4A (Expenses $ 44627991 including grants of $ 44591151) (Revenue $ 266872317)
BERGAN MERCY MEDICAL CENTER IS EQUIPPED WITH THE LATEST TECHNOLOGIES IN THE DIAGNOSTIC CENTER. THE CENTER IS COMPLETELY DIGITAL SO PATIENTS ARE NEVER WAITING ON FILMS. FEMALE PATIENTS CAN COUNT ON EXPERT IMAGING TESTS INCLUDING ULTRASOUND, BONE DENSITY TESTING, STEREOTACTIC BREAST BIOPSY AND DIGITAL MAMMOGRAPHY. THERE ARE A WIDE RANGE OF AVAILABLE TESTS AT THE DIAGNOSTIC CENTER THAT INCLUDE THE FOLLOWING: DIGITAL MAMMOGRAPHY, MRI AND OPEN MRI, CT, PET CT AND CARDIAC CT, 64-SLICE CT, FLUOROSCOPY, PULMONARY FUNCTION TESTING, ULTRASOUND, CARDIOVASCULAR IMAGING, PHLEMBOTOMY, NUCLEAR MEDICINE, DIGITAL IMAGING, EEG, EKG AND EMG, STRESS TESTING AND ARTERIOGRAM.

4B (Expenses $ 36100757 including grants of $ 7659547) (Revenue $ 56237598)
Alegent Health-BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS Offer patients THE MOST COMFORTABLE AND COMPREHENSIVE operating room SERVICES.

4C (Expenses $ 21950089 including grants of $ 6551879) (Revenue $ 43060696)
BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS OFFER A WIDE RANGE OF CARDIOVASCULAR SERVICES IN THE REGION, USING A TEAM APPROACH TO ADDRESS THE TOTAL NEEDS OF THE CARDIOVASCULAR PATIENT. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM PROVIDES A COMPREHENSIVE RANGE OF CARDIAC SERVICES, INCLUDING BUT NOT LIMITED TO: VASCULAR AND CARDIAC SURGERY, HEART SCANS AND HEART CHECKS, CARDIAC REHABILITATION, VASCULAR ULTRASOUND, NUCLEAR STRESS TESTS, DUAL SOURCE CT SCANNER AND ANGIOPLASTY. IN 2006, MERCY HOSPITAL OPENED A NEW STATE-OF-THE-ART CARDIAC CATHETERIZATION LAB, ALLOWING PHYSICIANS TO PERFORM PROCEDURES SUCH AS HEART CATHETERIZATIONS, CORONARY INTERVENTIONS INCLUDING BALLOON ANGIOPLASTY AND STENTING, AS WELL AS IMPLANTATION OF PACEMAKERS AND DEFIBRILLATORS.

4D (Expenses $ 550862922 including grants of $ 11671511) (Revenue $ 300915118)
BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS PROVIDE A LARGE RANGE OF HOSPITAL SERVICES INCLUDING BUT NOT LIMITED TO: EMERGENCY DEPARTMENT, INPATIENT HOSPITAL FACILITIES, PROCEDURE CENTER, ORTHOPEDIC SERVICES, DIGESTIVE HEALTH CENTER, FAMILY LIFE CENTER, RADIOLOGY, UROLOGY AND PHYSICAL THERAPY. PATIENTS ARE AT THE CENTER OF EVERYTHING DONE AT BERGAN MERCY MEDICAL CENTER AND MERCY HOSPITAL, COUNCIL BLUFFS. During FY 2016, Creighton University Medical Center was transferred from Alegent Creighton Health to Bergan Mercy. Creighton University Medical Center's health care mission align's with Bergan Mercy's mission.

Schedule H, Part V, Section B, Line 5 Facility A, 1
Facility A, 1 - Group A. Community input was collected through several processes with both the TriWest Group Assessment and the PRC Community CHNA. A full list of organizations who provided input and the mechanism through which their input was collected can be found in the complete versions of the TriWest Group Assessment and the PRC Community CHNA. Through the PRC CHNA process, input was gathered from several individuals whose organizations work with low-income, minority populations (including African-American, American Indian, Asian, asylees, Bhutanese, Burmese, Caucasian/White, child welfare system, children, disabled, elderly, ESL, hearing-impaired, Hispanic, homeless, immigrants/refugees, interracial families, Karen, LGBT, low-income, Medicaid, mentally ill, Middle Eastern, minorities, Muslim refugees, Nepali refugees, non-English speaking, North and South Omaha, residents of the suburbs, retired, rural, single-parent families, Somalian, Southeast Asian, Sudanese, teen pregnancy, underserved, undocumented, uninsured/ underinsured, veterans, Vietnamese, women and children, working professionals), or other medically underserved populations (including African-Americans, AIDS/HIV, autistic, Caucasian/white, children (including those with incarcerated parents and those of parents with mental illness), disabled, domestic abuse and sexual assault victims, elderly, ex-felons and recently incarcerated, Hispanic, homeless, immigrants/refugees, lack of transportation, LGBT, low-income, Medicaid/Medicare, mentally ill, minorities, non-English speaking, North and South Omaha, prenatal, substance abusers, undocumented, uninsured/underinsured, veterans, WIC clients, women and children, young adults). This input was gathered primarily through the key informant survey as described in the process section of the full CHNA report.

Schedule H, Part V, Section B, Line 6a Facility A, 1
Facility A, 1 - Group A. CHI Health Nebraska Medicine Methodist Health System

Schedule H, Part V, Section B, Line 6b Facility A, 1
Facility A, 1 - Group A. Douglas County Health Department Live Well Omaha Pottawattamie County Public Health Department/VNA Sarpy/Cass County Department of Health and Wellness Region 6 Behavioral Healthcare Behavioral Health Support Foundation

Schedule H, Part V, Section B, Line 11 Facility A, 1
Facility A, 1 - Group A. The community identified the following priorities as top health needs through primary and secondary data from key informant interviews: Top Health Needs (from 2015 CHNA): 1. Access to Health Services 2. Cancer 3. Dementia & Alzheimer's Diseases 4. Diabetes 5. Heart Disease & Stroke 6. Injury & Violence 7. Mental Health 8. Nutrition, Physical Activity & Weight 9. Respiratory Diseases 10. Sexually Transmitted Diseases 11. Substance Abuse For this plan the hospital prioritized the following health needs: Priority Health Need #1: Violence Prevention To address this need the hospital will implement the following strategies in 2016-2018: * Develop and implement a hospital-based violence prevention program for adult patients presenting to Emergency Department with injuries due to violent crime. (CUMC/BERGAN) * Continue development, implementation, and expansion of the Sexual Assault Nurse Examiner (SANE) program for women who present to the Emergency Department due to sexual assault and domestic violence. (BERGAN) * Develop internal and external programs around prevention, identification, and care for victims of human trafficking across the Omaha Metro Area. (BERGAN) * Establish infrastructure across multiple sectors to develop and implement trauma informed practice, as measured by 30 training programs established and implemented across sectors in the Omaha Metro Area. (SYSTEM) Priority Health Need #2: Behavioral Health To address this need the hospital will implement the following strategies in 2016-2018: * Create education and support infrastructure for families of teens at risk for suicide or dealing with a loss from suicide in Sarpy and Cass Counties. (MIDLANDS) * Continue administrative and financial support to Tobacco Free Sarpy (TFS) to reduce tobacco use in Sarpy and Cass Counties. (MIDLANDS) * Develop and implement a community-wide youth behavioral health system of care in the Omaha Metro area through the engagement of key community stakeholders. (SYSTEM) * Continue Integrated School-Based Mental Health program at six schools across North Omaha and Council Bluffs for students in need of mental health services. (IMMANUEL) * Continue development, integration, and implementation of eCPR, ACEs, and DLA 20 program at Charles Drew Health Center (IMMANUEL) * Provide Douglas County residents with access to integrated healthcare services (primary care, behavioral health, and pharmacy) through the health systems adoption of the SAMHSA Standard Framework for Level of Integrated Healthcare. (SYSTEM) Priority Health Need #3: Access to Care To address this need the hospital will implement the following strategies in 2016-2018: * Plan and host local health fair to offer low-to-no-cost screenings and education to encourage disease management and behavior change for participants in the Douglas, Sarpy and Cass County areas. (MIDLANDS) * Provide immunization services to qualifying individuals through the hosting of regular, on-going immunization clinics in Bellevue and Papillion, NE. (MIDLANDS) * Continue and enhance diabetes prevention collaboration for North Omaha residents. (IMMANUEL) * Continuation and enhancement of clinic-based diabetes program for those with limited access to care across the Omaha Metro Area. (IMMANUEL) Priority Health Need #4: Nutrition, Physical Activity & Weight Status (Childhood Obesity) To address this need the hospital will implement the following strategies in 2016-2018: * Offer Healthy Families Program to families with children identified in the 85th percentile of body mass index or above in the Omaha Metro Area. (SYSTEM/LAKESIDE/MIDLANDS) * Promote healthy lifestyles through 5-4-3-2-1 Go! campaign for children ages 5-12 years old in Douglas, Sarpy, and Cass Counties. (SYSTEM/MIDLANDS) * Develop and implement collective impact model for Live Well Omaha Kids Coalition. (SYSTEM) * Through community partnerships, offer the evidence-based Nutrition and Physical Activity Self-Assessment in Child Care (NAP SACC) program for early childhood professionals in order to support the development of good nutrition and physical activity habits in children ages 0-5 in the Omaha Metro Area. (SYSTEM) Priority Health Need #5: Heart Disease and Stroke To address this need the hospital will implement the following strategies in 2016-2018: * Implement community walking program (Heart & Sole) for those at high risk of heart disease or stroke. (BERGAN) * Implement stroke outreach program at Siena/Francis house for homeless population. (BERGAN) Priority Health Need #6: Social Determinants of Health While not addressed as a community priority through the CHNA data, during the implementation planning process, it was identified and prioritized as a top health need due to its indirect effect on the top health needs identified as part of the CHNA. To address this need the hospital will implement the following strategies in 2016-2018: * Launch and expand the Community Link program to screen patients for basic social needs and refer them to the appropriate community resources as part of their clinic visit. (SYSTEM/CUMC/BERGAN) * Provide case management to patients entering the Emergency Department who identify as homeless to assist in finding permanent housing. (SYSTEM/CUMC/BERGAN) Priority Health Need #7: Dementia To address this need the hospital will implement the following strategies in 2016-2018: * Engage in existing coalition work to support those affected by dementia-related illness with a priority of support for low-income elderly (LAKESIDE) In addition to the priorities areas and work being completed by the hospitals, CHI Health Creighton University Medical Center Bergan Mercy shares a tax ID with Lasting Hope Recovery Center, therefore priorities and work completed there are reported on this Schedule H form. The following strategies have been identified around Behavioral Health: * Improve insufficient access to care for patients in need of Behavioral Health services across the Region 6 area * Provide a comprehensive psychiatric emergency system to the Omaha Metro Area * Improve psychiatric workforce shortage across the Omaha Metro Area The hospital will not address the following health needs for the following reasons: Cancer. CHI Health will continue to perform existing cancer outreach throughout the community but did not feel cancer should be a top priority based on the considerations above and in order to focus and meaningfully impact other areas of need. Diabetes. CHI Health will continue performing diabetes outreach and education across the Omaha Metro Area while also addressing diabetes within the priority access to care. Notably, the area of nutrition, physical activity, and weight is a priority which relates to several root causes for diabetes and other chronic disease. Respiratory Diseases. This was not determined as a priority area based on the considerations above and in order to focus and meaningfully impact other areas of need. Sexually Transmitted Disease. There is extensive existing work by community partners currently taking place around sexually transmitted diseases across the Omaha Metro area. Therefore, this is not an area that CHI Health prioritized.

Schedule H, Part V, Section B, Line 13 Facility A, 1
Facility A, 1 - Group A. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES.

Schedule H, Part V, Section B, Line 22 Facility A, 1
Facility A, 1 - Group A. The organization will not charge individuals who are eligible for financial assistance more than amounts generally billed to those who have insurance.

Schedule H, Part VI, Line 5 Promotion of Community Health
"Nebraska City - People United for Families-provided financial support for Partners for Otoe County, a non-profit organization dedicated to building a healthy community where every child and family thrives. P4OC collaborates with individuals, organizations, local businesses, institutions, and agencies to take responsibility for improving the health and quality of life in our community. - Growing Great Kids-provided support for this program, which is a program housed out of Southeast District Health Department (SEDHD). The program provides home visiting services delivered by nursing staff, for families at risk for adverse childhood experiences during the prenatal to age 3 timeframe, to offer support in the prenatal time period as well as parenting support and resources as baby grows. Missouri Valley - Harrison County Home & Public Health-provided funding to Harrison County Home & Public Health (HCHPH) to host a Milk Mob Training (evidence based program) to train community health workers in breastfeeding support. Funding also allowed HCHPH to host R.E.S.P.E.C.T. program at local school assemblies for elementary-age students to learn to recognize bullies as being in danger of child abuse and neglect in their home, and how to help them as a peer. - Healthy Harrison Coalition-provided funding for referrals and vouchers distributed through local agencies such as WIC and West Central Community Action Partnership to families with low access to healthy foods. Vouchers offered participating families transportation to the County Farmer's Market, as well as a $20 voucher for fruits and vegetables. * Health professional education- - Clinical preceptorships and clinical rotations for healthcare professionals - Administration of nursing preceptorships and clinical rotations - Clinical pastoral education - Scholarships for healthcare education - Academic affiliation with Creighton University and its Health Professions Programs - Physician residency and fellowship programs training more than 230 residents and fellows annually * Research - unfunded staff support of the National Cancer Institute Community Oncology Research Program (NCORP) * Financial and in-kind contributions- - Corporate sponsorships - Tanzania health ministry - Staff service on health related board and coalitions - Participation in and funding of maternal health, breastfeeding, substance abuse, cancer, diabetes and other community health coalitions. - Participation in and sponsorship of mental health coalitions including Kim Foundation, Community Alliance Foundation, Voices for Children, Youth Emergency Service, Project Harmony and El Centro de las Americas. - Employee costs of coordinating community events not sponsored by CHI Health - In-kind donations (staff time, space, etc.) supporting grants for Behavioral Health, Telepsych, Community Link and 54321Go!. - City of Council Bluffs-provided funding to City of Council Bluffs for water rescue training manikins for City recreation staff. - Siena Francis House-provided support by purchasing equipment to continue providing stroke education and blood pressure screenings for guests at the homeless shelter. Basic necessities/preventative items (toothbrushes, socks, gloves, glasses, etc.) were also purchased for the guests who participated in the screenings and education. * Community building activities- - Healthcare career exploration camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions - Presentations to high school students about healthcare careers - Ralston High School Academy-provided health occupation shadowing to 5 students to give them the opportunity to explore a variety of healthcare professions - Community and economic development including support of local Chambers of Commerce - Strategic planning and consulting services for community - 10 nurses participated, as part of their work time, as ""victims"" in a community-wide disaster drill * The primary care and pediatric physician clinics that are part of the parent corporation provide access to care through the system's Financial Assistance Policy and participate in medical student preceptorships that advance the healthcare provider education process. * CHI Health has Open Medical staffs * CHI Health is the sole, comprehensive mental health provider in the Omaha MSA area operating a breakeven point of revenue. * CHI Health is a joint venture partner in a not-for-profit Hospice inpatient hospital and provides the management support contract. ALEGENT CREIGHTON HEALTH SYSTEM IS GOVERNED BY A BOARD OF DIRECTORS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF OUR LOCAL COMMUNITY WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. THE ALEGENT CREIGHTON HEALTH HOSPITALS HAVE FULL-TIME EMERGENCY DEPARTMENTS THAT ARE OPEN TO THE PUBLIC AND PROVIDE MEDICAL SCREENING EXAMINATIONS AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITIES OF THE HOSPITALS REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE, AND/OR ABILITY TO PAY. THE HOSPITALS ARE IN COMPLIANCE WITH THE FEDERAL EMTALA REGULATIONS. IN ADDITION, TOGETHER WITH UNRELATED HOSPITALS IN THE AREA, WORK CLOSELY WITH LOCAL FIRE AND RESCUE DEPARTMENTS TO ENSURE THAT AMBULANCES TAKE PATIENTS TO THE APPROPRIATE HOSPITAL. THIS IS GENERALLY THE HOSPITAL THAT IS CLOSEST GEOGRAPHICALLY WITH EXCEPTIONS BASED ON PATIENT PREFERENCE, PATIENT'S PHYSICIAN PREFERENCE, AND CAPACITY OR THE AVAILABILITY OF SPECIALIZED FACILITIES OR PROGRAMS RELATED TO THE PATIENT'S CONDITION. FINALLY, THE ALEGENT CREIGHTON HEALTH HOSPITALS MAINTAIN DETAILED PROCEDURES REGARDING WHEN AND UNDER WHAT CIRCUMSTANCES A PATIENT CAN BE TRANSFERRED. UNDER THIS POLICY, NO PATIENT WILL BE TRANSFERRED BASED ON RACE, CREED, RELIGION OR ABILITY TO PAY."

Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care
"WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG URBAN AND RURAL COMMUNITIES IN 18 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES (""FPG""), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES."

Schedule H, Part I, Line 6a Community benefit report prepared by related organization
Alegent Creighton Health

Schedule H, Part I, Line 7g Subsidized Health Services
There are no physician clinics included in subsidized health services.

Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance
A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using Worksheet 2 to compute the cost-to-charge ratio. The cost-to-charge ratio covers all patient segments.

Schedule H, Part II Community Building Activities
"CHI Health has a history of centralized community benefit investments, as well as hospital specific investments that address community health needs which include support of local health coalitions, investments in partnerships and programs that address top community health needs, participation in local committees and boards tied to top health needs, and investments in many other ways as described in other areas of the Schedule H narrative. Below are specific examples of work that falls within the definition of community building activities. These activities are critical in helping build social, health, and economic opportunities in our community that ultimately drive health status and quality of life for our residents: * Workforce development-the following activities work to strengthen the community's capacity to promote the health and well-being of our residents by driving entry into healthcare careers: - Healthcare career exploration camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions - Presentations to high school students about healthcare careers - Ralston High School Academy-provided health occupation shadowing to 5 students to give them the opportunity to explore a variety of healthcare professions * Community and economic development including support of local Chambers of Commerce * Strategic planning and consulting services for community partners to build capacity to address health and social needs of the community * 10 nurses participated, as part of work time, as ""victims"" in a community-wide disaster drill"

Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount
COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 22.36%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE.

Schedule H, Part III, Line 3 Bad Debt Expense Methodology
ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE.

Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote
"Alegent Health-Bergan Mercy Health System does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives. The consolidated footnote reads as follows: ""The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented on the consolidated statements of operations as a deduction from patient services revenues (net of contractual allowances and discounts) since CHI accepts and treats substantially all patients without regard to the ability to pay."""

Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs
"Using essentially the same Medicare cost report principles as to the allocation of general services costs and ""apportionment"" methods, the ""CHI Workbook"" calculates a payers' gross allowable costs by service (so as to facilitate a corresponding comparison between gross allowable costs and ultimate payments received). The term ""gross allowable costs"" means costs before any deductibles or co-insurance are subtracted. Alegent Health-Bergan Medical System's ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. Although not presented on the Medicare cost report, in order to facilitate a more accurate understanding of the ""true"" cost of services (for ""shortfall"" purposes) the CHI Workbook allows a health care facility not to offset costs that Medicare considers to be non-allowable, but for which the facility can legitimately argue are related to the care of the facility's patients. In addition, although not reportable on the Medicare cost report, the CHI workbook includes the cost of services that are paid via a set fee-schedule rather than being reimbursed based on costs (e.g. outpatient clinical laboratory). Finally, the CHI Workbook allows a facility to include other health care services performed by a separate facility (such as a physician practice) that are maintained on separate books and records (as opposed to the main facility's books and records which has its costs of service included within a cost report). True costs of Medicare computed using this methodology: Total Medicare Revenue: $113,973,354 Total Medicare costs: $146,184,677 Surplus or Shortfall ($32,211,323) Alegent Health-Bergan Medical System believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as ""subsidized health services."" Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays."

Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance
ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM DEBT COLLECTION POLICY PROVIDES THAT ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G MEDICAID) AND TO NOT QUALIFY FOR COVERAGE UNDER THE FINANCIAL ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO Alegent Health-Bergan Mercy Medical System FOR APPROPRIATE FOLLOW-UP. ALEGENT HEALTH-BERGAN MERCY HEALTH SYSTEM REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL OF CATHOLIC HEALTH INITIATIVES' HOSPITALS' CONTRACTS WITH THIRD-PARTY COLLECTION AGENCIES INCLUDE THE FOLLOWING STANDARDS: 1. NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL REQUEST BENCH OR ARREST WARRANTS AS A RESULT OF NON-PAYMENT; 2. NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL SEEK LIENS THAT WOULD REQUIRE THE SALE OR FORECLOSURE OF A PRIMARY RESIDENCE; AND 3. NO CHI COLLECTION AGENCY MAY SEEK COURT ACTION WITHOUT HOSPITAL APPROVAL. FINALLY, COLLECTION AGENCIES ARE TRAINED ON THE CHI MISSION, CORE VALUES AND STANDARD OF CONDUCT TO MAKE SURE ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT.

Schedule H, Part V, Section B, Line 16a FAP website
A - AH BERGAN MERCY MEDICAL CENTER: Line 16a URL: www.chihealth.com/financial-assistance;

Schedule H, Part V, Section B, Line 16b FAP Application website
A - AH BERGAN MERCY MEDICAL CENTER: Line 16b URL: www.chihealth.com/documents/financial_assistance_application.pdf;

Schedule H, Part V, Section B, Line 16c FAP plain language summary website
A - AH BERGAN MERCY MEDICAL CENTER: Line 16c URL: www.chihealth.com/financial-assistance;

Schedule H, Part VI, Line 2 Needs assessment
The process of identifying the community health needs across the Omaha Metro Area and Region 6 was accomplished by using data and community input from processes led by two main agencies: * The TriWest Group (TriWest) was hired in 2014 by The Behavioral Health Support Foundation, an existing group of local philanthropists within Omaha, to assess the mental health system in Omaha and across Region 6. This request was in response to mental health and substance abuse being identified as a top community health need through community key informants and supporting information gathered during the 2011 CHNA. The study had several key aims: to analyze the gaps in the Region 6 area, to confirm what community agencies were reporting as needs, to formulate workgroups around the identified gaps, to hire a project manager to oversee the plans around the gaps, and to implement process changes to improve and enhance mental health care for adults in the region. TriWest has led or participated in behavioral health system assessments in several other communities in the United States, resulting in recommendations to improve the coordination and availability of services shown to promote mental health recovery. * Professional Research Consultants, Inc. (PRC) is a third-party agent contracted by local health systems and local health departments ( see list below) to conduct the CHNA for a four-county area, referred to as the Omaha Metro Area that includes Douglas, Sarpy, and Cass Counties, Nebraska, and Pottawattamie County, Iowa. PRC is a nationally recognized healthcare consulting firm with extensive experience conducting CHNAs across the United States since 1994. Along with several other community stakeholders, CHI Health was an active key health partner working with PRC to design, implement, and review the data. The Omaha Metro Area CHNA, conducted by PRC, utilized both primary and secondary data collected through the PRC Community Health Survey (primary); Online Key Informant Survey (primary); and public health, vital statistics, and other data collection (secondary). TriWest collected qualitative and quantitative data to identify service gaps and barriers to effective care coordination in their study through key informant interviews and other methods. Please reference the complete CHNA and TriWest study attached for more in-depth details regarding the process.

Schedule H, Part VI, Line 3 Patient education of eligibility for assistance
There are several financial assistance access points throughout a patient's care cycle. Bills contain financial assistance verbiage; signs are posted in clinics and hospital, and there is information on financial assistance posted at registration points throughout clinics and hospitals. Information on The Alegent Creighton Health System's financial assistance policies are located several places on the system's website- http://www.chihealth.com. All efforts are made to establish whether patients are eligible for financial assistance prior to service if possible, otherwise as soon as possible following service. Alegent Creighton Health representatives help patients seek reimbursement from local, state and federal programs at no charge to the patient. After these efforts and resources have been exhausted, patients are assisted in the application process for financial assistance consistent with Alegent Creighton Health's Financial Assistance Policy. The application process requires that the patient complete a personal financial application and provide verification documents. Verification includes employment verification and obtaining documentation of the applicant's financial condition such as federal tax return, pay stub, net worth and/or liquid assets and reasonable household or business expenses. Financial assistance may still be granted in certain circumstances involving a catastrophic occurrence resulting in medical bills grossly exceeding the patient's ability to pay, and in these situations, the patient's responsibility will be limited to 20% of the family's gross annual income.

Schedule H, Part VI, Line 4 Community information
"CHI Health Creighton University Medical Center - Bergan Mercy is located in Omaha, NE and largely serves the Omaha Metro Area that consists of Douglas, Sarpy, and Cass Counties in Nebraska and Pottawattamie County in Iowa. These four counties were identified as the community for this CHNA, as they encompass the primary service for CHI Health hospitals located in the Omaha Metro Area, thus covering between 75% and 90% of patients served. These counties are considered to be and referred to as the ""Omaha Metro Area."" In addition, Lasting Hope Recovery Center serves the Omaha Metro area but also has service reach that aligns with the local behavioral health region (Region 6), which encompasses Washington and Dodge Counties (as shown on the Map below), but does not include Pottawattamie County. For the current CHNA, LHRC was engaged in two processes to identify the community health needs, as described below. Although the Omaha based CHI Health hospitals define their community as the four county Omaha Metro Area, since LHRC is a behavioral health focused facility, the community definition is aligned with Region 6 Behavioral Health service area of Dodge, Washington, Douglas, Sarpy, and Cass counties. These five counties are considered the primary service area for LHRC. The Omaha Metro Area is a largely Non-Hispanic White population (81.3%) with a total population of nearly 800,000 residents. Douglas and Sarpy Counties were identified as the most diverse among the four counties, while Cass County has the largest percentage of population over the age of 65 years (16.1%). Douglas County: identified as the most diverse county in the service area, Douglas County's population largely consists of 81.3% Non-Hispanic White residents, 12% Hispanic residents, and 11.6% Black or African American residents. Population: 543,244 residents 25.8% of population is below 18 years of age and 11.5% are 65 years or older Median household income is $53,444 Persons in poverty is 14% Children in poverty is 18% Unemployment rate is 3.6 High School graduation rate is 89.3% 72% of residents have some college education 12.44% of the population is uninsured, with 4.8% of children (under the age of 19) being uninsured Sarpy County: As the second most populated county, Sarpy County's population largely consists of 89.7% Non-Hispanic White residents, 8.3% Hispanic, and 4.5% Black or African American. Sarpy County boasts the highest median household income, lowest unemployment rate, and the second highest rate for high school graduation Population: 172,193 residents 28.2% of population is below 18 years of age and 10.2% are 65 years or older Median household income is $70,121 Persons in poverty is 5.3% Children in poverty is 7% Unemployment rate is 3.2 High School graduation rate is 95.2% 80% of residents have some college education 7.16% of the population is uninsured, with 4.32% of children (under the age of 19) being uninsured Cass County: Cass County is the second least diverse of the counties with 97% of the population being Non-Hispanic White. Cass County has the highest unemployment rate, the highest high school graduation and the second highest percentage of children who are uninsured. Population: 25,512 residents 24.6% of population is below 18 years of age and 16.1% are 65 years or older Median household income is $65,560 Persons in poverty is 6.9% Children in poverty is 10% Unemployment rate is 4 High School graduation rate is 94.7% 75% of residents have some college education 7.16% of the population is uninsured, with 5.77% of children (under the age of 19) being uninsured Pottawattamie County: the only county in Iowa, Pottawattamie County's population consists of 88.7% of the population being Non-Hispanic White, 7.2% Hispanic, and 1.6% Black or African American. Pottawattamie has the lowest percentage of women (40.9%). Population: 93,128 residents 23.7% of population is below 18 years of age and 15.7% are 65 years or older Median household income is $51,939 Persons in poverty is 12.3% Children in poverty is 18% Unemployment rate is 4.2 High School graduation rate is 89.6% 62% of residents have some college education 10.73% of the population is uninsured, with 3.88% of children (under the age of 19) being uninsured Dodge County: Dodge County is relatively diverse with 85.7% of residents being Non-Hispanic White, 11.3% Hispanic and 1.2% being Black or African American. Dodge County has the lowest median household income between the six counties and the second highest percentage of persons living in poverty. Dodge County also has the lowest percentage of residents with some college education and the highest percentage of uninsured children. Population: 36,706 residents 23.5% of population is below 18 years of age and 19% are 65 years or older Median household income is $47,991 Persons in poverty is 12.9% Children in poverty is 17% Unemployment rate is 3.5 High School graduation rate is 86% 55% of residents have some college education 12.21% of the population is uninsured, with 5.91% of children (under the age of 19) being uninsured Washington County: As the least populated of the six counties, Washington County is the least diverse with 97.4% Non-Hispanic White residents, 2.5% Hispanic residents, and 0.8% Black or African American residents. Washington County also has the second highest median household income of the six counties and one of the highest high school graduation rates. Population: 20,248 residents 23.8% of population is below 18 years of age and 16% are 65 years or older Median household income is $68,207 Persons in poverty is 7.4% Children in poverty is 9% Unemployment rate is 3.7 High School graduation rate is 93% 75% of residents have some college education 7.04% of the population is uninsured, with 4.5% of children (under the age of 19) being uninsured"

Schedule H, Part VI, Line 5 Promotion of community health
"CHI Health has a history of centralized community benefit and hospital specific community benefit investments to address community health needs of the particular service area. Examples of how CHI Health furthers its exempt purpose by promoting the health of the community include: * Financial Assistance and Unpaid costs of Medicaid * Community health improvement services- - Community education, classes and programs (car seat safety checks, community behavioral health support, diabetes, cancer, physical activity and healthy eating and cooking) - Support groups (cancer, bereavement, youth, etc.) - Community health fairs and screenings - Parish nursing program and faith community outreach - School based healthcare services - Healthy Families-this program is a free, 8-week health and nutrition program for families with a child between the ages of 4 to18 who has been identified in the top 85th percentile of body mass index. This program invites the whole families to participate in learning about physical activity, eating healthy, and setting realistic goals as a family. - Childcare-provided the Nutrition & Physical Activity Self-Assessment in Child Care (NAP SACC) Learning Collaborative for child care programs in Douglas, Sarpy and Cass Counties in Nebraska. Ten child care programs sent a total of 30 providers through a series of five workshops to learn about best practices for teaching healthy eating and physical activity habits to young children. - Breastfeeding-provided funding and planning support to host a 5 day training in York, NE for clinic and community healthcare workers to obtain their Certified Lactation Counselor (CLC) designation. CHI Health also provided funds towards the planning of a continuing education event (Beyond Best Practices: Creating a Supportive Environment for Breastfeeding Parents) for clinic and hospital professionals (nurses, medical assistants, dieticians, health coaches/navigators and providers) in addition to support for an online course called Breastfeeding the NICU Infant for hospital-based NICU nursing staff. Eighty professionals were enrolled in February of 2016. - Heart & Sole Walking Program-supported the program by purchasing two blood pressure cuffs and provided subsidized pricing for Heart Healthy Cooking classes allowing easier access for community members to attend. - Siena Francis Homeless Shelter-hospital provides staff and supplies for stroke education and screening at local homeless shelter. In FY16, over 1,250 shelter guests were screened and provided education. - Subsidized low income individuals' outpatient dialysis treatments in the community to give them the care that they require - Provided counseling, free of charge, to discharged Lasting Hope Recovery Center patients who needed to be seen within 7 days of discharge but couldn't get appointments. - Provided counseling and assistance in enrolling individuals in means tested insurance programs to improve access to care. - Image Recovery Center-free services offered by the CHI Health Image Recovery Center which is a comprehensive hospital-based appearance enhancement program available to cancer patients. Image Recovery is an integral part of oncology treatment services at CHI Health and is designed to help patients prepare for appearance changes they will experience due to chemotherapy, radiation therapy or surgery. - Provided support and office space to the Legal Aid of Nebraska to assist individuals with legal matters. - Provided cab vouchers and transportation to patients who cannot afford transportation to attend to their medical needs. - Provide support to health coalitions and investments in social and environmental improvement strategies. These are programs, activities and partnerships that improve the health of persons in the community by addressing the determinants of health, which includes the social, economic and physical environment. See specific examples by community below: Omaha/Council Bluffs Metro - Hope Medical Outreach Coalition-Board service and annual operating subsidy. CHI Health hospitals and physicians are one of three health systems that provide access for the patients of three area federally qualified healthcare centers to specialty physician services and hospital based diagnostics and treatment that are unable to afford medical services. - Metro Area Continuum of Care for the Homeless-Board service and financial support to this coalition addressing homelessness in the service area. - Live Well Omaha-a coalition founded by Alegent Creighton Health (now CHI Health) and the county health department that serves as convener of business, healthcare and community leaders to review health trends and catalyze community action to address health issues. - Live Well Omaha Kids-a community coalition using a collective impact approach to address childhood obesity. - African American Empowerment Network- Support of the Step Up summer jobs program a workforce development initiative serving a typically low-income part of the community. - Community Link-a partnership with Catholic Health Initiatives to improve the health and socioeconomic status of patients by assessing and treating their non-medical needs and barriers, which are important factors of their health. - Violence Prevention-a partnership with Catholic Health Initiatives, Women's Center for Advancement and Creighton University to implement a campus based violence prevention program known as ""Green Dot"". - Together, Inc.- provided funds to support the newly developed homeless case management project to be housed out of the CUMC emergency department and then at University Campus. The program will connect high utilizers of the emergency department, who are identified as homeless, with a case manager who will then assist them in finding sustainable housing and accessing other resources associated with social determinants of health. - YMCA-provided support of the Omaha Metro YMCA's Strong Community Campaign to provide for youth programming, medically based wellness, and youth and family memberships for low-income community members. - Pottawattamie County Development-provided support for the administration and delivery of The Big Garden project serving families identified by local healthcare agencies as needing support to access healthy foods at low cost. The program builds the family's skill for self-sustaining a garden and year-round preparation, planning, care, and harvest in a personal garden. - Project Extra Mile-provided funding for the evaluation of a clinic based Screening, Brief Intervention & Referral to Treatment (SBIRT) program that was piloted at the CHI Health 161st and Maple clinic, then implemented at the 132nd & West Center CHI Health Clinic. Lincoln - Partnership for a Healthy Lincoln-provided financial and partnership support as part of the community health improvement plan to PHL, a non-profit health coalition dedicate to improving the health, wellness, and fitness of all those in our community. - Clinic with a Heart-in addition to staffing free clinics each month, provided financial support for infrastructure and program implementation to this free clinic serving the uninsured and underinsured. Kearney - Buffalo County Community Health Partners-provided financial support and leadership to this health coalition that is a county-wide effort to address the leading health issues in the county. - Be Well Buffalo County Program-provided funding that supported establishment of Be Well coalition to advocate for a healthy community culture through infrastructure, education and programs to support healthy choices. Grand Island - Third City Community Clinic-provided funding to support the Access to Healthcare project which aims is to be proactive in the treatment and management of chronic disease in low-income and minority patients to 1) ensure a better quality of life for the patient 2) minimize their emergency room visits and hospital admissions to reduce costs to the patients and the healthcare provider(s)."

Schedule H, Part VI, Line 6 Affiliated health care system
"CHI Health Creighton University Medical Center - Bergan Mercy, along with its affiliated outpatient facilities, are part of Catholic Health Initiatives. Catholic Health Initiatives (CHI) is a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 104 hospitals, including four academic medical centers, and 30 critical access facilities; community health service organizations; accredited nursing colleges; home health agencies; and other facilities that span the inpatient and outpatient continuum of care. Together, these facilities provided $1.1 billion in financial assistance and community benefit in the 2016 fiscal year, including services for the poor, free clinics, education and research. CHI provides strategic planning and management services as well as centralized ""shared services"" for the MBOs. The provision of centralized management and shared services - including areas such as accounting, human resources, payroll and supply chain -- provides economies of scale and purchasing power to the MBOs. The cost savings achieved through CHI's centralization enable MBOs to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. CHI Health Creighton University Medical Center - Bergan Mercy operates with its wholly owned affiliates and community partners, along with its fundraising arm, the Alegent Creighton Health Foundation, to serve the health care needs of the Greater Omaha, Nebraska communities."

Schedule H, Part VI, Line 7 State filing of community benefit report
IA, NE