2014-11-13T16:47:06-06:00 2013-12-31 135565207 KPMG LLP 1212 NORTH 96TH STREET SUITE 300 OMAHA NE 68114 990 2013-01-01 420680355 JENNIE EDMUNDSON MEMORIAL HOSPITAL JENN 4023544840 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 LINDA BURT VICE PRES FINANCE, CFO 4023544000 2014-11-13 1 P01231721 4023481450 2013 2015-11-30 17:44:51Z STEVEN BAUMERT 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 107630596 0 X WWW.BESTCARE.ORG X 1894 IA TO PROVIDE AND MAINTAIN HOSPITAL AND AMBULATORY FACILITIES FOR THE CARE OF PATIENTS. 12 10 804 573 190097 -80707 764810 291587 91491298 93491013 722054 875120 1505649 1491806 94483811 96149526 6136409 7838966 0 0 45649437 44540286 0 0 0 38861215 40103946 90647061 92483198 3836750 3666328 69207656 73399044 33768860 22263208 35438796 51135836 X THE MISSION OF JENNIE EDMUNDSON MEMORIAL HOSPITAL IS TO IMPROVE THE QUALITY OF LIFE BY CARING FOR THE BODY AND MIND. JENNIE EDMUNDSON SUPPORTS ITS MISSION OF CARING FOR PEOPLE THROUGH THE PROVISION OF INPATIENT AND OUTPATIENT HOSPITAL SERVICES ON ITS MAIN CAMPUS AT 933 EAST PIERCE STREET,COUNCIL BLUFFS, IOWA AND AT VARIOUS SATELLITE LOCATIONS THROUGHOUT SOUTHWEST IOWA. 0 0 5799885 785383 9365861 JENNIE EDMUNDSON CARDIAC SERVICES INCLUDE SOUTHWEST IOWA'S FIRST STATE-OF-THE-ART CARDIAC CATHETERIZATION LAB. OTHER CARDIAC SERVICES OFFERED AT JENNIE EDMUNDSON MEMORIAL HOSPITAL INCLUDE HEART FAILURE PROGRAM, CARDIAC REHABILITATION SERVICES AND INPATIENT CARE PROVIDED BY HIGHLY TRAINED CARDIAC CARE PROFESSIONALS. 4401439 556908 6640653 JENNIE EDMUNDSON'S CANCER CENTER IS THE ONLY CANCER CENTER IN SOUTHWEST IOWA ACCREDITED BY THE AMERICAN COLLEGE OF SURGEONS. ALL NEWLY DIAGNOSED CANCER PATIENTS' CASES ARE PRESENTED AND REVIEWED AT THE WEEKLY CANCER CONFERENCE FOR IN-DEPTH REVIEW BY SURGEONS, RADIOLOGISTS, PATHOLOGISTS, MEDICAL AND RADIATION ONCOLOGISTS AND OTHER SPECIALIZED CARE PROVIDERS. EVERY YEAR SINCE 1996, JENNIE EDMUNDSON HAS RECEIVED APPROVAL FROM THE COMMISSION ON CANCER INCLUDING MEETING PROGRAM STANDARDS, PROVIDING SUPPORT AND EDUCATION, AND DELIVERING QUALITY CARE TO ITS PATIENTS. 12879219 1319049 15725741 QUALITY, COMPREHENSIVE SURGICAL SERVICES ARE PROVIDED AT JENNIE EDMUNDSON HOSPITAL BY A TEAM OF CARING AND EXPERT PHYSICIANS, NURSES AND ANESTHESIOLOGISTS USING STATE OF THE ART TECHNOLOGY. PATIENTS ARE ENCOURAGED TO TAKE AN ACTIVE ROLE IN THEIR SURGICAL EXPERIENCE. HIGHLY PERSONALIZED PRE- AND POST-OPERATIVE CARE IS DELIVERED FROM ADMISSION TO DISCHARGE BY NURSES WHO SPECIALIZE IN SURGICAL CARE.CARE IS PROVIDED TO CHILDREN, ADOLESCENTS AND ADULTS IN GENERAL, GYNECOLOGY, NEUROSURGERY, OPHTHALMOLOGY, ORTHOPEDICS, OTOLARYNGOLOGY, RESPIRATORY/PULMONARY, UROLOGY,AND VASCULAR/CARDIAC/THORACIC SURGICAL SPECIALTIES. 61232669 5177626 62460053 JENNIE EDMUNDSON HOSPITAL IS THE OLDEST ENTITY IN THE NEBRASKA HEALTH SYSTEM FAMILY. IT IS A 232-BED REGIONAL HEALTH CARE CENTER SERVING SOUTHWESTERN IOWA. IT IS THE ONLY HOSPITAL IN THE REGION THAT OFFERS NATIONALLY ACCREDITED CANCER AND BREAST CANCER PROGRAMS WHILE ALSO FEATURING SOUTHWEST IOWA'S ONLY ADVANCED WOUND CENTER AS WELL AS A FULL-LINE OF WOMEN'S SERVICES INCLUDING A BIRTHING CENTER AND LEVEL II NURSERY.ADDITIONAL CORE SERVICES INCLUDE MEDICAL/SURGICAL SERVICES, AN EMERGENCY DEPARTMENT, DIAGNOSTIC AND IMAGING SERVICES. EMPHASIS IS PLACED ON EDUCATION FOR PATIENTS, THEIR FAMILIES AND THE COMMUNITY. 61232669 5177626 62460053 84313212 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 X 38 0 804 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 IA X LINDA BURT 4023544840 8511 WEST DODGE ROAD OMAHA NE 68114 DAN KINNEY PHD CHAIRMAN 1.00 0.00 X X 0 0 0 EMMA CHANCE VICE CHAIRMAN 1.00 0.00 X X 0 0 0 ALLAN G LOZIER TREASURER 1.00 0.00 X X 0 0 0 JOHN NELSON SECRETARY 1.00 0.00 X X 0 0 0 KAREN COLLINS DIRECTOR 1.00 0.00 X 0 0 0 WILLIAM SHIFFERMILLER MD DIRECTOR 1.00 39.00 X 0 364551 106256 JOHN G SOUTHARD MD PHD DIRECTOR 1.00 0.00 X 0 0 0 SPENCER C STEVENS DIRECTOR 1.00 0.00 X 0 0 0 LAWRENCE F UEBNER DIRECTOR 1.00 0.00 X 0 0 0 RICK CROWL JR DIRECTOR 1.00 0.00 X 0 0 0 THOMAS D WHITSON DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL ZLOMKE MD DIRECTOR 1.00 0.00 X 0 0 0 STEVEN BAUMERT PRESIDENT 35.00 5.00 X 0 293431 79976 LINDA BURT VICE PRES-FINANCE & CFO 6.00 34.00 X 0 481614 91351 MICHAEL ROMANO MD PHYSICIAN /EXEC MED AFFAIR 40.00 0.00 X 197883 0 40631 PEGGY HELGET EXEC. PATIENT SVCS 40.00 0.00 X 157120 0 21458 JAMES CHAMBERS EXEC. CLINICAL AFFAIRS 40.00 0.00 X 148524 0 33677 ALAN FISHER MD PHYSICIAN 40.00 0.00 X 182648 0 36288 NGUYET TRAN MD PHYSICIAN 40.00 0.00 X 199671 0 7720 DONNA HUBBELL EXEC. QUALITY & PT SAFETY 40.00 0.00 X 134101 0 25797 SAMUEL OAKES PHARMACIST 40.00 0.00 X 137903 0 36305 1157850 1139596 479459 26 0 1 0 PATHLAB LTD 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 MEDICAL SERVICES 5914088 EMERGENCY PHYSICIANS WESTERN IOWA LLC 4950 SOUTH 177 CIRCLE OMAHA NE 68135 MEDICAL SERVICES 1734432 ACCELECARE WOUND CENTERS INC P O BOX 671242 DALLAS TX 75267 MEDICAL SERVICES 705422 HORIZON HEALTH MANAGEMENT P O BOX 840839 DALLAS TX 75284 MEDICAL SERVICES 657608 PULMONARYINFECTIOUS DISEASE ONE EDMUNDSON PLACE STE 312 COUNCIL BLUFFS IA 51503 MEDICAL SERVICES 314167 16 232249 59338 291587 NET PATIENT SVC REV. 621990 91143117 91143117 OTHER PATIENT REVENUE 621990 2347896 2347896 93491013 559603 559603 1463394 953522 509872 509872 509872 10668803 61995 10402000 13281 266803 48714 315517 315517 202809 112267 90542 90542 CAFETERIA 722210 699770 699770 LABORATORY 621500 190097 190097 TUITION REVENUE 611600 1525 1525 891392 96149526 94192308 190097 1475534 133266 133266 7705700 7705700 355003 355003 34085747 33803122 282625 2350593 2289557 61036 5478545 5412286 66259 2270398 2232955 37443 51934 51934 18660 18660 27751 27751 7162745 7162745 254163 254163 1349393 1349393 40254 40254 3987928 3987928 72485 72485 355499 355499 3347301 3347301 556070 445179 110891 MEDICAL SUPPLIES 13706738 13706738 ALLOCATIONS 7158384 7158384 MEDICAID PROVIDER TAX 859101 859101 DUES, LICENSES AND SUBS 203951 203951 951589 951589 92483198 84313212 8169986 0 6800640 9515646 13844973 11422341 215752 130983 2034410 2031122 474406 498864 124314326 90635549 35274549 33678777 6917090 14582852 3195659 189714 450177 1348745 69207656 73399044 10125218 11748159 5620000 4605000 18023642 5910049 33768860 22263208 X 34815950 50498824 522846 537012 100000 100000 35438796 51135836 69207656 73399044 X 3666328 516146 11514566 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 18660 0 0 0 18660 0 PART II-B, LINE 1: A PORTION OF THE ANNUAL DUES PAID TO THE AMERICAN HOSPITAL AND IOWA HOSPITAL ASSOCIATIONS IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 213966 11523 7225 218264 199654 5053 12759 3500 213966 185484 10963 9207 6000 199654 183700 1784 185484 257776 83700 157776 183700 0.00000 0.92320 0.07680 0 1 1 2807651 2807651 73812371 48703649 25108722 47694304 41931900 5762404 33678777 MINIMUM PENSION LIABILITY 3583317 COND. ASSET RETIREMENT OBLIGATION 1571525 ESTIMATED THIRD PARTY PAYABLE 755207 5910049 X PART V, LINE 4: PERMANENTLY RESTRICTED NET ASSETS INCLUDE ENDOWMENT FUNDS WHICH ARE INTENDED TO BE HELD IN PERPETUITY. THE INCOME ON SUCH FUNDS IS EXPENDABLE FOR THE BENEFIT OF JENNIE EDMUNDSON MEMORIAL HOSPITAL. PART X, LINE 2: JENNIE EDMUNDSON MEMORIAL HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. RECOGNIZED INCOME TAX POSITIONS ARE MEASURED AT THE LARGEST AMOUNT THAT IS GREATER THAN 50% LIKELY OF BEING REALIZED. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. IN 2013 AND 2012 MANAGEMENT DETERMINED THERE ARE NO INCOME TAX POSITIONS REQUIRING RECOGNITION OF THE FINANCIAL STATEMENTS. NO CHANGES WERE MADE TO THE FINANCIAL STATEMENTS DUE TO FIN 48. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 3146311 12736 3133575 0.03390 9603861 7763671 1840190 0.01990 12750172 7776407 4973765 0.05380 328162 328162 0.00350 859802 859802 0.00930 279892 279892 0.00300 340324 340324 0.00370 1808180 1808180 0.01950 14558352 7776407 6781945 0.07330 11483 11483 0.00010 11483 11483 0.00010 1 2263694 27982600 32062599 -4079999 X 1 1 1 1 JENNIE EDMUNDSON MEMORIAL HOSPITAL 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 780039H X X X X JENNIE EDMUNDSON MEMORIAL HOSPITAL 1 1 X X X X X X X X 12 1 1 1 X METHODISTCOMMUNITYBENEFIT.COM/OUR-PLAN/ X X X X X X X 0 0 1 1 200.000000000000 1 600.000000000000 1 X X X X X X X 1 1 X X X X 1 0 X X X 1 X 0 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 3: THE COMMUNITY HEALTH NEEDS ASSESSMENT (ASSESSMENT) WAS SPONSORED BY A COALITION OF LOCAL HEALTH SYSTEMS AND LOCAL HEALTH DEPARTMENTS. THE ASSESSMENT WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS INC. (PRC), A NATIONALLY-RECOGNIZED HEALTHCARE CONSULTING FIRM WITH EXTENSIVE EXPERIENCE CONDUCTING COMMUNITY HEALTH NEEDS ASSESSMENTS.THE ASSESSMENT INCORPORATED DATA FROM BOTH QUANTITATIVE AND QUALITATIVE SOURCES. QUANTITATIVE DATA INCLUDED PRIMARY DATA REPRESENTATION FROM TELEPHONE INTERVIEWS WHICH INCORPORATED BOTH LANDLINE AND CELL PHONE INTERVIEWS. IN ADDITION THERE WERE FIVE FOCUS GROUPS WHICH INCLUDED 88 KEY INFORMANTS INCLUDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, BUSINESS LEADERS AND OTHER COMMUNITY LEADERS. JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 4: THE CHNA WAS A COLLABORATIVE EFFORT OF THREE OMAHA HEALTH SYSTEMS - METHODIST HEALTH SYSTEM, ALEGENT HEALTH SYSTEM AND THE NEBRASKA MEDICAL CENTER AS WELL AS LOCAL HEALTH DEPARTMENTS FROM DOUGLAS, SARPY/CASS COUNTIES, NEBRASKA AND POTTAWATTAMIE COUNTY, IOWA. JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 7: JENNIE EDMUNDSON HOSPITAL DID NOT ADDRESS THE AREAS OF ORAL HEALTH AND SUBSTANCE ABUSE WHICH WERE OUTLINED IN THE CHNA. OTHER ORGANIZATIONS IN THE COMMUNITY HAVE THE RESOURCES AND QUALIFICATIONS TO PROVIDE FOR THESE AREAS OF COMMUNITY HEALTH.JENNIE EDMUNDSON MEMORIAL HOSPITAL WILL COLLABORATE WITH COMMUNITY ORGANIZATIONS THAT ARE ADDRESSING THESE NEEDS. JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 12I: JENNIE EDMUNDSON MEMORIAL HOSPITAL HAS ADOPTED A PROCEDURE FOR THOSE SITUATIONS IN WHICH A PATIENT MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT OR CANNOT COMPLETE AN APPLICATION. THIS PROCEDURE, REFERRED TO AS PRESUMPTIVE CHARITY PROCESS, IS FOLLOWED BY HOSPITAL PERSONNEL AS WELL AS THIRD-PARTY VENDORS WHO HAVE BEEN ENGAGED TO ASSIST WITH SELF-PAY COLLECTIONS. JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 14G: PATIENT STATEMENTS INCLUDE A STATEMENT ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDING CONTACT INFORMATION. JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 20D: THE AVERAGE COMMERCIAL INSURANCE RATE IS USED. PART I, LINE 7: THE METHODS PRIMARILY USED ARE THE FINANCIAL INFORMATION FROM THE MEDICARE COST REPORT AND ACTUAL EXPENDITURES. PART I, LINE 7G: A SUBSIDIZED HEALTH BENEFIT IS CALCULATED FOR DEPARTMENTS AND SERVICES RECOGNIZING THESE AREAS OPERATE AT A NEGATIVE MARGIN. TRANSPORT SERVICES AND CLINICS IN UNDERSERVED AREAS, FOR EXAMPLE, ARE SERVICES THAT OPERATE AT NEGATIVE MARGINS. PART I, LN 7 COL(F): THE PERCENTAGE IS ARRIVED AT BY DIVIDING NET COMMUNITY BENEFIT EXPENSES IN COLUMN (E) BY THE AMOUNT ON FORM 990, PART IX, LINE 25, COLUMN (A). PART I, LINE 6A AND 6B: ANNUAL COMMUNITY BENEFIT REPORT:NEBRASKA METHODIST HEALTH SYSTEM PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT WHICH INCLUDES INFORMATION ON COMMUNITY BENEFITS ACTIVITIES FROM ALL AFFILIATES. IN ADDITION, A QUARTERLY PUBLICATION, "CHART" ADDRESSES ONGOING COMMUNITY BENEFIT ACTIVITIES. THE WEBSITE "METHODISTCHART.ORG" IS DEDICATED TO JENNIE EDMUNDSON MEMORIAL HOSPITAL AND NEBRASKA METHODIST HEALTH SYSTEM AFFILIATES' COMMUNITY WORKS. IT PROVIDES INFORMATION ABOUT THE SUCCESSES IN IMPACTING THE COMMUNITY'S OVERALL HEALTH.PART VI, LINE 7:NO DIRECT REPORT IS PROVIDED TO THE STATE OF IOWA. HOWEVER, INFORMATION FROM THE HOSPITAL'S COMMUNITY BENEFIT DATA IS INCLUDED IN A REPORT COMPILED BY THE IOWA HOSPITAL ASSOCIATION. IN ADDITION, A COPY OF THE FORM 990 IS PROVIDED TO THE IOWA LEGISLATIVE AGENCY AND THE IOWA DEPARTMENT OF PUBLIC HEALTH.PART I, LINE 7:INFORMATION ON PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, SUBSIDIZED HEALTH SERVICES AND IN-KIND DONATIONS IS COLLECTED THROUGHOUT THE YEAR USING THE COMMUNITY BENEFITS INVENTORY SOCIAL ACCOUNTABILITY SOFTWARE WHICH FOLLOWS CATHOLIC HEALTH ASSOCIATION (CHA) GUIDELINES FOR COMMUNITY BENEFIT REPORTING. AMOUNTS SHOWN AS COMMUNITY BENEFIT ARE AT COST LESS ANY REVENUE EXCLUSIVE OF ANY GRANTS. CASH AND IN-KIND DONATIONS THAT SUPPORT FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT ACTIVITIES ARE INCLUDED IN CONTRIBUTIONS.PART I, LINE 7E:JENNIE EDMUNDSON AND 20 OTHER ORGANIZATIONS IN THE COMMUNITY HAVE UNITED IN THE SHAKEN BABY TASK FORCE IN A COMMUNITY EFFORT TO PREVENT SHAKEN BABY SYNDROME. THE TASK FORCE, LED BY MEMBERS OF THE STAFF OF JENNIE EDMUNDSON HOSPITAL, DEVELOPED A COPYRIGHTED CURRICULUM, VIDEO AND SAFEBABY.ORG WEBSITE AND THE NATION'S ONLY 24-HOUR DEDICATED CRYING BABY HOTLINE. THE VIDEO "SHAKEN BABIES: SHATTERED LIVES" IS FREE ON REQUEST AND HAS BEEN SENT TO REQUESTERS IN THE UNITED STATES AND COUNTRIES OUTSIDE THE UNITED STATES.JENNIE EDMUNDSON'S COMMITMENT TO SOUTHWEST IOWA EXTENDS TO A WIDE VARIETY OF OTHER ANNUAL SCREENING PROGRAMS ON PROSTATE CANCER, COLORECTAL CANCER, BREAST CANCER AND CERVICAL CANCER. IN ADDITION, PHYSICIANS AND HOSPITAL STAFF PROVIDE EDUCATIONAL PROGRAMS TO ORGANIZATIONS AND AT COMMUNITY EVENTS. PART II, COMMUNITY BUILDING ACTIVITIES: AS A COMMUNITY LEADER, JENNIE EDMUNDSON EMPLOYEES ARE ACTIVE IN COMMUNITY ORGANIZATIONS, HOLDING LEADERSHIP ROLES ON BOARDS OF DIRECTORS, COMMITTEE CHAIRMANSHIPS AND MEMBERSHIPS. JENNIE EDMUNDSON PARTICIPATES IN THE CHAMBER OF COMMERCE, THE AMERICAN HEART ASSOCIATION AND OTHER ORGANIZATIONS TO STRENGTHEN THE INFRASTRUCTURE OF THE COMMUNITY. PART III, LINE 4: FOOTNOTE TO THE FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE IS SHOWN IN THE ATTACHED AUDITED FINANCIAL STATEMENTS, PAGE 9. PART III, LINE 8: SOURCE FOR MEDICARE REVENUE AND ALLOWABLE COSTS IS THE 2013 MEDICARE COST REPORT AS FILED. PART III, LINE 9B: COLLECTION PRACTICES FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE.THE HOSPITAL BILLS ALL THIRD PARTY RESOURCES THAT MAY BE ABLE TO PROVIDE REIMBURSEMENT FOR CARE PROVIDED TO PATIENTS. THIS INCLUDES, BUT IS NOT LIMITED TO, COMMERCIAL INSURANCE, MEDICARE, MEDICAID, COUNTY GOVERNMENT AND OTHER GOVERNMENT PROGRAMS, AND ANY OTHER POTENTIAL SOURCE OF REIMBURSEMENT.EVERY EFFORT IS MADE TO IDENTIFY PATIENTS THAT MAY QUALIFY FOR FINANCIAL ASSISTANCE PRIOR TO OR DURING THE TIME OF SERVICE. THOSE PATIENTS ARE ENCOURAGED TO COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE.JENNIE EDMUNDSON MEMORIAL HOSPITAL HAS ADOPTED A PROCEDURE FOR THOSE SITUATIONS WHERE A PATIENT POTENTIALLY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BUT HAS NOT OR CANNOT COMPLETE THE APPLICATION. THIS PROCEDURE, REFERRED TO AS THE PRESUMPTIVE CHARITY PROCESS, IS FOLLOWED BY HOSPITAL PERSONNEL AS WELL AS THIRD-PARTY VENDORS ASSISTING WITH SELF-PAY COLLECTIONS.SOME OF THE INDIVIDUAL LIFE CIRCUMSTANCES THAT HAVE BEEN ESTABLISHED AS INDICATORS OF PRESUMPTIVE ELIGIBILITY INCLUDE:PARTICIPATION IN STATE-FUNDED PRESCRIPTION PROGRAMS; RECEIVING CARE FROM A HOMELESS PERSONS CLINIC; PARTICIPATION IN WOMEN, INFANTS AND CHILDREN (WIC) PROGRAMS; FOOD STAMP ELIGIBILITY; ELIGIBILITY FOR SUBSIDIZED SCHOOL LUNCH PROGRAM; ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS THAT ARE UNFUNDED (E.G. MEDICAID SPEND-DOWN); LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS VALID ADDRESS.THE HOSPITAL STAFF, AS WELL AS VENDORS UTILIZED FOR SELF-PAY COLLECTIONS, HAVE BEEN TRAINED TO IDENTIFY INDICATORS OF PRESUMPTIVE ELIGIBILITY AND DOCUMENT SUCH AS SUPPORT FOR A FINANCIAL ASSISTANCE DETERMINATION. PART VI, LINE 2: BROAD-BASED COMMUNITY HEALTH AND OUTREACH INTIATIVES INCLUDE TARGETED PROGRAMS THAT ALIGN WITH KEY HEALTH NEEDS IDENTIFIED BY LIVEWELL OMAHA. LIVEWELL OMAHA IS A FORUM OF ORGANIZATIONS WORKING TOGETHER TO POSITIVELY IMPACT HEALTH OUTCOMES FOR ALL INDIVIDUALS AND FAMILIES IN THE COMMUNITY. PART VI, LINE 3: FINANCIAL ASSISTANCE BROCHURES ARE INCLUDED IN ALL INPATIENT ADMISSION PACKETS. JENNIE EDMUNDSON HOSPITAL CONTRACTS WITH AN ELIGIBILITY SERVICE TO ASSIST INDIVIDUALS IN DETERMINING ELIGIBILITY AND COMPLETING THE REQUIRED PAPERWORK TO PARTICIPATE IN MEDICAID OR GOVERNMENT MEANS-TESTED PROGRAMS. HOSPITAL FINANCIAL COUNSELORS AND ELIGIBILITY SERVICE PERSONNEL ARE CONVENIENTLY LOCATED AT THE HOSPITAL FOR PRIVATE CONSULTATION FOR BOTH INPATIENT AND OUTPATIENT COUNSELING. THE COUNSELORS ARE INCLUDED IN THE ADMISSION/DISCHARGE PROCESS TO ENSURE THAT THE PATIENT IS FULLY INFORMED ABOUT THE PROCESS AND TO HELP THE PATIENT DETERMINE WHAT ASSISTANCE MAY BE NEEDED AND WHAT IS AVAILABLE TO THEM. THE HOSPITAL CUSTOMER SERVICE UNIT IS ALSO TRAINED TO ASSIST PATIENTS WITH FINANCIAL NEED. PATIENTS WHO CONTACT THE UNIT EXPRESSING DIFFICULTY IN MEETING THEIR FINANCIAL OBLIGATION ARE ASSESSED FOR ELIGIBILITY FOR FINANCIAL ASSISTANCE.APPROPRIATE RESOURCES ARE USED TO PROVIDE EFFECTIVE COMMUNICATION WITH NON-ENGLISH SPEAKING PATIENTS INCLUDING CYRACOM LANGUAGE LINE SYSTEM THAT PROVIDES 24-HOUR ACCESS TO SEVERAL HUNDRED DIFFERENT LANGUAGE INTERPRETERS. OTHER RESOURCES INCLUDE HOPE MEDICAL OUTREACH AND ON-SITE STAFF OR CONTRACTED INTERPRETER SERVICES. THE HOSPITAL PROVIDES FOR INTERPRETATIVE SERVICES AT NO COST TO THE PATIENT.INFORMATION ON THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE TO THE PUBLIC ON THE BESTCARE.ORG WEBSITE. ADDITIONALLY, PATIENT STATEMENTS INCLUDE A STATEMENT ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE INCLUDING CONTACT INFORMATION. PART VI, LINE 4: JENNIE EDMUNDSON SERVES COUNCIL BLUFFS, IOWA AND SURROUNDING COMMUNITIES IN SOUTHWESTERN IOWA.JENNIE EDMUNDSON'S PROGRAMS ALIGN CLOSELY WITH THE KEY HEALTH NEEDS IDENTIFIED BY LIVEWELL OMAHA, A COLLABORATION OF LOCAL NON-PROFIT, GOVERNMENTAL AND FOR-PROFIT ORGANIZATIONS DEDICATED TO IMPROVING THE HEALTH OF THOSE WHO LIVE AND WORK IN THE AREA. PART VI, LINE 5: JENNIE EDMUNDSON'S BOARD OF DIRECTORS IS COMPOSED OF COMMUNITY LEADERS WITH DIVERSE BACKGROUNDS AND PROVIDES OVERSIGHT OF ALL OPERATIONS. THE COMPOSITION INCLUDES A COMBINATION OF THOSE WITH LONGEVITY ON THE BOARD AND THOSE WHO ARE NEWER MEMBERS. PHYSICIAN INVOLVEMENT ON THE BOARD ENHANCES THE HOSPITAL'S ABILITY TO BE A LEADER IN MEDICAL SERVICES.MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL PRACTITIONERS WHO CONTINUOUSLY MEET THE QUALIFICATIONS, STANDARDS AND REQUIREMENTS TO PROMOTE A UNIFORM STANDARD OF QUALITY PATIENT CARE, TREATMENT AND SERVICES. PART VI, LINE 6: THE NEBRASKA METHODIST HEALTH SYSTEM INCLUDES JENNIE EDMUNDSON MEMORIAL HOSPITAL AND JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION, NEBRASKA METHODIST HOSPITAL, NEBRASKA METHODIST HEALTH SYSTEM, PHYSICIANS CLINIC INC., NEBRASKA METHODIST COLLEGE OF NURSING AND NEBRASKA METHODIST HOSPITAL FOUNDATION. AS A GROUP, THESE ENTITIES ARE COMMITTED TO CARING FOR THE PEOPLE OF THE COMMUNITY BY PROVIDING OUTSTANDING HEALTH CARE, EDUCATIONAL OPPORTUNITIES AND SUPPORT SERVICES. TO FULFILL OUR MISSION OF CARING FOR PEOPLE, AFFILIATES HAVE DEVELOPED A VARIETY OF WAYS TO CONTRIBUTE CARE AND HEALTH-RELATED EDUCATION TO THE POOR, TO MINORITIES, AND TO OTHER UNDERSERVED GROUPS AS WELL AS TO THE BROADER COMMUNITY. AS INDIVIDUAL AFFILIATES, A UNIFIED HEALTH SYSTEM AND AN ACTIVE PARTNER WITH OTHER COMMUNITY AND GOVERNMENTAL AGENCIES, JENNIE EDMUNDSON MEMORIAL HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH AND QUALIFY OF LIFE OF THE RESIDENTS OF THIS COMMUNITY. 0 IOWA WESTERN COMMUNITY COLLEGE FOUNDATION 2700 COLLEGE ROAD COUNCIL BLUFFS IA 51503 421224333 501(C)(3) 17250 EDUCATION / SCHOLARSHIPS JENNIE EDMUNDSON HOSPITAL FOUNDATION 933 EAST PIERCE ST COUNCIL BLUFFS IA 51503 421439454 501(C)(3) 80000 SUPPORT OF FOUNDATION PROGRAMS CONNECTIONS AREA AGENCY AGING 300 W BROADWAY STE 240 COUNCIL BLUFFS IA 51503 421146108 501(C)(3) 25483 PARTNERING TO REDUCE READMISSIONS 3 0 SCHOLARSHIPS 20 19506 CASH SCHOLARSHIPS FINANCIAL ASSISTANCE 15380 7686194 BOOK FINANCIAL ASSISTANCE TO PATIENTS PART I, LINE 2: JENNIE EDMUNDSON MEMORIAL HOSPITAL ONLY PROVIDES GRANTS TO IRC SECTION 501(C)(3) ORGANIZATIONS TO ENSURE THE FUNDS ARE USED FOR EXEMPT PURPOSES. 0 1 0 0 0 0 0 0 0 WILLIAM SHIFFERMILLER MD DIRECTOR 0 300927 0 946 0 62678 0 88873 0 19488 0 472912 0 45215 STEVEN BAUMERT PRESIDENT 0 253760 0 0 0 39671 0 61753 0 19212 0 374396 0 0 LINDA BURT VICE PRES-FINANCE & CFO 0 363574 0 25000 0 93040 0 77913 0 14427 0 573954 0 69490 MICHAEL ROMANO MD PHYSICIAN /EXEC MED AFFAIR 180383 0 0 0 17500 0 18203 0 23861 0 239947 0 0 0 PEGGY HELGET EXEC. PATIENT SVCS 153432 0 0 0 3688 0 14712 0 8179 0 180011 0 0 0 JAMES CHAMBERS EXEC. CLINICAL AFFAIRS 148524 0 0 0 0 0 20297 0 14813 0 183634 0 0 0 ALAN FISHER MD PHYSICIAN 182648 0 0 0 0 0 22136 0 15315 0 220099 0 0 0 NGUYET TRAN MD PHYSICIAN 199671 0 0 0 0 0 6175 0 2768 0 208614 0 0 0 DONNA HUBBELL EXEC. QUALITY & PT SAFETY 120252 0 0 0 13849 0 7824 0 19406 0 161331 0 0 0 SAMUEL OAKES PHARMACIST 137903 0 0 0 0 0 19016 0 18512 0 175431 0 0 0 PART I, LINE 3 JENNIE EDMUNDSON MEMORIAL HOSPITAL IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. METHODIST HEALTH SYSTEM, WITH WHICH JENNIE EDMUNDSON IS AFFILIATED, RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED AND COMPENSATION RANGES ARE SET. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NON-PROFIT CORPORATION AND A VOTING MEMBER OF JENNIE EDMUNDSON MEMORIAL HOSPITAL. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NONQUALIFIED PLAN DURING 2013 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: STEVEN BAUMERT $28,136 ACCRUAL LINDA BURT $59,332 ACCRUAL; $69,490 PLAN DISTRIBUTION WILLIAM SHIFFERMILLER MD $36,948 ACCRUAL;PLAN DISTRIBUTION $45,215 JOHN SOUTHARD MD MEMBER OF THE BOARD 314167 DR. SOUTHARD IS A 50% OWNER OF PULMONARY/INFECTIOUS DISEASE WHICH CONTRACTS WITH THE HOSPITAL TO PROVIDE SERVICES. 0 FORM 990, PART V, LINE 2B THE PAYROLL SYSTEM FOR JENNIE EDMUNDSON MEMORIAL HOSPITAL IS BEING HANDLED BY A COMMON PAYMASTER, NEBRASKA METHODIST HEALTH SYSTEM INC. ALL W-2 FORMS ARE ISSUED UNDER THE TAX IDENTIFICATION NUMBER OF NEBRASKA METHODIST HEALTH SYSTEM. ALL REQUIRED FEDERAL EMPLOYMENT TAX RETURNS WERE FILED BY NEBRASKA METHODIST HEALTH SYSTEM. WAGES AND BENEFITS SHOWN IN THIS FORM 990 ARE ACTUAL EXPENSES ASSOCIATED WITH JENNIE EDMONDSON MEMORIAL HOSPITAL PERSONNEL. FORM 990, PART VI, SECTION A, LINE 6 UNDER THE ARTICLES OF INCORPORATION OF JENNIE EDMUNDSON MEMORIAL HOSPITAL, AS RESTATED ON APRIL 29, 1994, THE WOMEN'S CHRISTIAN ASSOCIATION OF IOWA, AN IOWA NON-PROFIT CORPORATION IS A SPONSORING MEMBER OF JENNIE EDMUNDSON MEMORIAL HOSPITAL. UNDER THE SAME ARTICLES OF INCORPORATION, NEBRASKA METHODIST HEALTH SYSTEM INC.,A NEBRASKA NON-PROFIT CORPORATION, IS A CORPORATE MEMBER OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A UNDER THE ARTICLES OF INCORPORATION OF JENNIE EDMUNDSON MEMORIAL HOSPITAL, AS RESTATED ON APRIL 29 1994, THE WOMEN'S CHRISTIAN ASSOCIATION OF COUNCIL BLUFFS, IOWA, AN IOWA NON-PROFIT CORPORATION, IS A SPONSORING MEMBER OF THE ORGANIZATION AND HAS THE RIGHT TO NOMINATE TWO (2) OF ITS MEMBERS TO THE HOSPITAL'S BOARD OF DIRECTORS. LIKEWISE, THE NEBRASKA METHODIST HEALTH SYSTEM INC. HAS THE RIGHT TO NOMINATE TO THE HOSPITAL'S BOARD OF DIRECTORS THE NUMBER OF DIRECTORS THAT IS ONE (1) LESS THAN A MAJORITY OF THE SEATS ON THE BOARD OF DIRECTORS. NEBRASKA METHODIST HEALTH SYSTEM ALSO HAS THE RIGHT TO APPROVE ALL OF THE DIRECTORS NOMINATED. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING THE FORM 990, A COPY IS PROVIDED TO THE AUDIT COMMITTEE OF NEBRASKA METHODIST HEALTH SYSTEM AND THE JENNIE EDMUNDSON HOSPITAL BOARD OF DIRECTORS. THEY ARE GIVEN AN OPPORTUNITY TO ASK QUESTIONS OR REQUEST MORE INFORMATION. INFORMATION FOR THE FORM 990 IS GATHERED FROM APPROPRIATE RESPONSIBLE PARTIES THROUGHOUT THE ORGANIZATION, INCLUDING THE ORGANIZATION'S HUMAN RESOURCES, FINANCE AND COMPLIANCE DEPARTMENTS. THE RETURN GETS A DETAIL TIE-OUT AND DIRECTOR OF ACCOUNTING REVIEW. IT IS REVIEWED BY EXTERNAL TAX ADVISORS AND HAS A FINAL REVIEW BY THE CHIEF FINANCIAL OFFICER FOR NEBRASKA METHODIST HEALTH SYSTEM AND THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER. FORM 990, PART VI, SECTION B, LINE 12C AN ANNUAL QUESTIONNAIRE IS SENT TO ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES PURSUANT TO THE METHODIST HEALTH SYSTEM CONFLICTS OF INTEREST POLICY WHICH REQUIRES THE DISCLOSURE RELATIONSHIPS, NOT JUST FINANCIAL, THAT COULD GIVE RISE TO CONFLICTS WITH THE ORGANIZATION. A BOARD COMMITTEE MEETS ANNUALLY TO REVIEW ALL POTENTIAL CONFLICTS IDENTIFIED THROUGH THE SURVEYS. SHOULD A DECISION COME TO THE BOARD WITH AN IDENTIFIED CONFLICT, THE OFFICER, DIRECTOR OR KEY EMPLOYEE IS NOT PERMITTED TO VOTE OR USE PERSONAL INFLUENCE ON THE MATTER AND IS NOT COUNTED IN DETERMINING THE QUORUM FOR A MEETING AT WHICH THE MATTER IS DISCUSSED. A POTENTIAL CONFLICT OF INTEREST ONCE IDENTIFIED MUST BE EVALUATED ON A CASE BY CASE BASIS. IN ORDER TO APPROVE THE TRANSACTION WHICH INVOLVES A DIRECT CONFLICT OF INTEREST, THE BOARD MUST FIRST FIND, BY MAJORITY VOTE OF DIRECTORS FOR WHOM NO CONFLICT EXISTS, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTERESTS OF JENNIE EDMUNDSON MEMORIAL HOSPITAL AND/OR ITS HEALTH SYSTEM AFFILIATES, IS FAIR AND REASONABLE AND, AFTER INVESTIGATION, THE DIRECTORS HAVE DETERMINED THAT A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CANNOT BE OBTAINED WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. FORM 990, PART VI, SECTION B, LINE 15 JENNIE EDMUNDSON MEMORIAL HOSPITAL IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. METHODIST HEALTH SYSTEM, WITH WHICH JENNIE EDMUNDSON IS AFFILIATED, RETAINS AN INDEPENDENT CONSULTANT TO REVIEW ALL OFFICER COMPENSATION FOR EACH AFFILIATE. UNDER THIS PROCESS, MARKET DATA ON COMPENSATION IS GATHERED AND ANALYZED AND COMPENSATION RANGES ARE SET. THE INFORMATION IS THEN PROVIDED TO THE COMPENSATION COMMITTEE OF THE BOARD OF NEBRASKA METHODIST HEALTH SYSTEM INC., A NEBRASKA NON-PROFIT CORPORATION AND A VOTING MEMBER OF JENNIE EDMUNDSON MEMORIAL HOSPITAL. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. PHYSICIAN COMPENSATION IS COMPARED TO NATIONAL COMPENSATION SURVEY DATA FROM THE MEDICAL GROUP MANAGEMENT ASSOCIATION (MGMA) AND THE AMERICAN MEDICAL GROUP ASSOCIATION (AMGA). THE POLICY ON "PHYSICIAN COMPENSATION" IS FOLLOWED WHEN CONTRACTING WITH PHYSICIANS TO ENSURE APPROPRIATE APPROVALS, INCLUDING APPROVAL BY THE BOARD OF DIRECTORS, ARE OBTAINED WHEN WARRANTED. OPINIONS OF FAIR MARKET VALUE REGARDING A PARTICULAR COMPENSATION ARRANGEMENT OR TRANSACTION MAY ALSO BE OBTAINED FROM REPUTABLE, INDEPENDENT VALUATION CONSULTANTS. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 1023 WAS FILED PRIOR TO 7/15/87 AND NEED NOT BE MADE PUBLICLY AVAILABLE. A COPY OF THE IRS LETTER 947 WILL BE PROVIDED UPON WRITTEN REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. HOWEVER, ARTICLES OF INCORPORATION FOR THE ORGANIZATION ARE AVAILABLE THROUGH THE IOWA SECRETARY OF STATE'S WEBSITE. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS AND EMPLOYEES. FINANCIAL INFORMATION IS AVAILABLE TO THE PUBLIC THROUGH THE IRS FORM 990 AND FORM 990-T. THE ORGANIZATION ALSO CONTRIBUTES INFORMATION REGARDING THE COMMUNITY BENEFITS IT PROVIDES AS PART OF THE METHODIST HEALTH SYSTEM'S ANNUAL COMMUNITY BENEFIT REPORT. THIS REPORT IS AVAILABLE TO THE PUBLIC ON THE WEBSITE WWW.METHODISTCHART.ORG. FORM 990, PART XI, LINE 9: CHANGE IN MINIMUM PENSION LIABILITY 11,514,566. JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 421439454 SUPPORT OF JENNIE EDMUNDSON HOSPITAL IA 501(C)(3) L7 JENNIE EDMUNDSON MEMORIAL HOSPITAL 1 WOMEN'S CHRISTIAN ASSOCIATION OF COUNCIL BLUFFS IOWA 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 930957829 MEMBER OF JENNIE EDMUNDSON MEMORIAL HOSPITAL IA 501(C)(3) L11: III-O N/A 0 NEBRASKA METHODIST HEALTH SYSTEM INC 8511 W DODGE ROAD OMAHA NE 68114 470639839 ADMINISTRATIVE SUPPORT NE 501(C)(3) L11: III-FI N/A 0 NEBRASKA METHODIST HOSPITAL 8511 W DODGE ROAD OMAHA NE 68114 470376604 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM INC 0 NEBRASKA METHODIST COLLEGE OF NURSING & ALLIED HEALTH 8511 W DODGE ROAD OMAHA NE 68114 470724387 NURSING AND HEALTH EDUCATION FACILITY NE 501(C)(3) L2 NEBRASKA METHODIST HOSPITAL 0 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND 8511 W DODGE ROAD OMAHA NE 68114 363699672 INSURANCE NE 501(C)(3) L11: III-FI NEBRASKA METHODIST HEALTH SYSTEM INC 0 REAL ESTATE HOLDINGS 8511 W DODGE ROAD OMAHA NE 68114 470649790 PROPERTY MANAGEMENT NE 501(C)(2) N/A NEBRASKA METHODIST HEALTH SYSTEM INC 0 PHYSICIANS CLINIC INC 8511 W DODGE ROAD OMAHA NE 68114 470687317 CLINICAL HEALTH CARE NE 501(C)(3) L9 NEBRASKA METHODIST HEALTH SYSTEM INC 0 NEBRASKA METHODIST HOSPITAL FOUNDATION 8511 W DODGE ROAD OMAHA NE 68114 470595345 SUPPORT OF NEBRASKA METHODIST HOSPITAL NE 501(C)(3) L7 NEBRASKA METHODIST HEALTH SYSTEM INC 0 SHARED SERVICE SYSTEMS INC 8511 W DODGE ROAD OMAHA NE 68114 470649534 MEDICAL SUPPLY DISTRIBUTION & LAUNDRY NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 METHODIST HEALTH PARTNERS 8511 W DODGE ROAD OMAHA NE 68114 470797563 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION C 232249 CASH JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION B 80000 CASH