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        <FormAndLineReferenceDesc>SCHEDULE D, PAGE 2, PART V, LINE 4</FormAndLineReferenceDesc>
        <ExplanationTxt>FUNDS ARE HELD IN TRUST AND DISTRIBUTED TO FOUNDATION WHEN REQUESTED BY BOARD OF DIRECTORS.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleD>
    <IRS990ScheduleI documentId="RetDoc5">
      <GrantRecordsMaintainedInd>true</GrantRecordsMaintainedInd>
      <RecipientTable>
        <RecipientBusinessName>
          <BusinessNameLine1>PAWNEE COUNTY MEMORIAL HOSPITAL</BusinessNameLine1>
        </RecipientBusinessName>
        <USAddress>
          <AddressLine1>600 I STREET</AddressLine1>
          <City>PAWNEE CITY</City>
          <State>NE</State>
          <ZIPCode>68420</ZIPCode>
        </USAddress>
        <RecipientEIN>363169688</RecipientEIN>
        <CashGrantAmt>20750</CashGrantAmt>
        <PurposeOfGrantTxt>CAPITAL PROJECT</PurposeOfGrantTxt>
      </RecipientTable>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>SCHEDULE I, PAGE 1, PART I, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>THE PURPOSE OF THE FOUNDATION IS TO SUPPORT PAWNEE COUNTY MEMORIAL HOSPITAL, A 501 (C)3 ORGANIZATION. AS SUCH, THE ONLY GRANTS THAT ARE ISSUED ARE FOR THE BENEFIT OF THE HOSPITAL.</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleI>
    <IRS990ScheduleJ documentId="RetDoc6">
      <SeverancePaymentInd>false</SeverancePaymentInd>
      <SupplementalNonqualRtrPlanInd>false</SupplementalNonqualRtrPlanInd>
      <EquityBasedCompArrngmInd>false</EquityBasedCompArrngmInd>
      <CompBasedOnRevenueOfFlngOrgInd>false</CompBasedOnRevenueOfFlngOrgInd>
      <CompBsdOnRevRelatedOrgsInd>false</CompBsdOnRevRelatedOrgsInd>
      <CompBsdNetEarnsFlngOrgInd>false</CompBsdNetEarnsFlngOrgInd>
      <CompBsdNetEarnsRltdOrgsInd>false</CompBsdNetEarnsRltdOrgsInd>
      <AnyNonFixedPaymentsInd>false</AnyNonFixedPaymentsInd>
      <InitialContractExceptionInd>false</InitialContractExceptionInd>
      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>DR GEORGE VOIGTLANDER</PersonNm>
        <TitleTxt>PRESIDENT</TitleTxt>
        <CompensationBasedOnRltdOrgsAmt>167502</CompensationBasedOnRltdOrgsAmt>
        <DeferredCompRltdOrgsAmt>5863</DeferredCompRltdOrgsAmt>
        <TotalCompensationRltdOrgsAmt>173365</TotalCompensationRltdOrgsAmt>
      </RltdOrgOfficerTrstKeyEmplGrp>
    </IRS990ScheduleJ>
    <IRS990ScheduleO documentId="RetDoc7">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990 - ORGANIZATION'S MISSION</FormAndLineReferenceDesc>
        <ExplanationTxt>ADVANCE THE OBJECTIVES AND PURPOSES OF PAWNEE COUNTY MEMORIAL HOSPITAL, PAWNEE CITY, NEBRASKA, BY PROVIDING HEALTH CARE SERVICES, FACILITIES AND PROGRAMS IN SUPPORT OF PAWNEE COUNTY MEMORIAL HOSPITAL'S EFFORTS TO ASSIST THOSE SUFFERING FROM ANY DISEASE, INFIRMITY OR HEALTH NECESSITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE RETURN IS REVIEWED BY ONE MEMBER OF MANAGEMENT PRIOR TO FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PAGE 6, PART VI, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN INTEREST IN NET ASSETS OF TRUST 0</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XI, LINE 9</FormAndLineReferenceDesc>
        <ExplanationTxt>CHANGE IN EQUITY INTEREST OF AMBULANCE CO. 11,336 CHANGE IN INTEREST IN NET ASSETS OF TRUST 497</ExplanationTxt>
      </SupplementalInformationDetail>
    </IRS990ScheduleO>
    <IRS990ScheduleR documentId="RetDoc8">
      <IdRelatedTaxExemptOrgGrp>
        <DisregardedEntityName>
          <BusinessNameLine1>PAWNEE COUNTY MEMORIAL HOSPITAL</BusinessNameLine1>
        </DisregardedEntityName>
        <USAddress>
          <AddressLine1>600 I STREET</AddressLine1>
          <City>PAWNEE CITY</City>
          <State>NE</State>
          <ZIPCode>68420</ZIPCode>
        </USAddress>
        <EIN>363169688</EIN>
        <PrimaryActivitiesTxt>HOSPITAL</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NE</LegalDomicileStateCd>
        <ExemptCodeSectionTxt>501C3</ExemptCodeSectionTxt>
        <PublicCharityStatusTxt>3</PublicCharityStatusTxt>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedTaxExemptOrgGrp>
      <IdRelatedOrgTxblCorpTrGrp>
        <RelatedOrganizationName>
          <BusinessNameLine1>PAWNEE COUNTY AMBULANCE</BusinessNameLine1>
        </RelatedOrganizationName>
        <USAddress>
          <AddressLine1>600 I STREET</AddressLine1>
          <City>PAWNEE CITY</City>
          <State>NE</State>
          <ZIPCode>68420</ZIPCode>
        </USAddress>
        <EIN>470647810</EIN>
        <PrimaryActivitiesTxt>AMBULANCE</PrimaryActivitiesTxt>
        <LegalDomicileStateCd>NE</LegalDomicileStateCd>
        <DirectControllingNACd>N/A</DirectControllingNACd>
        <ControlledOrganizationInd>false</ControlledOrganizationInd>
      </IdRelatedOrgTxblCorpTrGrp>
      <ReceiptOfIntAnntsRntsRyltsInd>false</ReceiptOfIntAnntsRntsRyltsInd>
      <GiftGrntOrCapContriToOthOrgInd>true</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>false</GiftGrntCapContriFromOthOrgInd>
      <LoansOrGuaranteesToOtherOrgInd>false</LoansOrGuaranteesToOtherOrgInd>
      <LoansOrGuaranteesFromOthOrgInd>false</LoansOrGuaranteesFromOthOrgInd>
      <DivRelatedOrganizationInd>false</DivRelatedOrganizationInd>
      <AssetSaleToOtherOrgInd>false</AssetSaleToOtherOrgInd>
      <AssetPurchaseFromOtherOrgInd>false</AssetPurchaseFromOtherOrgInd>
      <AssetExchangeInd>false</AssetExchangeInd>
      <RentalOfFacilitiesToOthOrgInd>false</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>false</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>false</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>false</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>false</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>false</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>false</ReimbursementPaidToOtherOrgInd>
      <ReimbursementPaidByOtherOrgInd>false</ReimbursementPaidByOtherOrgInd>
      <TransferToOtherOrgInd>false</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>false</TransferFromOtherOrgInd>
      <TransactionsRelatedOrgGrp>
        <OtherOrganizationName>
          <BusinessNameLine1>PAWNEE COUNTY MEMORIAL HOSPITAL</BusinessNameLine1>
        </OtherOrganizationName>
        <TransactionTypeTxt>B</TransactionTypeTxt>
        <InvolvedAmt>20750</InvolvedAmt>
        <MethodOfAmountDeterminationTxt>CASH FOR CAPITAL PROJECT</MethodOfAmountDeterminationTxt>
      </TransactionsRelatedOrgGrp>
    </IRS990ScheduleR>
  </ReturnData>
</Return>