2015-11-12T15:46:35-06:00 2014-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2014-01-01 470378779 THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION MARY 4024634521 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 ERIC BARBER PRESIDENT 4024634521 2015-11-12 1 BARBARA J FAJEN P00400874 4023302660 2014 2016-03-07 17:11:31Z MARY LANNING HEALTHCARE ERIC BARBER 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 138656814 0 X WWW.MARYLANNING.ORG X 1915 NE ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFERING HOPE, HEALTH AND HEALING. 6 5 1156 150 509215 0 966008 807146 120103220 134494725 1312181 1827213 1091757 1203327 123473166 138332411 213571 211997 0 0 63445127 69685118 0 0 0 54222550 60236730 117881248 130133845 5591918 8198566 168002623 189540857 51008268 57902687 116994355 131638170 ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFERING HOPE, HEALTH AND HEALING. 0 0 107166712 211997 134494725 MARY LANNING HEALTHCARE (MLH) PROVIDES HEALTHCARE SERVICES TO THE GENERAL PUBLIC AND OPERATES ROUTINE SERVICE BEDS, ICU BEDS, OUTPATIENT SERVICES, A HOME HEALTH PROGRAM, AND A SCHOOL OF NURSING. MLH TAKES ITS RESPONSIBILITIES FOR PROVIDING BENEFITS TO THE SURROUNDING COMMUNITIES SERIOUSLY. THIS IS DEMONSTRATED IN NUMEROUS WAYS. THE HOSPITAL ABSORBED OVER $33 MILLION IN COSTS DURING 2014. OVER $11 MILLION OF THAT AMOUNT RELATES TO CARE PROVIDED TO MEDICARE AND MEDICAID PATIENTS WITH AN ADDITIONAL $2.1 MILLION IN CARE TO THE UNINSURED IN THE FORM OF CHARITY CARE. MUCH ATTENTION HAS BEEN PAID TO THE RESPONSIBILITIES OF TAX EXEMPT ORGANIZATIONS. FROM THE INFORMATION SUMMARIZED HERE, IT IS CLEAR THAT THE CONTRIBUTIONS OF THE HOSPITAL FAR EXCEED FUNDS THAT WOULD BE GENERATED BY A CORPORATE TAX STRUCTURE. 107166712 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 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 57 0 1 1156 1 1 1 0 0 0 0 0 0 0 0 0 X 6 5 0 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 0.00 X X 0 0 0 MICHELE BEVER VICE-CHAIR 1.00 0.00 X X 0 0 0 CLARENCE GARY ANDERSON SECRETARY/TREASURER 1.00 40.00 X X 0 107890 7730 MICHAEL ALLEN TRUSTEE 1.00 40.00 X 0 33033 561 CALVIN JOHNSON TRUSTEE 1.00 0.00 X 0 0 0 PRADIPTA CHAUDHURI TRUSTEE 1.00 0.00 X 0 0 0 ERIC BARBER PRESIDENT/CEO 40.00 0.00 X 405679 0 35006 SHAWN NORDBY CHIEF FINANCIAL OFFICER 40.00 0.00 X 165713 0 23322 MICHAEL SKOCH MD CHIEF MEDICAL OFFICER 40.00 0.00 X 429120 0 34547 RONDA EHLY CHIEF NURSING OFFICER 40.00 0.00 X 178508 0 25879 BRUCE CUTRIGHT VP HUMAN RESOURCES 40.00 0.00 X 171707 0 12216 MARK CALLAHAN CHIEF OPERATING OFFICER 40.00 0.00 X 167539 0 27904 CHARLENE SANDERS VP QUALITY 40.00 0.00 X 160643 0 11448 BENJAMIN FAGO PHYSICIAN 40.00 0.00 X 423502 0 37550 KALPESH GANATRA PHYSICIAN 40.00 0.00 X 589528 0 54042 SHAMILA GARG PHYSICIAN 40.00 0.00 X 408805 0 35963 MATTHEW STRITT PHYSICIAN 40.00 0.00 X 473656 0 51944 THOMAS ZUSAG PHYSICIAN 40.00 0.00 X 585083 0 33103 4159483 140923 391215 52 0 1 0 SS PSYCHIATRY GROUP 4110 HARGORD STREET GRAND ISLAND NE 68803 PHYSICIAN COVERAGE 1148313 MCKESSON INFORMATION BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 848886 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 SOFTWARE SUPPORT 538435 ROSCH COMMERCIAL BUILDERS 322 W SOUTH STREET HASTINGS NE 68901 GENERAL CONTRACTOR 533823 DAVIS DESIGN 1221 N ST 600 LINCOLN NE 68508 GENERAL CONTRACTOR 480467 112 807146 807146 ALL OTHER PATIENT REVE 621300 91279116 91279116 NET MEDICARE REVENUE 621300 37070679 37070679 NET MEDICAID REVENUE 621300 4452576 4452576 MEANINGFUL USE INCENTI 621300 570917 570917 RADIOLOGY SCHOOL 621300 130156 130156 991281 991281 134494725 1059691 1059691 264 264 264362 8065 256297 256297 256297 885891 0 118633 885891 -118633 767258 767258 203196 197705 5491 5491 CAFETERIA 722210 432324 432324 CATERING 722320 211565 211565 MHR HOME CARE 621610 194606 194606 103044 103044 941539 138332411 134494725 509215 2521325 211997 211997 2006927 2006927 115911 115911 50726076 42571191 8154885 3178334 2701546 476788 10194363 8665086 1529277 3463507 2838518 624989 327091 327091 72507 72507 122557 122557 12824917 8597814 4227103 561732 46799 514933 2157497 344962 1812535 1132390 1132390 362746 264812 97934 325800 210294 115506 1197781 1197781 9094231 7388766 1705465 1198921 453896 745025 MEDICAL SUPPLIES 19806766 19757392 49374 BAD DEBT EXPENSE 7785975 7785975 REPAIRS 1927412 1726384 201028 FOOD EXPENSE 993830 993830 344577 161368 183209 130133845 107166712 22967133 0 3588 3587 6428778 12098505 18513401 18407681 708421 1193755 2505644 2701997 1757460 1800065 168400575 100794839 66356852 67605736 36917514 39720807 33154716 44714025 380578 0 1275671 1294699 168002623 189540857 13246520 16579799 24815000 23460000 2096247 2912962 10850501 14949926 51008268 57902687 X 85237410 90125102 3399084 3397479 28357861 38115589 116994355 131638170 168002623 189540857 X 8198566 705553 5739696 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 0 0 1 22811 22811 0 PART II-B, LINE 1: A PORTION OF DUES PAID TO AHA, NHA AND NABHO ARE FOR LOBBYING PURPOSES. IN ADDITION, $9,750 PAID TO MCDERMOTT, WILL & EMERY LLP, ON BEHALF OF THE MEDICARE DEPENDENT RURAL HOSPITAL COALITION, SUPPORTS LOBBYING ACTIVITY CONDUCTED BY THAT ORGANIZATION. 29226433 9906390 39132823 23899866 5326567 29226433 20694745 3205121 23899866 17842614 3119278 267147 20694745 15975895 87241 1850255 70777 17842614 0.00000 1.00000 0.00000 0 1 1 4294205 4294205 90978084 49213616 41764468 68606432 51581223 17025209 4521854 4521854 67605736 STUDENT LOAN AND RESTRICTED FUNDS 813172 F JOINT VENTURES 627307 F BENEFICIAL INTEREST IN FOUNDATION 5670957 F BENEFICIAL INTEREST IN TRUST 37602589 F 44714025 THIRD PARTY REIMBURSEMENT CONTRACTS 2804579 LIABILITY FOR PENSION BENEFITS 12145347 14949926 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. IN GENERAL, SUCH STANDARDS REQUIRE THE HOSPITAL TO MEET A COMMUNITY BENEFIT STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. 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, 2014, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY U.S. FEDERAL, STATE OR LOCAL AUTHORITIES FOR YEARS BEFORE 2011. 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 1 X 125.000000000000 1 X 1 1 1 0 1 1 2174584 2174584 0.01780 10890132 4452576 6437556 0.05260 13064716 4452576 8612140 0.07040 1109778 1109778 0.00910 712911 712911 0.00580 309046 309046 0.00250 219050 219050 0.00180 2350785 2350785 0.01920 15415501 4452576 10962925 0.08960 7148 7148 0.00010 114432 114432 0.00090 700 700 0.00000 122280 122280 0.00100 1 7785975 0 26362181 37963730 -11601549 X 1 1 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 12 1 1 1 1 X WWW.MARYLANNING.ORG X 1 12 1 WWW.MARYLANNING.ORG 0 0 1 X 125.000000000000 200.000000000000 X 1 1 X X 1 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 PARTNERED WITH MULTIPLE ENTITIES TO COMPLETE THE NEEDS ASSESSMENT. THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT (SHDHD) WAS THE PRIMARY PARTNER AND CONDUCTED THE NEEDS ASSESSMENT THROUGH MAPP PROCESS. OTHER MEMBERS OF THE CORE TEAM INCLUDED REPRESENTATIVES FROM BRODSTONE MEMORIAL HOSPITAL, WEBSTER COUNTY COMMUNITY HOSPITAL, THE CLAY COUNTY HEALTH DEPARTMENT AND A MEMBER OF THE SHDHD BOARD OF HEALTH. CORE TEAM MEMBERS SERVED AS THE PLANNING COMMITTEE AND ASSISTED WITH THE IMPLEMENTATION OF THE ASSESSMENT AND THE IDENTIFICATION OF STAKEHOLDERS AS WELL AS PROVIDING IN-KIND AND MONETARY RESOURCES. OTHER PARTNERS INCLUDED THE CDC (FIELD TEST SITE FOR THE LOCAL PUBLIC HEALTH SYSTEM PERFORMANCE ASSESSMENT) AND THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES WHO COLLECTED THE DATA FOR THE COMMUNITY THEMES AND STRENGTHS SURVEY. 70 COMMUNITY STAKEHOLDERS ALSO PARTICIPATED IN THE NEEDS ASSESSMENT PROCESS. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 6A: MEMBERS OF THE CORE TEAM INCLUDED REPRESENTATIVES FROM BRODSTONE MEMORIAL HOSPITAL AND WEBSTER COUNTY COMMUNITY HOSPITAL. 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 - PARTICIPATION IN HEALTHY HASTINGS COALITION, COMMUNITY EDUCATION AND OUTREACH DEVELOPMENT WITHIN THE MARY LANNING CLINICS, OUTREACH TO MINORITY POPULATIONS FOR DIABETES, INCREASING NUMBER OF BUSINESSES OFFERING WORKSITE WELLNESS OPTIONS, COLLABORATIONS WITH SCHOOLS AND OTHER LOCAL HEALTH ENTITIES TO PROVIDE PROGRAMS AND EDUCATION, WORKING WITH THE HEALTH DEPARTMENT THROUGH GRANT FUNDING TO HELP IDENTIFY AND MANAGE TREATMENT FOR HYPERTENSION AND DIABETES. CANCER - SUPPORT OF THE MIDWEST LUNG CANCER SCREENING PROGRAM, PARTICIPATION AND EDUCATION AT COMMUNITY EVENTS PERTAINING TO DIFFERENT TYPES OF CANCER PREVENTION, ASSISTANCE FOR CANCER PATIENTS TO CONNECT WITH SUPPORTIVE RESOURCES. MENTAL HEALTH - PARTICIPATION AND COORDINATION OF LOCAL EVENTS TO INCREASE AWARENESS OF MENTAL ILLNESS, DEVELOPED PROCESS TO IDENTIFY PATIENTS WITH DUAL DIAGNOSIS, ADVOCATED AT THE STATE LEVEL FOR POLICIES THAT SUPPORT MENTAL HEALTH SERVICES, ADDED MENTAL HEALTH PRACTITIONERS, INCLUDING IN THE FAMILY CARE CLINIC, WHICH HELPED EXPAND SERVICES. SUBSTANCE ABUSE - PARTICIPATED IN DRUG TAKE-BACK EVENTS, ASSISTED WORKSITES WITH TOBACCO-FREE POLICIES, ASSISTED PATIENTS WITH TOBACCO-FREE RESOURCES, TRAINED EMPLOYEES TO BE TOBACCO CESSATION EDUCATORS, COUNSEL BEHAVIORAL HEALTH PATIENTS ON TOBACCO CESSATION AND CONNECT THEM TO THE QUITLINE. ACCESS TO CARE -CONTINUING TO DEVELOP A MEDICAL HOME MODEL FOR MLH CLINICS, SCREENING AND HEALTHCARE CASE MANAGEMENT OFFERED TO HISPANIC COMMUNITY, RECRUITED NEW SPECIALTY PHYSICIANS, WORKING WITH THE HEALTH DEPARTMENT THROUGH GRANT FUNDING TO INCREASE ACCESS TO CARE THROUGH THE CLINICS. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 16I: THE FULL POLICY IS AVAILABLE UPON REQUEST, FREE OF CHARGE. 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. 10 HASTINGS FAMILY CARE 223 E 14TH STREET STE 100 HASTINGS NE 68901 OUTPATIENT CLINIC LANNING CENTER 815 S BURLINGTON AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC HASTINGS PULMONARY & SLEEP 715 N KANSAS AVENUE STE 101 HASTINGS NE 68901 OUTPATIENT CLINIC HASTINGS ORTHOPAEDICS 2207 OSBORNE DR WEST STE 100 HASTINGS NE 68901 OUTPATIENT CLINIC COMMUNITY HEALTH CENTER 606 N MINNESOTA AVENUE STE 1 HASTINGS NE 68901 OUTPATIENT CLINIC CENTRAL NE GENERAL SURGERY 715 N KANSAS AVENUE STE 205 HASTINGS NE 68901 OUTPATIENT CLINIC CENTRAL NE INFECTIOUS DISEASE CLINIC 715 N KANSAS AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC BLUE HILL CLINIC 102 N PINE STREET BLUE HILL NE 68930 OUTPATIENT CLINIC EDGAR CLINIC 315 N C STREET EDGAR NE 68944 OUTPATIENT CLINIC CENTRAL NE ENDOCRINOLOGY 223 E 14TH STREET STE 100 HASTINGS NE 68901 OUTPATIENT CLINIC PART I, LINE 3C: NOT APPLICABLE PART I, LINE 6A: NOT APPLICABLE 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, LN 7 COL(F): BAD DEBT EXPENSE IS $7,785,975. PART II, COMMUNITY BUILDING ACTIVITIES: MLH PARTICIPATES IN NEBRASKA HEALTH INFORMATION INITIATIVE WHICH ALLOWS PHYSICIANS TO VIEW THE ENTIRE RECORD OF A PATIENT. THIS BENEFITS THE PATIENT BECAUSE THE DOCTOR SEES THEIR ENTIRE HISTORY INSTEAD OF JUST THE ILLNESS OR INJURY FOR WHICH THEY ARE CURRENTLY BEING TREATED. PART III, LINE 2: MLH RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYER COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, MLH RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF MLH'S UNINSURED PATIENTS WILL BE UNABLE TO PAY FOR THE SERVICES PROVIDED. THUS, MLH RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. PART III, LINE 3: NOT APPLICABLE PART III, LINE 4: THERE IS NO FOOTNOTE IN THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. HOWEVER, THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "PATIENT RECEIVABLES, NET:THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. 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.THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "NET PATIENT SERVICE REVENUE":THE HOSPITAL HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE HOSPITAL AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES, AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.THE FOLLOWING IS THE TEXT OF THE FOOTNOTE TITLED "CHARITY CARE":THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE IN THE CONSOLIDATED STATEMENTS OF OPERATIONS. 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. 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 2012 IN PARTNERSHIP WITH SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT UTILIZING THE MAPP PROCESS. SOUTH HEARTLAND AND MARY LANNING STAFF PARTNERED WITH OUR COMMUNITY STAKEHOLDERS TO DEFINE THE PRIORITY COMMUNITY NEEDS AND DEVELOP AN ACTION PLANS 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: NOT APPLICABLE 1 MARY LANNING HEALTHCARE FOUNDATION 715 NORTH ST JOSEPH AVENUE HASTINGS NE 68901 470800042 501(C)(3) 186997 TO ASSIST WITH THE OPERATING COSTS OF FUNDRAISING. ADAMS COUNTY CLERK 500 WEST 4TH STREET HASTINGS NE 68901 476006427 501(C)(1) 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 0 0 ERIC BARBER PRESIDENT/CEO 377973 0 27706 0 0 0 12900 0 22106 0 440685 0 0 0 SHAWN NORDBY CHIEF FINANCIAL OFFICER 160298 0 5415 0 0 0 8361 0 14961 0 189035 0 0 0 MICHAEL SKOCH MD CHIEF MEDICAL OFFICER 372555 0 56565 0 0 0 12900 0 21647 0 463667 0 0 0 RONDA EHLY CHIEF NURSING OFFICER 178468 0 40 0 0 0 9145 0 16734 0 204387 0 0 0 BRUCE CUTRIGHT VP HUMAN RESOURCES 166567 0 5140 0 0 0 8361 0 3855 0 183923 0 0 0 MARK CALLAHAN CHIEF OPERATING OFFICER 162324 0 5215 0 0 0 8361 0 19543 0 195443 0 0 0 CHARLENE SANDERS VP QUALITY 160643 0 0 0 0 0 8106 0 3342 0 172091 0 0 0 BENJAMIN FAGO PHYSICIAN 413902 0 9600 0 0 0 12900 0 24650 0 461052 0 0 0 KALPESH GANATRA PHYSICIAN 486008 0 103520 0 0 0 12900 0 41142 0 643570 0 0 0 SHAMILA GARG PHYSICIAN 383703 0 25102 0 0 0 12900 0 23063 0 444768 0 0 0 MATTHEW STRITT PHYSICIAN 335125 0 138531 0 0 0 12900 0 39044 0 525600 0 0 0 THOMAS ZUSAG PHYSICIAN 585083 0 0 0 0 0 12900 0 20203 0 618186 0 0 0 PART I, LINE 1A HEALTH OR SOCIAL CLUB DUES: A COUNTRY CLUB MEMBERSHIP IS PROVIDED TO ERIC BARBER, MARK CALLAHAN, SHAWN NORDBY AND BRUCE CUTRIGHT, FOR PERSONAL USE. THE VALUE OF THE MEMBERSHIP WAS INCLUDED AS TAXABLE WAGES IN THEIR 2014 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. A HOSPITAL AUTHORITY NO 1 OF ADAMS COUNTY NE 470762824 006060CL9 2008-07-01 23725120 TWO ADDITIONS TO THE HOSPITAL 0 0 0 B HOSPITAL AUTHORITY NO 1 OF ADAMS COUNTY NE 470762824 2013-08-20 3680000 REFUND PRIOR ISSUES (3/26/98 & 9/1/03) 0 0 0 A 3090000 24173723 1752116 22421606 2011 0 0 1 1 B 920000 3680000 3680000 2005 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 1 1 0 0 0 0 0 B 0 0 1 1 0 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: 06/30/2013 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. MONICA NORDBY EMPLOYEE OF ORGANIZATION AND WIFE OF SHAWN NORDBY, CFO 53719 EMPLOYEES W-2 WAGES 0 CONDA QUACKENBUSH EMPLOYEE OF ORGANIZATION AND SISTER OF RONDA EHLY, KEY EMPLOYEE 62192 EMPLOYEES W-2 WAGES 0 FORM 990, PART VI, SECTION B, LINE 11 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 EACH EMPLOYEE AND BOARD MEMBER MUST ANNUALLY COMPLETE A CONFLICT SURVEY AND SIGN A CONFLICT OF INTEREST STATEMENT. FORM 990, PART VI, SECTION B, LINE 15 AN EXECUTIVE COMPENSATION REVIEW IS PERFORMED ANNUALLY. IN 2010, THE BOARD HIRED AN INDEPENDENT CONSULTANT, GRANT THORTON, TO PERFORM A REVIEW OF EXECUTIVE COMPENSATION. 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: BOTH CLARENCE (GARY) ANDERSON AND MICHAEL ALLEN ARE EMPLOYED BY MARY LANNING TRUST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 1,523,500. CHANGE IN BENEFICIAL INTEREST OF TRUST 9,757,728. PENSION RELATED CHANGES -5,541,532. 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. 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 NONDISCRIMINITORY BASIS. MARY LANNING HEALTHCARE FOUNDATION 741 N DENVER AVE HASTINGS NE 68901 470800042 FUNDRAISING ACTIVITIES NE 501(C)(3) LINE 11C, 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 11B, 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 625000 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION B 186997 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION C 182146 CASH TRANSFER