2011-11-10T14:51:07-06:00 2010-12-31 KPMG LLP 2 CENTRAL PARK PLAZA SUITE 1501 OMAHA NE 68102 990 2010-01-01 420680355 JENNIE EDMUNDSON MEMORIAL HOSPITAL JENN 4023544840 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 LINDA BURT 4023544000 2011-11-08 1 4023481450 2010 2016-03-07 17:11:31Z STEVEN BAUMERT 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 96484281 0 X WWW.BESTCARE.ORG X 1894 IA TO PROVIDE AND MAINTAIN HOSPITAL AND AMBULATORY FACILITIES FOR THE CARE OF PATIENTS. 12 9 862 459 103050 -51465 183469 363964 91615939 93487745 146034 238211 1423074 1325455 93368516 95415375 24675 4247754 0 0 39917557 40834635 0 0 0 51691527 49308706 91633759 94391095 1734757 1024280 61188040 61502198 25069694 25944212 36118346 35557986 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 IN COUNCIL BLUFFS AND AT VARIOUS SATELLITE LOCATIONS THROUGHOUT SOUTHWEST IOWA. 0 0 86011160 34600 90752916 JENNIE EDMUNDSON MEMORIAL HOSPITAL IS RESPONSIBLE FOR INTRODUCING MANY MEDICAL "FIRSTS" INTO THE SOUTHWEST IOWA COMMUNITY INCLUDING HIGH-FIELD AND LOW-FIELD MRI'S, THE LATTER OF WHICH ALLOWS JENNIE EDMUNDSON TO TREAT LARGE AND CLAUSTROPHOBIC PATIENTS. JENNIE EDMUNDSON MEMORIAL HOSPITAL HAS ALSO INCORPORATED THE LATEST TECHNOLOGICAL ADVANCES TO AID IN THE EVALUATION AND DIAGNOSIS OF BREAST CANCER, INCLUDING DIGITAL MAMMOGRAPHY. IN ADDITION, JENNIE EDMUNDSON'S LEETE BREAST IMAGING CENTER PROVIDES WOMEN ACCESS TO STATE-OF-THE-ART TECHNOLOGY IN BREAST IMAGING OR MAMMOGRAPHY.JENNIE EDMUNDSON'S DIABETES SELF-MANAGEMENT EDUCATION, CERTIFIED BY THE AMERICAN DIABETES ASSOCIATION FOR MEETING THE NATIONAL STANDARDS FOR DIABETES SELF MANAGEMENT EDUCATION, IS PROVIDED FOR PATIENTS WHO HAVE BEEN RECENTLY DIAGNOSED WITH DIABETES OR THOSE WHO HAVE HAD THE DISEASE FOR SOME PERIOD OF TIME. INDIVIDUAL APPOINTMENTS CAN BE MADE WITH A DIABETES EDUCATOR OR DIETITIAN TO MEET EACH PATIENT'S NEEDS INCLUDING PATIENTS WITH DISABILITIES OR WHO DO NOT SPEAK ENGLISH.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 REHAB SERVICES AND INPATIENT CARE PROVIDED BY HIGHLY TRAINED CARDIAC CARE PROFESSIONALS. 1304352 0 3498897 JENNIE EDMUNDSON'S CANCER CENTER IS THE ONLY CANCER CENTER IS 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. 90275 0 0 THROUGH ITS FAMILY RESOURCE CENTER, JENNIE EDMUNDSON PROVIDES KEY LEADERSHIP TO IOWA'S SHAKEN BABY TASK FORCE. JENNIE EDMUNDSON EMPLOYEES WORK HAND-IN-HAND WITH TASK FORCE LEADERSHIP IN DISTRIBUTING INFORMATION AND MAKING PRESENTATIONS AIMED AT INCREASING PUBLIC AWARENESS OF THE DANGERS ASSOCIATED WITH SHAKEN BABY SYNDROME.THE FAMILY RESOURCE CENTER ALSO MAKES HEALTH-RELATED EDUCATIONAL MATERIALS AVAILABLE TO INDIVIDUALS AND THE COMMUNITY EITHER AT THE MAIN CAMPUS OR THROUGH THE WEBSITE AT WWW.BESTCARE.ORG. 87405787 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 33 0 862 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 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 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 BONNIE BOLTE 1.00 X 0 0 0 WILLIAM SHIFFERMILLER MD 1.00 X 0 475490 96025 JOHN G SOUTHARD MD PHD 1.00 X 27500 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 4002 0 0 STEVEN BAUMERT 40.00 X 0 268276 68233 LINDA BURT 40.00 X 0 369171 90349 JAMES CHAMBERS 40.00 X 142225 0 20236 CRAIG HANSEN MD 40.00 X 206461 0 15134 MICHAEL ROMANO MD 40.00 X 180481 0 34924 PEGGY HELGET 40.00 X 138788 0 17375 SAMUEL OAKES 40.00 X 134043 0 30409 833500 1112937 372685 17 0 1 0 PATHLAB LTD 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 MEDICAL 6303287 EMERGENCY PHYSICIANS WESTERN IOWA LLC 2015 SOUTH 86 AVENUE OMAHA NE 68124 MEDICAL 1580629 HORIZON HEALTH MANAGEMENT P O BOX 840839 DALLAS TX 75284 MEDICAL 672304 ACCELECARE WOUND CENTERS INC P O BOX 840703 DALLAS TX 75284 MEDICAL 393087 PSYCHIATRIC SERVICES OF WESTERN IOWA PC 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 MEDICAL 330000 13 184858 179106 363964 NET PATIENT SVC REV. 621990 92861397 92861397 OTHER PATIENT REVENUE 621990 626348 626348 93487745 215736 215736 1338821 943840 394981 394981 394981 22475 22475 22475 22475 188422 125066 63356 63356 CAFETERIA 722210 638712 638712 DAYCARE 624410 183037 79987 103050 TUITION REVENUE 611600 45369 45369 867118 95415375 94251813 103050 696548 25100 25100 4222654 4222654 801998 801998 30578942 30578942 1691487 1691487 5491135 5491135 2271073 2271073 65114 65114 21753 21753 623 623 8949006 8949006 177088 177088 15650588 15650588 32458 32458 3894117 3894117 51187 51187 118429 118429 458426 458426 4500679 4500679 792838 792838 ALLOCATIONS 6897818 6897818 PROVISION FOR BAD DEBTS 4218077 4218077 MEDICAL SUPPLIES 2259389 2259389 POSTAGE 235422 235422 BOOKS & SUBSCRIPTIONS 226390 226390 759304 759304 94391095 87405787 6985308 0 2342240 1629133 11600462 12979014 60505 552694 343262 720619 1044401 480544 693633 122042373 82963002 41840852 39079371 2334893 2274091 881321 892199 373910 2567094 61188040 61502198 9202728 9981779 8765518 7532841 7101448 8429592 25069694 25944212 X 35386074 34899020 632272 558966 100000 100000 36118346 35557986 61188040 61502198 X 1024280 -1584640 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 21753 0 0 0 21753 0 183700 1784 185484 257776 83700 -157776 183700 257776 257776 1.00000 0 1 1 2807651 2807651 71598728 43067208 28531520 47635994 39895794 7740200 39079371 MINIMUM PENSION LIABILITY 7081389 COND. ASSET RETIREMENT OBLIGATION 542850 ESTIMATED THIRD PARTY PAYABLE 805353 8429592 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. NO CHANGES WERE MADE TO THE FINANCIAL STATEMENTS DUE TO FIN48. 1 1 X 1 X 1 X 600.000000000000 1 1 1 0 1 1 2953656 0 2953656 0.03280 1212099 0 1212099 0.01340 0 0 4165755 4165755 0.04620 571805 0 571805 0.00630 190820 0 190820 0.00210 2310343 0 2310343 0.02560 0 0 30864 0 30864 0.00030 3103832 3103832 0.03430 7269587 7269587 0.08050 1 1274703 0 25967218 31084354 -5117136 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 PART I, LINE 7: THE METHODS PRIMARILY USED ARE THE RATIO OF COST TO CHARGES, FINANCIAL INFORMATION FROM THE MEDICARE COST REPORT AND ACTUAL EXPENDITURES.INFORMATION FOR FINANCIAL ASSISTANCE AND UNREIMBURSED MEDICAID REPORT THE NET OF GROSS PATIENT CHARGES WITH THE COST TO CHARGES RATIO APPLIED.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. 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 METHOD USED TO REPORT THE AMOUNT IN PART I, LINE 7, COLUMN (F):THE PERCENTAGE IS ARRIVED AT BY DIVIDING NET COMMUNITY BENEFIT EXPENSES IN COLUMN (E) BY THE SUM OF THE AMOUNTS ON FORM 990, PART IX, LINE 25, COLUMN (A) LESS BAD DEBT EXPENSE OF $4,218,077. PART II: COMMUNITY BUILDING ACTIVITIES INCLUDES PARTICIPATION IN COMMUNITY ORGANIZATIONS AND PARTNERSHIPS WITH ORGANIZATIONS WITH THE COMMON GOAL OF IMPROVING COMMUNITY HEALTH.JENNIE EDMUNDSON PERSONNEL OFFER THEIR LEADERSHIP SKILLS, TIME AND ASSISTANCE IN PROMOTING THE ECONOMIC DEVELOPMENT OF THE COUNCIL BLUFFS COMMUNITY THROUGH PARTICIPATION IN AND WITH THE LOCAL CHAMBER OF COMMERCE AND OTHER CIVIC ORGANIZATIONS. PART III, LINE 4: FOOTNOTE TO FINANCIAL STATEMENTS DESCRIBING BAD DEBT EXPENSE:THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. JENNIE EDMUNDSON MEMORIAL HOSPITAL 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. PART III, LINE 8: MEDICARE COST REPORT FOR 2010 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 ADDRESSTHE 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 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. 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 COLLABORATION OF LOCAL ORGANIZATIONS, IN WHICH NEBRASKA METHODIST HEALTH SYSTEM PARTICIPATES, WHICH IS DEDICATED TO IMPROVING THE HEALTH OF THOSE WHO LIVE AND WORK IN THE METROPOLITAN AREA. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: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. PART VI, LINE 4: JENNIE EDMUNDSON SERVES COUNCIL BLUFFS, IOWA AND SURROUNDING COMMUNITIES IN SOUTHWESTERN IOWA. PART VI, LINE 6: PROMOTING COMMUNITY HEALTH: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.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 24 STATES AND FIVE COUNTRIES OUTSIDE THE UNITED STATES INCLUDING CANADA, THE PHILLIPPINES, THE NETHERLANDS AND RUSSIA.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 2010 THE HELPLINE RECEIVED 154 CALLS FROM CAREGIVERS, PARENTS AND BABY SITTERS. 32,256 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 2010, 37,599 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 VI, LINE 7: 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. BROAD-BASED COMMUNITY HEALTH AND OUTREACH INTIATIVES INCLUDE TARGETED PROGRAMS THAT ALIGN CLOSELY WITH THE HEALTH NEEDS IDENTIFIED BY LIVEWELL OMAHA, A COLLABORATIVE ORGANIZATION DEDICATED TO IMPROVING THE HEALTH OF THOSE WHO LIVE AND WORK IN THE METROPOLITAN OMAHA AREA. THE LIST OF COMMUNITY BENEFITS PROGRAMS AND PROJECTS CONTINUALLY EVOLVES TO KEEP PACE WITH CHANGING TIMES, RESOURCES AND COMMUNITY NEEDS.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) 10500 EDUCATION / SCHOLARSHIPS IOWA LEGAL AID SOCIETY 532 FIRST AVENUE SUITE 300 COUNCIL BLUFFS IA 51503 421079277 501(C)(3) 10000 COMMUNITY NEED 2 0 SCHOLARSHIPS 14 34700 CHARITY CARE 6141 4187954 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. X X X X X 0 1 0 0 0 0 0 0 0 WILLIAM SHIFFERMILLER MD 0 285259 0 554 0 189677 0 80229 0 19736 0 575455 0 157790 STEVEN BAUMERT 0 213433 0 15000 0 39843 0 51255 0 18285 0 337816 0 0 LINDA BURT 0 333520 0 15030 0 20621 0 83219 0 8437 0 460827 0 0 JAMES CHAMBERS 142195 0 30 0 0 0 15199 0 5957 0 163381 0 0 0 CRAIG HANSEN MD 64298 0 92163 0 50000 0 7937 0 7603 0 222001 0 0 0 MICHAEL ROMANO MD 163886 0 95 0 16500 0 13434 0 22410 0 216325 0 0 0 PEGGY HELGET 138758 0 30 0 0 0 10558 0 7737 0 157083 0 0 0 SAMUEL OAKES 130986 0 30 0 3027 0 14660 0 16389 0 165092 0 0 0 PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NONQUALIFIED PLAN DURING 2010 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: STEVEN BAUMERT $21,905 ACCRUAL LINDA BURT $66,959 ACCRUAL WILLIAM SHIFFERMILLER MD $34,188 ACCRUAL AND PLAN DISTRIBUTION OF $157,790 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 AND THE EXECUTIVE COMMITTEE OF THE JENNIE EDMUNDSON HOSPITAL BOARD WHO REVIEWED IT IN DETAIL. THE COMMITTEES REPORTED TO THE BOARD OF DIRECTORS ON THEIR REVIEW OF THE FEDERAL FORM 990. A COPY WAS MADE AVAILABLE 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, SUCH AS MGMA OR OTHER RELIABLE COMPARABILITY DATA. 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.BESTCARE.ORG. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 137,111. CHANGE IN MINIMUM PENSION LIABILITY -1,524,971. NET ASSETS RELEASED FOR OPERATIONS -208,317. TRANSFER TO AFFILIATES 7,571. INCOME REPORTED ON SEPARATE TAX RETURN 3,966. TOTAL TO FORM 990, PART XI, LINE 5: -1,584,640. 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 EDUCATIONAL INSTITUTION 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 HEALTHCARE PARTNERS OF WESTERN IOWA 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 421411452 MANAGED CARE CONTRACTING IA N/A C 400 1.00000 SHARED SERVICE SYSTEMS INC 8511 W DODGE ROAD OMAHA NE 68114 470649534 MEDICAL SUPPLY DISTRIBUTION & LAUNDRY NE N/A C METHODIST HEALTH PARTNERS 8511 W DODGE ROAD OMAHA NE 68114 470797563 MANAGED CARE CONTRACTING NE N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION C 184858 CASH