2018-11-15T10:03:37-06:00 2017-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2017-01-01 470378779 THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION MARY 4024634521 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 ERIC BARBER PRESIDENT 4024634521 2018-11-14 1 BARBARA J FAJEN P00400874 4023302660 209.34.201.180 2018-11-14 12:18:18 CS P B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C 2017 2019-02-21 02:37:17Z MARY LANNING HEALTHCARE ERIC BARBER 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 211450846 0 X WWW.MARYLANNING.ORG X 1915 NE ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING HEALTHCARE IS DEDICATED TO OFFERING HOPE, HEALTH AND HEALING. 7 6 1432 250 292135 0 682606 1014825 161484140 170833804 1951518 6036869 1460327 1127581 165578591 179013079 588401 234610 0 0 97499268 102644790 0 0 0 71921965 83949065 170009634 186828465 -4431043 -7815386 213477692 211707759 66591029 66073742 146886663 145634017 X ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFERING HOPE, HEALTH AND HEALING. 0 0 155855559 234610 170833804 MARY LANNING HEALTHCARE (MLH) PROVIDES HEALTHCARE SERVICES TO THE GENERAL PUBLIC AND OPERATES ROUTINE SERVICE BEDS, ICU BEDS TOTALING 27,784 PATIENT DAYS. MLH HAD 169,161 OUTPATIENT VISITS AND EMERGENCY ROOM VISITS OF 15,308 IN 2017. MLH ALSO OPERATES A HOME HEALTH PROGRAM AND A SCHOOL OF NURSING. IN ADDITION, MLH OPERATES SEVENTEEN PHYSICIAN CLINICS IN CENTRAL NEBRASKA, ALONG WITH AN OUTREACH PROGRAM TO SMALLER HOSPITALS IN WHICH TOGETHER MLH SEES APPROXIMATELY 40,000 PATIENTS PER YEAR. MLH OFFERS BEHAVIORAL HEALTH SERVICES ON AN INPATIENT AND OUTPATIENT BASIS, ACCOUNTING FOR 5,573 INPATIENT DAYS AND APPROXIMATELY 30,000 OUTPATIENT VISITS. MLH PROVIDES SEVERAL COMMUNITY PROGRAMS AS WELL. WE LIST ONLY THREE OF THEM. MLH PROVIDES COMMUNITY OUTREACH AND MATERNAL CHILD HEALTH ASSESSMENTS AND EDUCATION AT A COST OF OVER $297,000. MLH PROVIDES A PLACE FOR FAMILY MEMBERS TO STAY AT A MINIMAL COST DURING TREATMENT, AT A COST TO MLH OF $204,000 PER YEAR. AND, MLH HAS A PHARMACEUTICAL PATIENT ASSISTANCE PROGRAM THAT ASSISTS THOSE UNABLE TO PAY FOR PRESCRIPTION MEDICATIONS TO FIND ALTERNATIVE FUNDING THROUGH PHARMACEUTICAL COMPANIES AT A COST OF $181,000.TO PROVIDE THESE SERVICES, MLH ABSORBED OVER $45 MILLION IN COSTS DURING 2017. NEARLY $35 MILLION OF THAT RELATES TO CARE PROVIDED TO MEDICARE AND MEDICAID PATIENTS WITH AN ADDITIONAL $5.2 MILLION IN CARE TO THE UNINSURED IN THE FORM OF CHARITY CARE. 155855559 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 113 0 1 1432 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X SHAWN NORDBY 4024615344 715 N ST JOSEPH AVE HASTINGS NE 68901 X JEFF S ANDERSON CHAIR 1.00 X X 0 0 0 MICHELE BEVER VICE-CHAIR 1.00 X X 0 0 0 MICHAEL ALLEN SECRETARY/TREASURER 1.00 40.00 X X 0 135814 7247 CLARENCE GARY ANDERSON TRUSTEE 1.00 X 0 0 0 PRADIPTA CHAUDHURI TRUSTEE 1.00 X 0 0 0 JANIS JOHNSON TRUSTEE 1.00 X 0 0 0 ANNA STEHLIK TRUSTEE 1.00 X 0 0 0 ERIC BARBER PRESIDENT/CEO 40.00 X 429126 0 130439 SHAWN NORDBY CHIEF FINANCIAL OFFICER 40.00 X 193457 0 28053 BARRY BOHLEN PHYSICIAN 40.00 X 942198 0 43086 KALPESH GANATRA PHYSICIAN 40.00 X 770985 0 42546 BRENT HOOD PHYSICIAN 40.00 X 631516 0 41027 KARTIC RAJPUT PHYSICIAN 40.00 X 642509 0 29621 THOMAS ZUSAG PHYSICIAN 40.00 X 584577 0 21826 4194368 135814 343845 89 0 1 0 THE NEBRASKA MEDICAL CENTER 4350 DEWEY AVE OMAHA NE 68105 SOFTWARE SUPPORT 5219920 SS PSYCHIATRY GROUP 4110 HARGORD STREET GRAND ISLAND NE 68803 PHYSICIAN COVERAGE 1257813 MCKESSON BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 735942 HURON HEALTHCARE 550 W VAN BUREN STREET CHICAGO IL 60607 SOFTWARE CONSULTANT 735029 HOSPITAL HOUSEKEEPING SYSTEMS 216 E 4TH ST AUSITN TX 78701 HOUSEKEEPING 626135 40 960827 53998 1014825 ALL OTHER PATIENT REVE 621300 119641998 119641998 NET MEDICARE REVENUE 621300 43746304 43746304 NET MEDICAID REVENUE 621300 4967021 4967021 RADIOLOGY SCHOOL 621300 78878 78878 MEANINGFUL USE INCENTI 621300 1633 1633 2397970 2397970 170833804 776794 776794 244889 1782 243107 243107 243107 37442115 32069751 112289 5372364 -112289 5260075 5260075 268600 253945 14655 14655 CAFETERIA 722210 577684 577684 PARTNERSHIP INCOME 621610 169928 169928 CATERING 722320 116467 116467 5740 5740 869819 179013079 170833804 292135 6872315 X 234610 234610 781075 781075 59242 59242 74264113 64118596 10145517 2310783 1974598 336185 20518229 17533128 2985101 4711348 4025916 685432 344842 344842 88185 88185 136193 136193 22740603 10890817 11849786 635810 170216 465594 4175589 1825470 2350119 1432030 1432030 333607 253340 80267 468680 339181 129499 1490577 1490577 10990969 10990969 1329347 1329347 MEDICAL SUPPLIES 24673601 24607064 66537 BAD DEBT EXPENSE 9610692 9610692 REPAIRS 3562526 3229022 333504 FOOD EXPENSE 1380586 1380586 555228 360158 195070 186828465 155855559 30972906 0 8861 7111 3802802 2778291 19829850 23579219 203337 2158228 3125467 4418410 5380452 1769846 1261322 208350517 130304846 81955340 78045671 43324483 36010503 56209872 59534586 1781800 213477692 211707759 19863176 18542441 27238682 24328119 4938249 5878719 8500000 15776035 6050922 1548428 66591029 66073742 X 97645570 96748200 2898770 3238594 46342323 45647223 146886663 145634017 213477692 211707759 X -7815386 534843 6027897 X X 0 1 X 1 0 X 1 1 0 0 0 0 0 1 991 1 13113 14104 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO AHA, NHA AND NABHO ARE FOR LOBBYING PURPOSES. 46342323 -695100 45647223 45879485 462838 46342323 39132823 6746662 45879485 29226433 9906390 39132823 23899866 5326567 29226433 0.00000 1.00000 0.00000 0 1 1 4312950 4312950 106262232 59050931 47211301 95121578 69774692 25346886 2653757 1479223 1174534 78045671 STUDENT LOAN AND RESTRICTED FUNDS 942929 F JOINT VENTURES 6499219 F BENEFICIAL INTEREST IN FOUNDATION 7410179 F BENEFICIAL INTEREST IN TRUST 44682259 F 59534586 THIRD PARTY REIMBURSEMENT CONTRACTS 1548428 1548428 X PART V, LINE 4: TEMPORARILY RESTRICTED FUNDS ARE HELD FOR CAPITAL ACQUISITION, SCHOLARSHIPS, EDUCATION AND COMMUNITY HEALTH CARE. PERMANENTLY RESTRICTED FUND ASSETS ARE HELD IN PERPETUITY WITH THE INCOME USED FOR HOSPITAL OPERATIONS, SCHOLARSHIPS AND RESEARCH. PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS RECEIVED A DETERMINATION LETTER THAT IT IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX-EXEMPT STATUS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2017 AND 2016, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART V, LINE 3A(II): MARY LANNING HEALTHCARE FOUNDATION AND MARY LANNING HOSPITAL TRUST HOLD ENDOWMENT FUNDS RESTRICTED TO DISTRIBUTION TO MARY LANNING HEALTHCARE. THESE FUNDS ARE REFLECTED ON MARY LANNING HEALTHCARE'S BALANCE SHEET IN "INVESTMENTS - OTHER SECURITIES AND ARE SHOWN ON SCHEDULE D, PART VII. THESE FUNDS ARE NOT UNDER THE CONTROL OF MARY LANNING HEALTHCARE. 1 1 X 1 X 125.000000000000 1 X 1 1 1 0 1 1 5221676 5221676 0.02790 15361316 4967021 10394295 0.05560 20582992 4967021 15615971 0.08350 51 57829 904218 8957 895261 0.00480 11 1255 307393 135900 171493 0.00090 3 425 174778 24000 150778 0.00080 13 4885 232415 232415 0.00120 78 64394 1618804 168857 1449947 0.00770 78 64394 22201796 5135878 17065918 0.09120 3 137 9512 9512 0.00010 2 385 170857 170857 0.00090 5 522 180369 180369 0.00100 1 9610690 0 37295743 61499954 -24204211 X 1 1 1 HASTINGS SURGICAL CENTER LLC SURGICAL CENTER 0.21050 0.00000 0.16330 1 1 MARY LANNING HEALTHCARE 715 NORTH ST JOSEPH AVENUE HASTINGS NE 68901 WWW.MARYLANNING.ORG 010002 X X X X MARY LANNING HEALTHCARE 1 0 0 1 X X X X X X X X X 15 1 1 1 1 X HTTPS://WWW.MARYLANNING.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENTS X 1 15 1 HTTPS://WWW.MARYLANNING.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENTS 0 1 X 125.000000000000 200.000000000000 X 1 1 X X X 1 X HTTPS://WWW.MARYLANNING.ORG/PATIENT-VISITOR-INFO/FINANCIAL-ASSISTANCE X HTTPS://WWW.MARYLANNING.ORG/PATIENT-VISITOR-INFO/FINANCIAL-ASSISTANCE X HTTPS://WWW.MARYLANNING.ORG/PATIENT-VISITOR-INFO/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 MARY LANNING HEALTHCARE PART V, SECTION B, LINE 5: MARY LANNING HEALTHCARE CONDUCTED ITS INITIAL COMMUNITY HEALTH NEEDS ASSESSMENT IN 2012 USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS. THIS WAS CONDUCTED IN PARTNERSHIP WITH THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT (SHDHD). THE CURRENT ASSESSMENT, CONDUCTED IN 2015, IN PARTNERSHIP WITH THE SHDHD USED A MINI-MAPP PROCESS FOR THE CHNA. THE ENTIRE MAPP PROCESS WILL BE USED EVERY SIX YEARS IN CONJUNCTION WITH THE SHDHD. ELEMENTS OF THE MINI-MAPP PROCESS INCLUDED A COMMUNITY THEMES AND STRENGTHS SURVEY, HEALTH STATUS ASSESSMENT, COUNTY HEALTH RANKINGS AND FOCUS GROUPS WITH ELEMENTS OF FORCES OF CHANGE. THE MINI-MAPP PROCESS ALSO HELPED TO IDENTIFY AND VALIDATE PREVIOUSLY DETERMINED COMMUNITY HEALTH NEEDS THAT ENABLED MARY LANNING TO CREATE AN IMPLEMENTATION PLAN THAT IS IN ALIGNMENT WITH THE SHDHD'S CHIP (COMMUNITY HEALTH IMPROVEMENT PLAN) AS BOTH PLANS WORK TOGETHER TO ADDRESS THE NEEDS IN THE IDENTIFIED COMMUNITY. WORK IS UNDERWAY TO COMPLETE THE 2018 ASSESSMENT. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 6A: MEMBERS OF THE CORE TEAM INCLUDED REPRESENTATIVES FROM BRODSTONE MEMORIAL HOSPITAL. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 6B: OTHER NON-HOSPITAL ORGANIZATIONS INCLUDED: -SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT -THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MARY LANNING HEALTHCARE PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA BY: ADOPTING AN IMPLEMENTATION STRATEGY ADDRESSING EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED, EXECUTION OF THE IMPLEMENTATION STRATEGY, PARTICIPATION IN THE DEVELOPMENT OF A COMMUNITY-WIDE PLAN, INCLUSION OF A COMMUNITY BENEFIT SECTION IN OPERATIONAL PLANS, ADOPTION OF A BUDGET FOR PROVISION OF SERVICES THAT ADDRESS THE NEEDS IDENTIFIED IN THE CHNA, PRIORITIZATION OF THE HEALTH NEEDS IN THE COMMUNITY AND PRIORITIZATION OF SERVICES THAT THE HOSPITAL FACILITY WILL UNDERTAKE TO MEET HEALTH NEEDS IN ITS COMMUNITY. MARY LANNING PARTNERED WITH THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT TO COORDINATE OUR IMPLEMENTATION PLAN WITH THEIR COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). MONTHLY MEETINGS WERE HELD WITH THE HEALTH DEPARTMENT AND OTHER PARTNER ORGANIZATIONS TO DISCUSS PROGRESS AND AVOID DUPLICATION. THE MARY LANNING TEAM ALSO CONTINUED TO UPDATE AND PROVIDE SERVICES IN THE FIVE AREAS OF NEED. HIGHLIGHTS FROM EACH AREA OF NEED INCLUDE THE FOLLOWING: OBESITY: MLH IS COMMITTED TO INCREASING COMMUNICATION WITH THEIR PATIENTS ON OPPORTUNITIES AVAILABLE TO ADDRESS OBESITY; AND INCREASE COMMUNITY AWARENESS OF THE IMPORTANCE OF WELLBEING IN ALL FIVE AREAS: PURPOSE, SOCIAL, FINANCIAL, PHYSICAL AND COMMUNITY; CANCER: MLH IS COMMITTED TO DEVELOPING A WOMEN'S HEALTH PROGRAM, DEVELOPING A PATIENT NAVIGATION SYSTEM AT THE MORRISON CANCER CENTER, PROVIDING AND EDUCATING THE COMMUNITY ON AVAILABLE SCREENING, AND COLLABORATING WITH THE HOME HEALTH DEPARTMENT TO DEVELOP SERVICES FOR WOMEN AND CHILDREN. MENTAL HEALTH: MLH IS COMMITTED TO IMPLEMENTING THE INTEGRATED CARE MODEL; EXPANDING TELE-MENTAL HEALTH; AND EXPANDING MENTAL HEALTH FIRST AID. SUBSTANCE ABUSE: MLH IS COMMITTED TO TRAINING PROVIDERS TO IDENTIFY AND REFER HIGH-RISK PATIENTS. ACCESS TO CARE: MLH IS COMMITTED TO DEVELOPING A STRATEGY TO ENCOURAGE MEDICARE RECIPIENTS TO EXAMINE THEIR PART D OPTIONS ANNUALLY, EXPANDING INTERPRETER SERVICES; EXPANDING TELE-HEALTH TECHNOLOGY; COLLABORATING WITH HOSPITALIST LEADERSHIP TO DEVELOP A FORMAL PALLIATIVE CARE PROGRAM; AND IMPLEMENT A HEALTH LITERACY INITIATIVE AT MLH THROUGH PARTNERSHIP WITH SHDHD.PRIORITIZED NEEDS STAKEHOLDERS IN THE ORIGINAL MAPP PROCESS WERE ASKED TO RANK ALL NEEDS ON A SCALE TO DETERMINE PRIORITY AREAS. THE TOP FOUR RANKED AREAS THROUGH THIS PROCESS WERE: OBESITY, CANCER, SUBSTANCE ABUSE AND MENTAL HEALTH. ACCESS TO CARE WAS ALSO IDENTIFIED PREVIOUSLY THROUGH THE PUBLIC HEALTH SYSTEM ASSESSMENT. THE PROCESS OF THE MINI-MAPP AGAIN IDENTIFIED ALL FIVE AS AN AREA OF NEED AND THESE AREAS WILL CONTINUE TO BE THE PRIORITY FOR MARY LANNING HEALTHCARE. THE OTHER NEEDS THAT WERE IDENTIFIED THROUGH THE ASSESSMENT PROCESS THAT ARE NOT CURRENTLY BEING ADDRESSED INCLUDE: CARDIOVASCULAR, INJURY, ENVIRONMENTAL, DIABETES, COMMUNICABLE DISEASE, REPRODUCTIVE HEALTH AND ORAL HEALTH. IT IS ANTICIPATED THAT SEVERAL AREAS WILL OVERLAP AND ONE ACTIVITY MAY MEET THE STRATEGIC GOAL IN SEVERAL AREAS AND MAY HAVE A POSITIVE IMPACT ON NEEDS THAT ARE IDENTIFIED BUT NOT IN THE TOP FIVE PRIORITY AREAS. FOR EXAMPLE, ADDRESSING NUTRITION UNDER THE PRIORITY AREA OF OBESITY WOULD LOGICALLY HAVE AN IMPACT ON PREVALENCE OF DIABETES AND HEART DISEASE AS WELL AS INCREASING ACCESS TO CARE. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 16J: THE FULL POLICY IS AVAILABLE UPON REQUEST, FREE OF CHARGE, AS WELL AS ON THE HOSPITAL'S WEBSITE. A SUMMARY OF THE POLICY AND CONTACT INFORMATION IS POSTED ON MARY LANNING HEALTHCARE'S WEBSITE, PRINTED ON BILLING STATEMENTS, POSTED IN ALL ADMISSION AREAS AND PROVIDED IN WRITING TO ALL PATIENTS UPON CHECK IN. 17 1 - HASTINGS FAMILY CARE 223 E 14TH STREET STE 100 HASTINGS NE 68901 OUTPATIENT CLINIC 2 - LANNING CENTER 815 S BURLINGTON AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC 3 - HASTINGS PULMONARY & SLEEP 715 N KANSAS AVENUE STE 101 HASTINGS NE 68901 OUTPATIENT CLINIC 4 - HASTINGS ORTHOPEDICS 2207 OSBORNE DR WEST STE 100 HASTINGS NE 68901 OUTPATIENT CLINIC 5 - COMMUNITY HEALTH CENTER 606 N MINNESOTA AVENUE STE 1 HASTINGS NE 68901 OUTPATIENT CLINIC 6 - CENTRAL NE GENERAL SURGERY 715 N KANSAS AVENUE STE 205 HASTINGS NE 68901 OUTPATIENT CLINIC 7 - CENTRAL NE INFECTIOUS DISEASE CLINIC 715 N KANSAS AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC 8 - BLUE HILL CLINIC 102 N PINE STREET BLUE HILL NE 68930 OUTPATIENT CLINIC 9 - EDGAR CLINIC 315 N C STREET EDGAR NE 68944 OUTPATIENT CLINIC 10 - CENTRAL NE ENDOCRINOLOGY 223 E 14TH STREET STE 100 HASTINGS NE 68901 OUTPATIENT CLINIC 11 - CENTRAL NE PAIN CENTER 715 N KANSAS AVENUE STE 202 HASTINGS NE 68901 OUTPATIENT CLINIC 12 - CENTRAL NE UROLOGY 2115 N KANSAS AVENUE STE 108 HASTINGS NE 68901 OUTPATIENT CLINIC 13 - CENTRAL NE UROLOGY 620 N ALPHA ST GRAND ISLAND NE 68803 OUTPATIENT CLINIC 14 - WOOD RIVER FAMILY CARE 905 MAIN STREET WOOD RIVER NE 68883 OUTPATIENT CLINIC 15 - CENTRAL NE KIDNEY CARE 715 N KANSAS AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC 16 - MIDWEST NEUROLOGY 3008 W STOLLEY PARK ROAD STE 1 GRAND ISLAND NE 68801 OUTPATIENT CLINIC 17 - MIDWEST NEUROLOGY 2115 N KANSAS AVENUE STE 102 HASTINGS NE 68901 OUTPATIENT CLINIC PART I, LINE 3C: THE ORGANIZATION ONLY USED FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE. PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION. PART I, LINE 7: THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST-TO-CHARGE RATIO. THE RATIO WAS DERIVED FROM WORKSHEET 2. PART I, LINE 7G: THE HOSPITAL DOES NOT REPORT ANY SUBSIDIZED HEALTH SERVICES ON LINE 7(G). PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $9,610,690 PART II, COMMUNITY BUILDING ACTIVITIES: HASTINGS FAMILY CARE, A CLINIC OF MLH, HOSTED PROJECT SEARCH STUDENTS FOR AN EIGHT WEEK ROTATION SO THAT THEY MAY GAIN JOB SKILLS TO PREPARE THEM FOR FUTURE JOB OPPORTUNITIES. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PATIENT RECEIVABLES ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. PART III, LINE 3: THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTH CARE SERVICES THEY RECEIVE. PATIENTS WHO QUALIFY FOR CHARITY CARE ARE GIVEN A PERCENTAGE DISCOUNT FROM ESTABLISHED CHARGES BASED ON A SLIDING SCALE USING POVERTY GUIDELINES. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN NET OPERATING REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR THE HOSPITAL ONLY. THE COSTS OF CARING FOR CHARITY CARE PATIENTS FOR THE YEARS ENDED DECEMBER 31, 2017 AND 2016 WERE APPROXIMATELY $5,450,000 AND $4,370,000, RESPECTIVELY. PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. FOOTNOTES TITLED "PATIENT RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE, AND "FINANCIAL ASSISTANCE/CHARITY CARE" CAN BE FOUND ON PAGES 8 AND 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: FOR-PROFIT SPECIALITY HOSPITALS HAVE BEEN CARVING OUT CERTAIN HIGH-MARGIN SERVICES, LEAVING GENERAL ACUTE CARE HOSPITALS WITH LOWER-MARGIN MEDICARE SERVICES. THIS INDICATES THAT MEDICARE LOSSES CAN BE A RESULT OF RENDERING THESE LOWER-MARGIN SERVICES RATHER THAN INEFFICIENT OPERATIONS. ALL OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. PART III, LINE 9B: ACCOUNTS WILL BE SCREENED FOR APPROPRIATE REFERRAL TO FINANCIAL ASSISTANCE VS. BAD DEBT WRITE OFF DURING THE COLLECTION PROCESS. THE FINANCIAL ASSISTANCE POLICY DOES INCLUDE PROVISION FOR IMPLIED CHARITY CARE IF THERE IS SUFFICIENT KNOWLEDGE TO DETERMINE THAT THE PATIENT MEETS THE QUALIFYING FACTORS OF THE PROGRAM. PART VI, LINE 2: A NEEDS ASSESSMENT WAS CONDUCTED IN 2015 IN PARTNERSHIP WITH SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT UTILIZING THE MINI-MAPP PROCESS, THE COMPLETE MAPP PROCESS WILL BE USED EVERY SIX YEARS. SOUTH HEARTLAND AND MARY LANNING STAFF PARTNERED WITH OUR COMMUNITY STAKEHOLDERS TO DEFINE THE PRIORITY COMMUNITY NEEDS AND DEVELOP AN ACTION PLAN FROM THE ASSESSMENT DATA. PART VI, LINE 3: MLH INFORMS AND EDUCATES PATIENTS BY POSTING SIGNS IN ALL ADMISSION AREAS AND PATIENT ROOMS. BROCHURES ARE AVAILABLE IN ADMISSION AREAS. ALL NON-INSURED INPATIENTS ARE PERSONALLY VISITED AND PATIENTS MAY HAVE DISCUSSIONS WITH A FINANICAL COUNSELOR AT ANYTIME DURING THE BILLING/COLLECTION PROCESS. PART VI, LINE 4: MLH'S PRIMARY SERVICE AREA IS ADAMS COUNTY WITH A SECONDARY AREA INCLUDING MERRICK, HALL, HAMILTON, KEARNEY, CLAY, FRANKLIN, WEBSTER, AND NUCKOLLS COUNTIES. THE ESTIMATED POPULATION OF ADAMS COUNTY IS 35,000 AND THE SECONDARY SERVICE AREA IS 93,000. ADAMS COUNTY IS 563 SQ. MILES. FIFTEEN PERCENT OF THE POPULATION IN ADAMS COUNTY IS MEDICARE AGE OR OLDER. PART VI, LINE 5: MARY LANNING CURRENTLY PROMOTES HEALTH IN THE COMMUNITY THROUGH OUTREACH TO A WIDE VARIETY OF COMMUNITY ORGANIZATIONS. MUCH FOCUS IS ALREADY PLACED ON THE FIVE PRIORITY NEED AREAS IDENTIFIED IN THE CHNA. MANY DEPARTMENTS WITHIN MARY LANNING PARTICIPATE IN COMMUNITY COALITIONS, PROVIDE OUTREACH TO WORKSITES AND COMMUNITY MEMBERS INCLUDING MINORITIES AND LOW INCOME GROUPS, EDUCATE AND PROVIDE LOW COST OR NO COST SCREENINGS AND CARE. PART VI, LINE 6: MARY LANNING IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. 1 MARY LANNING HEALTHCARE FOUNDATION 741 N DENVER AVE HASTINGS NE 68901 470800042 501(C)(3) 209610 TO ASSIST WITH THE OPERATING COSTS OF FUNDRAISING. ADAMS COUNTY CLERK 500 WEST 4TH STREET HASTINGS NE 68901 476006427 GOVERNMENTAL 25000 TO ASSIST WITH OPERATING COSTS OF THE AMBULANCE SERVICE. 2 0 PART I, LINE 2: MARY LANNING HEALTHCARE ONLY MAKES CONTRIBUTIONS AND GRANTS TO CHARITABLE OR GOVERNMENTAL TAX EXEMPT ENTITIES. THE HOSPITAL VERIFIES THE TAX EXEMPT STATUS OF THE GRANT RECIPIENTS PRIOR TO MAKING THE GRANT. TERMS OF THE GRANT STATE THAT THE FUNDS ARE ONLY TO BE USED FOR CHARITABLE PURPOSES. X X 0 0 X X X 0 1 0 0 0 0 0 1 0 ERIC BARBER PRESIDENT/CEO 369930 0 58760 0 436 0 100800 0 29639 0 559565 0 0 0 SHAWN NORDBY CHIEF FINANCIAL OFFICER 186287 0 6886 0 284 0 8110 0 19943 0 221510 0 0 0 BARRY BOHLEN PHYSICIAN 941205 0 0 0 993 0 10800 0 32286 0 985284 0 0 0 KALPESH GANATRA PHYSICIAN 770081 0 0 0 904 0 10800 0 31746 0 813531 0 0 0 BRENT HOOD PHYSICIAN 630805 0 0 0 711 0 10800 0 30227 0 672543 0 0 0 KARTIC RAJPUT PHYSICIAN 642088 0 0 0 421 0 10397 0 19224 0 672130 0 0 0 THOMAS ZUSAG PHYSICIAN 576576 0 0 0 8001 0 10800 0 11026 0 606403 0 0 0 PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: A COUNTRY CLUB MEMBERSHIP IS PROVIDED TO ERIC BARBER, SHAWN NORDBY, AND MICHAEL ALLEN, FOR PERSONAL USE. THE VALUE OF THE MEMBERSHIP WAS INCLUDED AS TAXABLE WAGES IN THEIR 2017 W-2'S. CHAUFFEUR: VEHICLES OWNED BY MARY LANNING HEALTHCARE AND DRIVERS EMPLOYED BY THE HOSPITAL ARE MADE AVAILABLE TO PHYSICIANS WHO CHOOSE TO USE THEM FOR TRAVEL TO CLINICS IN OTHER CITIES. SUCH TRAVEL IS STRICTLY FOR HOSPITAL BUSINESS PURPOSES, AND THE PROVISION OF CARS AND DRIVERS ENABLES THE PHYSICIANS TO PERFORM VARIOUS ADMINISTRATIVE TASKS DURING THE TRAVEL TIME. PHYSICIANS ARE NOT REQUIRED TO "ACCOUNT" TO THE HOSPITAL FOR THE NUMBER OF MILES DRIVEN, AS THE ENTIRE TRAVEL COST IS A HOSPITAL BUSINESS EXPENSE. PART I, LINE 4B THE HOSPITAL CONTRIBUTED $20,000 TO A 457(F) ACCOUNT FOR ERIC BARBER; THIS AGREEMENT IS ONGOING FOR $20,000 ANNUALLY FOR 5 YEARS, BEGINNING IN 2013. AT THAT TIME, MR. BARBER WILL RECEIVE THE BALANCE IN THE ACCOUNT. PART I, LINE 7 THE PRESIDENT OF THE ORGANIZATION'S EMPLOYMENT AGREEMENT PROVIDES FOR UP TO A 20% DISCRETIONARY BONUS. A HOSPITAL AUTHORITY NO 1 OF ADAMS COUNTY NE 470762824 NONEAVAIL 2013-08-20 3680000 REFUND PRIOR ISSUES (3/26/98 & 9/1/03) 0 0 0 B HOSPITAL AUTHORITY NO 1 OF ADAMS COUNTY NE 470762824 NONEAVAIL 2015-08-27 28335905 RENOVATIONS & REFUND ISSUE (7/1/08) 0 0 0 A 2990000 3680000 3680000 2005 1 0 1 1 B 4542740 28741234 17596230 7500327 3644677 0 1 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 1 1 0 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 0 B 0 SCHEDULE K, PART IV, LINE 2C: (A) ISSUER NAME: HOSP AUTHORITY NO. 1 OF ADAMS COUNTY NE DATE THE REBATE COMPUTATION WAS PERFORMED: 02/20/2014 NOTE REGARDING THE REBATE COMPUTATION ON 2/20/2014: SINCE THE BOND PROCEEDS HAVE BEEN SPENT, A SPENDING EXCEPTION WAS MET, AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. ERIC BARBER CEO/EMPLOYEE OF ORGANIZATION FORGIVABLE LOAN X 200000 203337 0 1 1 203337 MONICA NORDBY EMPLOYEE OF ORGANIZATION AND WIFE OF SHAWN NORDBY, CFO 59242 EMPLOYEES W-2 WAGES 0 FORM 990, PART IV, LINE 13: FORM 990, PART IV, LINE 13 IS ANSWERED "NO" BECAUSE MARY LANNING HEALTHCARE'S PRIMARY PROGRAM SERVICE IS THE PROVISION OF MEDICAL CARE THROUGH ITS HOSPITAL. HOWEVER, IT ALSO CONDUCTS A NURSING SCHOOL IN CONJUNCTION WITH CREIGHTON UNIVERSITY AND A RADIOLOGY SCHOOL. SCHEDULE E HAS NOT BEEN PREPARED BECAUSE THE ORGANIZATION DOES NOT CHECK BOX 2, PART I OF SCHEDULE A TO INDICATE IT IS A "SCHOOL". BOTH THE NURSING SCHOOL AND THE RADIOLOGY SCHOOL ARE OPERATED ON A NONDISCRIMINATORY BASIS. FORM 990, PART VI, SECTION A, LINE 2 MICHELE BEVER, VICE-CHAIR, AND JANIS JOHNSON, TRUSTEE, SHARE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 WAS PROVIDED TO THE MEMBERS OF THE BOARD ELECTRONICALLY AND WAS REVIEWED BY THOSE MEMBERS PRIOR TO FILING THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, TRUSTEES, COMMITTEE MEMBERS AND KEY EMPLOYEES MUST ANNUALLY REVIEW AND COMPLETE A CONFLICT SURVEY AND SIGN A CONFLICT OF INTEREST STATEMENT. AS PER THE POLICY, ANY POTENTIAL CONFLICT OF INTEREST MUST BE DISCLOSED AND MADE A MATTER OF RECORD. ANY PERSON WITH A POSSIBLE CONFLICT OF INTEREST IN ANY MATTER SHOULD NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 AN EXECUTIVE COMPENSATION REVIEW IS PERFORMED ANNUALLY. THE HOSPITAL CONSULTED WITH KATHY NOLAN REGARDING SALARY COMPARISONS AS WELL AS HIRING AN INDEPENDENT CONSULTANT, GRANT THORTON, TO PERFORM A REVIEW OF EXECUTIVE COMPENSATION IN 2010. THE BOARD'S GOAL IS TO REVIEW OUTSIDE PUBLISHED STUDIES WHEN DETERMINING THE CEO'S COMPENSATION PACKAGE EVERY THIRD YEAR. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, THE CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST THROUGH MARY LANNING HEALTHCARE'S ADMINISTRATIVE OFFICES. FORM 990, PART VII, SECTION A, COLUMN B: MICHAEL ALLEN IS EMPLOYED BY MARY LANNING TRUST, A RELATED ENTITY. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 10,890,817. MANAGEMENT AND GENERAL EXPENSES 11,849,786. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,740,603. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 795,104. CHANGE IN BENEFICIAL INTEREST OF TRUST -695,100. PENSION RELATED CHANGES 5,927,893. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. MARY LANNING HEALTHCARE FOUNDATION 741 N DENVER AVE HASTINGS NE 68901 470800042 FUNDRAISING ACTIVITIES NE 501(C)(3) LINE 12C, III-FI THE MARY LANNING HOSPITAL ASSOCIATION 1 MARY LANNING HOSPITAL TRUST 122 N HASTINGS AVE HASTINGS NE 68901 476000224 INVESTMENT MANAGEMENT NE 501(C)(3) LINE 12B, II THE MARY LANNING HOSPITAL ASSOCIATION 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 MARY LANNING HOSPITAL TRUST C 780000 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION B 209610 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION C 180827 CASH TRANSFER