SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2019
Open to Public Inspection
Name of the organization
THE MARY LANNING MEMORIAL
HOSPITAL ASSOCIATION
Employer identification number

47-0378779
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    3,883,472 0 3,883,472 1.980 %
b Medicaid (from Worksheet 3, column a) . . . . .     15,938,658 7,671,192 8,267,466 4.210 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     19,822,130 7,671,192 12,150,938 6.190 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4). 50 49,831 1,003,796 13,460 990,336 0.500 %
f Health professions education (from Worksheet 5) . . . 14 1,715 1,195,321 129,938 1,065,383 0.540 %
g Subsidized health services (from Worksheet 6) . . . . 4 524 188,893 36,800 152,093 0.080 %
h Research (from Worksheet 7) .            
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . . 12 3,648 258,816 0 258,816 0.130 %
j Total. Other Benefits . . 80 55,718 2,646,826 180,198 2,466,628 1.250 %
k Total. Add lines 7d and 7j . 80 55,718 22,468,956 7,851,390 14,617,566 7.440 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support 2   8,400 0 8,400 0 %
4 Environmental improvements            
5 Leadership development and
training for community members		 3 405 88,131 0 88,131 0.040 %
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total 5 405 96,531   96,531 0.040 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
10,574,921
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
38,852,564
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
60,679,342
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-21,826,778
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
11 HASTINGS SURGICAL CENTER LLC
  		SURGICAL CENTER 21.050 % 0 % 16.330 %
22 HASTINGS MOB LLC
  		REAL ESTATE 51.000 % 0 % 39.000 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2019
Schedule H (Form 990) 2019
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 MARY LANNING HEALTHCARE
715 NORTH ST JOSEPH AVENUE
HASTINGS,NE68901
WWW.MARYLANNING.ORG
010002 		X X   X     X      
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
MARY LANNING HEALTHCARE
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 18
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 18
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): HTTPS://WWW.MARYLANNING.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENTS
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Financial Assistance Policy (FAP)
MARY LANNING HEALTHCARE
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTPS://WWW.MARYLANNING.ORG/PATIENT-VISITOR-INFO/FINANCIAL-ASSISTANCE
b
HTTPS://WWW.MARYLANNING.ORG/PATIENT-VISITOR-INFO/FINANCIAL-ASSISTANCE
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Billing and Collections
MARY LANNING HEALTHCARE
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
MARY LANNING HEALTHCARE
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
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Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
MARY LANNING HEALTHCARE PART V, SECTION B, LINE 5: MARY LANNING HEALTHCARE (MLH) CONDUCTED ITS COMMUNITY HEALTH NEEDS ASSESSMENT IN 2018 USING THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS (MAPP) PROCESS. THIS WAS CONDUCTED IN PARTNERSHIP WITH THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT (SHDHD). THE COMMUNITY HEALTH NEEDS ASSESSMENT ENABLED MARY LANNING'S ADMINISTRATIVE TEAM AND BOARD OF TRUSTEES TO INCLUDE THE FINDINGS IN THE OVERALL STRATEGIC PLAN AND TO CREATE AN IMPLEMENTATION STRATEGY THAT IS IN ALIGNMENT WITH THE SHDHD'S CHIP (COMMUNITY HEALTH IMPROVEMENT PLAN) AS BOTH PLANS WORK TOGETHER TO ADDRESS THE NEEDS IN THE IDENTIFIED COMMUNITY.
MARY LANNING HEALTHCARE PART V, SECTION B, LINE 6A: MEMBERS OF THE CORE TEAM FOR THE 2018 CHNA INCLUDED REPRESENTATIVES FROM BRODSTONE MEMORIAL HOSPITAL AND WEBSTER COUNTY COMMUNITY HOSPITAL.
MARY LANNING HEALTHCARE PART V, SECTION B, LINE 6B: OTHER NON-HOSPITAL ORGANIZATIONS INCLUDED: -SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT -THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES -UNITED WAY OF SOUTH CENTRAL NEBRASKA
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 AND RELATED HEALTH CONDITIONS: MLH IS COMMITTED TO PROVIDING ACTIVITIES, EDUCATION AND ASSESSMENT TO ASSIST COMMUNITY MEMBERS WITH THE TOOLS AND RESOURCES FOR BETTER DISEASE PREVENTION AND SELF MANAGEMENT THROUGH THE FOLLOWING ACTIONS: CREATING A CHRONIC CARE MANAGEMENT POSITION, ESTABLISHING A DIABETES REGISTRY, OFFERING AT LEAST ONE DIABETES PREVENTION CLASS PER YEAR AND ENSURING THE CARDIAC AND PULMONARY REHAB PATIENTS COMPLETE EDUCATION FOCUSED ON THEIR DIAGNOSED DISEASE STATE AMONG OTHER ACTIVITIES. CANCER: MLH IS COMMITTED TO DECREASING THE INCIDENCE OF CANCER BY PROVIDING LIMITED SKIN SCREENINGS AT HEALTH FAIRS AND FOR EMPLOYEES, COORDINATING AN EVENT TO ADDRESS OVERALL WOMEN'S HEALTH, SEEKING FUNDS TO SUPPLY ORAL CHEMOTHERAPY FOR PATIENTS WHOSE COVERAGE DOES NOT PAY, ESTABLISHING A MAMMOGRAM REGISTRY AND ESTABLISHING A SYSTEM TO NOTIFY PATIENTS OF UPCOMING PREVENTATIVE SCREENINGS AT THE FIRST YEAR OF ELIGIBILITY. MENTAL HEALTH: MLH IS COMMITTED TO PROVIDE EDUCATION AND SCREENINGS IN CLINIC AND COACHING SETTINGS FOR BETTER MENTAL HEALTH ASSESSMENT AND SELF-CARE BY THE FOLLOWING ACTIONS: ESTABLISHING TRACKING MECHANISMS TO DEMONSTRATE THE USAGE OF MENTAL HEALTH RESOURCES, ESTABLISHING INSOMNIA PATHWAY AT HASTINGS FAMILY CARE, DEVELOPING A STRESS QUESTIONNAIRE TO PUT IN INITIAL EVALUATION PACKETS AND OTHER ACTIONS. SUBSTANCE MISUSE: MLH IS COMMITTED TO PROVIDING EDUCATION AND RESOURCES TO 100% OF HEALTHY BEGINNINGS CLIENTS WHO HAVE BEEN IDENTIFIED AS POTENTIAL OR CONFIRMED AT RISK FOR SUBSTANCE MISUSE, DEVELOPING A PRESENTATION ON SUBSTANCE MISUSE/MENTAL HEALTH TARGETED AT 8TH GRADERS AND INCORPORATING A HUMAN TRAFFICKING ASSESSMENT IN THE EMERGENCY ROOM. ACCESS TO CARE: MLH IS COMMITTED TO DEVELOPING A STRATEGY TO ENCOURAGE ACCESS TO SPECIALTY SERVICES BY EXPLORING TELEMEDICINE OUTREACH AND PROVIDING EDUCATION ABOUT HOME CARE SERVICES TO AT LEAST TWO COMMUNITY GROUPS EVERY QUARTER. MLH IS ALSO SEEKING TO INCREASE THE AVAILABILITY OF URGENT CARE IN THE CLINIC, AS WELL AS INCREASING THE PATIENTS ABILITY TO MANAGE THEIR OWN CARE. PRIORITIZED NEEDS STAKEHOLDERS IN THE 2018 MAPP PROCESS WERE ASKED TO RANK ALL NEEDS ON A SCALE TO DETERMINE PRIORITY AREAS. THE TOP FIVE RANKED AREAS THROUGH THIS PROCESS WERE: ACCESS TO CARE, MENTAL HEALTH, SUBSTANCE MISUSE, OBESITY AND RELATED HEALTH CONDITIONS AND CANCER. THE OTHER NEEDS THAT WERE IDENTIFIED THROUGH THE ASSESSMENT PROCESS THAT ARE NOT CURRENTLY BEING ADDRESSED INCLUDE: AGING PROBLEMS, ENVIRONMENTAL, CHILD ABUSE/NEGLECT, DOMESTIC VIOLENCE, AND INJURY. EVEN THOUGH THESE ISSUES WERE NOT STAND ALONE PRIORITY NEEDS, IT IS ANTICIPATED THAT SEVERAL AREAS WILL OVERLAP AND ONE ACTIVITY MAY MEET THE STRATEGIC GOAL IN SEVERAL AREAS AND MAY HAVE A POSITIVE IMPACT ON NEEDS THAT ARE IDENTIFIED BUT NOT IN THE TOP FIVE PRIORITY AREAS. FOR EXAMPLE, ADDRESSING MENTAL HEALTH AND SUBSTANCE MISUSE PRIORITY AREAS WOULD LOGICALLY HAVE AN IMPACT ON PREVALENCE OF CHILD ABUSE/NEGLECT AND DOMESTIC VIOLENCE; ADDRESSING MENTAL HEALTH ACROSS THE LIFESPAN NATURALLY INCLUDES THE AGING POPULATION AND INCLUDES STRATEGIES FOR INCREASING ACCESS TO (MENTAL HEALTH) CARE. SOME OF THE IDENTIFIED NEEDS THAT ARE NOT PRIORITY AREAS ARE BEING ADDRESSED AT SOME LEVEL BY OTHER STAKEHOLDERS IN THE COMMUNITY, SUCH AS THE PUBLIC HEALTH DEPARTMENT.
MARY LANNING HEALTHCARE PART V, SECTION B, LINE 16J: THE FULL POLICY IS AVAILABLE UPON REQUEST, FREE OF CHARGE, AS WELL AS ON THE HOSPITAL'S WEBSITE. 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.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?17
Name and address Type of Facility (describe)
1 1 - HASTINGS ORTHOPEDICS
2207 OSBORNE DR WEST STE 100
HASTINGS,NE68901 		OUTPATIENT CLINIC
2 2 - HASTINGS FAMILY CARE
223 E 14TH STREET STE 100
HASTINGS,NE68901 		OUTPATIENT CLINIC
3 3 - CENTRAL NE UROLOGY
2115 N KANSAS AVENUE STE 108
HASTINGS,NE68901 		OUTPATIENT CLINIC
4 4 - CENTRAL NE UROLOGY
620 N ALPHA ST
GRAND ISLAND,NE68803 		OUTPATIENT CLINIC
5 5 - LANNING CENTER
815 S BURLINGTON AVENUE
HASTINGS,NE68901 		OUTPATIENT CLINIC
6 6 - CENTRAL NE GENERAL SURGERY
715 N KANSAS AVENUE STE 205
HASTINGS,NE68901 		OUTPATIENT CLINIC
7 7 - HASTINGS PULMONARY & SLEEP
715 N KANSAS AVENUE STE 101
HASTINGS,NE68901 		OUTPATIENT CLINIC
8 8 - CENTRAL NE FAMILY CARE
3016 W FAIDLEY AVE
GRAND ISLAND,NE68803 		OUTPATIENT CLINIC
9 9 - COMMUNITY HEALTH CENTER
606 N MINNESOTA AVENUE STE 1
HASTINGS,NE68901 		OUTPATIENT CLINIC
10 10 - CENTRAL NE PAIN CENTER
715 N KANSAS AVENUE STE 202
HASTINGS,NE68901 		OUTPATIENT CLINIC
11 11 - INSPIRED BRAIN & SPINE SURGERY
715 N KANSAS AVE STE 207
HASTINGS,NE68901 		OUTPATIENT CLINIC
12 12 - CENTRAL NE KIDNEY CARE
715 N KANSAS AVENUE
HASTINGS,NE68901 		OUTPATIENT CLINIC
13 13 - WOUND CENTER
715 N KANSAS AVE STE 302
HASTINGS,NE68901 		OUTPATIENT CLINIC
14 14 - CENTRAL NE INFECTIOUS DISEASE CLINIC
715 N KANSAS AVENUE
HASTINGS,NE68901 		OUTPATIENT CLINIC
15 15 - BLUE HILL CLINIC
102 N PINE STREET
BLUE HILL,NE68930 		OUTPATIENT CLINIC
16 16 - DONIPHAN CLINIC
2011 W CLARICE STREET
DONIPHAN,NE68832 		OUTPATIENT CLINIC
17 17 - MIDWEST COSMETIC & WOUND SURGERY
715 N KANSAS AVE STE 206
HASTINGS,NE68901 		OUTPATIENT CLINIC
Schedule H (Form 990) 2019
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Schedule H (Form 990) 2019
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
PART I, LINE 3C: THE ORGANIZATION ONLY USED FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY FOR FREE AND DISCOUNTED CARE.
PART I, LINE 6A: THE COMMUNITY BENEFIT REPORT IS NOT PREPARED BY A RELATED ORGANIZATION.
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, LINE 7G: THE HOSPITAL DOES NOT REPORT ANY SUBSIDIZED HEALTH SERVICES ON LINE 7(G).
PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $10,574,921.
PART II, COMMUNITY BUILDING ACTIVITIES: HASTINGS FAMILY CARE, A CLINIC OF MLH, HOSTED PROJECT SEARCH STUDENTS FOR AN EIGHT WEEK ROTATION SO THAT THEY MAY GAIN JOB SKILLS TO PREPARE THEM FOR FUTURE JOB OPPORTUNITIES.
PART III, LINE 2: GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE.FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018, NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.
PART III, LINE 3: THE HOSPITAL PROVIDES CHARITY CARE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTH CARE SERVICES THEY RECEIVE. PATIENTS WHO QUALIFY FOR CHARITY CARE ARE GIVEN A PERCENTAGE DISCOUNT FROM ESTABLISHED CHARGES BASED ON A SLIDING SCALE USING POVERTY GUIDELINES. IT IS THE POLICY OF THE HOSPITAL NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. ACCORDINGLY, THE HOSPITAL DOES NOT REPORT THESE AMOUNTS IN NET OPERATING REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON THE OVERALL COST TO CHARGE RATIO FOR THE HOSPITAL ONLY. THE COSTS OF CARING FOR CHARITY CARE PATIENTS FOR THE YEARS ENDED DECEMBER 31, 2019 AND 2018 WERE APPROXIMATELY $3,900,000 AND $3,740,000, RESPECTIVELY.
PART III, LINE 4: THE COSTING METHODOLOGY USED IN DETERMINING THE BAD DEBT EXPENSES INCLUDES CALCULATING ON A MONTHLY BASIS THE TOTAL ESTIMATED AMOUNTS BASED ON HISTORICAL WRITE OFFS.THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. FOOTNOTES TITLED "PATIENT RECEIVABLES," "PATIENT SERVICE REVENUE, AND "FINANCIAL ASSISTANCE/CHARITY CARE" CAN BE FOUND ON PAGES 8, 10 AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
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. ALL OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT.
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: IN ADDITION TO THE STANDARD CHNAS CONDUCTED USING THE MAPP (2012, 2018) OR MINI-MAPP (2015), MARY LANNING UTILIZES OTHER METHODS OF ASSESSING THE HEALTH NEEDS OF THE COMMUNITIES IT SERVES. IN PARTNERSHIP WITH THE SOUTH HEARTLAND DISTRICT HEALTH DEPARTMENT (SHDHD), THE 2018 CHNA INCLUDED A NEW SPECIAL FOCUS ON ACCESS TO CARE, TO INCLUDE FOCUS GROUPS WITH HEALTH SYSTEM USERS (IN ENGLISH AND SPANISH) AND FOCUS GROUPS WITH HEALTH SYSTEM PROVIDERS AND COMMUNITY LEADERS. THE OVERALL GOAL OF THIS SPECIAL FOCUS WAS TO IDENTIFY GAPS IN HEALTH SERVICES AND BARRIERS TO ACCESSING HEALTH CARE. MARY LANNING ALSO PARTNERS WITH THE SHDHD ON AN ONGOING BASIS TO ASSESS OR RECEIVE ASSESSMENT REPORTS ON SPECIFIC HEALTH NEEDS, SUCH AS SKIN CANCER, TO SUPPORT PLANNING AND IMPLEMENTATION OF COMMUNITY OUTREACH PROGRAMS, SUCH AS FOR SKIN CANCER PREVENTIVE SCREENING OPPORTUNITIES. CLINICS ARE ALSO UTILIZING CLIENT/PATIENT POPULATION DATA REPORTED FROM THE ELECTRONIC HEALTH RECORDS TO UNDERSTAND THE NEEDS OF PATIENTS (SUCH AS HYPERTENSION MANAGEMENT OR PRE-DIABETES) AND ADDRESSING THESE NEEDS IN PART THROUGH PARTNERSHIPS WITH, AND REFERRALS TO, EVIDENCE-BASED COMMUNITY PROGRAMS.
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: MARY LANNING IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.
Schedule H (Form 990) 2019
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