2011-11-15T14:19:00-06:00 2010-12-31 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2010-01-01 470378779 THE MARY LANNING MEMORIAL HOSPITAL ASSOCIATION MARY 4024634521 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 BRADLEY NEET 4024634521 2011-09-26 1 BARBARA J FAJEN 4023302660 2010 2016-03-07 17:11:31Z MARY LANNING MEMORIAL HOSPITAL BRADLEY NEET 715 NORTH ST JOSEPH AVE HASTINGS NE 68901 100095427 0 X WWW.MLMH.ORG X 1915 NE ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING MEMORIAL HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFERING HOPE, HEALTH AND HEALING. 7 6 1104 328 438264 0 808768 3104386 92831185 92963581 999321 1533313 2423564 2206802 97062838 99808082 273483 313767 0 0 51371486 52508986 0 0 92220 45065997 43982501 96710966 96805254 351872 3002828 134412002 136946286 57377893 51445541 77034109 85500745 X ADVANCING OUR TRADITION OF SERVICE, EDUCATION AND COMMUNITY INVOLVEMENT, MARY LANNING MEMORIAL HEALTHCARE IS DEDICATED TO EXCELLENCE, OFFEREING HOPE, HEALTH AND HEALING. 0 0 81962849 313767 93762449 MARY LANNING MEMORIAL HOSPITAL (MLMH) 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. MLMH TAKES ITS RESPONSIBILITIES FOR PROVIDING BENEFITS TO THE SURROUNDING COMMUNITIES SERIOUSLY. THIS IS DEMONSTRATED IN NUMEROUS WAYS. THE HOSPITAL ABSORBED OVER $46 MILLION IN COSTS DURING 2010. OVER $35 MILLION OF THAT AMOUNT RELATES TO CARE PROVIDED TO MEDICARE AND MEDICAID PATIENTS WITH AN ADDITIONAL $1.4 MILLION IN CARE TO THE UNINSURED IN THE FORM OF CHARITY CARE. SEVENTY-TWO (72) ADDITIONAL PROGRAMS SERVED OVER 43,000 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. 81962849 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 61 0 1 1104 1 1 1 0 0 0 0 0 0 0 0 0 X 7 6 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 ROBERT ANDERSON MD 1.00 X 0 0 0 TIM BOYD 1.00 X 0 0 0 CLARENCE GARY ANDERSON 1.00 X 0 76037 32179 COLLEEN WERNER 1.00 X 0 0 0 DENNIS KRIENERT 1.00 X 0 0 0 CALVIN JOHNSON 1.00 X 0 0 0 RUTH KOEPKE 1.00 X 0 0 0 BRADLEY NEET 40.00 X 246714 0 24965 TIMOTHY GRONSETH 40.00 X 212474 0 7972 LEOTA ROLLS 40.00 X 192834 0 85489 LEON JOE DAVIS 40.00 X 240661 0 10660 BRUCE CUTRIGHT 40.00 X 135502 0 -10567 MARK CALLAHAN 40.00 X 110051 0 25866 SHAWN RIGGS 40.00 X 40078 0 5532 SHAWN NORDBY 40.00 X 93955 0 18158 KALPESH D GANATRA 40.00 X 840997 0 27994 DENNIS HATCH 40.00 X 279770 0 22153 JOHN BECK 40.00 X 371927 0 25595 THOMAS SCHEER 40.00 X 495457 0 15237 BRENELLY LOZADA 40.00 X 238631 0 5463 3499051 76037 296696 21 0 1 0 KIEWIT BUILDING GROUP 3921 MASON STREET OMAHA NE 68105 GENERAL CONTRACTOR 9271382 MCKESSON INFORMATION BOX 98347 CHICAGO IL 60693 SOFTWARE SUPPORT 1427677 SS PSYCHIATRY GROUP 4110 HARGORD STREET GRAND ISLAND NE 68803 PHYSICIAN COVERAGE 888468 VISIONS IN ARCHITECTURE 8700 EXECUTIVE WOODS DR SUITE 300 LINCOLN NE 68512 ARCHITECT 323603 HASTINGS HEART INSTITUTE LLC 715 N KANSAS HASTINGS NE 68901 CARDIAC CATH SERVICES 300443 79 1048 3011674 91664 3104386 ALL OTHER PATIENT REVE 621300 53786948 53786948 NET MEDICARE REVENUE 621300 33987048 33987048 NET MEDICAID REVENUE 621300 5189585 5189585 92963581 114328 114328 863693 863693 346936 4360 342576 342576 342576 538862 17103 673 538862 16430 555292 16430 538862 285350 282312 3038 3038 MISCELLANEOUS 900099 782438 782438 CAFETERIA 722210 640486 640486 438264 438264 1861188 99808082 93762449 438264 2502983 313767 313767 1358631 1358631 92220 92220 38516607 34143707 4372900 2545169 2265644 279525 7288308 6487865 800443 2708051 2410638 297413 204827 204827 60042 60042 90040 90040 2201626 2201626 2204979 1751829 453150 1110374 1110374 266678 236145 30533 169052 92033 77019 836116 836116 6116764 5290834 825930 1063284 474887 588397 MEDICAL SUPPLIES 17407906 17337302 70604 CONTRACTED SERVICES 7168396 5548038 1620358 BAD DEBT EXPENSE 3246214 3246214 REPAIRS 1108025 1049579 58446 MINOR EQUIPMENT 537399 330086 207313 190779 82379 108400 96805254 81962849 14750185 92220 12662586 5345066 10368909 9902145 539325 527390 2273244 2146691 929096 1038602 138154874 72928500 54441824 65226374 29007619 29366443 22969414 22230245 1219985 1163330 134412002 136946286 12272660 11836931 31065000 29820000 14040233 9788610 57377893 51445541 X 56725358 65607501 4103468 1899028 16205283 17994216 77034109 85500745 134412002 136946286 X 3002828 5463808 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 17025 17025 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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, $4,500 PAID TO RURAL REFERRAL CENTER / SOLE COMMUNITY HOSPITAL COALITION SUPPORTS LOBBYING ACTIVITY CONDUCTED BY THAT ORGANIZATION. 15975895 87241 1850255 70777 17842614 14499723 67547 1873061 464436 15975895 13467863 37074 994786 14499723 0.00000 1.00000 0.00000 0 1 1 5608172 5608172 67241476 33751327 33490149 51078167 39177173 11900994 14227059 14227059 65226374 STUDENT LOAN AND RESTRICTED FUNDS 855474 F JOINT VENTURES 121745 F BENEFICIAL INTEREST IN FOUNDATION 4037847 F BENEFICIAL INTEREST IN TRUST 17215179 F 22230245 THIRD PARTY REIMBURSEMENT CONTRACTS 1843564 LIABILITY FOR PENSION BENEFITS 7945046 9788610 99808082 96805254 3002828 1263190 4200618 5463808 8466636 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, 2010, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 8 - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST OF FOUNDATION -2,165,130. CHANGE IN BENEFICIAL INTEREST OF TRUST 1,787,487. PENSION RELATED CHANGES 4,578,261. PART V, LINE 3A(II): MARY LANNING HEALTHCARE FOUNDATION AND MARY LANNING HOSPITAL TRUST HOLD ENDOWMENT FUNDS RESTRICTED TO DISTRIBUTION TO MARY LANNING MEMORIAL HOSPITAL. THESE FUNDS ARE REFLECTED ON MARY LANNING MEMORIAL 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 MEMORIAL HEALTHCARE. 1 1 1 X 1 X 1 1 1 0 1 1 1701310 0 1701310 0.01820 9172214 7253659 1918555 0.02050 10873524 7253659 3619865 0.03870 828454 0 828454 0.00890 829850 0 829850 0.00890 60795 0 60795 0.00060 0 0 245967 0 245967 0.00260 1965066 1965066 0.02100 12838590 7253659 5584931 0.05970 320 320 0.00000 9078 9078 0.00010 9398 9398 0.00010 1 1798960 0 17802416 53337860 -35535444 X 1 1 1 1 MARY LANNING MEMORIAL HOSPITAL

715 NORTH ST JOSEPH AVENUE HASTINGS NE 68901

X X X X NA 1 10 LANNING CENTER

815 S BURLINGTON AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC HASTINGS PULMONARY

715 N KANSAS AVENUE STE 203 HASTINGS NE 68901

OUTPATIENT CLINIC PRIMARY CARE CENTER

715 N KANSAS AVENUE 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 CENTRAL NE INFECTIOUS DISEASE

715 N KANSAS AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC COMMUNITY HEALTH CENTER

715 N KANSAS AVENUE HASTINGS NE 68901

OUTPATIENT CLINIC EDGAR CLINIC

315 N C STREET EDGAR NE 68944

OUTPATIENT CLINIC HASTINGS IMAGING CENTER

2207 OSBORNE DRIVE WEST HASTINGS NE 68901

DIAGNOSTIC IMAGING SERVICES HASTINGS HEART INSTITUTE

715 N KANSAS AVENUE HASTINGS NE 68901

HEART MEDICAL CARE 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 $3,246,214. PART II: MLMH 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. PART VI, LINE 2: MLMH 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 MLMH. PARNERSHIPS AND COLLABORATIONS OCCUR REGULARLY WITH THE HEALTH DEPARTMENT AND OTHER AGENCIES IN THE COMMUNITY TO ADDRESS AND MEET NEEDS. MLMH 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: MLMH 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: MLMH'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 6: NOT APPLICABLE PART VI, LINE 7: NOT APPLICABLE 1 MARY LANNING HEALTHCARE FOUNDATION 715 NORTH ST JOSEPH AVENUE HASTINGS NE 68901 470800042 501(C)(3) 313767 TO ASSIST WITH THE OPERATING COSTS OF FUNDRAISING. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: MARY LANNING MEMORIAL HOSPITAL 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 1 0 0 0 0 0 0 0 0 BRADLEY NEET 246714 0 0 0 0 0 6990 0 17975 0 271679 0 0 0 TIMOTHY GRONSETH 146508 0 0 0 65966 0 2859 0 5113 0 220446 0 0 0 LEOTA ROLLS 192834 0 0 0 0 0 75314 0 10175 0 278323 0 0 0 LEON JOE DAVIS 240661 0 0 0 0 0 6534 0 4126 0 251321 0 0 0 KALPESH D GANATRA 399311 0 0 0 441686 0 7350 0 20644 0 868991 0 0 0 DENNIS HATCH 270116 0 0 0 9654 0 7350 0 14803 0 301923 0 0 0 JOHN BECK 371927 0 0 0 0 0 7350 0 18245 0 397522 0 0 0 THOMAS SCHEER 495457 0 0 0 0 0 0 0 15237 0 510694 0 0 0 BRENELLY LOZADA 205015 0 24000 0 9616 0 0 0 5463 0 244094 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 2010 W-2. CHAUFFEUR: VEHICLES OWNED BY MARY LANNING MEMORIAL HOSPITAL 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 2010 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. PART I, LINE 4A TIMOTHY GRONSETH, CFO THROUGH JULY 2010, RECEIVED SEVERANCE PAYMENTS OF $65,966. HOSPITAL REVENUE BONDS SERIES 2003 OF ADAMS COUNTY NE 470762824 006060BUO 2003-10-15 3305000 RENOVATION OF LOBBY AND ELEVATORS 0 0 0 HOSPITAL REVENUE BONDS SERIES 2008 OF ADAMS COUNTY NE 470762824 006060CL9 2008-07-01 23725120 TWO ADDITIONS TO THE HOSPITAL 0 0 0 1320000 3353561 305276 3048285 2005 0 0 1 1 580000 24173679 1752073 22421606 0 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 KATHY ANDERSON STUDENT LOAN X 40800 40800 0 1 1 40800 ELLERBROCK NORRIS INSURANCE BROKERAGE THE MAJORITY OWNER IS THE BROTHER OF COLLEEN WERNER, A TRUSTEE. 178195 INSURANCE SERVICES. 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 MEMORIAL HOSPITAL'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 GAINS ON INVESTMENTS: 1,263,190. CHANGE IN BENEFICIAL INTEREST OF FOUNDATION -2,165,130. CHANGE IN BENEFICIAL INTEREST OF TRUST 1,787,487. PENSION RELATED CHANGES 4,578,261. TOTAL TO FORM 990, PART XI, LINE 5: 5,463,808. 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 MEMORIAL HOSPITAL FORM 990, PART IV, LINE 13: FORM 990, PART IV, LINE 13 IS ANSWERED "NO" BECAUSE MARY LANNING MEMORIAL HOSPITAL'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 750000 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION B 313767 CASH TRANSFER MARY LANNING HEALTHCARE FOUNDATION C 2261674 CASH TRANSFER