2014-11-14T09:42:06-06:00 2013-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2013-01-01 470378779 THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION MARY 4024634521 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 ERIC BARBER PRESIDENT 4024634521 2014-11-06 1 BARBARA J FAJEN P00400874 4023302660 2013 2015-11-30 17:44:51Z MARY LANNING HEALTHCARE ERIC BARBER 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 123557488 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 1136 153 182877 0 1531890 966008 113975564 120103220 1475204 1312181 4113414 1091757 121096072 123473166 331620 213571 0 0 59926430 63445127 0 0 0 54425002 54222550 114683052 117881248 6413020 5591918 152040846 168002623 57163837 51008268 94877009 116994355 ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFERING HOPE, HEALTH AND HEALING. 0 0 89387652 213571 120103220 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 $27 MILLION IN COSTS DURING 2013. OVER $8 MILLION OF THAT AMOUNT RELATES TO CARE PROVIDED TO MEDICARE AND MEDICAID PATIENTS WITH AN ADDITIONAL $1.9 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. 89387652 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 0 0 0 0 0 0 0 1 1 1 0 0 1 51 0 1 1136 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 1.00 40.00 X X 0 104613 15263 DENNIS KRIENERT TREASURER 1.00 0.00 X X 0 0 0 MICHAEL ALLEN TRUSTEE 1.00 0.00 X 0 0 0 CALVIN JOHNSON TRUSTEE 1.00 0.00 X 0 0 0 ERIC BARBER PRESIDENT/CEO (EFFECTIVE 9/13) 40.00 0.00 X 123919 0 18708 MICHAEL SKOCH MD CHIEF MEDICAL OFFICER 40.00 0.00 X 394115 0 30935 RONDA EHLY CHIEF NURSING OFFICER 40.00 0.00 X 180587 0 22466 SHAWN NORDBY CHIEF FINANCIAL OFFICER 40.00 0.00 X 145676 0 21628 BRUCE CUTRIGHT VP HUMAN RESOURCES 40.00 0.00 X 171776 0 10522 MARK CALLAHAN CHIEF OPERATING OFFICER 40.00 0.00 X 232100 0 26211 SHAWN RIGGS VP AMBULATORY SERVICES 40.00 0.00 X 131579 0 24691 CHARLENE SANDERS VP QUALITY 40.00 0.00 X 39742 0 9085 BENJAMIN FAGO PHYSICIAN 40.00 0.00 X 423375 0 32444 KALPESH GANATRA PHYSICIAN 40.00 0.00 X 627298 0 31799 JAMES NEALON PHYSICIAN 40.00 0.00 X 492499 0 31690 MATTHEW STRITT PHYSICIAN 40.00 0.00 X 484149 0 31107 THOMAS ZUSAG PHYSICIAN 40.00 0.00 X 599561 0 24844 4046376 104613 331393 41 0 1 0 MCKESSON INFORMATION BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 1101618 SS PSYCHIATRY GROUP 4110 HARGORD STREET GRAND ISLAND NE 68803 PHYSICIAN COVERAGE 1059838 SIEMENS MEDICAL SOLUTIONS DEPT CH 14195 PALATINE IL 60055 SOFTWARE SUPPORT 957725 ROSCH COMMERCIAL BUILDERS 322 W SOUTH STREET HASTINGS NE 68901 GENERAL CONTRACTOR 617594 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 SOFTWARE SUPPORT 546959 99 18 965990 966008 ALL OTHER PATIENT REVE 621300 79003993 79003993 NET MEDICARE REVENUE 621300 32984527 32984527 NET MEDICAID REVENUE 621300 4929983 4929983 MEANINGFUL USE INCENTI 621300 1285386 1285386 RADIOLOGY SCHOOL 621300 88671 88671 1810660 1810660 120103220 8209 8209 884981 884981 279005 5471 273534 273534 273534 418991 0 418991 418991 418991 193814 78851 114963 114963 CAFETERIA 722210 520383 520383 182877 182877 703260 123473166 120103220 182877 2221061 213571 213571 1771545 1771545 47200998 39689694 7511304 3147996 2661667 486329 8086328 6837084 1249244 3238260 2652112 586148 271180 271180 69606 69606 109567 109567 2230383 2230383 1905862 198252 1707610 1074971 1074971 326295 270826 55469 394020 221824 172196 1324166 1324166 8930294 7559193 1371101 1169776 476325 693451 MEDICAL SUPPLIES 16867128 16818018 49110 CONTRACTED SERVICES 9520098 5211220 4308878 BAD DEBT EXPENSE 7726654 7726654 REPAIRS 1933833 1789307 144526 368717 159039 209678 117881248 89387652 28493596 0 3486 3588 5743936 6428778 14879823 18513401 865590 708421 2635092 2505644 1142319 1757460 158729595 92372743 67782889 66356852 29973868 36917514 27218168 33154716 761157 380578 1034518 1275671 152040846 168002623 11888042 13246520 27185000 24815000 1732665 2096247 16358130 10850501 57163837 51008268 X 68691762 85237410 3020527 3399084 23164720 28357861 94877009 116994355 152040846 168002623 X 5591918 4492289 12033139 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 1 0 0 0 0 1 350 0 1 22320 22670 0 PART II-B, LINE 1: A LUNCHEON WITH SENATOR LES SEILER WAS ATTENDED BY ERIC BARBER, CEO, AND MEMBERS OF THE BOARD TO DISCUSS MEDICAID EXPANSION. A PORTION OF DUES PAID TO AHA, NHA, NRHA 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. 23899866 5326567 29226433 20694745 3205121 23899866 17842614 3119278 267147 20694745 15975895 87241 1850255 70777 17842614 14499723 67547 1873061 464436 15975895 0.00000 1.00000 0.00000 0 1 1 4326468 4326468 88756324 45349746 43406578 63314720 47022997 16291723 2332083 2332083 66356852 STUDENT LOAN AND RESTRICTED FUNDS 762892 F JOINT VENTURES 399505 F BENEFICIAL INTEREST IN FOUNDATION 4147457 F BENEFICIAL INTEREST IN TRUST 27844862 F 33154716 THIRD PARTY REIMBURSEMENT CONTRACTS 3885428 LIABILITY FOR PENSION BENEFITS 6965073 10850501 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, 2013, 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 2010. 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 2206893 2206893 0.02000 10864616 5613970 5250646 0.04770 13071509 5613970 7457539 0.06770 1096240 1096240 0.01000 561392 561392 0.00510 341932 341932 0.00310 164818 164818 0.00150 2164382 2164382 0.01970 15235891 5613970 9621921 0.08740 3817 3817 0.00000 66581 66581 0.00060 1329 1329 0.00000 71727 71727 0.00060 1 7726654 0 28751696 37202945 -8451249 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 1 X X X X X X X X X 13 1 1 1 X WWW.MARYLANNING.ORG X X X X X X X X X X 1 0 1 1 125.000000000000 1 200.000000000000 1 X X 1 1 X X 1 1 X X X X X 1 X 0 0 MARY LANNING HEALTHCARE PART V, SECTION B, LINE 3: 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 4: MEMBERS OF THE CORE TEAM INCLUDED REPRESENTATIVES FROM BRODSTONE MEMORIAL HOSPITAL AND WEBSTER COUNTY COMMUNITY HOSPITAL. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 6I: 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 SEVERAL GOALS IN MIND. THE FIRST GOAL WAS TO DEFINE A WAY TO COLLECT DATA FROM ALL PARTNER ORGANIZATIONS AND HAVE A COMPATIBLE, CENTRALIZED TOOL FOR STAKEHOLDERS TO INPUT DATA. ANOTHER PRIORITY ACTION WAS TO DEVELOP THE PERFORMANCE MEASURES TO BE USED TO EVALUATE PROGRESS ON THE CHIP AS INDIVIDUAL ORGANIZATIONS AND AS THE COMMUNITY AS A WHOLE. MARY LANNING WORKED TO DEVELOP TOOLS AND MEASURES WITHIN OUR OWN ORGANIZATION THAT ADDRESS THE NEEDS OF THE COMMUNITY AND ALIGN WITH THE OBJECTIVES OF THE CHIP. MEMBERS OF THE MARY LANNING TEAM WORKING ON THE IMPLEMENTATION PLAN MET TO DEFINE HOW THEIR DEPARTMENTS WERE SPECIFICALLY ADDRESSING THE FIVE AREAS IDENTIFIED IN THE NEEDS ASSESSMENT (OBESITY, CANCER, SUBSTANCE ABUSE, MENTAL HEALTH AND ACCESS TO CARE). MANY STRATEGIES FROM THE ORIGINAL IMPLEMENTATION PLAN WERE ALREADY BEING MET AND THE GROUP DISCUSSED HOW DEPARTMENTS COULD CONTINUE TO CREATE PARTNERSHIPS WITH EACH OTHER TO FURTHER DEVELOP FUTURE STRATEGIES. HIGHLIGHTS FROM EACH AREA OF NEED INCLUDE THE FOLLOWING:OBESITY - PARTICIPATION IN HEALTHY HASTINGS COALITION, COMMUNITY EDUCATION AND OUTREACH DEVELOPMENT WITHIN THE CLINICS, OUTREACH TO MINORITY POPULATIONS FOR DIABETES, INCREASING NUMBER OF BUSINESSES OFFERING WORKSITE WELLNESS OPTIONS. CANCER - ESTABLISHMENT 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 A PROCESS TO IDENTIFY PATIENTS WITH DUAL DIAGNOSIS, ADVOCATED AT THE STATE LEVEL FOR POLICIES THAT SUPPORT MENTAL HEALTH 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.ACCESS TO CARE - WORKING WITH PARTNERS TO HAVE A FQHC SATELLITE OFFICE IN HASTINGS, DEVELOPING A MEDICAL HOME MODEL FOR MLH CLINICS, SCREENING AND HEALTHCARE CASE MANAGEMENT OFFERED TO HISPANIC COMMUNITY, CONCENTRATED RECRUITMENT OF SPECIALTY PHYSICIANS. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 14G: 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. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 17E: THE FACILITY TAKES REASONABLE EFFORTS TO NOTIFY PATIENTS OF THE FAP BEFORE THE FACILITY OR AUTHORIZED THIRD PARTY PERFORMS ANY COLLECTION ACTIONS. HENCE, NO ITEMS WERE CHECKED IN QUESTIONS 16 OR 17. THE EFFORTS/ACTIONS TAKEN BY THE FACILITY BEFORE INITIATING ANY COLLECTION ARE PERSONAL VISITS WITH ALL PATIENTS AND FAP IS DISCUSSED IN DETAIL WHEN FINANCIAL CONCERNS ARE EXPRESSED DURING PHONE CALLS WITH PATIENTS REGARDING COLLECTION ISSUES. 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 FAMILY PRACTICE 606 N MINNESOTA HASTINGS NE 68901 OUTPATIENT CLINIC HASTINGS PULMONARY 715 N KANSAS AVENUE STE 203 HASTINGS NE 68901 OUTPATIENT CLINIC COMMUNITY HEALTH CENTER 715 N KANSAS AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC CENTRAL NE GENERAL SURGERY 715 N KANSAS AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC BLUE HILL CLINIC 102 N PINE STREET BLUE HILL NE 68930 OUTPATIENT CLINIC CENTRAL NE INFECTIOUS DISEASE 715 N KANSAS AVENUE HASTINGS NE 68901 OUTPATIENT CLINIC EDGAR CLINIC 315 N C STREET EDGAR NE 68944 OUTPATIENT CLINIC SUTTON MEDICAL CLINIC 301 S WAY SUTTON NE 68979 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 $7,726,654. 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 2013 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) 188571 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. 1 1 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 X 0 0 X X X 0 1 0 0 0 0 0 0 0 MICHAEL SKOCH MD CHIEF MEDICAL OFFICER 360235 0 33880 0 0 0 12500 0 18435 0 425050 0 0 0 RONDA EHLY CHIEF NURSING OFFICER 176587 0 4000 0 0 0 9145 0 13321 0 203053 0 0 0 SHAWN NORDBY CHIEF FINANCIAL OFFICER 138577 0 7099 0 0 0 8361 0 13267 0 167304 0 0 0 BRUCE CUTRIGHT VP HUMAN RESOURCES 163426 0 8350 0 0 0 8361 0 2161 0 182298 0 0 0 MARK CALLAHAN CHIEF OPERATING OFFICER 154970 0 77130 0 0 0 8361 0 17850 0 258311 0 0 0 SHAWN RIGGS VP AMBULATORY SERVICES 127579 0 4000 0 0 0 6841 0 17850 0 156270 0 0 0 BENJAMIN FAGO PHYSICIAN 423375 0 0 0 0 0 12500 0 19944 0 455819 0 0 0 KALPESH GANATRA PHYSICIAN 627298 0 0 0 0 0 12500 0 19299 0 659097 0 0 0 JAMES NEALON PHYSICIAN 492499 0 0 0 0 0 12500 0 19190 0 524189 0 0 0 MATTHEW STRITT PHYSICIAN 429062 0 55087 0 0 0 12500 0 18607 0 515256 0 0 0 THOMAS ZUSAG PHYSICIAN 599561 0 0 0 0 0 12500 0 12344 0 624405 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE: DURING 2013, THE HOSPITAL PAID ERIC BARBER $3,200 IN MORTGAGE ASSISTANCE PAYMENTS; THIS AMOUNT WAS ADDED TO HIS TAXABLE WAGES ON HIS 2013 W-2. 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 2013 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; 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 2425000 24173708 1752102 22421606 2011 0 0 1 1 B 230000 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 1 1 0 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 PART II, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) DUE TO INVESTMENT EARNINGS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 WAS PROVIDED TO THE MEMBERS OF THE BOARD AND WAS REVIEWED WITH 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: CLARENCE (GARY) ANDERSON IS EMPLOYED BY MARY LANNING TRUST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF FOUNDATION 537,744. CHANGE IN BENEFICIAL INTEREST OF TRUST 5,193,142. PENSION RELATED CHANGES 6,302,253. FORM 990, PART XI, LINE 2C: THE BOARD OF TRUSTEES OF THE ORGANIZATION ASSUMES RESPONSIBILITY FOR 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 RACIALLY 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 775000 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION B 188571 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION C 190990 CASH TRANSFER