2012-10-31T13:30:12-05:00 2011-12-31 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2011-01-01 470378779 THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION MARY 4024634521 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 MARK CALLAHAN 4024634521 2012-10-25 1 BARBARA J FAJEN P00400874 4023302660 2011 2016-02-24 21:20:13Z MARY LANNING HEALTHCARE MARK CALLAHAN 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 104944334 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. 7 7 1090 275 230811 0 3104386 2473735 92963581 98090488 1533313 1609435 2206802 2550114 99808082 104723772 313767 1083322 0 0 52508986 53561201 0 0 89550 43982501 47769774 96805254 102414297 3002828 2309475 136946286 138226405 51445541 56406414 85500745 81819991 X ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFERING HOPE, HEALTH AND HEALING. 0 0 79981352 1083322 99509189 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 $72 MILLION IN COSTS DURING 2011. OVER $57 MILLION OF THAT AMOUNT RELATES TO CARE PROVIDED TO MEDICARE AND MEDICAID PATIENTS WITH AN ADDITIONAL $1.2 MILLION IN CARE TO THE UNINSURED IN THE FORM OF CHARITY CARE. SEVENTY-TWO (72) ADDITIONAL PROGRAMS SERVED OVER 77,000 PEOPLE. MUCH ATTENTION HAS BEEN PAID RECENTLY TO THE RESPONSIBILITIES OF TAX EXEMPT ORGANIZATIONS. FROM THE INFORMATION SUMMARIZED ABOVE, IT IS CLEAR THAT THE CONTRIBUTIONS OF THE HOSPITAL WOULD FAR EXCEED FUNDS THAT WOULD BE GENERATED BY A CORPORATE TAX STRUCTURE. 79981352 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 0 0 1 0 0 0 0 1 1 0 1 0 1 44 0 1 1090 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 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 1.00 X 0 0 0 MICHELE BEVER 1.00 X 0 0 0 CLARENCE GARY ANDERSON 1.00 X 0 80888 0 DENNIS KRIENERT 1.00 X 0 0 0 CALVIN JOHNSON 1.00 X 0 0 0 PRADIPTA CHAUDHURI MD 1.00 X 0 0 0 ROBERT ANDERSON MD 1.00 X 0 0 0 BRADLEY NEET 40.00 X 256047 0 35111 LEOTA ROLLS 40.00 X 263818 0 2940 LEON JOE DAVIS 40.00 X 218068 0 12857 BRUCE CUTRIGHT 40.00 X 139164 0 20246 MARK CALLAHAN 40.00 X 118907 0 47614 SHAWN RIGGS 40.00 X 110116 0 25131 SHAWN NORDBY 40.00 X 105869 0 13123 RENEE SIDLEY 40.00 X 80552 0 7204 KALPESH D GANATRA 40.00 X 1057308 0 34153 DENNIS HATCH 40.00 X 398580 0 25464 JOHN BECK 40.00 X 388549 0 27829 THOMAS SCHEER 40.00 X 324472 0 16822 PORNCHAI JONGLERTHAM 40.00 X 316630 0 35111 3778080 80888 303605 29 0 1 0 KIEWIT BUILDING GROUP 3921 MASON STREET OMAHA NE 68105 GENERAL CONTRACTOR 2259763 FARRIS CONSTRUCTION PO BOX 2046 HASTINGS NE 68902 GENERAL CONTRACTOR 1046281 MCKESSON AUTOMATION PO BOX 642164 PITTSBURGH PA 15264 SOFTWARE SUPPORT 989795 SS PSYCHIATRY GROUP 4110 HARGORD STREET GRAND ISLAND NE 68803 PHYSICIAN COVERAGE 982469 MCKESSON INFORMATION BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 806528 82 131 2471254 2350 1480440 2473735 ALL OTHER PATIENT REVE 621300 58227642 58227642 NET MEDICARE REVENUE 621300 34689660 34689660 NET MEDICAID REVENUE 621300 5173186 5173186 98090488 15451 15451 884903 884903 299477 2908 296569 296569 296569 704703 11055 0 6677 704703 4378 709081 4378 704703 205916 210977 -5061 -5061 MISCELLANEOUS 900099 1414323 1414323 CAFETERIA 722210 613472 613472 230811 230811 2258606 104723772 99509189 230811 2510037 1083322 1083322 1618775 1618775 89550 89550 40455893 34727186 5728707 2265331 1955148 310183 6249455 5393742 855713 2882197 2487549 394648 140440 140440 64314 64314 97542 97542 2009911 2009911 2914690 1033649 1881041 1162247 1162247 345323 252319 93004 249874 112903 136971 1476957 1476957 6662074 5455585 1206489 991684 382979 608705 MEDICAL SUPPLIES 17054149 17007935 46214 CONTRACTED SERVICES 8464397 4116490 4347907 BAD DEBT EXPENSE 4503830 4503830 REPAIRS 1251564 1129658 121906 380778 193772 187006 102414297 79981352 22343395 89550 5345066 4488544 9902145 9861799 527390 584309 2146691 2403869 1038602 1173074 148001445 80433401 65226374 67568044 29366443 27451673 22230245 23597435 1163330 1097658 136946286 138226405 11836931 10973989 29820000 28530000 9788610 16902425 51445541 56406414 X 65607501 58800159 1899028 2950416 17994216 20069416 85500745 81819991 136946286 138226405 X 2309475 -5990229 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18345 18345 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: A PORTION OF DUES PAID TO AHA AND NHA IS FOR LOBBYING PURPOSES AND 100% OF DUES PAID TO NABHO IS FOR LOBBYING ACTIVITIES. IN ADDITION, $6,000 PAID TO RURAL REFERRAL CENTER / SOLE COMMUNITY HOSPITAL COALITION SUPPORTS LOBBYING ACTIVITY CONDUCTED BY THAT ORGANIZATION. 17842614 3119278 267147 20694745 15975895 87241 1850255 70777 17842614 14499723 67547 1873061 464436 15975895 13467863 37074 994786 14499723 1.00000 0 1 1 5889784 5889784 83742067 37952863 45789204 57339612 42480538 14859074 1029982 0 1029982 67568044 STUDENT LOAN AND RESTRICTED FUNDS 603639 F JOINT VENTURES 13499 F BENEFICIAL INTEREST IN FOUNDATION 3423881 F BENEFICIAL INTEREST IN TRUST 19556416 F 23597435 THIRD PARTY REIMBURSEMENT CONTRACTS 2899845 LIABILITY FOR PENSION BENEFITS 14002580 16902425 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 FASB 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, 2011, 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 VIII. 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 1478691 1478691 0.01510 10347973 4441318 5906655 0.06030 11826664 4441318 7385346 0.07540 555680 555680 0.00570 985445 985445 0.01010 120533 120533 0.00120 118629 118629 0.00120 1780287 1780287 0.01820 13606951 4441318 9165633 0.09360 4455 4455 0.00000 1413 1413 0.00000 7188 7188 0.00000 13056 13056 1 2482950 0 25025165 33123769 -8098604 X 1 1 1 1 MARY LANNING HEALTHCARE

715 NORTH ST JOSEPH AVENUE HASTINGS NE 68901

X X X X MARY LANNING HEALTHCARE 1 1 1 125.000000000000 1 200.000000000000 1 X X 1 1 X X 1 0 1 X 0 0 11 LANNING CENTER

815 S BURLINGTON AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC MOSCATI

223 E 14TH STREET STE 100 HASTINGS NE 68901

OUTPATIENT CLINIC HASTINGS PULMONARY

715 N KANSAS AVENUE STE 203 HASTINGS NE 68901

OUTPATIENT CLINIC HASTINGS FAMILY PRACTICE

606 N MINNESOTA HASTINGS NE 68901

OUTPATIENT CLINIC SUTTON MEDICAL CLINIC

301 S WAY SUTTON NE 68979

OUTPATIENT CLINIC BLUE HILL CLINIC

102 N PINE STREET BLUE HILL NE 68930

OUTPATIENT CLINIC COMMUNITY HEALTH CENTER

715 N KANSAS AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC CENTRAL NE INFECTIOUS DISEASE

715 N KANSAS AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC PRIMARY CARE CENTER

715 N KANSAS AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC CENTRAL NE GENERAL SURGERY

715 N KANSAS AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC EDGAR CLINIC

315 N C STREET EDGAR NE 68944

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, L7 COL(F): BAD DEBT EXPENSE IS $4,503,830. PART II: 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 4: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. AN ALLOWANCE FOR BAD DEBTS HAS BEEN ESTABLISHED FOR THE UNCOLLECTIBLE PORTION OF THESE RECEIVABLES AND IS ADJUSTED THROUGHOUT THE YEAR BASED ON THE AGING OF EACH FUNDING SOURCE'S RECEIVABLE ACCOUNT. INDIVIDUAL ACCOUNTS WITH BALANCES OVER NINETY DAYS ARE REVIEWED PERIODICALLY FOR FUNDING SOURCE DENIALS, REBILLS TO DIFFERENT FUNDING SOURCES, SUBMISSIONS TO A COLLECTION AGENCY OR WRITE-OFF AS BAD DEBT. THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED ON LINES 2 AND 3 IS TOTAL EXPENSES DIVIDED BY TOTAL REVENUE TIMES BAD DEBT EXPENSE. 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. MARY LANNING HEALTHCARE PART V, SECTION B, LINE 13G: THE FULL POLICY IS AVAILABLE UPON REQUEST FREE OF CHARGE. A SUMMARY OF THE POLICY AND CONTACT INFORMATION IS POSTED ON MLH'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 WHERE CHECKED IN QUESTIONS 15 OR 16. 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. PART VI, LINE 2: MLH CURRENTLY UTILITIZES THE MAPP ASSESSMENT CONDUCTED BY THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT IN 2008. THIS ASSESSMENT COVERS A FOUR COUNTY AREA THAT CLOSELY MATCHES THE PATIENT BASE OF MLH. PARNERSHIPS AND COLLABORATIONS OCCUR REGULARLY WITH THE HEALTH DEPARTMENT AND OTHER AGENCIES IN THE COMMUNITY TO ADDRESS AND MEET NEEDS. MLH CURRENTLY PROVIDES MANY SERVICES AND PROJECTS THAT TARGET THE NEEDS OF THE COMMUNITY INCLUDING THE ANNUAL FLU SHOT PROGRAM AS WELL AS OUTREACH OF HEALTHY LIVING AND DISEASE MANAGEMENT TO WORKSITES, MINORITIES AND THE COMMUNITY AT LARGE. 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: NOT APPLICABLE PART VI, LINE 6: NOT APPLICABLE 1 MARY LANNING HEALTHCARE FOUNDATION 715 NORTH ST JOSEPH AVENUE HASTINGS NE 68901 470800042 501(C)(3) 298209 760113 FMV INVESTMENT TRANSFER TO ASSIST WITH THE OPERATING COSTS OF FUNDRAISING. ADAMS COUNTY CLERK 500 WEST 4TH STREET HASTINGS NE 68901 476006427 501(C)(1) 25000 0 TO ASSIST WITH OPERATING COSTS OF THE AMBULANCE SERVICE. 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 0 0 0 0 0 0 0 BRADLEY NEET 256047 0 0 0 0 0 11840 0 23271 0 291158 0 0 0 LEOTA ROLLS 263818 0 0 0 0 0 0 0 2940 0 266758 0 0 0 LEON JOE DAVIS 218068 0 0 0 0 0 8712 0 4145 0 230925 0 0 0 BRUCE CUTRIGHT 139164 0 0 0 0 0 0 0 20246 0 159410 0 0 0 MARK CALLAHAN 118907 0 0 0 0 0 0 0 47614 0 166521 0 0 0 KALPESH D GANATRA 499990 0 0 0 557318 0 7350 0 26803 0 1091461 0 0 0 DENNIS HATCH 354363 0 0 0 44217 0 7350 0 18114 0 424044 0 0 0 JOHN BECK 344132 0 0 0 44417 0 9800 0 18029 0 416378 0 0 0 THOMAS SCHEER 324472 0 0 0 0 0 0 0 16822 0 341294 0 0 0 PORNCHAI JONGLERTHAM 316630 0 0 0 0 0 11840 0 23271 0 351741 0 0 0 PART I, LINE 1A PART I, LINE 1A: HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES: A COUNTRY CLUB MEMBERSHIP IS PROVIDED TO BRADLEY NEET, CEO, FOR PERSONAL USE. THE VALUE OF THE MEMBERSHIP WAS INCLUDED AS TAXABLE WAGES IN MR. NEET'S 2011 W-2. 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. PERSONAL SERVICES: A VEHICLE ALLOWANCE IS GIVEN MONTHLY TO BRADLEY NEET. THE ALLOWANCE WAS INCLUDED AS TAXABLE WAGES IN MR. NEET'S 2011 FORM W-2. PART I, LINE 1B: MR. NEET TURNS IN THE MONTHLY BILL FROM THE COUNTRY CLUB FOR THE MEMBERSHIP DUES. 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. HOSPITAL AUTHORITY NO 1 OF ADAMS COUNTY NE 470762824 006060BUO 2003-10-15 3305000 RENOVATION OF LOBBY AND ELEVATORS 0 0 0 HOSPITAL AUTHORITY NO 1 OF ADAMS COUNTY NE 470762824 006060CL9 2008-07-01 23725120 TWO ADDITIONS TO THE HOSPITAL 0 0 0 1535000 3350850 302565 3048285 2005 0 0 1 1 1175000 24173723 1752116 22421606 2011 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 1 KATHY ANDERSON STUDENT LOAN X 50400 50400 0 1 1 50400 X 1 1480440 BOOK VALUE OF DONOR 0 0 0 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 FILL OUT 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. HE WORKS 40 HOURS PER WEEK FOR THE TRUST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -1,469,411. CHANGE IN BENEFICIAL INTEREST OF FOUNDATION -613,966. CHANGE IN BENEFICIAL INTEREST OF TRUST 2,341,237. PENSION RELATED CHANGES -6,248,089. TOTAL TO FORM 990, PART XI, LINE 5: -5,990,229. AUDIT OF ORGANIZATION'S FINANCIAL STATEMENTS 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. SCHOOLS CONDUCTED WITHIN MARY LANNING HEALTHCARE 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) 509(A)(3) TYPE III N/A 1 MARY LANNING HOSPITAL TRUST 122 N HASTINGS AVE HASTINGS NE 68901 476000224 INVESTMENT MANAGEMENT NE 501(C)(3) 509(A)(3) TYPE II N/A 1 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 MARY LANNING HOSPITAL TRUST C 850000 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION B 298209 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION C 140814 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION B 492966 INVESTMENT TRANSFER MARY LANNING HEALTHCARE FOUNDATION C 1480440 ASSET TRANSFER