2012-11-06T09:13:37-06:00 2011-12-31 135565207 KPMG LLP 2 CENTRAL PARK PLAZA SUITE 1501 OMAHA NE 68102 990 2011-01-01 420680355 JENNIE EDMUNDSON MEMORIAL HOSPITAL JENN 4023544840 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 LINDA BURT 4023544000 2012-11-06 1 P00223617 4023481450 2011 2016-02-25 16:41:14Z STEVEN BAUMERT 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 95158722 0 X WWW.BESTCARE.ORG X 1894 IA TO PROVIDE AND MAINTAIN HOSPITAL AND AMBULATORY FACILITIES FOR THE CARE OF PATIENTS. 12 11 844 572 63649 -28300 363964 606424 93487745 91832269 238211 243395 1325455 1239485 95415375 93921573 4247754 5065862 0 0 40834635 41597668 0 0 0 49308706 44805982 94391095 91469512 1024280 2452061 61502198 64622876 25944212 33580903 35557986 31041973 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 7047634 399701 7317450 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. 5633668 336538 6160820 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. 14014389 794692 14551059 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. 57431410 3534931 64570255 57431410 3534931 64570255 84127101 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 0 0 0 0 0 0 1 1 1 0 0 1 31 0 844 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IA X LINDA BURT 4023544840 8511 WEST DODGE ROAD OMAHA NE 68114 X JOHN P NELSON 1.00 X X 0 0 0 EMMA CHANCE 1.00 X X 0 0 0 ALLAN G LOZIER 1.00 X X 0 0 0 DAN KINNEY PHD 1.00 X X 0 0 0 KAREN COLLINS 1.00 X 0 0 0 WILLIAM SHIFFERMILLER MD 1.00 X 0 367102 98091 JOHN G SOUTHARD MD PHD 1.00 X 0 0 0 SPENCER C STEVENS 1.00 X 0 0 0 LAWRENCE F UEBNER 1.00 X 0 0 0 VELDA WEEKS 1.00 X 0 0 0 THOMAS D WHITSON 1.00 X 0 0 0 MICHAEL ZLOMKE MD 1.00 X 0 0 0 STEVEN BAUMERT 36.00 X 0 275226 77145 LINDA BURT 6.00 X 0 471507 95632 JAMES CHAMBERS 40.00 X 144842 0 28424 ALAN FISHER MD 40.00 X 185227 0 30869 MICHAEL ROMANO MD 40.00 X 194352 0 32647 PEGGY HELGET 40.00 X 145789 0 18222 NGUYET TRAN 40.00 X 200013 0 4790 870223 1113835 385820 21 0 1 0 PATHLAB LTD 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 MEDICAL SERVICES 6302220 EMERGENCY PHYSICIANS WESTERN IOWA LLC 2015 SOUTH 86 AVENUE OMAHA NE 68124 MEDICAL SERVICES 1728792 HORIZON HEALTH MANAGEMENT P O BOX 840839 DALLAS TX 75284 COLLECTION SERVICES 649077 ACCELECARE WOUND CENTERS INC P O BOX 840703 DALLAS TX 75284 MEDICAL SERVICES 544856 PSYCHIATRIC SERVICES OF WESTERN IOWA PC 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 MEDICAL SERVICES 330000 11 407926 198498 606424 NET PATIENT SVC REV. 621990 91153374 91153374 OTHER PATIENT REVENUE 621990 678895 678895 91832269 217849 217849 1397957 1098481 299476 299476 299476 36650 11104 25546 25546 25546 236609 127564 109045 109045 CAFETERIA 722210 664228 664228 DAYCARE 624410 118749 55100 63649 TUITION REVENUE 611600 47987 47987 830964 93921573 92599584 63649 651916 70862 70862 4995000 4995000 870223 870223 30593964 30593964 1515865 1515865 6367194 6367194 2250422 2250422 99913 99913 21960 21960 192111 192111 9044138 9044138 137972 137972 3970371 3970371 31514 31514 2380622 2380622 59921 59921 450382 450382 4065414 4065414 755214 755214 MEDICAL SUPPLIES 13914566 13914566 ALLOCATIONS 7028427 7028427 MEDICAID PROVIDER TAX 1288651 1288651 BILLING & COLLECTION FE 453237 453237 911569 911569 91469512 84127101 7342411 0 1629133 8367375 12979014 13469274 343262 715195 1044401 1101679 693633 611743 121903909 84786379 39079371 37117530 2274091 2294330 892199 843139 2567094 102611 61502198 64622876 9981779 11228950 7532841 6585000 8429592 15766953 25944212 33580903 X 34899020 30407127 558966 534846 100000 100000 35557986 31041973 61502198 64622876 X 2452061 -6968074 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 21960 0 0 0 21960 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: A PORTION OF THE ANNUAL DUES PAID TO THE AMERICAN HOSPITAL AND IOWA HOSPITAL ASSOCIATIONS IS ATTRIBUTABLE TO LOBBYING ACTIVITIES. 185484 10963 9207 6000 199654 183700 1784 185484 257776 83700 157776 183700 257776 257776 0.00000 0.98400 0.01600 0 1 1 2807651 2807651 72271400 44898760 27372640 46824858 39887619 6937239 37117530 MINIMUM PENSION LIABILITY 13408946 COND. ASSET RETIREMENT OBLIGATION 1387690 ESTIMATED THIRD PARTY PAYABLE 970317 15766953 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 2011 AND 2010 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 9374110 5296836 4077274 0.04460 2021280 2021280 0.02210 0 11395390 5296836 6098554 0.06670 559421 559421 0.00610 173970 173970 0.00190 174655 174655 0.00190 0 86569 86569 0.00090 994615 994615 0.01080 12390005 5296836 7093169 0.07750 0 5066 5066 0.00010 58789 58789 0.00060 3311 3311 0.00000 67166 67166 0.00070 1 2925093 0 27909404 32318036 -4408632 X 1 1 1 1 JENNIE EDMUNDSON MEMORIAL HOSPITAL

933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503

X X X X JENNIE EDMUNDSON MEMORIAL HOSPITAL 1 1 1 200.000000000000 1 600.000000000000 1 X X X X X X 1 1 X X X 1 0 1 X 0 0 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. EMERGENCY ROOM, TRANSPORT SERVICES, AND CLINICS IN UNDERSERVED AREAS ARE SERVICES THAT OPERATE AT NEGATIVE MARGINS. PART I, L7 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 BENEFITS 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 BENEFITS 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. SCHEDULE H, PART I, LINE 7 INFORMATION ON PROGRAMS CONSTITUTING COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, SUBSIDIZED HEALTH SERVICES AND IN-KIND DONATIONS IS COLLECTED THROUGH THE YEAR USING THE COMMUNITY BENEFITS INVENTORY SOCIAL ACCOUNTABILITY SOFTWARE WHICH FOLLOWS CATHOLIC HEALTH ASSOCIATION(CHA) GUIDELINES FOR COMMUNITY BENEFITS 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. SCHEDULE H, 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 BEENSENT TO REQUESTERS IN THE UNITED STATES AND COUNTRIES OUTSIDE THE UNITED STATES.SHAKEN BABY SYNDROME (SBS) IS CAUSED BY THE VIOLENT SHAKING OF A BABY OR A YOUNG CHILD, CAUSING THE HEAD TO FLOP BACK AND FORTH. THIS WHIPLASH MOTION CAN SLAM THE BRAIN AGAINST THE INSIDE OF THE SKULL AND TEAR BLOOD VESSELS. BRAIN SWELLING AND INTERNAL BLEEDING FROM INJURY CAUSES BRAIN TISSUE TO TEAR. BABIES UNDER THE AGE OF 6 MONTHS ARE AT THE HIGHEST RISK OF SBS, BUT IT CAN AFFECT CHILDREN UP TO THE AGE OF 3 DEPENDING ON MUSCLE DEVELOPMENT.STAFF MAKE REGULAR PRESENTATIONS AT SCHOOLS FROM ELEMENTARY THROUGH COLLEGE, COMMUNITY AGENCIES, CIVIC GROUPS AND CHURCH GROUPS ON THE TOPIC OF SHAKEN BABY SYNDROME. IN 2011 THE HELPLINE RECEIVED 155 CALLS FROM CAREGIVERS, PARENTS AND BABY SITTERS. 27,767 COPIES OF EDUCATIONAL MATERIALS WERE DISTRIBUTED. PARENTS ARE PROVIDED WITH A "NEW PARENT RESOURCE" BAG WHICH INCLUDES HELPFUL INFORMATION ABOUT SERVICES AND RESOURCES AVAILABLE TO THEM.THE FAMILY RESOURCE CENTER AT JENNIE EDMUNDSON HOSPITAL PROVIDED INFORMATION TO PATIENTS, COMMUNITY AND EMPLOYEES ABOUT SMOKING CESSATION IN AN EFFORT TO MOVE THE INDICATOR RELATING TO LUNG CANCER AND LUNG DISEASES. IN 2011, 44,156 COPIES OF SUCH MATERIALS WERE DISTRIBUTED. THE TOP FIVE TOPICS MOST REQUESTED RELATED TO NUTRITION, CANCER, CARDIOVASCULAR ISSUES, SUPPORT GROUPS AND SMOKING CESSATION.JENNIE EDMUNDSON HOSPITAL HOLDS AN ANNUAL FREE SKIN CANCER SCREENING. PHYSICIANS CONDUCT A SPOT CHECK OR FULL-BODY EXAM, BUT PARTICIPANTS ARE NOT REQUIRED TO UNDERGO A COMPLETE EXAM IF IT IS NOT DESIRED. A COPY OF THE SCREENING RESULTS ARE SENT TO EACH PARTICIPANT. INFORMATION ON THE PREVENTION OF SKIN CANCER IS ALSO AVAILABLE. JENNIE EDMUNDSON'S COMMITMENT TO SOUTHWEST IOWA EXTENDS TO A WIDE VARIETY OF OTHER ANNUAL SCREENING PROGRAMS COVERING 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: 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: THE PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING THE ACCOUNTS RECEIVABLE AGING, HISTORICAL COLLECTIONS EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND CONTRACTUAL ADJUSTMENTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO ESTABLISH THE NET REALIZABLE VALUE OF PATIENT ACCOUNTS RECEIVABLE. THE HEALTH SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES. SELF-PAY ACCOUNTS ARE CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AT THE TIME OF TRANSFER TO THE COLLECTION AGENCY. DEDUCTIBLES AND COINSURANCE ARE CLASSIFIED AS EITHER THIRD-PARTY OR SELF-PAY RECEIVABLES ON THE BASIS OF WHICH PARTY HAS THE PRIMARY REMAINING FINANCIAL RESPONSIBILITY, WHILE THE TOTAL GROSS REVENUE REMAINS CLASSIFIED BASED ON THE PRIMARY PAYOR AT THE TIME OF SERVICE. THERE ARE VARIOUS FACTORS THAT CAN IMPACT COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN MAY HAVE AN IMPACT ON UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE VOLUME OF PATIENTS THROUGH OUR EMERGENCY DEPARTMENTS, THE INCREASED BURDEN OF COPAYMENTS AND DEDUCTIBLES TO BE MADE BY PATIENTS WITH INSURANCE, AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND CAN HAVE AN IMPACT ON COLLECTION TRENDS AND OUR ESTIMATION PROCESS. NET PATIENT ACCOUNTS RECEIVABLE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE COLLECTED AND DO NOT BEAR INTEREST. PART III, LINE 8: SOURCE FOR MEDICARE REVENUE AND ALLOWABLE COSTS IS THE 2011 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 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. JENNIE EDMUNDSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 19D: THE AVERAGE COMMERCIAL INSURANCE RATE IS USED. 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 INSURE 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 NEEDS. 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 INFORM PATIENTS OF THE HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY. 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 PROVIDES OVERSITE OF ALL OPERATIONS. IT IS COMPOSED OF COMMUNITY LEADERS WITH DIVERSE BACKGROUNDS WITH A COMBINATION OF THOSE WITH LONGEVITY ON THE BOARD AND THOSE WHO ARE NEWER MEMBERS. THERE IS PHYSICIAN INVOLVEMENT WHICH ENHANCES THE ABILITY TO BE LEADERS 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. STATE FILING OF COMMUNITY BENEFIT REPORT LINE 7: NO DIRECT REPORT IS PROVIDED TO THE STATE OF IOWA. HOWEVER, INFORMATION FROM THE HOSPITAL'S COMMUNITY BENEFITS 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. 0 IOWA WESTERN COMMUNITY COLLEGE FOUNDATION 2700 COLLEGE ROAD COUNCIL BLUFFS IA 51503 421224333 501(C)(3) 14750 EDUCATION / SCHOLARSHIPS JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 421439454 501(C)(3) 40000 CHARITABLE CARE 2 0 SCHOLARSHIPS 8 5500 FINANCIAL ASSISTANCE 9090 4989500 BOOK FINANCIAL ASSISTANCE TO PATIENTS PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 0 289749 0 9052 0 68301 0 81377 0 20884 0 469363 0 41740 STEVEN BAUMERT 0 238985 0 0 0 36241 0 58008 0 20390 0 353624 0 0 LINDA BURT 0 345340 0 0 0 126167 0 82134 0 14751 0 568392 0 105240 JAMES CHAMBERS 144842 0 0 0 0 0 16697 0 12759 0 174298 0 0 0 ALAN FISHER MD 185227 0 0 0 0 0 18874 0 12548 0 216649 0 0 0 MICHAEL ROMANO MD 179112 0 0 0 15240 0 14626 0 19051 0 228029 0 0 0 PEGGY HELGET 145789 0 0 0 0 0 11482 0 7849 0 165120 0 0 0 NGUYET TRAN 200013 0 0 0 0 0 4790 0 754 0 205557 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 2011 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: STEVEN BAUMERT $27,414 ACCRUAL LINDA BURT $65,226 ACCRUAL; $105,240 PLAN DISTRIBUTION WILLIAM SHIFFERMILLER MD $34,366 ACCRUAL;PLAN DISTRIBUTION $41,740 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 A COPY OF THE FORM 990 WAS PROVIDED TO THE MEMBERS OF THE NEBRASKA METHODIST HEALTH SYSTEM AUDIT COMMITTEE WHO REVIEWED IT IN DETAIL. A COPY WAS PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS FOR REVIEW THROUGH A SECURE INTERNET PORTAL. INFORMATION FOR THE FORM 990 IS GATHERED FROM APPROPRIATE RESPONSIBLE PARTIES THROUGHOUT THE ORGANIZATION INCLUDING FINANCE, HUMAN RESOURCES AND CORPORATE COMPLIANCE DEPARTMENTS; IS REVIEWED BY EXTERNAL TAX ADVISORS AND HAS FINAL REVIEW BY THE CHIEF FINANCIAL OFFICER FOR THE 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 OF ALL CONFLICTS OF INTEREST, NOT JUST FINANCIAL, THAT COULD GIVE RISE TO CONFLICTS WITH THE ORGANIZATION. SHOULD A CONFLICT BE IDENTIFIED, 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. HOURS FOR RELATED ORGANIZATIONS FORM 990, PART VII, COLUMN B LINDA BURT,VICE PRESIDENT OF FINANCE AND CFO OF NEBRASKA METHODIST HEALTH SYSTEM, IS A FULLTIME EMPLOYEE OF NEBRASKA METHODIST HEALTH SYSTEM INC. HER AVERAGE HOURS PER WEEK HAVE BEEN ALLOCATED AMONG THE ENTITIES THAT COMPRISE THE NEBRASKA METHODIST HEALTH SYSTEM. HOURS FOR RELATED ORGANIZATIONS FORM 990, PART VII, COLUMN B STEVEN BAUMERT IS A KEY EMPLOYEE OF NEBRASKA METHODIST HEALTH SYSTEM AND IS ASSIGNED FULLTIME DUTIES AS PRESIDENT OF JENNIE EDMUNDSON MEMORIAL HOSPITAL. SALARY AND BENEFITS ARE INCLUDED IN ALLOCATIONS. HOURS FOR RELATED ORGANIZATIONS FORM 990, PART VII, COLUMN B DR. WILLIAM SHIFFERMILLER IS AN EMPLOYEE OF NEBRASKA METHODIST HOSPITAL WITH AN AVERAGE OF 40 HOURS PER WEEK. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -36,667. CHANGE IN MINIMUM PENSION LIABILITY -6,711,692. NET ASSETS RELEASED FOR OPERATIONS -219,715. TOTAL TO FORM 990, PART XI, LINE 5: -6,968,074. FORM 990, PART V, LINE 2A AND PART IX, LINE 5-10 THE PAYROLL SYSTEM FOR JENNIE EDMUNDSON MEMORIAL HOSPITAL IS BEING HANDLED BY A COMMON AGENT, NEBRASKA METHODIST HEALTH SYSTEM INC. ALL W-2 FORMS ARE ISSUED UNDER THE TAX IDENTIFICATION OF NEBRASKA METHODIST HEALTH SYSTEM. ALL REQUIRED EMPLOYMENT TAX RETURNS WERE FILED BY NEBRASKA METHODIST HEALTH SYSTEM. JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 421439454 SUPPORT OF JENNIE EDMUNDSON HOSPITAL IA 501 (C) (3) L11: I 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) 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 METHODIST HEALTH PARTNERS 8511 W DODGE ROAD OMAHA NE 68114 470797563 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C HEALTHCARE PARTNERS OF WESTERN IOWA 933 E PIERCE STREET COUNCIL BLUFFS IA 51503 421411452 MANAGED CARE CONTRACTING IA JENNIE EDMUNDSON MEMORIAL HOSPITAL C 1.00000 0 1 1 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION C 407926 CASH