t)(A)(vi) (Also complete the Support Schedule in Part IV-A )

12 0 An organization that normally receives (1 ) more than 33 1/3% of its support tram contnbutions, membership tees and gross

receipts from activities related to its charitable, etc , functions -subjecl to certain exceptions and (2) no more than 33 7(3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired

by the organization otter June 30, 7975 See section 509(a)(2) (Also complete the Support Schedule in Part IV-A )

HEALTH-MERCY HE A (Form 990 or -0489769 Page 3

bins NBA ;counnn

(e) Total

if you checked a box online 10, 11, or 12 ) Use cash meths n the instructions for convertina from the accrual to the cash

year

27 Organizations described On line 12 a For amounts included in lines 15, 16 and 17 gnat were received from a'disqualitied person' prepare a list for your records to show the name of, and total amounts received in each year from each 'disqualified person' Do not file this list with your return Enter the sum of such amounts for each yeas (2000) (1999) (7998) (1997)

b For any amount included in line 17 that was received from each peson (other than 'disqualified persons') prepare a list for your records to show the name of and amount received for each year, that was more khan the larger of (1) the amount on line 25 for the year or (2) $5 000 (Include in the list organizations described in lines 5 through 11, as well as inArviOuals ) Do not file this list with your return After computing the difference between tie amount received and the larger amount described in (t) or (2), enter the sum of these differences (the excess amounts) for each yeas (2000) (1999) (1998) (1997)

16 21

c Add Amounts from column (e) for lines 15 17 20

D Add Line 27a total and line 27b total " 27A N / A e Public support (line 27c total minus line 27d total) " 27e N / A I Total support tot section 509(a)(2) test Enter amount on line 23 column (e) " 27t N / A g Public support percentage (line 27e (numerator) divided by line 271 (denominator)) 1 27 N/A %

h Investment income percentage (line 18, column (e) (numerator) divided by line 2711 (denominator)) It- 27h N/ A %

28 Unusual Grants For an organization described in line 10, 11, or 12, that received any unusual grants during 1997 through 2000 prepare a list tai your records to show for each year the name of tie contributor, the date and amount of the grant and a brief description of tie nature of the grant Do not file this list with your return Do not include these grants in line 15

123121 12 29 - 01 Schedule A (Form 990 or 990-EZ) 2001

15 Girls prang and mnMbuuona reccve0 (DOna1induce unuauYprenb Sea line 28 )

16 Membership tees received

17 Gross receipts from admissions merchandise sold or services performed, or furnishing of facilities in any activity that is relayed to the organization's charitable, etc , purpose

18 Gross income from interest, dividends, amounts received from payments an securities loans (section 512(a)(5)), penis, royalties and unrelated business taxable income (less section 511 lazes) from businesses acquired by the organization after June 30, 1975

19 Net income from unrelated business

activities not included in line 18 20 Tai revenues; IwiW for one or,pnixauon a

benefit and amer paid to it or wpenCeC on Ltit behalf

21 Tie value of serves or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or facilities generally furnished to the public without charge

22 ONerinmme Atixh a schedule Do not induce can or lots) from safe of ca,:iitud d5"6

23 Total of lines 15 through 22 0 . 1 0 . 0 . 0 . 0 . 24 Line 23 minus line 17

25 Enter 1% of line 23

26 Organizations described on lines 10 or 11 a Enter 2% 01 amount in column (e) line 24 1 26a N/A

b Prepare a list for your records to show the name of and amount conlnbuteU by each person (other than a governmental

unit or publicly supported organization) whose lout gifts for 1997 through 2000 exceeded the amount shown in line 26a

Do not lile this list with your return Enter the total at all these excess amounts " 26b N/A

c Tout support for section 509(a)(1) test Enter line 24, column (e) 1 26c N/A

d Add Amounts from column (e) for lines 18 79

22 2sb " 26a NBA

e Public support (line 46c minus line 26d total) It- 25e N/A

f Public support percentage (line 26e (numerator) divided by line 26e (denominator) 1 261 N/A i

34 a Does the organization receive any financial aid or assistance from a governmental agency? b Has the organization s right to such aid ever been revoked or Suspended?

It you answered 'Yes'to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 OS of Rev Proc 75-50,

1975-2 C B 587 . covenna racial nondiscrimination? It 'No.- attach an explanation Schedule A (Form 990 or 990-EZ) 2001

17]1J1 12 2401

~ALEGENT HEALTH- Schedule A(FOrm990or990-EZ)20If~ BERGAN MERCY HEALTH SYSTEM ~47-0984769 Pages

Part V Private School Questionnaire (Seepage 7 of the instructions) N/A (To be completed ONLY by schools that checked the box on line 6 in Part IV)

29 Does tie organization have a racially nondiscriminatory policy toward students by statement in its charter bylaws other governing Yes No

instrument, or in a resolution of its governing body 29 30 Does the organization include a statement 01 its racially nondiscriminatory policy toward students in all its brochures catalogues,

and other written communications with the public dealing with student admissions, programs, and scholarshiDS9 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper of broadcast media doling the period of

solicitation for students, or during the registration period if it has no solicitation program in a way that makes the policy known to all parts of the general community it serves 31 If Yes; please describe, if'NO ; please explain (It you need more space, attach a separate statement

32 Does the organization maintain the following a Records indicating the racial composition of ine student body, laculry, and administrative staft7 b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis c Copies of all catalogues, brochures, announcements, and other written communications to tie public dealing with student

admissions, programs, and scholarships? d Copies of all material used by the organization or on its behalf to solicit contn6utions9

11 you answered No* to any of the above, please explain (II you need mole space, attach a separate statement ~

33 Does the organization discriminate by race in any way with respect la a Students' rights or pwileges7 D Admissions policies c Employment of faculty or administrative staff 9 d Scholarships or other financial assistance? e Educational poliaes7 1 Use of facilihes9 q Athletic programs h Other extracurricular activities7

It you answered 'Yes'to any of tie above, please explain (It you need more space, attach a separate statement ~

"ALEGENT HEALTH- Schedule n (Form 990 or 990-EZ) 200i BERGAN MERCY HEALTH SYSTEM 47-0484764 Page 5 PaR VI-A Lobbying Expenditures by Electing Public Charities (see page 9 of the instructions)

(TO be completed ONLY by an eligible organization that tiled Form 5768) ( SEE STMT . 33 )

Check 1 a n d no. nrnanvahnn halnnns fn an atfihatnd nrnun fhnc4 1 h n d urn, chnc4oA "a" and 'hmrtan rnntml' nn.,, annc annA,

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from the following table

II the amount an line 40 is - The lobbying nontaxable amount Is -

Not over S500 000 20% of Me lunount on tons 40

Over5500000CU1notover 51000000 $100 000 plus 15% of the ucess over $50D000

Overf1000000pu1nolover 31500000 f175000plus 10%olNewcafaover f1000000

Over $1,500 Dan but not over 517000000 $275,000 plus 5% 01 the ucesa wei 51 300000

Over f 17 000 000 $1 .000 000

42 Grassroots nontaxable amount (enter ZS% of line 41) 43 Subtract line 42 from line 36 Enter-0-ii line 42 is more than line 36 44 Subtract line 47 from line 38 Enter -0-A line 47 is more than line 38

494,032,707 .1265,998,270 .

1 .000 .0

Caution 11 there is an amount on ether line 43 or line 44, you must file Form 4720

67 78 .047 .

250,000 .1 250,000 .1 1,000,00 49 Gessroots ceiling amount

50 Giassrootslo6bying expenditures I I I I 0

Part VI-B Lobbying Activity by Nonelectme Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 12 of fee instructions ) N / A

During the year did the organization attempt to influence national, state or local legislation including any attempt to Yes No Amount

influence public opinion on a legislative matter or referendum, through the use of a Volunteers h Paid staff or management (Include compensation in expenses reported an lines e through h e Media advertisements d Mailings to members, legislators or the public e Publications, of published or broadcast statements 1 Grants to other organizations for lobbying purposes p direct contact with legislators their staffs, government officials, or a legislative body h Rallies, demonstrations seminars, conventions, speeches, lectures or any peer means I Total lobbying expenditures (Add linese through h ) ~ 1 0 .

It 'Yes'to any of the above also attach a statement giving a detailed description of the lobbying activities izain i2 ss-oi Schedule A (Form 990 or 990-EZ) 2001

Limits on Lobbying Expenditures

term 'expenditures' means amounts paid or incurred )

(a) (D) Affiliated group To be completed for ALL

totals electing organizations

Calendar year for fiscal year beginning in) 1111 . 45 Lobbying nontaxable

06 lobbying ceiling amount

47 Total lobbying

OB Grassroots nontaxable

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns

below See the instructions tar lines 45 through 50 on Oape 11 of the instructions I

Lobbying Expenditures During 4-Year Averaging Period

(a) (6) (c) (d) 2001 2000 7999 7998

1 .000 .000 .

lei Total

250,000 .1 250,000

ALEGENT HEALTH- Schedule A (Farm 990 or 990-EZ) * BERGAN MERCY HEALTH SYSTEM ~ 7-0484764 Page 6 Part YII Information Regarding Transfers To and Transactions and Relationships With Nonchantable

Exempt Organizations (See oaoe iz of the instructions I 51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations9 a Transfers from the reporting organization to a noncharRaDle exempt organization o1 Yes No

(i) Cash Sla(i) X ( d ) Other assets a(u) X

b Other transactions (i) Sales or exchanges of assets with a nonchantable exempt organization b(i) X (ii) Purchases of assets from a noncharAable exempt organization h(ii) X (ui) Rental of facilities equipment, or other asses b(III) X (rv) Reimbursement arrangements b(iv) X (v) Loans or loan guarantees b(v) X vi) Performance of services or membership or fundraising solicitations h(vi) X

c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X 0 If the answer to any of the above is Yes; complete tie following schedule Column (b) should always show the fair market value of the

goads, other assets, or services given by tie reporting organization If the organization received less than fair market value in any

52a Is the organization directly or indirectly affiliated with, or related to one or more tax-exempt organizations described in section 501(c) of tie Code (other than section 501(c)(3)) or in section 527 " OX Yes ~ No

ALEGENT HEALTH- IDGAN MERCY HEALTH SYST

RENTAL INCOME I FORM 990

I TOTAL TO FORM 990, PART I, LINE 6A

STATEMENT S) 1

KIND AND LOCATION OF PROPERTY

I NON-DEBT FINANCED REAL PROPERTY RENTAL

" 47-0989769

STATEMENT 1

ACTIVITY GROSS NUMBER RENTAL INCOME

1 1,883,708 .

1,883,708 .

" 47-0484769 ALEGENT HEALTH- jrGAN MERCY HEALTH SYST

SALE OF INVESTMENTS

TOTAL TO FM 990, PART I, LN 8

STATEMENT S) 2

FORM 990 GAIN (LOSS) FROM NON-PUBLICLY TRADED SECURITIES STATEMENT 2

DESCRIPTION

NET GAIN OR (LOSS)

<769,412 .>

<769,412 .>

STATEMENT S) 3

I ALEGENT HEALTH- *GAN MERCY HEALTH SYST " 47-0989764

FORM 990 GAIN (LOSS) FROM SALE OF OTHER ASSETS STATEMENT 3

DATE DATE METHOD II DESCRIPTION ACQUIRED SOLD ACQUIRED

LAND VARIOUS VARIOUS PURCHASED

GROSS COST OR EXPENSE NET GAIN SALES PRICE OTHER BASIS OF SALE DEPREC OR (LOSS)

141,835 . 211,835 . 0 . 0 . <70,000 .>

DATE DATE METHOD DESCRIPTION ACQUIRED SOLD ACQUIRED

LAND IMPROVEMENTS VARIOUS VARIOUS PURCHASED


0 . 742,439 . 0 . 726,236 . <16,203 .>


BUILDINGS VARIOUS VARIOUS PURCHASED


58,165 . 5,222,228 . 0 . 9,181,963 . <982,100 .>


II FIXED EQUIPMENT VARIOUS VARIOUS PURCHASED

GROSS COST OR EXPENSE NET GAIN SALES, PRICE OTHER BASIS OF SALE DEPREC OR (LOSS)

90 . 529,283 . 0 . 489,095 . <90,098 .>


MOVEABLE EQUIPMENT VARIOUS VARIOUS PURCHASED


975 . 1,083,008 . 0 . 1,015,975 . <66,058 .>

TO FM 990, PART I, LN 8 201,065 . 7,788,793 . 0 . 6,413,269 . <1179959 .>

" 47-0484769 ALEGENT HEALTH- *GAN MERCY HEALTH SYST

STATEMENT S) 4

FORM 990 SPECIAL EVENTS AND ACTIVITIES STATEMENT 9

GROSS CONTRIBUT . GROSS DIRECT NET DESCRIPTION OF EVENT RECEIPTS INCLUDED REVENUE EXPENSES INCOME

CANDLELIGHT DINNER RECOGNITION 6 FUNDRAISING EVENT 136,128 . 0 . 136,128 . 37,937 . 98,191 .

TO FM 990, PART I, LINE 9 136,128 . 0 . 136,128 . 37,937 . 98,191 .

STATEMENT S) 5

ALEGENT HEALTH- ]*GAN MERCY HEALTH SYST " 97-0484764

FORM 990 INCOME AND COST OF GOODS SOLD STATEMENT 5 INCLUDED ON PART I, LINE 10

INCOME

1 . GROSS RECEIPTS . . . . . . . . . . . . . . . 628,086 2 . RETURNS AND ALLOWANCES . . . . . . . . . . . 3 . LINE 1 LESS LINE 2 . . . . . . . . . . . . . 628,086

4 . COST OF GOODS SOLD (LINE 13) . . . . . . . . 453,015 5 . GROSS PROFIT (LINE 3 LESS LINE 4) . . . . . 175,071

COST OF GOODS SOLD

6 . INVENTORY AT BEGINNING OF YEAR . . . . . . . 7 . MERCHANDISE PURCHASED . . . . . . . . . . . 8 . COST OF LABOR . . . . . 9 . MATERIALS AND SUPPLIES . . . . . . . . . . .

10 . OTHER COSTS . . . . . . . . . . . . . . . . 453,015 11 . ADD LINES 6 THROUGH 10 . . . . . . . . . . . 953,015

12 . INVENTORY AT END OF YEAR . . . . . . . . . . 13 . COST OF GOODS SOLD (LINE 11 LESS LINE 12) . . 453,015

ALEGENT HEALTH- 411GAN MERCY HEALTH SYST " 47-0989769

FORM 990 COST OF GOODS SOLD - OTHER COSTS STATEMENT 6

TOTAL INCLUDED ON FORM 990, PART I, LINE lOB 953,015 .

FORM 990 OTHER CHANGES IN NET ASSETS OR FUND BALANCES STATEMENT 7

6,533,917 . I TOTAL TO FORM 990, PART I, LINE 20

FORM 990 OTHER EXPENSES STATEMENT B

162,699 . TOTAL TO FM 990, LN 43 51,707,095 . 46,859,542 . 4,684,859 .

STATEMENT S) 6, 7, 8

DESCRIPTION

I COST OF GOODS SOLD

AMOUNT

453,015 .

DESCRIPTION

CONTRIBUTIONS FOR PURCHASES OF ASSETS CONTRIBUTIONS RESTRICTED BY DONOR UNREALIZED LOSS ON INVESTMENTS TRANSFERS TO AFFILIATED ORGANIZATIONS

I JOA-CAPITAL EXPENDITURES TRANSFER IN OF MEDICAL STAFF FUNDS

AMOUNT

50,000 . 6,477 .

<2,840,501 .> <815,818 .> 9,649,000 .

484,759 .

(A) (B) (C) PROGRAM MANAGEMENT

I DESCRIPTION TOTAL SERVICES AND GENERAL

BAD DEBTS 12,821,878 . 12,821,878 . 0 . ADVERTISING/PUBLIC RELATIONS 2,201,562 . 1,114,895 . 1,086,717 . AMORTIZATION 12,386 . 12,386 . 0 . INSURANCE 1,136,069 . 786,043 . 350,026 . MEMBERSHIP b DUES 273,278 . 273,278 . 0 . MISCELLANEOUS 1,012,084 . 692,233 . 319,851 . PRO FEES S CONTRACT LABOR 12,541,964 . 12,250,759 . 291,205 . PURCHASED SERVICES 20,664,684 . 18,157,961 . 2,507,223 . RECRUITING FEES 467,159 . 337,327 . 129,832 . TAXES & LICENSES 413,332 . 913,332 . 0 . BERGAN AUXILIARY 124,556 . MERCY AUXILIARY 38,143 .

(D)

FUNDRAISING

0 .

0 . 0 . 0 . 0 .

0 . 0 . 0 . 0 .

124,556 . 38,143 .

FORM 990 SPECIFIC ASSISTANCE TO INDIVIDUALS STATEMENT 10

DESCRIPTION

SEE STATEMENT 24

TOTAL TO FORM 990, PART II, LINE 23

STATEMENT S) 9, 10

ALEGENT HEALTH- *GAN MERCY HEALTH SYST " 47-0484769

FORM 990 CASH GRANTS AND ALLOCATIONS STATEMENT 9

DONEE'S CLASSIFICATION DONEE'S NAME RELATIONSHIP AMOUNT

ANNUAL GIFT MERCY FOUNDATION AFFILIATE 10,000 .

Ii CHARITABLE WINGS OF HOPE AFFILIATE CONTR . 3,500 .

CANDLELIGHT MERCY FOUNDATION AFFILIATE BALL 8,400 .

GOLF CLASSIC BERGAN FOUNDATION AFFILIATE 10,500 .

CHARITABLE BETH EL SYNAGOGUE NONE CONTR . 1,000 .

MISC . VARIOUS NONE CONTRIBUTIONS 915 .

CHARITABLE HOSPICE HOUSE AFFILIATE CONTR . 20,000 .

TOTAL INCLUDED ON FORM 990, PART II, LINE 22 53,815 .

AMOUNT

141,189 .

141,189 .


OTHER PUBLICLY TOTAL

CORPORATE CORPORATE TRADED OTHER NON-GOV'T SECURITY DESCRIPTION STOCKS BONDS SECURITIES SECURITIES SECURITIES

BOARD DESIGNATED INVESTMENTS 22,987,491 . 22,987,991 . HOARD DESIGNATED INVESTMENTS 10,588,770 . 10,588,770 .

TO 990, LN 54 COL B 22,987,491 . 10,588,770 . 33,576,261 .

FORM 990 GOVERNMENT SECURITIES STATEMENT 12

STATE AND TOTAL GOV T LOCAL GOVT SECURITIES

TOTAL TO FORM 990, LINE 54, COL B 7,007,678 . 7,007,678 .

FORM 990 OTHER INVESTMENTS STATEMENT 13

COST

TOTAL TO FORM 990, PART IV, LINE 56, COLUMN B 13,600 .

FORM 990 OTHER ASSETS STATEMENT 14

TOTAL TO FORM 990, PART IV, LINE 58, COLUMN B

STATEMENT S) 11, 12, 13, 14

FORM 990 NON-GOVERNMENT SECURITIES STATEMENT 11

DESCRIPTION

BOARD DESIGNATED INVESTMENTS

U .S . GOVERNMENT

7,007,678 . 7,007,678 .

', DESCRIPTION

JOINT VENTURES

VALUATION METHOD AMOUNT

13,600 .

DESCRIPTION

DEFERRED COMPENSATION BERGAN AUXILIARY ASSETS MERCY GUILD ASSETS INTERCOMPANY RECEIVABLES MEDICAL STAFF ASSETS

AMOUNT

800,269 . 99,060 .

203,275 . 97,111,391 .

569,461 .

98,778,956 .


I FORM 990 OTHER LIABILITIES STATEMENT 15

TOTAL TO FORM 990, PART IV, LINE 65, COLUMN B 26,959,611 .

FORM 990 OTHER REVENUE NOT INCLUDED ON FORM 990 STATEMENT 16

TOTAL TO FORM 990, PART IV-A

OTHER EXPENSES NOT INCLUDED ON FORM 990

DESCRIPTION

TOTAL TO FORM 990, PART IV-B

OTHER REVENUE INCLUDED ON FORM 990

DESCRIPTION

1,034,223 . TOTAL TO FORM 990, PART IV-A

STATEMENT S) 15, 16, 17, 18

DESCRIPTION

THIRD PARTY PAYOR RESERVE INTERCOMPANY PAYABLES

AMOUNT

8,844,291 . 18,115,320 .

DESCRIPTION

OTHER ENTITIES REPORTED ON THEIR OWN RETURN

I FORM 990

OTHER ENTITIES REPORTED ON THEIR OWN RETURN OTHER REVENUE ALLOCATION RECLASS COST OF GOODS SOLD SPECIAL EVENT EXPENSE

FORM 990

BERGAN AUXILIARY INCOME MEDICAL STAFF INCOME MERCY GUILD INCOME OTHER REVENUE ALLOCATION RECLASS COST OF GOODS SOLD SPECIAL EVENT EXPENSE

AMOUNT

11,189,172 .

11,189,172 .

STATEMENT 17

AMOUNT

11,405,297 . <1,021,960 .>

453,015 . 37,937 .

10,874,289 .

STATEMENT 18

AMOUNT

292,870 . 180,039 . 30,306 .

1,021,960 . <953,015 .> <37,937 .>


I FORM 990 IDENTIFICATION OF RELATED ORGANIZATIONS STATEMENT 20

PART VI, LINE BOB

BERGAN MERCY FOUNDATION, INC . ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IOWA MERCY HOSPITAL FOUNDATION, COUNCIL BLUFFS, IOWA MERCY MEDICAL OFFICE BUILDING, INC .

X X X X X

STATEMENT S) 19, 20, 21

FORM 990 OTHER EXPENSES INCLUDED ON FORM 990 STATEMENT 19

DESCRIPTION AMOUNT

BERGAN AUXILIARY EXPENSES 285,745 . MEDICAL STAFF EXPENSES 95,337 . MERCY GUILD EXPENSES 38,143 .

TOTAL TO FORM 990, PART IV-B 419,225 .

NAME OF ORGANIZATION EXEMPT NONEXEMPT

FORM 990 PROGRAM SERVICE REVENUE STATEMENT 21

RELATED OR BUS UNRELATED EXCL EXCLUDED EXEMPT FUNC-

DESCRIPTION CODE BUSINESS INC CODE AMOUNT TION INCOME

NET PATIENT SERVICE REV 621500 1,599,077 . 272,291,156 . MCCAULEY BERGAN 33,752 . FOOD SERVICE 722320 167,399 . 03 1,023,727 . LAUNDRY SERVICES 812300 43,507 . 03 38,962 . RETAIL PHARMACY 621500 2,811,062 . 03 1,399,979 . HEALTH EDUCATION PRGMS 69,863 . JOINT HEALTH VENTURES <13,677,067 .> HME SALES 03 20,900 . REIMBURSABLE AFFILIATES 4,956,579 .

TO FORM 990, PART VII, LINE 93 4,621,045 . 2,427,563 . 263,669,283 .

STATEMENT S) 22, 23

ALEGENT HEALTH- IDGAN MERCY HEALTH SYST " 97-0484764

FORM 990 PART VIII - RELATIONSHIP OF ACTIVITIES TO STATEMENT 22 ACCOMPLISHMENT OF EXEMPT PURPOSES

LINE EXPLANATION OF RELATIONSHIP OF ACTIVITIES

93A NET PATIENT SERVICES INCLUDES ACUTE, INPATIENT ANCILLARY AND OUTPATIENT CARE SERVICES IN SUPPORT OF OUR MISSION TO PROVIDE HIGH QUALITY, COST-EFFECTIVE HEALTH CARE TO OUR COMMUNITY

93B REPRESENTS INCOME FROM THE MEDICAL CENTER'S SENIOR DAY CARE PROGRAM WHICH PROVIDES MEALS, ACTIVITIES AND REGULAR INTERACTION WITH PEERS AND TRAINED GERIATRIC PROFESSIONALS

93F IN ACCORDANCE WITH ITS MISSION TO IMPROVE THE HEALTH STATUS OF THE COMMUNITY, ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM OFFERS NUMEROUS HEALTH EDUCATION CLASSES, OPEN HOUSES, AND HEALTH SCREENINGS .

93G RESULTS FROM JOINT VENTURE ACTIVITIES WITH OTHER NON-PROFIT HEALTH ORGANIZATIONS .

931 REPRESENTS REIMBURSEMENTS FOR HEALTH AND SUPPORT SERVICES PROVIDED TO RELATED NON-PROFIT ORGANIZATIONS

SCHEDULE A EXPLANATION OF QUALIFICATIONS TO RECEIVE PAYMENTS STATEMENT 23 PART III, LINE 4

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 TO ENSURE THAT THEY ARE QUALIFIED RECIPIENTS .

r1

Specific Assistance to Individuals:

STATEMENT 24

Alegent Health "Bergan Mercy Health System 47-0484764 2001 Tax Return

FORM 990, PART II, LINE 23

The Mercy Fund is administered by the Bergan Mercy Auxiliary This fund is composed primarily of donations made to primarily Bergan Mercy Medical Center employees who are in crisis situations such as losing an apartment due to nonpayment of rent, car repairs, etc

20,676,229 Total

STATEMENT 25

Alegent Health-Bergan Mercy Health System 47-0484764 2001 Tax Return

FORM 990. PART IV. PAGE 3. LINE 57 (a)

Borrower Dr Thomas Van Geem Original Amount $ 96,700 Amount Outstanding $ 56,141 Date of Original Note 11/01/96 Interest Rate 7% Security Provided None Purpose of Loan To assist the borrower in locating his

OB/GYN practice in Omaha to further develop BMHS' mission in the community

Amount Outstanding

Notes Receivable-Midlands 8 Lakeside

56,141

20,620,088

Douglas E Parrott Barley Lauerman 900 Wells Fargo Center Lincoln, NE 68503

Charles McMinn, M D 8613 North 30th Street Omaha, NE 68112-1807

Charles J Marr CEO-Alegent Health 1010 N 96th Street, Suite 200 Omaha NE 68114-2595

STATEMENT 26

Alegent Health-Bergan Mercy Health System 47-0484764 2001 Tax Return Directors

FORM 990 . PART V

Lawrence Beckman Smith Peterson Law Firm 35 North Main, Suite 300 Council Bluffs, IA 51502

Timothy J Burke Omaha Public Power District 444 South 16th Street Mall SW-EPI Omaha, NE 68102

Sid C Ddlon, Sr Sid Dillon Motors 2500 East 23rd Street P O Box 625 Fremont, NE 68026

John W Hancock C P A Hancock & Dana, P C 12829 West Dodge Road Omaha, NE 68154

Deborah Lee Eddie Senior Vice President Operations Catholic Health Initiatives 7999 Broadway, Suite 2600 Denver . CO 80202

William E Seim, C P A 6018 Oak Hills Drive Omaha, NE 68137

Vice-Chair Kathryn M Mershon The Mersohn Company 2311 Raleigh Lane Louisville, KY 40206

Edgar H Smith, M D SeclTreas 315 North 97th Court Omaha, NE 68114

Sr Lillian Murphy, R S M President 8 CEO Mercy Housing, Inc

Chair 601 East 18th Avenue, Suite 150 Denver, CO 80203

Joseph A Jaaobski, M D Bergen Cardiology Specialists, P D 7710 Mercy Road, Suite 426 Omaha, NE 68124-2346

Directors and Officers serve on a part-time basis (approx 10 hours/month), are not compensated, do not contribute to pension plans, and do not receive expense accounts for services performed in this capacity

Contribution Expense Acct to Employee and Other

Name Organization Title/Hours Compensation Benefit Plans Allowances

Charles J Mart 1010 North 96th Street Omaha, NE 68114-2595

Charles E McMinn, MD 8613 North 30th Street Omaha, NE 68112

Deborah Lee Eddie 1999 Broadway, Suite 2600 Denver, CO 80202

Richard A Hachten II 1010 North 96th Street Omaha, NE 68114-2595

Dwight Youngman 1010 North 961h Street Omaha. NE 68114-2595

AlegentHealth ' CFO-4O+Avk 293,884 86,647 7,800

STATEMENT 27

Alegent Health-Bergan Mercy Health System 47-0484764 2001 Tax Return Compensation from Related Organizations

FORM 990. PART V

Alegent Health' CEO-40+/wk 602,346 152,686 10,508 Alegent Health-Bergan Director 0 0 0 Mercy Health System 602,346 152,686 10,508

Alegent Health Clinic Physiaan-40+Avk 230,263 23,932 0 Alegent Health-Bergan Director 0 0 0 Mercy Health System 230,263 23,932 0

Catholic Health Initiatives Executive-40+twk 412,416 84,727 12.855 Alegent Health-Bergan Director 0 0 0 Mercy Health System 42,416 84,727 12,855

Alegent Health' President-0O+/wk 541,364 144,873 9,600

Donald Manning Alegent Health ' CMO-40"/wk 365,416 91,686 7,800 1010 North 96th Street Omaha, NE 68114-2595

'Charles Marr, Richard Hachten, Donald Manning, and Dwight Youngman provide management services for Alegent Health, Alegent Health-Bergan Mercy Health System, and Alegent Health-Immanuel Medical Center, dividing then time equally between the three

STATEMENT 28


FORM 990 . PART IV. LINE 57 :

Cost or Other Accumulated Book Description Basis Depreciation Value Land 3,143,765 0 3,143,765 Land Improvements 5,716,986 4,090,042 1,626,944 Buildings 103,147,826 60,862,872 42,284,954 Fixed Equipment 36,882,508 25,711,252 11,171,256 Moveable Equipment 95,062,001 66,437,260 28,624,741 Info System Equipment 6,522,311 3,576,450 2,945,861 Construction in Progress 19,581,149 0 19,581,149

Total Land, Buildings, & Equipment 270,056,545 160,677,876 109,378,669

FORM 990. PART II . LINE 42.

Depreciation Expense 13,781,683 Depreciation Allocation 4,230,137

Total Depreciation Expense 18,011,820

Property, Plant, and Equipment are slated at historical cost or, if donated, at the estimated fair market value at the date of receipt Depreciation is calculated using the straight-line method over the estimated lives of the asset

The long-term debt of the hospital as of June 30, 2002 consists of the following

STATEMENT 29


FORM 990. PART IV. LINE 64b :

Date of Note Repayment Terms Interest

Relationship Maturity Date Loan Purpose Rate Balance Promissory Note-CHI January 1, 1999 Annual Installments Between 4 85%

and 5 50% December 1, 2018 Funding of Capital Expenditures 62,895,847

STATEMENT 30


FORM 990. PART VI, Line 90b :

Number of Alegent Health-Bergan Mercy Health System employees whose compensation was reported on Alegent Health-Bergan Mercy Health System's Forth 941

Number of Alegent Health-Bergan Mercy Health System employees whose compensation was reported on Alegenl Health System's Form 941 through a common paymaster agreement 2,569

Number of Alegent Health-Bergan Mercy Health System employees 2,569

STATEMENT 31


FORM 990, SCHEDULE A. PART III . LINE 4:

Ategent Health-Bergan Mercy Health System does not have a section 403(b) annuity plan However, its employees can and do participate in the Alegenl Health defined contribution and defined benefit retirement program

STATEMENT 32


Schedule A, Part In, Line 2 :

Alegent Health Creighton Saint Joseph Managed Care Services, Inc , a taxable corporation majority-owned by Alegent Health, provides contracting and physician relations services to Alegent Health and affiliated corporations Alegent Health furnishes all property used by Alegent Health Creighton Saint Joseph Managed Care Services, Inc , provides legal, financial, management, marketing, information systems, and personnel services, and provides operating funds as needed

STATEMENT 33


Form 990. Schedule A. Part VI-A Alegent Health- Alegent Health- Bergan Mercy Immanuel

Name of Organization Alegenl Health Health System Medical Center Total

EIN Number 47-0757164 47-0484764 47-0376615

Grassroots Lobbying Expenditures none none none

Direct Lobbying Expenditures $ 65,650 $ 11,666 $ 11,669 $ 88,985

Other Exempt Purpose Expenditures $ 60,851,145 $ 265,998,270 $ 167,183,292 $ 494,032,707

Total Exempt Purpose Expenditures $ 60,916,795 $ 266,009,936 $ 167,194,961 $ 494,121,692

Lobbying Nontaxable Amount $ 1,000,000 $ 1,000,000 $ 1,000,000 $ 7,000,000

Grassroots Nontaxable Amount $ 250,000 $ 250,000 $ 250,000 $ 250,000

Excess Grassroots Lobbying none none none none

Excess Direct Lobbying none none none none

F«� . 8868 Application for Extension of Time To File an (Decent., _0W) Exempt Organization Return OMB No 155-1709

~w �°~ p,�� e ~ " File a separate application fix each return

" If you are filing for an Automatic 3-Month Extension, complete only Pan I and check this box " II you are filing for an Additional (not automatic) 3-Month Extension, complete only Pan II (an page 2 of this form) Note . Do not complete Part 11 unless you have already been granted an automatic 3-month extension on a previously filed Form 896d LUM Automatic 3-Month Extension of Time-Only s Note : Form 990.T corporations requesting an automatic 6-month ext AO other corporations (lnNudmg Form 990-C hers) must use Form returns Partnerships, REMICs and trusts must use Form 8736 to r

7004 to request an extension of time to file income tax ,quest an extension of time to file Form 1065, 1066, a 1011

Employer Identification ritimbe 47 : 0484764

Name d Exempt Organization Alegent Health " Bergen Mercy Health

Type or print File 6y 1M du dsb la riling yow n~um Sae mancvom

Number. street. end roan a v 7500 Mercy Road City, lawn a post office, state. Omaha NE 68124

ro 7 a P O box. see Instructiorm

cone ra a foreign eaaess, sets instrLictions

Check type of return to be filed (file a separate application for each return) a Form 990 ~ Form 990-7 (corporation) 0 Form 4720

Form 990-BL ~ Form 990-T (sec 401(a) a 408(a) trust) 0 Form 5227 Form 990-EZ 0 Form 990-T (trust other than above) 0 Form 6069

2 II this tax year is for less than 12 months, check reason 0 Initial return 0 Final return O Change In accounting period

3a If this application Is for Form 990-BL, 99aPF 990.7 4720, a 6069, enter the tentative tax, less any ' nonrefundable credits See Instructions , , , . , , , , , , , , , , , , , , , S

b If this application Is for Form 990.PF a 990.7, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit . . . . . . , , . . , , f

c Balance Due Subtract line 3b horn line 3a Include your payment with this fern, a, d required, deport with FTD coupon a, if required, by using EFTPS (Electronic Federal Tax Payment System) See , instructions , f

Signature and Verification Undo pesxRns of ppury I decbn that I hew wmmd Uo Mm, eri,dng xcompaiy,ri9 crlrd,ln and nat,rt� ,ys end to the best of mr Vw4dpe end MiN a if true cortM, end mnpbn. end Wt 1 em authorized to prspen the form

TN, p . Operations Director Date I- , Form 8868 (12-20001 Cat No 27916D For Paperwork Reduction Act Notice, sea Instruction

il (no copies needed) this box and complete Part 1 only ,

" If we organization does not have an office or place of business In the United States, check this box li0 " II Ws Is for a Group Return, enter the organization's four digit Group Exemption Number (GEN If this Is for the whole group, check this box " 0 If it Is for part of the group, check this box " 0 and attach a Ast with the names and EINs of all members the extension will covet

1 I request an automatic 3-month (6-month, for 990-T corporation) extension of time until . . . . . . . . . 200 '

3,

to file the exempt organization return for the organization named above The extension Is for the organization's return for 0 calendar year 20 __ a D lax year beginning _July.7. . . . . . .. . . . __ . . . . . . . . . . , 20 ~!, and ending .. . ..--

June 30 02 -- ----- °--°--°°-- -- . 20 . .

n U 01

0 If you are Mg for an Additional 4+a automatic) iMorrh Edwlaa complete only Pan 11 and diedc this box . . " 0 NoLk arey oonQlae. Fan a arou fry ar..dy es.n pane.a an rOmeae s~m eroxdon on a prevwuso-tW Form 666s. 0 7 you am (a an AutornaCe 7-Month Extentsim cornplete only Part 1 (on page 1

owt autanslle 3-MaNh Entenslon d Tbr*-Nlusl F9e 1 and One 11d~tbnal '=

ALEGEIR HFJ1L N MERCY HEALTH SYSTEM . " ' , -, , 47 E�Vb".Warmnerlon meter

Fy W dr 0484764

NwEa~ attw4 rd roan a aft m If a P 0 box we Instructions. I

For Muse my atnd~d~ 75M MERCY ROAD

[ay, town a pmt amaR stem, i OMAHA NE B81?A

Cheek typo d return to be Mill File a separate appOCetlon for each retwnk 0 Form 890 D Form 68aQ D Form 9W7 pee 407N a 108W msQ 0 Form 107-A I] Form 5221 D Form 8870 O Farm sso-eL O Pam esaPF O Form sear muse ono men above) D Form ono rl FM� sin

STOV: Do nit eonqYb Pat I f )ou wn nit ate n a~t~d an ifnmAle Il-marh oRwulon an spwlou*Nod Fam !!BL

" If the organization does not here an Wtlce or place d Maslreu In the United Raw, check 7is box . . . . . 1P. D " d Ws k for a (Crag Return, ai0ar the orgardmtbrtS Ide digit Group Exemption Number (GEfj . If this is r« me waA group, d eac this box . o n n m tai part a the group. awac ft box . a and attach a list with the

1 I request an additional 3-month extension of time U!4601 ,o S Far colander year .. ..... . a other we year begkubg ..... . ... . .... ...... . Well end ending JUNE !0 ...... ... . 2dQ~~! B I! this tax yew b for Jim than 12 months. check season. O Mtld re0cn O Final return 13 Change In ecodm"`~ 7 SteOS In d wh THE ORGANIZATION RESPECTFULLY REQUESTS ADDITIONAL TIME' oeT~~ INM°°rtr~rWoNI%ec=6't0 pWXWii'i;BfIPfM7iffD XitUkAVrMi'UAN:'---~°----~--.. .

90. If this application Is for Farm 990.81. 99o-PF 990-7 1720, a 6069, enter the tentstlve tax, less any norueiNMa01e credits. Sae UsCUaforn . . . . . . . . . . . . . . . . . . . . . .

b If Ws application k for Form 99dPF, 99a7 1120, a 6069. enter any reMridable credits and estimated tax payments made. Include anY Prior yew overpayment elbwed as a audit and any amount paid previously With Form 8868 . . . . . . . . . . . . . . . . . .

e Balance Due. Subtract Jim 8b IYam Iris 8e. include ~J~ke Federal Tax Payment

with this form . or, If required , deposit with FTD coupon or, K requYed, by using EFfPS Instructions f

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OPERATIONS DIRECTOR Dam 1~ 2J !o

, ..,~ Nodes w AppYcmrtrTo Be Canpleled by the IRS Qd We hew approved Ws application Please etledi ft font to tea agstrellonh rWrn 13 Wb haw not approved Oft melon Hwwv. w Arm perW a 10-ft pace period Own N0. later d the deb Oman below or the Our

Ads d the o~g~eUon's nlun Ruft9 arN R1w . This gxa plod b meNvW W be a veN amnion d tyro for Wttlve ansWse raWtad w E0. made m a tlmoy rmwn Prs+a etrech ft lam m w agerbeovts rerun

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Alternate Ma" Address - Enter the address H you want the copy of Ude application lot an additional 3-month extension

ALEGEIR MEALTN, ATTIC HMI IQtIEfE, FINANCE Type w Number 0.M itryl 0=Nft 0.4 roam, a apt no.) Or 0 P print 8901 N 7211110 ST

City a win pwlnee a VAW rd coral Pewc" Post OMAHA ME M22-1790

vow 8888 112-moo

STATEMENT 34

ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM 47-0484764 2001 TAX RETURN

FORM 990, PART 111

Statement of Program Service Accomplishments

Alegent Health-Bergan Mercy Health System is composed of Alegent Health Bergan Mercy Medical Center, located m Omaha, and Alegent Health Mercy Hospital, m Council Bluffs, Iowa

Bergan Mercy Health System is part of Alegent Health, one of the largest healthcare systems in Nebraska with seven hospitals, 35 primary care physician offices, 100 outpatient service centers, more than 7,500 associates and 1,500 physicians

Mission Faithful to the healing rrunistry of Jesus Christ, Alegent Health's cmssion is to provide high quality care (or the body, mind and spent of every person Our comrtutment to healing calls us to

create canng 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

For the past several years, Alegent Health was cited as one of the top 100 healthcare systems in the nation m Modem Healthcare magazine The Alegent Health system provided services to more than 37,000 inpatients and 453,000 outpatient visas m fiscal year 2002

Aleeent Health-Ber¢an Mercy Medical Center Bergan Mercy Medical Center is a full-service healthcare provider well known (or it medical expertise Bergan Mercy Health System has achieved leadership in maternity services, orthopedics, cardiovascular services, oncology, surgical services, emergency room care, hospice and senior health services It's new Joint Replacement Center has garnered several awards, has earned very high patent satisfaction scores, and serves as a model for other health care systems across the nation Bergan Mercy Medical Center is Alegent Health's largest hospital and draws more patents from the metropolitan area than any other hospital m Omaha

Bergan Mercy has been providing quarry healthcare since 1910 when the sisters of Mercy opened Saint Catherine's Hospital at Ninth and Forest Streets In 1964, a new 250 bed hospital, now known as Bergan Mercy, was opened at our current location The Hospital was named in honor of the Sisters of Mercy and the late Archbishop Gerald T Dergan Bergan Mercy Hospital became Bergan Mercy Health System of the Midlands in 1985 when Bergan and Mercy Hospital, Council Bluffs, merged During 1991, Bergan Mercy Hospital expanded to offer comprehensive healthcare and became Bergan Mercy Medical Center

In an addendum to the 2001 list of 100 Top Hospitals, Alegent Health-Bergan Mercy Medical Center was honored to be named one of the nation's 100 Top Large Community Hospitals for the fast nine m a recent announcement by Modem Healthcare magazine This selection was deternuned after studying more than 6,000 acute care and specialty hospitals across the United States

STATEMENT 34

ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM 47-0484764 2001 TAX RETURN

FORM 990, PART 111

Ale¢ent Health-Mercy Hospital Alegent Health-Mercy Hospital, located m Council Bluffs, Iowa, includes the Center for Mental Health, the Hospital, and physician office buildings Patient care services include general medical and surgical care, cardiology, pediatrics, the Joint Replacement Center, orthopedics, maternity services, cnucal care, mental health, emergency services, oncology, sleep lab, skilled care and more

Mercy Hospital recently opened a new lobby and entrance area for its patients Future plans include a first of its land Women's Center featuring diagnostic and treatment services as well as alternative and complementary medicine A new Medical Office Building to house both pnmary care physicians and specialists is also bung planned A Heart Center, complete with the most innovative cardiovascular technology and treatments, will be available In addition, the new campus will feature expanded parking and will be more accessible to the public

History: 1887 - Sisters of Mercy founded St Bemards Hospital 1902 - Built Mercy Hospital as an acute care facility 1965 - Merged St Bemards Hospital and Mercy Hospital 1971 - Built a new 284-bed acute care hospital and 40-bed menial health facility known as Mercy Hospital 1985 - Bergan Mercy Hospital and Mercy Hospital, Council Bluffs, merged

Recognizing the benefits of allegiances m health care, Bergan Mercy Health System joined with Immanuel Medical Center to form Alegent Health in June of 1996, while continuing to maintain their separate corporate identities and religious affiliations

Both hospital campuses are currently undergoing mayor remodeling and construction in order to better serve their patients Alegent Health has always been comrtutted to providing excellent care to our patients, and these building projects will highlight how we intend to serve our growing community (or years to come

Community Benefits

In compliance with our mission, Alegent Health Bergan Mercy Health System provides high quarry care (or the body, mind, and spent of every person, without regard to ability to pay Dunng fiscal 2002, Bergan Mercy Health System provided care to 21,356 acute and sub-acute inpatients, 168 long-term care residents, and nearly 24,000 outpatient visas The system provided $1,283,000 of charity care to nearly 700 patients, and unreimbursed patient care was provided to nearly 100,000 Medicaid and Medicare patients at a value of $15 5 million In addition, Alegent Health Bergan Mercy Health System provided nonbilled and subsidized services, such as support groups, screenings, and education, to 613,000 members of the community at a value of S6 5 million The hospitals also forgave $12,821,878 of previously billed medical services to individuals who could not make payments after their treatment

Please see attachment at the end of the tax return for more information on community benefits provided by Alegent Health-Bergan Mercy Health System

BERGAM MERCY HEALTH SYSTEM

* BERGAN MERCY MEDICAL CENTER

*SOUTHWEST IOWA MEDICAL CENTER- COUNCIL BLUFFS

-_-----~~- RcY HOSPITAL= . ~a ---- -_-

McKgighl

Efff6r

" oai1tisooz Bergan Mercy Medicenter Summary of Quantifiable Benefits July 1, 2001 -June 30, 2002 Unclassified Final Report " One Facility

Persons Total BMC Bergan Mercy Medical Served Expense Center

Offsetting Net Community % of Organization Revenue Benefit Expenses Revenues

Traditional Charity Care 493 806,610 0 806,670 0 4 0 4 Unpaid Costs of Medicare 66,927 83,361,841 70,451,276 12,910,565 6 5 5 8 Unpaid Costs of Medicaid 17,278 15,647,806 17,750,525 (2,102,719) (1 1) (09) Community Services NonbiIledServices 351,338 817,253 91,643 725,610 04 03 Medical Education 2,647 617,178 65,783 551,395 0 3 0 2 Subsidized Health Services 122,718 8,895,137 6,109,430 2,785,707 1 4 1 2 Cash 1 Inkmd Donations 6,033 394,948 0 394,948 0 2 0 2 Community Building 0 20,112 0 20,112 0 0 0 0

Community Services - Lona Term Care

Grand Totals, 567,434 110,560,885 94,468,657 16,092,228 8 1 7 2

C`

" Page 1

Expenses Revenues Benefit A - Nonbilled Services

E1 - Cash Donations E2 - Inland Donations

Totals (E - Cash and Inkind Donations)

525 371,071 0 371,071 5,508 23,877 0 23,877 6,033 394,948 0 394,948--

Grand Totals 482,736 10,744,635 6,268,858 4,477,779

0812212007 Alegent Health Bergen Mercy Medical Center All Activities Summary by Category Type

C For period from 0710112001 through 0613012002

# of Persons

A1 - Community Education and Outreach A2 - Screenings A3 - Support Groups A5 - Self-Help A8 - Patient Education A9 - Employee

Totals (A -All Nonbilled Services)

B - Medical Education 87 -PhysiGans, Medical Students B2 - Scholarships/Funding for Prof Educ B3 - Nurses BS - Other Hearth Professionals B8 - Other 07 - Dieticians B8 - Chaplains/SeminariansICPE

Totals (B - Medical Education)

C -Subsidized Health Services C1 - Emergency and Trauma Services C2 - Neonatal Intensive Care C3 - Free-standing Community Clinic C4 - Collaborative Efforts In Preventive Medicine

G -1 C7 - Hospice/Home Care C8 - Other C9 - Employee

Totals (C -Subsidized Health Services)

E-Cash and Inkind Donations

305,912 225,510 41,694 183,818 400 37,353 11,095 28,258

1,085 78,165 5,466 12,699 34 2,020 0 2,020

21,095 80,824 0 80,624 22,812 453,587 33,388 420,199 351,338 817,260 97,643 725,617-

1,981 340,594 19,607 320,987 9 25,838 0 25,836

273 95,975 0 95,975 135 82,233 43,496 38,737 200 470 0 410 35 761 0 781 14 71,369 2,880 68,689

2,647 617,178 65,783 651,395-

45 3,133 0 3,133 301 2,217,935 2,023,882 194,053

8,865 23,695 1,849 21,848 3,939 76,813 758 75,855

69,780 4,839,081 3,358,730 1,280,931 39,654 1,922,321 724,811 1,197,510

154 12,379 0 12,379 122,718 8,895,137 6,109r430 2,785,707

F-All Community Building Activities F3 - Support System Enhancements 0 18,991 0 18,991 F5-Leadership Development and Skills Training 0 1,121 0 1,121

Totals (F -All Community Building Activities) 0 20,172 0 20,172

- J r

1

. , ;'

0812212002 /Uegent Health Bergan Mercy Medical Center Community Education and Outreach - Details For period from 0710112001 through 0613012002

# Persons Expenses Revenues Benefit

Title: 4096 of System Total for Community Education & Outreach (Activity #22) Sex: Both Males and Females

Department: 0 Q Activity Totals 302,211 171,799 14 171,785

Title : Childbirth Education - Breastteeding Class (Activity #42) Description : This class discusses the many (accts of breasHeeding including preparation for nursing,

nutrition, first feedings, short-term obstacles and solutions . Targeted : Minority Uninsured/Underinsured

Sex : Both Males and Females Ages: Teens Adults

Settings : Facility Formats : Class

Department: 31108100 (Obstetrics) Objective. To describe the process of breastfeeding and concepts of nutrition, first feedings,

short-term obstacles and solutions. Outcome: Education and increased compliance for breaslieeding

Activity Totals 477 4,998 150 4,848

Title : Childbirth Education - Early Pregnancy (Activity if43) Description : Overview of the physical, emotional and psychological changes occunng during early

pregnancy and a review of nutrition, activity, and education recommended for a positive pregnancy outcome .

Targeted: Minority Uninsured/Underinsured Sex: Both Males and Females

Ages: Teens Adults Settings: Fatality Formats: Presentation

Department: 31108100 (Obstetrics) Objective: To inform potential mothers and fathers about the physical, emotional, psychological, and

educational needs of early pregnancy to achieve a positive pregnancy outcome Outcome : Education and increased compliance (or potential mothers and fathers

Activity Totals 9 92 25 67

Title : Childbirth Education - Grandparents Class (Activity #44) Description : Discusses a wide range of topics specifically related to grandparents including

generational changes in pregnancy and delivery, current trends m baby care, safety in the home and car seat safety

Targeted: Minority UnmsuredNndennsured Sex: Both Males and Females

Ages: Seniors Settings : Facility Formats : Class

Department : 31108100 (Obstetrics) Objective : To prepare expectant grandparents for then role including generational changes in

pregnancy and delivery, current trends m baby care, safety in the home and pr seat safety.

Outcome : Education and increased compliance for expectant grandparents

Title : Childbirth Education - Hospital Preview (Activity 971) Description : Tour of hospital maternity services areas and provision of Information regarding

preadmission registration and educational offering overview. Targeted: Disabled Minority

Sex: Both Mates and Females Ages: Teens Adults

Settings : Facility Department: 31108100 (Obstetrics)

Objective : To inform potential mothers and fathers about the maternity facilities and educational programs available to facilitate delivery and care of themselves and their newborns

Outcome : Gave education and increased compliance. Activity Totals 307 1,455 0 1,455

Title: Childbirth Education - Pre Delivery Class (Activity #38)

.`

0812212002 Alegent Health Bergan Mercy Medical Center Community Education and Outreach - Details For period from 0710112001 through 0613012002

# Persons Expenses Revenues Benefit Activity Totals 35 371 210 181

Title : Childbirth Education - Hospital Tour (individualized) (Activity #45) Description : Tour of hospital matemdy services area and provision of information regarding

pre-admission registration and educational offering overview Provided individually as needed

Targeted: Minority UninsuredRJndennsured Sex: Both Males and Females

Ages: Teens Adults Settings : Facility Formats : Tour

Department: 31108100 (Obstetrics) Objective: To inform potential mothers and fathers about the maternity facilities and educational

programs available to facilitate delivery end care of themselves and their newborns Outcome: Education, increased compliance, encouraging parents to choose Ategent Health for then

maternity care Activity Totals 274 985 0 985

Title: Childbirth Education - New Parents Class (Activity #40) Description : Class designed to meet the needs of the parent-to-be including information on growth and

development, feeding, sleep cycles, baby care, car seat safety, diapering, Immunizations, and safety.

Targeted: Minority UrnnsuredNndennsured Sex: Both Males and Females

Ages: Teens Adults Settings : Facility Formats : Class

Department: 31108100 (Obstetrics) Objective : To inform expectant parents about parenting, including Information on growth and

development, feeding, sleep cycles, baby care, car seat safety, diapering, immunizations, and safety

Outcome : Education and increased compliance for expectant parents about parenting Activity Totals 658 5,353 60 5,293

Alegent Health Bergan Mercy Medical Center Community Education and Outreach - Details For period from 0710112007 through 0613012002

3

0812?J2002

# Persona Expenses Revenues Benefit Description: A concise one session overview and preparation for childbirth Covers when to come to

the hospital, admission procedure, labor, pain control, and a tour of the maternity area . Targeted : Minority Uninsured/Undennsured

Sex: Bath Males and Females Ages: Teens Adults

Settings : Facility Formats: Class

Department: 31106100 (Obstetrics) Objective: To prepare expectant parents for childbirth Including when to come to the hospital,

admission procedure, labor, pain control, and a tour of the maternity area . Outcome: Education and increased compliance to expectant parents for childbirth .


Title : Childbirth Education - Prepared Childbirth Class (Activity #41) Description: Four sessions providing Information on the stages of labor, breathing techniques and

coach's role in addition to discussion of medication, anesthesia and delivery. Targeted: Minority Uninsured/Underinsured

Sex: Both Males and Females Ages: Teens Adults


Department: 31108100 (Obstetrics) Objective : To inform expectant parents about the stages of labor, breathing techniques and coach's

role in addition to discussion of medication, anesthesia, and delivery. C, Outcome : Education and increased compliance for expectant parents about childbirth

Activity Totals 802 21,445 21,840 -395

Title : Childbirth Education - Prepared Childbirth Refresher (Activity #37) Description : A quick review of the stages and phases of labor and breathing techniques. A tour is

included Targeted: Minority UninsuredNnderinsured

Sex: Bow Males and Females Ages: Teens Adults

Settings : Facility Formats: Presentation

Department: 31108100 (Obstetrics) Objective : To renew the stages and phases of tabor and breathing techniques with the couple who

has completed prepared childbirth education with a previous pregnancy Outcome: Stages and phases of labor and breathing techniques was given to couple who have

compled prepared childbirth education with a previous pregnancy Activity Totals 781 2,441 2,275 168

Title : Childbirth Education - Pre-pregnancy Class (Activity #39) Description : Pre-conception Information for women wishing to conceive a child including nutrition,

exercise, tobacco, alcohol and drug use, fertility, and physical and emotional changes of pregnancy

Targeted: Minority Uninsured/Underinsured Sex: Both Males and Females

Ages: Teens Adults

08/2y2002 Alegent Health Bergan Mercy Medical Center Community Education and Outreach - Details For period from 0710112007 through 0815012002

Revenues Benefit # Persons Expenses


4

U


Department: 31708100 (Obstetrics) Objective: To inform potential mothers and fathers about the physical, nutritional, emotional, and

soaal preparation required for pregnancy and shddbearing. Outcome: Education and increased compliance for potential mothers and fathers


Title : Childbirth Education - Save-A-Tot (Activity #36) Description : This class focuses on CPR for infants and children, obstructed airways of Infants and

children, child safety, and first aid . Targeted : Minority UnlnsuredlUnderinsured

Sex: Both Males and Females Ages: Teens Adults


Department: 31108700 (Obstetrics) Objective : To review the principles of CPR, obstructed airway, first aid, and safety for infants and

children Outcome : Education and increased compliance on CPR for infants and children was taught.

Activity Totals 48 2,298 1,440 858

Title: Childbirth Education - Sibling Sneak Preview Class (Activity 1135) Description : A one time class for the expectant brother or sister, Including a tour of the matemdy area

and nursery and discussion of their new role A gift for the baby is made by each child Targeted: Minority Uninsured/Underinsured

Sex: Both Males and Females Ages: Children Teens Adults


Department: 31106100 (Obstetrics) Objective : To prepare expectant siblings for the artival of a new baby into the family and to discuss

changes in the sibling role and production of a present for the new arrival Outcome: Education and increased compliance for siblings of a new baby

Title : Childbirth Education - Working Parents Prepared Childbirth Class (Activity 1134) Description : An all day session providing information on the stages of labor, breathing techniques and

coach's role in addition to discussion of medication, anesthesia, and delivery . Targeted: Minority UrnnsuredNnderinsured

Sex: Both Males and Females Ages: Adults

Settings: Facility Formats: Presentation

Department: 31108700 (Obstetrics) Objective : To inform expectant parents about the stages of labor, breathing techniques and coach's

role in addition to discussion of medication, anesthesia and delivery Outcome : Education and increased compliance for expectant parents .

Activity Totals 514 10,355 15,420 -5,065

0812212002 Alegent Health Bergan Mercy Medical Center Community Education and Outreach - Details

~.` For period from 0710112001 through 0613012002

# Persona Expenses Revei

~..-

oentisooz Alegent Health Bergen Merey Medical Center Screenings - Details For period from 0710112001 through 0613012002


Title: 40% of the System Total for Comm Ed & Outreach A2 Screenings (Activity #24) Sex: Both Males and Females

Department: 0 Q 0 9,082 Activity Totals 160 9,082

Title: The Hat Center Physical Exam ProgramlHeatth Fair (Activity #72) Description : Provided supplies for School Nurses to do screening exams end counseling to school age

children m Omaha. Targeted: UninsuredNndennsured

Sex: Both Males and Females Ages: Children

Settings : Community Formats : Health FairsJSueeings

Department: 31107100(ER/PEX) Objective : To provide 75-100 children with medical screening exam including assessment of

immunizations Outcome: 85 children were screened


\f

Title : Legal Blood Alcohol Testing and Witness (Activity #10) Description : Emergency staff collect serum specimens for ETCH testing by Omaha Police Department

and then appear in court for the city and/or county Sex: Both Males and Females

Ages: All Ages Settings : Facility Courthouse

Department: 31107100 (Emergency) Objective : Emergency Department staff collected 128 serum specimens that followed procedure

needed to convic a drunk driver Outcome : Emergency department collected 128 legal blood alcohol specimen and court

appearances. Activity Totals 155 24,287 11,095 13,192

Alegent Health Bergen Mercy Medical Center Support Groups - Details For period from 0710712001 through 061J012002


Title : 40% of the System Total for Comm Ed & Outreach A3 Support Groups (Activity #21) Sex: Both Males and Females

Department: 0 Q Activity Totals 411 7,682 5,488 2,218

9,211

Prostate Cancer Support Group (Activity #70) Support groups for men Hnth prostate cancer and their family members Both Males and Females Adults Seniors

Title : Description :

Sex: Ages:

Settings : Formats :

Department: Objective : Outcome :

Totals 242

osnysooz

C

Title : Description :

Sex: Ages:

Settings : Formats:

Department: Objective: Outcome:

Living with Cancer. (Activity #52) An adult support group for patients with cancer Families and friends are also encouraged to attend Both Males and Females Adults Facility Events/Meetings 31106085 (Oncology) To provide an environment of education and support for adults with cancer . Education and support were given to adults with cancer

Activity Totals 432 9,211 0

Outpatient Events/Meetings 31100 (Oncology) Education and support for men wrath prostate cancer and weir families Provided knowledge about prostate cancer treatment options, side effect, treatment for side effects, etc

2,020

0812212002 7 Alegent Health Bergen Mercy Medical Center Self-Help - Details

~- For period from 0710112001 through 0813012002

~-= ii Persons Expenses Revenues

Title: 40% of System Total for Self-Help activities (Activity #92) Sex: Both Males and Females

Ages: All Ages Settings : Fatality Community Formats : Seminars Events/Meetings

Department: 0 Q Activity Totals 34 2,020 0

C-.

Benefit

C_

08/2212002 Alegent Health Bergen Mercy Medical Center Patient Education - Details

~ For period from 0710112001 through 0813012002

# Persona Expenses Revenues Benefit

Title: 40% of Systems Total for Comm Ed & Outreach A8 Patient Education (Activity i160) Sex: Both Mates and Females

Department: 0 Q Activity Totals 59 1,538 0 1,538

Title: Patient Management Call Backs (Activity #8) Description: Emergency Department staff, register nurses, calls all discharge patients at home

Targeted : Disabled Minority UrnnsuredNnderinsured All discharged patients Sex: Both Males and Females

Settings: Home Formats: Telephone Call

Department: 31107100 (Emergency) Objective: To provide assessment of patient compliance with follow up care instruction, assist with

any follow up care needed and provide education. Outcome: 100% of education patients discharged were contacted Education was provided,

prescriptions provided . Activity Totals 21,038 79,088 0 79,088

C

0812Y12002 Alegent Health Bergan Mercy Medical Center Employee - Details

~ For period from 0710112001 through 0613012002


Title: 40% of System Total (includes Edue S1rs Internal training prgs) (Activity #B2) Sex: Both Males and Females

Department: 0 Q Totals 22,812 453,587 33,388 420,199

r a

" J

~~)

oananooz Alegent Health Bergan Mercy Medical Center Physicians, Medical Students - Details For period from 0710112001 through 0613012002


Title: 40% of System Total for Phys,Med Students Ed Includes CME prgs (Activity #83) Sex: Both Males and Females

Department: 0 Q Activity Totals 1,770 78,818 19,607 57,209

Title : Supervision of Physician Asst Students . (Activity #49)

Title: Community PracUcum Experience for Medical/Nursing, health profess (Activity #11) Description : Educational practicum experience for medical, nursing, social work and other health

professionals/students in a geriatric setting in the community Sex : Both Males and Females

Ages: Adults Settings : Outpatient

Department: 31287785 (McAuley Bergan) Objective: To give educational pradicum experience for medical health professionals . Outcome: Community precticum experience was given to heakh professional.


Title : Crelghton Residents OBIGYN Rotation (Activity #55) Description : Creighton OB Residents are here to team OB/GYN practice from fellow OB/GYN

Physicians on the teaching service at Creighton They sleep here during their rotation for 24 hour coverage They provide service to our patient population They collaborate with Drs Flemmmg end Bonebrake of Creighton's Pennatology program

Sex: Bow Males and Females Ages; Adult

Settings: Inpatient Outpatient Facility Department: 31708100 (Obstetrics)

Objective: To provide teaming opportunities for Creighton OB Residents m their OB/GYN rotation . Outcome: Residents gain knowledge and skills to the Labor and Delivery, Postpartum and GYN

Clinical setting . They assist with deliveries and C-sections, evaluate patients, assist with GYN surgeries, perform diagnostic tests and interpret findings Many times dyed the attending for patient pre.

Activity Totals 12 168,025 0 188,025

Title : Medical Student OB Rotation (Activity #54) Description : Medical Students in their 3rd year are here to do History and Physicals, assist the

Resident and MD's m vaginal deliveries and scrub In for C-sections . They sleep here during their rotation for 24 hour coverage


Settings: Inpatient Outpatient Facility Formats : Clinic

Department: 31108100 (Maternal Child Health) Objective : To create a teaming environment for Medical students while maintaining a safe

environment for the patents we care for. Outcome: Medical students gained knowledge and skills m the Labor and Delivery Clinical setting

They assist with deliveries and C-sections Activity Totals 110 91,993 0 91,993

2

0812212002 Alegent Health Bergan Mercy Medical Center Physicians, Medical Students - Details For period from 0710112001 through 0613012002

# Persons Expenses Revenues BeneTrt Description : Partnership wrath UNMC Geratncs to provide supervision of Physician Assistant Students

during their clinical rotation Sex: Both Males and Females

Ages: Seniors Settings : Inpatient Geriatrics Formats: Clinic

Department: 31308371 (MCC Adm.) Objective: Increase knowledge of UNMC Physician Assistant Students exposure to gerlactrics. Outcome: Increased knowledge of geriatrics .

Activity Totals B 372 0 372

C

oantisooz Alegent Health Bergen Mercy Medical Center ScholarshipslFunding for Prof Educ - Details For period from 0710112001 through 0613012002

C= # Persons Expenses Revenues Benefit

Title: Bergan Radiology School (Activity x'15) Description: The Alegent School of Radiology Technology offers a 24 month program of academic

study and clinical education In the radiology department Sex: Both Males and Females

Department: 31107330 (Radiology) ActNitY Totals 9 25,836 0 25

C

A

C"

0812212002 Alegent Health Bergan Mercy Medical Center Nurses - Details C For period from 07/01/2001 through 0813012002

# Persona Expenses Revenues

Activity Totals 99 109 109

Title, Nursing Student Perceptorships - NICU (Activity #73) Description : Nursing students care for patients within the clinical department and are led by a staff

member as a preceptor The Perceptor is sell responsible for complete and safe patient pre and assists m nursing mtem with teaming situations similar to onentaLon as a new hue.

Title: 40% of Systems Total for Medical Education B3 Nurses (Activity #61) Sex: Bath Males and Females

Department: 0 Q

Benefit

Title : Nursing Education (Activity #57) Description- Nurse preceptor program . Nursing students are required to job shadow a regular nurse's

schedule for five weeks and complete 180 hours Sex: Both Males and Females

Ages: Adults Settings : Inpatient Facility

Department: 31108100 (Obstetrics) ObJeetNe : To simulate the prospective work environment for the nursing students Provides real life

experience Prodder mentoring to those new to the profession . Outcome: Nursing students complete 3 credit hours required for graduation This is also a

significant recruitment tool. Activity Totals 1 7,487 0 7,467

Title: Nursing Student Clincal Schedule (Activity #58) Description : Nursing students care for patients within the clinical department and are led by then

Nursing instructor. Staff RN's are still responsible for safe and complete patient pre and assist the nursing students with teaming sdutabons


Settings : Inpatient Facility Department 31108100 (Obstetrics)

Objective : To create a leammg environment for nursing students while maintaing a safe environment for the patients we care for


Title: Nursing Student Clinical Schedule NICU (Activity #74) Description : Nursing students care for patents within we clinical department and are led by their

nursing instructor Stall RN's are still responsible for complete and safe patent care and assist the nursing students with teaming situations

Sex: Both Males and Females Ages: Infants

Settings : Inpatient Facility Department: 31008125(NICU)

Objective : To create a teaming environment for nursing students while maintaining a safe environment for the patient we care for

Outcome : Nursing students gam clinical skills m the NICU clinical setting . Activity Totals 38 3,921 0 3,927

0812212002 Alegent Health Bergen Mercy Medical Center Nurses - Details For period from 07/01!2007 through 06/3012002

# Persons Expenses Revenues Gene Sex: Both Males and Females

Ages: Infants Settings : Inpatient Facility

Department: 31008125 (NICU) Objective: To create a teaming environment for nursing interns while maintaining a safe environment

for the patients we care for . Outcome: Nursing students gain clinical skills in the NICU clinical setting


osizzizoos Alegent Health Bergen Mercy Medical Center Other Health Professionals - Details For period from 0710112001 through 08130/2002

Persons Expenses Revenues Benefit

Title: 4096 of the System (Includes Allied Health Ed prgs) (Activity #28) Sex: Both Males and Females

Department: 0 Q Activity Totals 135 81,487 43,498 37,997

Title: Association for Professionals In Infection Control - Mercy Care Ce (Activity X68) Description: Association for professionals that are Infection Control

Sex: Both Males and Females Ages: All Ages

Settings : Community Fortnab: Events/Meetings

Department: 0 (Mercy Care Center) Objective: To help reduction of hospital acquired infections outcome: Helped in the reduction of nosocomial infections

AeBvftv Totals 0 748 0 746

0812212002 Alegent Health Bergen Mercy Medical Center Outer - Details For period from 07101/2001 through 06/30/2002


Title: 40% of System Total for Medical Education category BB Other (Activity #84) Sex: Both Males and Females

Departrnent: 0 Q 0 410

r

Totals 200 410

08122/2002 Alegent Health Bergan Mercy Medical Center Dieticians - Details For period from 0710112001 through 0813012002

# Persons Expenses Revenues

Totals 35 781 761 0

r-

Title: 40% of System Total for Med Ed prgs B7 Dieticians (Activity #85) Sex: Both Males and Females

Department: 0 Q

Benefit

oarl2nooz Alegent Health Bergan Mercy Medical Center ChaplainslSemfnarians/CPE - Details For period from 0710112001 though 06/30/2002


Title: 40% of System Total for Clinical Pastoral Education (Activity #87) Sex : Both Males and Females

Department: 0 0

701 0

1

40

Activity Totals 7 70,868

Title : Shadowing for Lay PreaeherslPresbyterlans (Activity 1169) Description : Training in hospital visitation and introduction to hospital

Sex : Both Males and Females Ages: Adults

Settings: Inpatient Formats : EventsRdeetings Shadowing at BMMC

Department: 31958420 (Mission Services) Objective : Train lay pastors - Increase comfort level In hospital

AcWilvTotals 7 701

2,680

Benefit

87,988

oanysoos Alegent Health Bergan Mercy Medical Center Emergency and Trauma Services - Details For period from 0710712001 through 0613012002 C= # Persons Expenses Revenues Benefit

Title: No Charge Emergency Department VIsiUMedleal Screening (Activity #9) Description : Patient present for a medical screening exam, exam provided and education required .


Settings: Outpatient Format: MSE

Department: 31107100 (Emergency) Objective: To provide a medical screening examinationto ensure no emergency medical condition

and the follow up for education outcome: The emergency department provided MSE and education to 148 patients and families.

Totals 45 3,133 0 3.133

\~� r

Revenues Benefit

0812212002 Alegent Health Bergan Mercy Medical Center Neonatal Intensive Care - Details For period from 07101/2007 through 06/30/2002

# Persons Expenses

Title: BMMC Neonatal Intensive Care Unit (Activity #80) Sex: Both Males and Females

Ages: Infants Settings : Facility Formats: NICU

Department: 31708725(N1CU) Activity Totals 301 2,277,!

5,344

1

0812212002 Alegent Health Bergen Mercy Medical Center Free-standing Community Clinic - Details For period from 0710112001 through 0613012002


Title : 40% of System Total (ICHC) (Activity X88) Sex: Both Males and Females

Department: 0 Q Activity Totals 8,800 18,502 0

Title: McCauley Bergen Community Connection (Activity #17) Description : Community transporabon services provided for adults

Sex: Both Males and Females Department: 31287785 (McCauley Bergan)

Activity Totals 85 7,193 1,849

Benefit

18,502

0812212002 Alegent Health Bergan Mercy Medical Center Collaborative Efforts in Preventive Medicine - Details

~' For period from 0710112001 through 0813012002

# Persona Expenses Revenues Benefit

Title: 40% of System Total (Ministry Development & HMOC) (Activity #89) Sex: Both Males and Females

Department: 0 Q Totals 3,939 78,813 758

0812212002 Alegent Health Bergen Mercy Medical Center Hospice/Home Care - Details For period from 0710112001 through 08/30/2002


Title: Home Health Care and Hospice (Activity 1179) Description: Providing Home Health Services and Hospice Services

Sex: Both Males and Females Ages: Adults Seniors

Settings: Facility Home Formats: Home Health 8 Hospice

Department: 31100 (HomeCare Adm) Activity Totals 69,730 4,538,053 3,358,130 1,779,923

Title : Sudanese TB Program (Activity #59) Description : This program mondors TB medication for Sudanese population free of charge

Targeted: Minority UninsuredNndennsured Sex: Both Males and Females

Ages: All Ages Settings : Home Formats: Health Fairs/Screeings

Department: 31458311 (Home Care 8 Hospice) Objective : To provide quality home heath care for all patients regardless of financial resources

Activity Totals 30 701,008 0 101,008

\y

08/2212002 Alegent Health Bergan Mercy Medical Center Other - Details

~, For period from 0710712001 through O6f30f2002


Title : BMMC Child Care Center (Activity #77) Description : Daycare services provided for children of employees

Sex: Both Males and Females Ages: Infants Children

Settings : Facility Formats : Child Care Center

Department: 37958210 (BMMC Child Care Center) Objective: To provide child pre services to employees

Activity Totals 0 974,358 723,741 250,615

Title: Patient SupporUPastoral Care (Activity #14) Description: Direct spiritual care available for spiritual support for any person whose life is touched by

suffering. Sex: Bow Males and Females

Department: 31958420 (Pastoral Services) Activity Totals 39,654 375,570 893 374,677

Title : Volunteer Services Bergan (Activity #16) Description : Help meet the needs at Bergen by providing unpaid personnel to supplement and

enhance the services of paid staff Sex: Both Males and Females

Department: 31958280 (Volunteer Services) 457 0 457 Totals

Title: 40% of System Total for Ethics 8 Community Service (Activity #90) Sex: Both Males and Females

Department: 0 Q Activity Totals 0 715,056 777

Benefit

114,879

L

0812212002 Alegent Health Bergan Mercy Medical Center Employee - Details For period from 0710112001 through 0613012002


Title : 40% of System Total for Subsidy provided to low Income Employees (Activity #97) Sex: Both Males and Females

Department : 0 Q Activity Totals 154 12,379 0 12,379

C,

0 0

lk

DON ONS

Title : BMMC Foundation - Donation to DVCC (Activity #58) Description : Donation to Domestic Violence Coordinating CounaPs Medical Healthcare Probed

Sex: Both Males and Females Ages. Adults Seniors

Settings: Community Formats: Donation

Department: 37739360 (8ergan Mercy Foundation) Objective : To provide assistance in Domestic violence training of healthcare professionals Outcome : With AlegenYs support over 10,000 individuals m our community have had training on

domestic violence 2,500 0 2,500 Activity Totals

Title : Employee/Center participants Christmas Drive (Activity #13) Description : A joint project of center employees and participants to collect food items, clothing, toys

and money for a family referred by Mercy Housing Sex: Both Males and Females

Ages: Children Adults Settings: Workplace

Department: 37287785 (MrAuley Bergen)

T

0812212002 Alegent Health Bergan Mercy Medical Center - Cash Donations - Details For period from 0710112001 through 06/30/2002

`-- it Persons Expenses Revenues Benefit

Title : 40% of the System Total for Cash Donations (Activity #28) Sex : Both Males and Females

Departrnent: 0 0 Activity Totals 501 58,344 0 58,344

Title : Bergan Mercy Auxllary (Activity X48) Description : Fund raised through Bergen's volunteer sponsored events and distributed to various in

house and community needs Sex: Both Males and Females

Settings : Facility Formats : Fundraising

Department: 37958280 (Volunteer) Objective : To raise dollars for Bergen projects . Outcome : Provided dollars needed to venous projects Wnthin system

Activity Totals 19 309,510 0 309,510

Title : BMMC Charitable Donations (Activity #75) Description : Charitable contributions to community organizations .


Settings : Community Formats: Donations

~- Department: 0 () Objective : To collaborative and cooperative vAth community organizations to address community

needs Outcome : Provide support dollars to various community organizations and projects


# Persons Expenses Revenues Benefit Objective: To tolled food items, clothing, toys and money for a family referred by mercy Housing at

Christmas. Outcome: Food and other items were collected for a needy family at Christmas time


C-

0812212002 Alegent Health Bergan Mercy Medical Center - Cash Donations - Details For period from 0710112001 through 0813012002

oanyzoos Alegent Health 8ergan Mercy Medical Center - Inkind Donations - Details For period tom 0710112001 through 06130/2002

t !I Persons Expenses Revenues Benefit

Title: 4096 of Systems Total for Inklnd Donations (Activity #62) Sex: Both Males and Females

Department: 0 Q Activity Totals 1,348 73,869 0 13,869

AA Support Groups (Activity iR50) AA Support Groups meet at Mercy Care Center twice weekly Both Males and Females Teens Adults Seniors Facility Events/Mee6ngs 31308311 (MCC Admin ) To provide community organizations use of fatality showing we are a good partner Locations for meetings are drfficuR to find - especially those who do not charge for the room.

4,160 4,855

Linen Donation (Activity il87) Donated linen to local shelters . Shelter residents Both Mates and Females All Ages Community Donation 31958170 (Bergen Laundry) Provided line to shelters

Title: Description:

Targeted : Sex:

Ages: Settings: Formats:

Department: Objective : Outcome : Linen was donated to shelters throughout the area .


l" -1

Title: Description:

Sex: Ages:

Settings: Formats:

Department: Objective : Outcome :

Activity Totals 4,855

0 0

(I

0812212002 Alegent Health Bergan Merey Medical Center Support System Enhancements - Details For period from 07107/2001 through 0613012002


0 18,991 Totals 0 18,991

Title: 40% of the System for Support System Enhancements (Activity #29) Sex: Both Males and Females

Department: 0 Q

Benefit

C

0012212002 Alegent Health Bergan Mercy Medical Center Leadership Development and Skills Training - Details For period from 0710112001 through 0613012002


Totals 0 1,121 121

Title: 40% of System Total for Leadership Develpment 8 Skill Training (Activity 986) Sex: Both Males and Females

Department: 0 Q

sets

Iowa IR4e dc@hl

v .7,"

l

" 08/13/2002 Southwest Iowa Med*Center Summary of Quantifiable Benefits July 1, 2001 - June 30, 2002

,.-. Unclassified Final Report-One Facility

\ I Persons Total Offsetting Net Community % of Organization MCB: Southwest Iowa Medical Served Expense Revenue Benefit Expenses Revenues Center Traditional Charity Care 180 476,400 0 476,400 4 9 1 0 Unpaid Costs of Medicare 9,767 19,317,638 15,602,425 3,715,213 7 3 7 9 Unpaid Costs of Medicaid 5,737 7,827,504 6,844,063 983,441 1 9 2 1 Community Services Nonbdled Services 83,931 193,460 9,718 183,742 0 4 0 4 Medical Education 563 57,619 16,446 41,173 0 1 0 1 Subsidized Health Services 45,528 4,847,404 3,041,719 1,805,685 3 5 3 8 Cash / Inkind Donations 774 28,157 0 28,157 0 1 0 1 Community Building 0 7,855 0 7,855 0 0 0 0

Community Services - Lona Term Care

Grand Totals . 146,480 32,756,037 25,514,377 7,241,666 142 154

" Page 1

Expenses Revenues Benefit A - Nonbilled Services

340 21,950 0 21,950 434 8,207 0 8,207 774 28,757 0 28,157

E1 -Cash Donations E2 - Inkmd Donations

Totals (E - Cash and Inkind Donations)

0812212007 Alegent Health Southwest Iowa Medical Center All Activities Summary by Category Type For period from 0710112001 through 08130/2002

# of Persons

A1 - Community Education and Outreach A2 - Screenings A3 - Support Groups AS - Self-Help AB - Patient Education A9 - Employee

Totals (A-All Nonbilled Services)

B - Medical Education 81 - Physicians, Medical Students 83 - Nurses BS - Other Health Professionals 88 - Other 87 - Diebaans B8 - Chaptains/SemmarianslCPE

Totals (B - Medical Education)

C - Subsidized Health Services C3 - Free-standing Community Clinic C4 - Collaborative Efforts m Preventive Methane C8 - Other C9 - Employee

Totals (C - Subsidized Health Services)

E -Cash and Inkind Donations

77,590 71,637 4 71,827 160 3,550 0 3,550 348 3,826 7,387 2,259

9 505 0 505 123 751 0 751

5,703 113,397 8,347 10.5,050 83,931 193,461 9,718 183,743

442 19,204 4,902 14,302 25 27 0 27 34 20,372 10,874 9,498 51 159 0 159 9 190 0 190 2 17,687 870 16,997

563 57,619 16,446 41,173

2,200 4,128 0 4,128 985 19,153 189 18,964

42,305 4,821,030 3,041,530 7,779,500 38 3,095 0 3,095

45,528 4,847,404 3,047,719 1,805,885

F-All Community Building Activities F3 - Support System Enhancements 0 4,748 0 4,748 F4 - Environmental Improvements 0 2,827 0 2,827 F5 - Leadership Development and Skills Training 0 280 0 280

Totals (F -All Community Building Activities) 0 7,855 0 7,855

Grand Totals 130,798 5,134,498 3,087,883 2.066,873

i 1

I

I

I ,

08122/2002 0 Alegent Health Southwest Iowa Medical Center Community Education and Outreach - Details For period from 07/01/2001 through 0613012002


Activity Totals 75,553 42,950 42,946

Title: Celebrate Health 2002 (SWIMC) (Activity #85) Description: Health fair for promoting general health education to the community of Council Bluffs

Targeted : Disabled Minority UninsuredfUndennsured Sex: Both Males and Females

Ages: All Ages Settings : Community Formats: Health Fairs/Screeings

Department: 11988417 (Cancer Center) Objective: To promote health education to Iowa community Outcome: General health education was presented to the community of Council Bluffs

Activity Totals 1,775 25,306 25,306

Title: Christmas Care RLDS - PMIC Glenwood (Activity #70) Description: Loaded can goods, assembled gift baskets for Christmas Care

Targeted : Homeless/low income Sex: Both Males and Females

Ages: All Ages Settings : Community Formats: Events/Meebngs

Department: 32100 (Beh Hlth-PMIC) Objective: Give back to the community. Outcome: Yes, there are others in the community who help with these projects. Yes it does meet a

need Activity Totals 0 2,722 0 2,722

Title: Community Education Presentations (Activity #80) Description: A one hour program for residents of Southwest Iowa The program included a brief

history and update of Mercy Hospital The Mercy Century Plan video was shown followed by a time for questions and answers

Sex: Both Males and Females Ages: Seniors

Settings : Community Formats: Seminars

Title : 10% of Systems Total for Community Education & Outreach (Activity #60) Sex : Both Males and Females

Department : 0 0

Benefit

Title : American Heart Assn. - Annual Celebrity Walter Dinner - Polt Count (Activity #81) Description: Participate in annual fundraiser event to raise money for the American Heart Association


Formats: Events/Meetings Department: 32100 (SNF-CardiopuiRehab)

Objective: Solicit guests, auction items, sell raffle tickets, decorate tables, get costumes, visit tables outcome: Successful event raising money for American Heart Association.


Revenues Benefit

0 104

Department 32739360 (Mercy Hosp Foundation) objective : To inform community of Mercy Hospbl's future plans Outcome: Community response was overwhelmingly positive

Activity Totals 62 104

I

0812212002 0 Alegent Health Southwest Iowa Medical Center Community Education and Outreach - Details For period from 0710112001 through 06130/2002

# Persons Expenses

0

0812212002 0 Alegent He a Medical Center Screenings - Details For period from 07/0112001 through 06130/2002

C # Persons Expenses Revenues Beinefit

Tide : 10% of Systems Total for Comm Ed & Outreach A2 Screenings (Activity #61) Sax: Both Males and Females

Department: 0 0 Totals 40 2,270

0

ratio: "A Foot Affairs" (Activity 973) Description: An Educational Seminar and Foot Screening held at the Council Bluffs Senior Center


Settings : Community Formats: Health Fairs/Screeings

Department: 32106180 (Diabetes Education) Objective: To identify persons in the community with diabetes having foot problems so they can

receive treatment and prevent further complications Outcome: 60 persons attended, 43 persons had their feet screened by a podiatrist.


0812212002 0 0 Alegent Health Southwest Iowa Medical Center Support Groups - Details

C

I

For period from 07/01121111 through 01130/2002

9 Persons Expenses Revenues Benefit

Title : 10% of Systems Total for Comm Ed& Outreach A3 Support Groups (Activity #62) Sex: Both Males and Females

Department : 0 0 Activity Totals 103 1,921 1 .367 554

Title: Better Breathers Club (Activity #84) Description : Monthly meetings to learn more about living with chronic lung disease

Sex: Both Males and Females Ages: Adults Seniors

Settings : Workplace Department: 32100 (Rehab-CardiopuiRehab)

objective: Support, education for persons with lung disease Outcome: Support was given to patients with chronic lung disease.


Title: Diabetes Support Group (Activity #74) Description : Continuing education on diabetes subjects

Sex: Both Males and Females Ages : AJI Ages

Settings : Facility Formats : Seminars

Department: 32958100 (Food & Nutrition) Objective: Provide up to date info on diabetes care Outcome: Information was given to the Diabetes Support Group


Title: Oncology Support Group (ActIvity #78) Description: Plan and present program an nutntlon for cancer patients


Settings: Outpatient Formats: Seminars

Department: 32958100 (Food & Nutrition) Objective: Improve nutrition and body's ability to fight cancer. Outcome: Encouraged the Importance of nutrition.


Title: Southwest Iowa Medical Center Cancer Support Group (Activity #82) Description: Cancer Support Group for cancer patients and families

Targeted : Patients with cancer Sex- Both Males and Females

Ages: Adults Seniors Settings : Outpatient Formats: Events/Meetings

Department: 32107570 (Oncology Services) Objective: To pro%nde support for cancer patents and their families Outcome: Increased the quality of Ida for those living with cancer and their families .

# Persons Expenses Revenues Benefit Totals 50 644 0 644

081=002 0 Alegent Health Southwest Iowa Medical Center Support Groups - Details For period from 0710112001 through 0113012002

0

Revenues Benefit

0 505

Title : 10% of System Total for Self-Help activities (Activity #91) Sex: Both Males and Females

Department: 0 0 Totals 9;05

0812212002 0 Alegent Health Southwest Iowa Medical Center Self-Help - Details For period from 071OU2001 through 0613012002

0 Persons Expenses

0

C I

0812212002 0 Alegent He a Medical Center Patient Education - Details For period from 0710112001 through 06/3012002


Title: Diabetes Seminar (Activity #79) Description : Plan and present programs for patents that aftended disbetics clinic or graduated from

out patient diabetics classes Sex: Both Mates and Females

Ages: All Ages Settings : Facility Formats: Seminars

Department: 32958100 (Food & Nutrition) Objective: Education program for people with diabetes and their families Outcome: Increase understanding of diabetes


0

Title: 10% of Systems Total for Comm Ed & Outreach Ali Patient Education (Activity #63) Sex: Both Males and Females

Department: 00 Activity Totals 15 384 0 384

Title: Class Reunion for past class participants for the Diabetes Educati (Activity #13) Description: Had educational games, educational materials for handouts and participation by all

present in discussions. Sex: Both Males and Females

Ages: Adults Settings: Facility Formats: Events/Meefings

Department: 32106180 (Diabetes Education) Objective: To encourage communication between the people that have attended classes the past

year and to let them know diabetes can be fun Outcome: 22 people attended. Comments were very favorable from those attending The program

had only been in available since July 1, 1998. Activity Totals 18 157 0 157

08/2212002 0 Alegent Health Southwest Iowa Medical Center Employee - Details For period from 07/0112001 through 06/3012002


Title: 10% of System Total (includes Educ Svs Internal training prgs) (AcUvity#92) Sex: Both Males and Females

Department: 0 0 11 Totals 105,050

0

0812212002 0 Alegent Health Southwest Iowa Medical Center Physicians, Medical Students - Details For period from 07/0112001 through 08130/2002


Title : 10% of System Total for Phys,Med Students Ed Includes CME prgs (Activity #93) Sex: Both Males and Females

Department: 0 0 Totals 442 4,902

0

0812212002 0 Alegent Health Southwest Iowa Medical Center Nurses - Details For period from 0710112001 through 06130/2002

# persons Expenses Revenues

Totals 25 27 27

I-

0

Title: 10% of Systems Total for Medical Education B3 Nurses (Activity #64) Sax: Both Males and Females

Department: 0 0

,Benefit

0812212002 0 Alegent Health Southwest Iowa Medical Center Other Health Professionals - Details For period from 0710112001 through 06/3012002


Tide : 10% of Systems Total (Includes Allied Health Ed prgs) (Actlvlty#65) Sex: Both Males and Females

Department: 0 0 Totals 34 10,874 9,498

0

0812212002 0 Alegent He a Medical Center Other - Details For period from 0710112001 through 06130/2002


Title'. S.P.A.C.E . Student Shadowing (Activity #76) Description : Allowed a S P A.C student to shadow the clinical dlebtan at the hospital

Sex-. Both Males and Females Ages: Teens

Settings : Facility Formats : Events/Meefings

Department: 32958100 (Food & Nutrition) Objective : Allow a high school student to learn more about a career in dietetics . Outcome: Public relations and possible future hospital employees

Actlvitv Totals 1 57 57

1~

0

Title: 10% of System Total for Mod Ed category B6 Other (Activity #94) Sex: Both Males and Females

Department: 0 0 Activity Totals 50 102

Benefit

102

08/22/2002 0 Alegent Health Southwest Iowa Medical Center Dieticians - Details For period from 0710112001 through 06/3012002


Title: 10% of System Total for Mod Ed pgrs B7 Dieticians (Activity #95) Sex: Both Males and Females

Department: 0 0 190 190 Totals

is

Benefit

08/2212002 0 Alegent Health Southwest Iowa Medical Center Chaplains/Seminarians/CPE - Details For period from 0710112001 through 0613012002


Title: 10% of System Total for Clinical Pastoral Education (Activity #97) Sex: Both Males and Females

Department: 0 0 16,997 17,667 670 Totals

0

Benefit

0

0

s

0

Revenues Benefit

0812212002 0 Alegent Health Southwest Iowa Medical Center Free-6tanding Community Clinic - Details For period from 07/01/2001 through 0613012002

0 Persons Expenses

0 4,126 Totals 2,200 026

Title: 10% of System Total (ICHC) (Activity #98) Sex: Both Males and Females

Department: 0 0

08122(2002 0 Alegent Health Southwest Iowa Medical Center Collaborative Efforts In Preventive Medicine - Details For period from 0710112001 through 0613012002


Totals 985 19,153 189

0

Title: 10% of System Total (Ministry Development & HMOC) (Activity #99) Sex: Both Males and Females

Department: 0 0

0812212002 0 Alegent He a Medical Center Other - Details For period from 0710112001 through 0613012002

X Persons Expenses Revenues Benefit

Title: 10% of System Total for Ethics & Community Services (Activity #100) Sex: Both Males and Females

Department: 0 () 28,764 Activity Totals 0 28,764

40

Title : Patient Support/ Pastoral Care (Activity #1 5) Description : Direct spiritual care available for spiritual support for any person whose life is touched by

suffering Sex: Both Males and Females

Department: 32958250 (Pastoral Services) Activity Totals 9,614 131,029 0 131,029

Title: SWIMC Child Care Center (Activity #89) Description: Providing employees child care services 24f7

Sex: Both Males and Females Ages: Infants Children

Settings : Facility Formats: Child Care

Department: 32958210 (SWIMC Child Care Center) Objective: To provide employees child care services

Activity Totals 0 288,177 250,761 37,416

Title : SWIMC Inpatient Behavioral (Activity #86) Sex: Both Males and Females

Ages : Children Teens Adults Seniors Settings : Facility Formats: Inpatient

Department: 32100 (Beh Hfth-Adm) Activity Totals 1,491 4,309,801 2,790,769 1,519,032

Title: Volunteer Services/Marcy (Activity #16) Description: Helps meet the needs at Mercy by providing unpaid personnel to supplement and

enhance the services of paid staff. Sex: Both Males and Females

Department: 32958280 (Volunteer Services) Activity Totals 31,200 63,259 0

0812212002 0 0 Alegent Health Southwest Iowa Medical Center Employee - Details For period from 07/01/2001 through 06/30/2002

# persons Expenses Revenues Benefit

Title: 10% of System Total for Subsidy provided to Low Income Employee (Activity #101) Sex- Both Males and Females

Department: 0 0 Activity Totals 38 3,095 0 3.095

0

4t

ONS DO

Title : Charitable Donations (Activity #59) Description : Charitable donations to various community organizations

Sex- Both Mates and Females Ages: Ail Ages

Settings : Community Formats : Community Donations

Department: 00 Activity Totals 0 5.315 5,315

Title: Mercy Hospital Guild (Acdvity#17) Description: Funds raised for Mercy Hospital through volunteer sponsored special events

Sex: Both Males and Females Department: 32958280 (Volunteer Services)

0 Totals 215

0812212002 0 Alegent He a Medical Center - Cash Donations - Details For period from 07101/2001 through 0613012002

# Persons Expenses

Title : 10% of Systems Total for Cash Donations (Activity #66) Sex: Both Males and Females

Department : 0 0 Activity Totals 125 14,586

0

Revenues Benefit

0 14,588

Title: Blanket Drive (Activity #75) Description: Collect blankets and donate to community residents in need

Sex. Both Males and Females Ages: All Ages

Settings : Workplace Formats: Events/Meetings

Department: 8210 (Little Blessings) Objective: Help those in need to keep warm. Outcome: Over 95 blankets were donated and collected . They were given to a church sponsored

kitchen (MOHM'S Place) Activity Totals 95 996 0 996

Title: Homeless Shelter In the warehouse. Glenwood, [A (Activity #71) Description: Assisted in loading food to be delivered to the food bank

Targeted : Homesless/Low income Sex: Both Males and Females

Ages: All Ages Settings : Community Formats: Events/Meetings

0812212002 0 0 Alegent Health Southwest Iowa Medical Center - Inkind Donations - Details For period from 07/01/2001 through 06/30/2002


Title : 10% of Systems Total for Inkind Donations (Activity 967) Sex: Both Males and Females

Department: 0 0 Activity Totals 337 3,467 0 3,487

Title: Donation of 5 cans Glucerna (Activity #77) Description: Five cans of Glucema, nutrition supplement, donated to a patient when discharged

Targeted : Uninsured/Underinsured Sex: Both Males and Females

Ages : Seniors Settings : Inpatient Formats: Donation

Department: 32958100 (Food & Nutrition) Objective: Provide nuttion formula for patient unable to eat solid food . outcome: Nutrition formula was provided to a patient that wasn't able to eat solid food .


Title: Donation of Tube Feeding Formula (Activity #83) Description: Twelve cans Jevrty tube feeding given to patient


Settings : Outpatient Formats: Donation

Department: 32958100 (Food & Nutrition) Objective: To help those in need . Outcome: Provided necessary medical supplies to patent in need .


1,653

2

0812212002 0 Alegent He a Medical Center - Inkind Donations - Details For period from 0710112001 through 0613012002

# Persons Expenses Revenues Department: 32100 (PMIC)

Objective: To give back to the community. Actlvltv Totals 0 1,653 0

Benefit

0812212002 0 Alegent He a Medical Center Support System Enhancements - Details For perlod from 0710112001 through 06130/2002


Title: 10% of Systems Total for Support System Enhancements (Activity #68) Sax: Both Mafes and Females

Department: 0 0 4,748 Totals 0 4.748

/I

0

Revenues Benefit

2,827

0812212002 0 Alegent He a Medical Center Environmental Improvements - Details For period from 0710112001 through 06130/2002

# Persons Expenses

711.1e: Neighborhood Beautifleation -Glenwood, IA (Activity #72) Description: Pick up trash at different location in the community


Settings : Outdoors environment Formats : Events/Meetings

Department : 32100 (Beh Hlth-PMIC) Objective : Give back to the community

Activity Totals 0

0812212002 0 0 Alegent Health Southwest Iowa Medical Center Leadership Development and Skills Training - Details For period from 07/01/2001 through 06130/2002


Title: 10% of System Total for Leadership Develpment & Skills Training (Activity #96) Sax: Both Males and Females

Department: 0 0 Activity Totals 0 280 0 280

49551 vi

0 0

FIRST AMIENDMENT TO

RESTATED BYLAWS OF ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM

The Restated Bylaws of Alegent Health - Bergan Mercy Health System are hereby amended by deleting the previous Section 6.2 and replacing it in its entirety with the following new Section 6 2:

Section 6.2 Term of Office All appointments of Directors to committees shall be for a term of two years or until the successor of the Director committee member shall be appointed. All appointments of Non-Director committee members shall be for a term of one year or until the successor of the non-Director comn-dttee member shall be appointed Any comnuttee member may resign by written notice to the committee on which he or she serves or to the Chair of the Corporation . Any committee member may be removed without cause at any time by the Board

Dated: December 13, 2001 .

Edgar H. Smith, M D, Secretary/Treasurer

I 46773 v1

ORIGINAL I RESTATED BYLAWS OF

ALEGENT HEALTH - BERGAN MIERCY HEALTH SYSTEM

For the purposes of these Bylaws, the terms herein referred to shall have the following meanings:

I . The term "Act" means the Nebraska Nonprofit Corporation Act, or any successor law, as the same may be amended from time to time.

2. The term "Affiliate" means with respect to any corporation or other entity (including, without limitation, HSM and IHS), any person, group of persons, entity or entities controlling, controlled by or under common control with such corporation or enbty. As used in this paragraph, the term "control" means the right to appoint greater than fifty percent of the voting members of the governing body of an entity .

3. The term "Alegent" means Alegent Health, a Nebraska nonprofit corporation.

4. The term "Alegent Board" or "Alegent Board of Directors" means the board of directors of Alegent, and the term "Alegent Director" means an individual member of the Alegent Board.

5 . The term "Alegent Corporate Members" means CHI and IHS in their capacities as members of Alegent.

6. The term "Articles of Incorporation" means the Articles of Incorporation of the Corporation as amended or revised from time to time.

I Nebraska nonprofit corporation

2 46773 Y1

I

7 . The term "Board" or "Board of Directors" means the Board of Directors of the Corporation and the term "Director" means an individual member of the Board, unless from their context or use, such terms clearly have different meanings.

8 'Me term "CHI" means Catholic Health Initiatives, a Colorado nonprofit

corporation .

9 The term "Corporation" means Alegent Health - Bergan Mercy Health System, a Nebraska nonprofit corporation, unless, from its context or use, it clearly has a different meaning.

10 The term "Effective Date" means January 1, 1996, the date on which the JOA became effective .

It . The term "14SM" means Health System of Mercy, a Nebraska nonprofit corporation .

12 The term "HSM Entities" means the entities participating in the JOA which

are listed on Exhibit B to the JOA, with such additions or deletions as are approved

pursuant to Sections 4.04 and 4.05 of the JOA.

13 . The term "IHS" means Immanuel Health Systems, Inc., a Nebraska

nonprofit corporation .

14 . The term "IHS Entities" means the entities participating in the JOA which

are listed on Exhibit A to the JOA, with such additions or deletions as are approved

pursuant to Sections 4.04 and 4.05 of the JOA.

15 The term "IMC" means Alegent Health - Immanuel Medical Center, a

located in the City of Omaha, County of Douglas, State of Nebraska . The Corporation

may have such other offices and facilities within or outside the State of Nebraska, as the Board of Directors may designate or as the business of the Corporation may require from

time to time

3 46773 v]

I

16. The term "Investments" means the cash, cash equivalents and marketable securities designated by HSM and IHS pursuant to Article 6 of the JOA to be used in

carrying out the capital and operating purposes of the Participants .

17. The term "Joint Operating Agreement" or "JOA" means an agreement

made as of the 15th day of December, 1995, by and among Community Health Vision

(now known as Alegent), Immanuel Healthcare Systems, Inc. (now known as Immanuel

Health Systems, Inc.), Health System of Mercy, Immanuel Medical Center, Inc . (now known as Alegent Health - Immanuel Medical Center), Catholic Health Corporation, a Colorado nonprofit corporation (now known as Catholic Health Initiatives), and the

Corporation, as the same may be amended from time to time.

18 . The term "Member" means CHI in its capacity as sole member of the

Corporation .

19 . The term "Participants" means Alegent, the IHS Entities, the HSM

Entities, including the Corporation, with such additions or deletions as are approved

pursuant to Sections 4.04 and 4.05 of the JOA

ARTICLE I NAME AND OFFICES

Section 1 .1 Name The name of the Corporation is Alegent Health - Bergan

Mercy Health System .

Section 1 .2 Principal Office . The principal office of the Corporation shall be

and hour of the meeting and, in the case of a special meeting, the purpose or purposes for

which the meeting is called, shall be delivered, either personally or by mail, by the

Secretary/Treasurer or by the officers or persons calling the meeting, to the Member at

such address as appears upon the records of the Corporation, not less than ten nor more

4 46773A

Section 1 .3 Registered Office . The Corporation shall have and continuously maintain in the State of Nebraska a registered office in accordance with the requirements of the Act . Ile registered office may, but need not, be identical with the principal office of the Corporation, and the address of the registered office may be changed from time to time by the Board of Directors .

ARTICLE 2

The purposes of the Corporation are set forth in the Articles of Incorporation of the Corporation.

ARTICLE 3

Section 3.1 Member. The sole Member of the Corporation shall be CHI. CHI shall not have any voting rights as a Member of the Corporation

Section 3 .2 Annual Meetin . The annual meeting of the Member shall be held at such time and place as are determined by the Board of Directors of the Corporation for the purpose of transacting such business as may properly come before the Board .

Section 3 3 Special Meetin Special meetings of the Member may be called at

any time by the Chair or the Member and shall be called by the Chair upon the request in

writing of at least five Directors of the Corporation.

Section 3.4 Notice of Meetings. A written or printed notice, stating the place, day

46773 v] 5

0

than fifty days before the date of the meeting . If mailed, such notice shall be deemed to be delivered when deposited in a mail receptacle maintained by the United States Postal

Service, with postage thereon prepaid .

Section 3.5 Waiver of Notice . Whenever any notice is required to be given to the Member under the Articles of Incorporation, these Bylaws or the Act a waiver thereof in writing signed by the person or persons entitled to such notice, whether before or after the time stated therein, shall be equivalent to the giving of such notice.

Section 3 .6 Written Consent. Any action required or permitted by law to be taken

at an annual or special meeting of the Member also may be taken without a meeting if a consent in writing, setting forth the action so taken, is signed by the Member. Such consent shall have the same force and effect as a vote of the Member for all purposes .

ARTICLE 4 BOARD OF DIRECTORS

Section 4 1 General Powers. To the fullest extent permitted by law, and except as

otherwise expressly provided in these Bylaws, 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 of the Corporation

and these Bylaws. Notwithstanding any other provisions of these Bylaws or the Articles

of Incorporation of the Corporation to the contrary, the following actions shall be

effective only if approved by the Alegent Board and by both IHS and 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

46773 v 1 6

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;

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, and

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.

Section 4 2 Authorijy Over HSM Entities . In consideration for entering into the JOA, the Corporation hereby authorizes the Alcgent Board to act as its proxy to take any and all actions on behalf of and in the name of the Corporation which it is authorized to take as a shareholder or member of the other HSM Entities Imis proxy shall remain in effect and be irrevocable throughout the term of the JOA. In ftirtherance of the foregoing, the officers of the Corporation shall take all actions necessary to cause the proxy to remain in effect throughout the term of the JOA

Section 4.3 Authority Over Medical Staff Matters. Notwithstanding the provisions of Section 4.1, and except as may be otherwise expressly delegated by the Board of Directors of the Corporation to the medical staffs of the hospitals operated by the Corporation or to a committee of the Board, the Board of Directors of the Corporation shall continue to perform all functions related to the medical staffs of the hospitals operated by the Corporation including, without limitation, determining appointments, reappointments and delineation of privileges for members of the medical staffs, taking corrective action relating to the medical staffs ; and reviewing and monitoring quality

0 0

I

46773 v 1 8 a

Section 4.7 Resignation of Directors. A Director may resign by written notice to the Corporation . The resignation shall be effective upon its receipt by the Chair of the Corporation or at a subsequent time as specified in the notice of resignation .

Section 4.8 Removal of Directors. Directors shall not be removed from office as long as they serve as members of the Alegent Board. Upon the termination of an Alegent Director's service on the Alegent Board, whether as a result of the Alegent Director's removal, resignation or otherwise, such Alegent Director shall immediately and automatically be removed by the Alegent Board from service on the Board of Directors of the Corporation.

Section 4.9 Vacancies. Vacancies on the Board shall be filled pursuant to the procedure set forth in Section 4.5 above, provided that any such Director shall at all times possess the qualifications set forth in Section 4.4. Directors so appointed shall hold office for the remainder of the term for which the vacancy resulted, or until their resignation or removal.

Section 4.10 Meetings . The Corporation has determined that it is in the best interests of the Corporation for its Board of Directors to act in a coordinated manner with the Boards of Directors of Alegent and IMC consistent with the principles of joint governance and operations of the three entities described in the JOA. In furtherance of the foregoing, the Boards of Directors of the Corporation, Alegent and IMC shall hold joint meetings. An annual joint meeting of the Boards of Directors of the Corporation, Alegent and IMC will be held at such tune, date and place as shall be designated from

time to time by the Chair of Alegent Regular joint meetings of the Boards of the Corporation, Alegent and IMC shall be held at such date, time and place, either within or outside the State of Nebraska, as the Boards of Directors of the three Corporations shall

determine . Special joint meetings of the three Boards may be called at any time by the Chair or Chief Executive Officer of Alegent and shall be called by the Chair of Alegent upon the request in writing of at least five Directors of the Corporation, by means of

46773 v] 9

0

written notice pursuant to Section 4.11 below The Corporation, Alegent and IMC each shall prepare and maintain separate minutes of all joint meetings .

Section 4.11 Notice of Meetings. Notice of annual, regular and special meetings

of the Boards of Directors of the Corporation, Alegent and IMC shall be provided simultaneously to all Directors of the Corporation, Alegent and IMC by the Secretaryfrreasurer of Alegent, or by the person or persons calling the meeting. Tlie

notice shall specify the time and place of all regular, special and annual meetings, but need not specify the purpose or purposes of meetings . Notice shall be served upon each Director of the Corporation, Alegent and IMC at least five days prior to the date of the meeting either in person, by telephone, by facsimile or by electronic mail. Alternatively, notice may be given by mail by depositing the notice in a regularly maintained receptacle

of the United States Postal Service addressed to the last known post office address of the Director at least five days prior to the date and time of the meeting.

Section 4.12 Waiver of Notice . Whenever any notice is required to be given to a

Director under the Articles of Incorporation of the Corporation, these Bylaws or the Act, a waiver thereof in writing signed by the person or persons entitled to such notice, whether before or after the time stated therein, shall be equivalent to the giving of such notice A waiver of notice of a meeting shall be deemed a waiver of notice of the meeting of each of the Boards of Directors of the Corporation, Alegent and IMC Presence of a

Director at a joint meeting of the Boards of Directors of the Corporation, Alegent and

IMC shall constitute waiver of notice of the joint meeting unless the Director attends the

meeting for the express purpose of objecting to the transaction of any business because

the meeting was not lawfully called or convened .

Section 4 .13 Quorum Except as otherwise provided in the Articles of

incorporation of the Corporation or these Bylaws, eight of the twelve voting members of

the Board of Directors of the Corporation shall constitute a quorum for the transaction of business Action shall not be taken by any of the Boards of Directors of the Corporation,

46773 A 10

1 0 0

Alegent or IMC at a joint meeting unless a quorum of Directors of each of the Corporation, Alegent and IMC, as the same may be specified from time to time in the Bylaws of the Corporation, Alegent and IMC, respectively, shall be present at the meeting . If a quorurn of Directors of any of the Corporation, Alegent or IMC shall not be present at any joint meeting of the three Boards, the Directors of each of the Corporation, Alegent and IMC present thereat may adjourn the joint meeting from time to time and to another place without notice, other than announcement at the meeting, until a quorum shall be present.

Section 4.14 Valid Director Action . Except as may otherwise be required by the

Articles of Incorporation of the Corporation, these Bylaws, the JOA or applicable law, any action submitted to a vote of the Directors shall be authorized by the affirmative vote of eight voting members of the Board present at any meeting of the Board at which a quorum is present.

Section 4.15 Unanimous Written Consent. Any corporate action required or

permitted by the Articles of Incorporation of the Corporation, by these Bylaws, by the

JOA or by the laws of the State of Nebraska, to be taken at an annual, regular or special meeting of the Directors, also may be taken without a meeting if a consent, in writing,

setting forth the action so taken, shall be signed by all of the Directors entitled to vote

with respect to the subject matter thereof Such consent shall have the same force and

effect as a unanimous vote of the Directors for all purposes .

Section 4.16 Meetings by TelMhone or Video Teleconference A Director may

participate in a meeting of the Board, or a committee thereof, by means of a conference

telephone, video teleconference or similar communications equipment by which all

persons participating in the meeting may hear each other if all the participants are advised

of the communications equipment and the names of the participants in the conference are

divulged to all participants . Participation in a meeting pursuant to this Section constitutes

presence in person at the meeting

I

46773 Y1 I I

0 0

Section 4.17 Compensation . Voting Directors of the Corporation shall not receive

any compensation for their services to the Corporation as Directors, other than reimbursement for reasonable out-of-pocket expenses incurred in performing such services ; provided, however, that nothing contained herein shall be construed to preclude

any Director from serving the Corporation in any other capacity and receiving reasonable

compensation therefor .

Section 4.18 Conflicts with JOA . The management of the business and affairs of

the Corporation shall also be subject to the terms, conditions and delegations of authority

set forth in the Joint Operating Agreement. In the event there appears to be a conflict or

inconsistency between the provisions of the Articles of Incorporation of the Corporation or these Bylaws and the terms and conditions of the JOA, and the terms and conditions of

the JOA are more specific, then the provisions of the JOA shall be deemed to control.

ARTICLE 5

Section 5 .1 Officers The officers of the Corporation shall consist of a Chair, a Vice Chair, a Secretary/Treasurer and such other officers as the Board of Directors of the

Corporation shall deem necessary or appropriate. The officers of the Corporation shall

have the duties and responsibilities set forth below.

A Chair The Chair shall perform such duties and carry out such

responsibilities as may be prescribed by these Bylaws or assigned to him or her from time to time by the Board of Directors . The Chair also shall serve as the president of the

Corporation for purposes of the Act and any other applicable laws and regulations and

shall perform all duties required to be performed by the president under the Act or other

applicable laws or regulations .

46773 v] 12

B Vice Chair. The Vice Chair shall assist the Chair in the performance of his or her duties . Ile Vice Chair shall perform the duties and exercise the powers of the Chair during any absence or disability of the Chair. The Vice Chair shall carry out such additional duties as may be assigned to him or her from time to time by the Chair or the Board of Directors . 'Me Vice Chair also shall serve as the vice president of the Corporation for purposes of the Act and any other applicable laws and regulations and shall perform all duties required to be performed by the vice president under the Act or other applicable laws or regulations

C. Secretary/Treasurer. The Secretary/Treasurer shall record or assure the recording of the minutes of all meetings of the Corporation and of the Board of Directors . The Secretary/Treasurer shall have custody of all of the funds of the Corporation, shall keep or assure the keeping of a full and accurate account of receipts and expenditures, and shall make or assure the making of disbursements in accordance with the approved budget, as authorized by the Board of Directors or a committee of the Board The Secretary/Treasurer shall present interim financial reports when requested by the Board of Directors and shall make or assure the making of a full report at the annual meeting The Secretary/Treasurer shall be responsible for the maintenance of such books of accounts and records as conform to the requirements of these Bylaws . The Secretary/Treasurer shall perform such other duties as may be assigned to him or her from time to time by the Board of Directors of the Corporation .

Section 5.2 Other Officers . The Board of Directors may, from time to time,

appoint such other officers and agents as it shall deem necessary or appropriate, who shall hold their offices for such terms and shall exercise such powers and perform such

duties as shall be determined from time to time by the Board.

Section 5 3 Election . The officers of the Corporation shall be appointed by the

Board of Directors at its annual meeting Officers shall serve two-year terms and until

I

46773 Y 1 13

0 0

'I their successors are appointed and qualified or until their sooner resignation or removal There shall be no limit on the number of consecutive terms which officers may serve

Section 5 .4 Removal . Ile officers of the Corporation shall hold office at the pleasure of the Board. Any officer may be removed by the Board of Directors at any time without cause . The removal of an officer shall be without prejudice to the officer's contract rights, if any, provided that appointment of an officer shall not in and of itself create contract rights .

Section 5 .5 Resiggation. Any officer, other than the Chair, may resign by written notice to the Chair of the Corporation . The resignation is effective upon its receipt by the Chair or at a subsequent time specified in the notice of resignation. The Chair may resign by written notice to the Board.

Section 5 6 Vacancies. Any vacancy occurring in any office of the Corporation by death, resignation, removal or otherwise shall be filled by the Board of Directors. Officers so appointed shall hold office for the remainder of the term for which the vacancy resulted or until their resignation or removal.

Section 5 .7 Compensation. The compensation, if any, for each officer of the Corporation for his or her services to the Corporation as an officer shall be fixed by the Board of Directors.

ARTICLE 6 COMMITTEES

Section 6.1 Committees of Directors. The Board of Directors may from time to time, by resolution adopted by a majority of the Directors then in office, designate and appoint such committees as it deems appropriate, some of which will have and exercise specifically delegated authority of the Board of Directors in the management of the Corporation ; provided that each such committee shall consist of two or more Directors,

46773 v 1 14

and provided further that no committee shall have the authority of the Board of Directors in reference to (1) amending, altering or repealing these Bylaws; (2) electing, appointing or removing any member of any committee or any Director or officer of the Corporation, (3) amending the Articles of Incorporation of the Corporation; (4) adopting a plan of merger or adopting a plan of consolidation with another corporation; (5) authorizing the

sale, lease, exchange or mortgage of all or substantially all of the property and assets of

the Corporation; (6) authorizing the voluntary dissolution of the Corporation or revoking proceedings therefor; (7) adopting a plan for the distribution of the assets of the Corporation ; (8) amending, altering or repealing any resolution of the Board of Directors which by its terms provides that it shall not be amended, altered or repealed by such committee; or (9) taking any other actions which require the approval of the Alegent Corporate Members under Section 4.1 of these Bylaws. The designation and appointment of any committee, whether or not the committee has specific Board-delegated authority, shall not operate to relieve the Board of Directors, or any individual Director, of any responsibility imposed upon it or him or her by law.

Section 6.2 Term of Office All appointments to committees shall be for a term of one year or until the successors to the committee members shall be appointed . Any committee member may resign by written notice to the committee on which he or she serves or to the Chair of the Corporation. Any committee member may be removed without cause at any time by the Board.

Section 6.3 Chair. One member of each committee shall be appointed chair of the

committee by the Chair of the Corporation .

Section 6 4 Vacancies . Any vacancy in the membership of any committee shall be

filled by the Board.

Section 6 .5 Ouorum. Unless otherwise provided in the resolution of the Board of

Directors designating a committee, a majority of the whole committee shall constitute a

activities and their results in writing to the Board of Directors

15 46773 v I

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quorum and the act of a majority of the members present at a meeting at which a quonim is present shall be the act of the committee.

Section 6.6 Rules . Each committee may adopt rules for its own govemance not inconsistent with the Articles of Incorporation of the Corporation, these Bylaws, the JOA or any policies adopted from time to time by the Board of Directors.

ARTICLE 7 MEDICAL STAFF

Section 7.1 Medical Staffs The Board of Directors shall organize those persons permitted to practice in the hospitals operated by the Corporation into medical staffs as appropriate for such hospitals under Medical Staff Bylaws and policies and related protocols and manuals, including for example, credentials policy and procedure manuals, corrective action and fair hearing plans, and organization and fimctions manuals (collectively referred to as "Medical Staff Bylaws"), all of which are subject to the approval of the Board of Directors . Subject to the hospitals' needs, the Board of Directors shall consider recommendations of the respective medical staffs for the addition of physicians, dentists, podiatrists and other licensed independent practitioners who meet the qualifications for membership as set forth in the respective Medical Staff Bylaws.

Section 7.2 Quahly Review. The Board of Directors shall assure quality medical care for the hospitals' patients through proper evaluation of the performance of the

medical staffs and shall delegate to the medical staffs the responsibility for evaluating the

performance of the medical staff and its individual members and making

recommendations to the Board regarding the performance of the medical staff. The

Board of Directors reserves the right to rescind any delegated authonty .

A . Each medical staff shall conduct a continuing review and appraisal

of the quality of professional care rendered in the respective hospital and shall report such

I

46173 v 1 16

B . Each President of the Medical Staff or Chief of Staff shall have the direct responsibility for the organization and professional activities of the respective medical staff in accordance with the terms of the Medical Staff Bylaws approved by the Board of Directors . In all medical-administrative matters, he or she shall act in coordination and cooperation with the President of the Corporation in giving effect to the approved policies of the Board of Directors .

C . Each President of the Medical Staff or Chief of Staff shall be responsible to the Board of Directors for the program to assure high quality of medical care in the respective hospital . He or she shall be responsible for the processes of supervision, control and appraisal necessary to assure the standards of medical care affirmed by the Board of Directors .

D. Each President of the Medical Staff or Chief of Staff shall regularly and at intervals stipulated by the Board of Directors submit a report to the Board of Directors stating all information appraising the quality of the medical care provided in the respective hospital .

E. Each President of the Medical Staff or Chief of Staff shall convey to the Professional Affairs Committee of the Board of Directors the recommendations of the appropriate Executive Committee of such medical staff respecting (1) the appointments and reappointments to the staff, (2) the granting or restricting of clinical privileges of individual members of the medical staff-, (3) disciplinary action against individual members of the medical staff; and (4) amendments or additions to the respective Medical Staff Bylaws

F. Each President of the Medical Staff or Chief of Staff, with respect to

the hospital facility and medical staff of which he or she serves as President of the Medical Staff or Chief of Staff shall, except as otherwise provided in the Medical Staff

Bylaws: (1) Aid in coordinating the activities and concerns of the Administration and of the nursing and other patient care services with those of the medical staff, (2)

Communicate and represent the opinions, policies, concerns, needs and grievances of the

medical staff to the Board of Directors ; (3) Be responsible for the enforcement of the

i Medical Staff Bylaws, for implementation of sanctions where those are indicated, and for

I

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such m edical staffs compliance with procedural safeguards in all instances where corrective action has been requested against a member of the medical staff-, (4) Call, preside at, and be responsible for the agenda of all general meetings of the medical staff, (5) Assure the appointment of all Department Chairs, Department Vice Chairs, Committee Chairs and Com-mittee Vice Chairs as prescribed by the Medical Staff Bylaws; (6) Serve as ex-officio member without vote on all other medical staff committees unless otherwise appointed as a member; (7) Appoint members of committees with the assistance of the committee chairs with the exception of those committees that may have their membership outlined in the Medical Staff Bylaws; and (8) Appoint and disband committees as necessary.

Section 7.3 Medical Staff Bylaws . Subject to the approval of the Board of Directors, the medical staff of each hospital shall adopt Medical Staff Bylaws governing the organization, operation and self-discipline of the medical staff as may be necessary to implement the general principles found within the Medical Staff Bylaws, to promote the delivery of quality healthcare within the respective hospital and to provide for the efficient operation of the hospital . The Medical Staff Bylaws shall be reviewed annually and updated as required . Proposed changes to the Medical Staff Bylaws shall be submitted to the Board of Directors and shall only become effective upon approval of the Board of Directors. Any conflict between the medical staff and the Board of Directors amending the Medical Staff Bylaws shall be referred to the Professional Affairs Committee for consultation and referral back to the medical staff and the Board of

Directors .

Section 7.4 Medical Staff Membershi . The Board of Directors shall be responsible for granting medical staff membership for each hospital and delineating

clinical privileges In carrying out these duties, the Board of Directors shall adopt a

credentials policy and procedure manual or comparable document of a different title for each medical staff setting forth the procedure governing : (1) appointments and

reappointments to each medical staff, (2) delineation of clinical privileges, (3) granting,

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renewal and revision of clinical privileges ; and (4) assignments to staff categories The appointment procedure shall also set forth the manner in which the credentials (including, without limitation, the medical education, training, clinical ability, professional competence, judgment, character and ability to work with others) of each applicant and staff appointee will be evaluated . No aspect of appointment status or specific clinical privileges shall be limited or denied to a practitioner on the basis of sex, race, age, creed, color, disability, religion, or national origin . Applicants for reappointment and/or renewal of clinical privileges shall submit reasonable evidence of current health status as required by each medical staff Executive Committee . All applicants shall be required to acknowledge their responsibility for providing continuous care for their patients . The appointment procedure shall provide for the establishment of a committee which shall be responsible directly to the Board of Directors and shall assist the Board of Directors in conducting professional review activities (as such term is defined in the Health Care Quality Improvement Act of 1986, as amended) . Complete applications shall be acted on within the period of time set forth in the respective Medical Staff Bylaws .

Section 7.5 Corrective Action and Fair Hearing PI . The Board of Directors shall adopt a corrective action and fair hearing plan or comparable document of another

title for each medical staff setting forth : (1) the hearing rights which shall be afforded to

applicants and appointees to the respective medical staff in the event of a reduction,

restriction, suspension, revocation, denial or failure to renew staff appointment or clinical privileges, or a recommendation of any of the foregoing; (2) the circumstances under

which such hearing rights will be made available; and (3) the manner in which such

hearings will be conducted. The corrective action and fair hearing plan shall include all

provisions necessary under the Health Care Quality Improvement Act of 1986, as

amended, and applicable state law to protect the Corporation, the Board of Directors and

all other persons assisting the Board of Directors in professional review activities from

civil liability .

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Section 7.6 Responsibilfty for Patients Each medical staff member shall have appropriate authority and responsibility for the care of his or her patients, subject to limitations contained in these Bylaws, in the Medical Staff Bylaws, and subject to any limitations attached to his or her appointment .

Section 7.7 Board Authority . The Board specifically reserves the authority to :

A. Take any direct action that is appropriate with respect to any individual appointed to a medical staff or given clinical privileges or the right to practice in its

hospitals who is charged with questions involving clinical incompetence, inappropriate behavior, or violations of these Bylaws or the Medical Staff Bylaws or the policies and procedures of the Corporation.

B Periodically examine, analyze and evaluate its goals, its policies, the current programs of the hospitals, and data which reflect the community's present and projected

health needs and accordingly develop a written plan for the hospitals' growth and development The Board of Directors shall have the authority to provide appropriate physical and financial resources and personnel to meet the needs of the community and the hospitals' patients Further, the Board of Directors has the authority to limit or restrict any specialty's right to membership on a medical staff in order to implement the Board's written plan .

ARTICLE 8 AUXILIARY AND ASSOCIATED ORGANIZATIONS

The Board of Directors may authorize the formation of auxiliary groups to work for and promote the Corporation by volunteer service Such auxiliary groups shall

develop bylaws that delineate their purpose and ftinction, which bylaws shall be submitted to the Board of Directors for approval.

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ARTICLE 9 INDEMNWICATION

Section 9.1 General . The Corporation shall indemnify, to the ftillest extent authorized or permitted by the Act, any person (and such person's heirs and legal representatives) who is made or threatened to be made a party to any threatened, pending or completed action, suit or proceeding (whether civil, criminal, administrative or investigative), whether formal or informal, by reason of the fact that such person is or was a Director, officer or administrative officer (for purposes of this Article, "administrative officer" shall mean any person designated as a vice president of the Corporation, with responsibility for an administrative department and reporting directly to any corporate officer) of the Corporation, or such person is or was serving on any formally constituted advisory body or voluntary committee of the Corporation or the Board of Directors, or any such person is or was serving at the request of the Corporation as a trustee, shareholder, member, partner, officer or director of any other corporation, partnership, joint venture, trust, association or any other enterprise, against expenses (including attorneys' fees), judgments, fines and amounts paid in settlement, actually and reasonably incurred by the person in connection with such action, suit or proceedmg, if such person acted in good faith and in a manner the person reasonably believed to be in or not opposed to the best interests of the Corporation, and with respect to any criminal action or proceeding, had no reasonable cause to believe that the conduct was unlawfW.

Section 9.2 Limitations, Actions in Right of Co1poration . Notwithstanding the foregoing, the Corporation shall not indemnify any person in connection with any action

or suit by or in the right of the Corporation to procure a judgment in its favor, to the extent such indemnification would be in respect of any claim, issue or matter as to which such person shall have been adjudged to be liable for negligence or misconduct in the performance of the person's duty to the Corporation, except and only to the extent that the court in which such action or suit was brought shall determine upon application that despite the adjudication of liability but in view of all circumstances of the case, such

person is fairly and reasonably entitled to indemnity for such expenses which such court

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shall deem proper. The Corporation shall also not indemnify any person for any expenses or liability incurred in settlement of any disputed claim to the extent that, in connection with such claim, such person was liable, or it is determined to be substantially likely that a court would have found such person to be liable, for negligence or willful misconduct in the performance of the person's duty to the Corporation . As to whether or not such a person was liable or would have been substantially likely to have been adjudged to be liable for negligence or willful misconduct in the performance of the person's duty to the Corporation with respect to any settled claim, the Corporation and such person shall conclusively rely upon an opinion of legal counsel or an arbitrator selected by or in the manner designated by the Board of Directors .

Section 9.3 No Presumption. The termination of any action, suit or proceeding by judgment, order, settlement, conviction, or upon a plea by nolo contendere or its equivalent, shall not, of itself, create a presumption that the person did not act in good faith and in a manner which the person reasonably believed to be in or not opposed to the best interests of the Corporation, or, with respect to any criminal action or proceeding, had reasonable cause to believe that his or her conduct was unlawful .

Section 9 4 Defense by Co1poration. The Corporation shall fulfill its responsibility hereunder by providing or offering to provide such indemnified person with a defense and agreeing to pay the costs thereof. The indemnified person shall

cooperate with the conduct of the defense by the Corporation and legal counsel retained by it for such purposes Costs or expenses incurred by the indemnified person in obtaining separate counsel or other independent arrangements shall be such person's sole responsibility

Section 9 .5 Success on the Merits To the extent that a Director, officer, administrative officer, advisory board member, voluntary committee member, employee or agent of the Corporation has been successful on the merits or otherwise in defense of any action, suit or proceeding referred to in this Article 9, or in defense of any claim,

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issue or matter herein, such person shall be indemnified against expenses, including attorneys' fees, actually and reasonably incurred by such person in connection therewith .

Section 9.6 Standard of Conduct Determination . Any indemnification under this Article 9, unless ordered by a court, shall be made by the Corporation only as authorized in the specific case upon a determination that indemnification of the applicable person is proper in the circumstances because the person has met the applicable standard of conduct set forth in this Article 9 . Such determination shall be made by the Board of Directors by a majority vote of a quorum consisting of Directors with voting power who are not parties to such action, suit or proceeding or if such quorum is not obtainable, or even if obtainable and a quorum of disinterested Directors so directs, by independent legal counsel in a written opinion .

Section 9.7 Expenses Paid in Advance. Expenses incurred in defending a civil or criminal action, suit or proceeding may be paid by the Corporation in advance of the final disposition of such action, suit or proceeding as authorized by the Board of Directors in the mariner provided for under Section 9.6, upon receipt of an undertaking by or on behalf of the Director, officer, employee or agent to repay such amount unless it shall ultimately be determined that such person is not entitled to be indemnified by the Corporation as authorized in this Article 9.

Section 9 .8 Non-Exclusive . Survival . The indemnification provided by this Article 9 shall not be deemed exclusive of any other rights to which those indemnified may be entitled under these Bylaws, or any agreement, vote of members or vote of disinterested Directors or otherwise, both as to action in their official capacity and as to action in another capacity while holding such office, and shall continue as to any person who has ceased to hold the position for which such person is entitled to be indemnified hereunder, and shall inure to the benefit of the heirs, executors and administrators of such person .

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Section 9.9 Liabili1y Insurance . A. The Corporation shall have the power to purchase and maintain

liability insurance on behalf of any person who is or was a Director, officer, administrative officer, advisory board or voluntary committee member, employee or agent of the Corporation, or who is or was serving at the request of the Corporation as a director, officer, member, employee or agent of another corporation, partnership, limited liability company, joint venture, trust or other enterprise against any liability asserted against such person and incurred by the person in any such capacity or arising out of such person's status as such, whether or not the Corporation would have the power to indemnify such person against such liability under this Article 9 .

B. Notwithstanding the foregoing provisions of this Article 9, the indemnification provided to any person described above shall be only in excess of any valid and collectible insurance or other source of indemnification available for the benefit of such person, including any benefit available under any insurance or self-insurance plan of the Corporation, and no rights of subrogation are intended to be created hereby .

ARTICLE 10 IMMUNITY OF NON-COMPENSATED DIRECTORS AND OFFICERS

Those Directors and officers who arc not compensated for their services to the Corporation as Directors or officers on a salary or prorated equivalent basis shall be immune from civil liability for any act or omission which results in damage or injury if the Director or officer was acting within the scope of his or her official functions and duties as a Director or officer, unless such damage or injury was caused by the willful or wanton act or omission of such Director or officer. For purposes of this Article, a Director or officer shall not be considered to have received compensation for his or her services solely by reason of the payment of his or her actual expenses incurred in attending meetings or in executing such office, the receipt of meals at meetings, or the receipt of gifts not exceeding a total value of $100 in any twelve consecutive months .

officer or to any Director .

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ARTICLE 11 CONTRACTS, LOANS, CHECKS, DEPOSITS

Section It . I Contracts. The Board of Directors may authorize any officer(s) or

agent(s) of the Corporation, in addition to the officers so authorized by these Bylaws, to enter into any contract or execute and deliver any instrument in the name of and on behalf of the Corporation, and such authority may be general or confined to specific instances .

Section 11 2 Checks, Drafts, and Money Orders . All checks, drafts or orders for the payment of money, notes or other evidences of indebtedness issued in the name of the Corporation, shall be signed in the name of the Corporation by such officer(s) or agent(s) of the Corporation and in such manner as shall from time to time be determined by resolution of the Board of Directors. In the absence of such determination by the Board of Directors, such instruments shall be signed by the Secretaryfrreasurer and countersigned by the Chair of the Corporation.

Section 11 .3 Deposits . All funds of the Corporation not otherwise employed shall

be deposited from time to time to the credit of the Corporation in such banks, trust

companies or other depositories as the Board of Directors may from time to time

designate

Section 11 4 Gifts. 'Me Board of Directors may accept on behalf of the

Corporation any gift, bequest or devise for the general purposes or for any special

purposes of the Corporation

Section 11 .5 Loans Prohibited. No loans shall be made by the Corporation to any

0

committee with Board-delegated powers that has a direct or indirect financial interest, as

defined below, is an interested person. If a person is an interested person with respect to any entity in the healthcare system of which the Corporation is a part, he or she is an interested person with respect to all entities in the healthcare system

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ARTICLE 12 GENERAL PROVISIONS

Section 12 .1 Books and Records . The Corporation shall keep correct and complete books and records of accounts and shall also keep minutes of the proceedings of its Member, Board of Directors and committees having authority from the Board of Directors . All books and records of the Corporation may be inspected by the Member or its agents or attorneys for any proper purpose at any reasonable time .

Section 12 .2 Fiscal Year. The fiscal year of the Corporation shall end on June 30 or such other date as shall be fixed from time to time by resolution of the Board of Directors

ARTICLE 13 CONFLICTS OF INTEREST POLIC

Section 13 1 -PuMose. The purpose of this conflicts of interest policy is to protect the Corporation's interest when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or Director of the

Corporation. This policy is intended to supplement but not replace any applicable state laws governing conflicts of interest applicable to nonprofit and chantable corporations

Section 13 2 Definitions .

A Interested Person . Any Director, principal officer, or member of a

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I I B . Financial Interest . (1) A person has a financial interest if the person has, directly or

indirectly, through business, investment or family-

(i) An ownership or investment interest in any entity with which the Corporation has a transaction or arrangement, or

(ii) A compensation arrangement with the Corporation or with any entity or individual with which the Corporation has a transaction or arrangement, or

(iii) A potential ownership or investment interest in, or compensation arrangement with, any entity or individual with wtuch the Corporation is negotiating a transaction or arrangement.

(2) Compensation includes direct and indirect remuneration as well as gifts or favors that are substantial in nature .

(3) A financial interest is not necessanly a conflict of interest. Under Section 13 .3(B), a person who has a financial interest may have a conflict of interest only if the appropriate Board or committee decides that a conflict of interest exists .

Section 13 3 Procedures.

A. Duty to Disclose . In connection with any actual or possible conflicts of interest, an interested person must disclose the existence of his or her financial interest and must be given the opportunity to disclose all material facts to the Directors and members of committees with Board-delegated powers considering the proposed transaction or arrangement .

B Determining Whether a Conflict of Interest Exists After disclosure of the financial interest and all material facts, and after any discussion with the interested

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person, he/she shall leave the Board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaining Board or committee members shall decide if a conflict of interest exists .

C . Procedures for Addressing the Conflict of Interest

(1) An interested person may make a presentation at the Board or committee meeting, but after such presentation, he/she shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in the conflict of interest

(2) The Chair of the Board or committee shall, if appropriate, appoint a disinterested person or committee to investigate alternatives to the proposed transaction or arrangement .

(3) After exercising due diligence, the Board or committee shall determine whether the Corporation can obtain a more advantageous transaction or arrangement with reasonable efforts from a person or entity that would not give rise to a conflict of interest .

(4) If a more advantageous transaction or arrangement is not reasonably attainable under circumstances that would not give rise to a conflict of interest, the Board or committee shall determine by a majority vote of the disinterested Directors whether the transaction or arrangement is in the Corporation's best interest and

for its own benefit and whether the transaction is fair and reasonable to the Corporation

and shall make its decision as to whether to enter into the transaction or arrangement in conformity with such determination.

D Violations of the Conflicts of Interest Policy

(1) If the Board or committee has reasonable cause to believe that a member has failed to disclose actual or possible conflicts of interest, it shall inform the

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I member of the basis for such belief and afford the member an opportunity to explain the alleged failure to disclose .

(2) If, after hearing the response of the member and making such ftirther investigation as may be warranted in the circumstances, the Board or committee determines that the member has in fact failed to discAe an actual or possible conflict of interest, it shall take appropriate disciplinary and corrective action.

Section 13.4 Records of Proceedings Tle minutes of the Board and all committees with Board-delegated powers shall contain -

A 'Me names of the persons who disclosed or otherwise were found to have a financial interest in connection with an actual or possible conflict of interest, the nature of the financial interest, any action taken to determine whether a conflict of interest was present, and the Board's or committee's decision as to whether a conflict of interest in fact existed

B. The names of the persons who were present for discussions and

votes relating to the transaction or arrangement, the content of the discussion, including

any alternatives to the proposed transaction or arrangement, and a record of any votes taken in connection therewith .

Section 13 .5 Compensation .

A. A voting member of the Board of Directors who receives compensation, directly or indirectly, from the Corporation for services is precluded from voting on matters pertaining to that member's compensation .

B. A physician who is a voting member of the Board of Directors and

receives compensation, directly or indirectly, from the Corporation for services is

precluded from discussing and voting on matters pertaining to that member's and other

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physicians' compensation . No physician or physician director, either individually or collectively, is prohibited from providing information to the Board of Directors regarding

physician compensation . C. A voting member of any committee whose jurisdiction includes

compensation matters and who receives compensation, directly or indirectly, from the Corporation for services is precluded from voting on matters pertaining to that member's compensation.

D. Physicians who receive compensation, directly or indirectly, from the Corporation, whether as employees or independent contractors, are precluded from membership on any committee whose jurisdiction includes compensation matters. No physician, either individually or collectively, is prohibited from providing information to any committee regarding physician compensation .

Section 13 .6 Annual Statements . Each Director, principal officer and member of a committee with Board-delegated powers shall annually sign a statement that affirms that

such person -

A Has received a copy of the conflicts of interest policy,

B. Has read and understands the policy,

C Has agreed to comply with the policy, and

D Understands that the Corporation is a charitable organization and that in order to maintain its federal tax exemption it must engage primarily in activities that accomplish one or more of its tax-exempt purposes.

Section 13 .7 Periodic Reviews . To ensure that the Corporation operates in a manner consistent with its charitable purposes and that it does not engage in activities that could jeopardize its status as an organization exempt from federal income tax,

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periodic reviews shall be conducted . The periodic reviews shall, at a minimum, include the following subjects .

A Whether compensation arrangements and benefits are reasonable and are the result of arm's-length bargaining .

B . Whether acquisitions of physician practices and other provider services result in inurement or impermissible private benefit

C . Whether partnership and joint venture arrangements and arrangements with management service organizations and physician hospital organizations conform to written policies, are properly recorded, reflect reasonable payments for goods and services, further the Corporation's charitable purposes and do not result in inurement or impermissible private benefit .

agr ement"o-pfovide-Aiealtheare-end-ageernene-with-----other healthcare providem, employees, and third party payors further the Corporation's charitable purposes and do not result in inurement or impennissible private benefit.

Section 13 8 Use of Outside Experts. In conducting the periodic reviews provided for in Section 13 7, the Corporation may, but need not, use outside advisors If outside experts are used, their use shall not relieve the Board of its responsibility for ensuring that periodic reviews are conducted.

ARTICLE 14 AMENDMENTS TO ARTICLES OF INCORPORATION AND BYLAWS

Neither the Articles of Incorporation nor these Bylaws may be amended or

repealed, or new Articles of Incorporation or Bylaws adopted, except by approval of the

Alegent Board and by the Alegent Corporate Members

I

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These Bylaws are effective this ;7~day of .2001 .

ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM, a Nebraska nonprofit corporation

By: ZdA6 -92P P-dgar W. Smith, M D, Secretary/Treasurer

009e67f1 - foundation center990s.foundationcenter.org/990_pdf_archive/470/470484764/470484… ·...

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