2023-11-13T16:57:43-06:00 2022-12-31 990 2022-01-01 421439454 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION JENN 4023544840 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 JEFFREY E FRANCIS VP FINANCE & CFO 4023544000 2023-11-13 JEFFREY FRANCIS 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DAVID BURD 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 1597226 0 X N/A X 1994 IA SUPPORT THE PROGRAMS OF JENNIE EDMUNDSON MEMORIAL HOSPITAL. 19 18 0 0 0 0 1556695 1334257 0 0 412756 101277 1628 41452 1971079 1476986 920118 975089 0 0 0 0 0 0 0 20246 31240 940364 1006329 1030715 470657 6352475 5734093 49823 36985 6302652 5697108 SUPPORT JENNIE EDMUNDSON MEMORIAL HOSPITAL AND PROMOTE THE HEALTHCARE NEEDS OF THE RESIDENTS OF SOUTHWEST IOWA. 0 0 986799 975089 JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION PROVIDES SUPPORT FOR THE JENNIE EDMUNDSON MEMORIAL HOSPITAL'S KEY HOSPITAL BASED SERVICES INCLUDING THE BREAST HEALTH CENTER, CANCER-RELATED PROGRAMS, THE FAMILY RESOURCE CENTER AND CHARITABLE PATIENT CARE.A SIGNIFICANT PORTION OF THE FUNDRAISING CAMPAIGN RESULTS ARE CHANNELED TO THE CHARITABLE CANCER FUND WHICH PROVIDES FINANCIAL ASSISTANCE TO JENNIE EDMUNDSON HOSPITAL CANCER CENTER PATIENTS IN THEIR TIME OF NEED. THE FUND HAS HELPED UNDER-INSURED WITH CO-PAYS AND DEDUCTIBLES. IN SOME INSTANCES WHERE NEED HAS BEEN DEMONSTRATED, THE FUND HAS PROVIDED FINANCIAL ASSISTANCE FOR TREATMENT. 986799 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 19 18 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JEFFREY E FRANCIS 4023544840 825 S 169TH STREET OMAHA NE 68118 LEISHA HAMMER DIRECTOR 1.00 0.00 X 0 0 0 KATE MCGANN DIRECTOR 1.00 0.00 X 0 0 0 TERI WILSON DIRECTOR 1.00 0.00 X 0 0 0 BARB WALSH SECRETARY & TREASURER 1.00 0.00 X X 0 0 0 TAMI DOLL DIRECTOR 1.00 0.00 X 0 0 0 EDWARD LYNN DIRECTOR 1.00 0.00 X 0 0 0 MIKALA HOLTZ DIRECTOR 1.00 0.00 X 0 0 0 JOHN PAUL DIRECTOR 1.00 0.00 X 0 0 0 GRANT DEAN DIRECTOR 1.00 0.00 X 0 0 0 JEN CARLSON DIRECTOR 1.00 0.00 X 0 0 0 KATHY TISHER DIRECTOR 1.00 0.00 X 0 0 0 JANET WHITSON VICE CHAIRMAN 1.00 0.00 X X 0 0 0 SCOTT HARTMAN CHAIRMAN 1.00 0.00 X X 0 0 0 PAT ANDERSEN IMMEDIATE PAST CHAIRMAN 1.00 0.00 X 0 0 0 PAT AHRENS MD DIRECTOR 1.00 39.00 X 0 510445 60546 DIANE HUGHES DIRECTOR 1.00 0.00 X 0 0 0 CODY FORRISTALL DIRECTOR 1.00 0.00 X 0 0 0 JOHN MARSHALL DIRECTOR 1.00 0.00 X 0 0 0 STACEY TAMS DIRECTOR 1.00 0.00 X 0 0 0 JEFFREY FRANCIS CFO 4.00 36.00 X 0 631955 130435 DAVID BURD PRESIDENT 4.00 36.00 X 0 346220 42436 TARA SLEVIN VICE PRESIDENT 40.00 0.00 X 0 188437 31916 0 1677057 265333 0 0 1 0 0 90451 1243806 1334257 78962 78962 22315 0 22315 22315 22315 161692 90451 120240 41452 41452 1476986 0 0 142729 975089 975089 19530 19530 11710 11710 1006329 986799 19530 0 1 1305101 1263477 54839 75391 4915446 4310085 77089 85139 6352475 5734093 49823 36985 49823 36985 X 3719562 3263282 2583090 2433826 6302652 5697108 6352475 5734093 X 470657 -683000 -393201 X 0 1 X 1 0 X 1234553 1235758 1480589 1556695 1334257 6841852 1234553 1235758 1480589 1556695 1334257 6841852 746605 6095247 81300 469466 266395 190416 78962 1086539 7928391 0.76880 0.78230 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 196460 15598 4375 207683 199129 12581 15250 196460 191251 13993 6115 199129 201045 16825 26619 191251 109797 126500 -6314 28938 201045 0.60910 0.39090 0 0 0 OTHER LIABILITIES 21796 DUE TO AFFILIATES 15189 36985 X PART V, LINE 4: ENDOWMENT FUNDS ARE DESIGNATED FOR SCHOLARSHIPS. PART X, LINE 2: THE FOUNDATION 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 AS A RESULT OF FIN 48. CELEBRITY WEEKEND 252143 90451 161692 92892 10109 17239 252143 90451 161692 92892 10109 17239 120240 41452 1 JENNIE EDMUNDSON MEMORIAL HOSPITAL 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 420680355 501(C)(3) 675639 0 SUPPORT OF HOSPITAL PROGRAMS 1 FINANCIAL ASSISTANCE 67 56847 BOOK CHARITY CARE ADJUSTMENT PART I, LINE 2: GRANTS ARE PROVIDED TO OR FOR THE BENEFIT OF JENNIE EDMUNDSON MEMORIAL HOSPITAL ON A DEMONSTRATED SHORT-TERM NEED BASIS. NO FOLLOW-UP IS REQUIRED. PART III, COLUMN B: FINANCIAL ASSISTANCE IS OFTEN PROVIDED TO PATIENTS WITH DEMONSTRATED NEED WHO PARTICIPATE IN THE BREAST HEALTH CENTER, FAMILY RESOURCE CENTER AND CANCER-RELATED PROGRAMS. AS AN EXAMPLE, THIS ASSISTANCE IS OFTEN USED TO PAY FOR MEDICATIONS AND RADIATION/CHEMO TREATMENTS. 0 1 0 0 0 0 0 0 0 JEFFREY FRANCIS CFO 0 520672 0 14154 0 97129 0 99231 0 31826 0 763012 0 93756 PAT AHRENS MD DIRECTOR 0 475247 0 14284 0 20914 0 30610 0 31714 0 572769 0 0 DAVID BURD PRESIDENT 0 294226 0 31080 0 20914 0 17010 0 26048 0 389278 0 0 TARA SLEVIN VICE PRESIDENT 0 151955 0 15540 0 20942 0 23878 0 8575 0 220890 0 0 PART I, LINE 3 SEE SCHEDULE O, PART VI, SECTION B, LINE 15 EXPLANATION REGARDING THE METHODS USED BY A RELATED ORGANIZATION TO ESTABLISH COMPENSATION. PART I, LINE 4B THE FOLLOWING INDIVIDUALS PARTICIPATED IN A NEBRASKA METHODIST HEALTH SYSTEM NONQUALIFIED PLAN DURING 2022 AND RECEIVED CONTRIBUTIONS, PLAN ACCRUALS OR PLAN DISTRIBUTIONS IN THE FOLLOWING AMOUNTS: DAVID BURD $1,660 ACCRUAL JEFFREY FRANCIS $77,881 ACCRUAL; $93,756 PLAN DISTRIBUTION TARA SLEVIN $6,295 ACCRUAL PATRICK AHRENS, MD $10,889 ACCRUAL FORM 990, PART VI, SECTION A, LINE 6 UNDER THE ARTICLES OF INCORPORATION FOR THE FOUNDATION, JENNIE EDMUNDSON MEMORIAL HOSPITAL, AN IOWA NONPROFIT CORPORATION, IS THE SOLE VOTING MEMBER OF THE JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION. THE AFFAIRS OF THE CORPORATION ARE DIRECTED BY A BOARD OF DIRECTORS, 50% OF WHOM ARE MEMBERS OF THE WOMEN'S CHRISTIAN ASSOCIATION OF COUNCIL BLUFFS, IOWA. FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION IS COMPOSED OF NO LESS THAN 3 PERSONS. AT LEAST 50% OF THE DIRECTORS SHALL BE MEMBERS OF THE WOMEN'S CHRISTIAN ASSOCIATION OF COUNCIL BLUFFS, IOWA (WCA) WHO HAVE FIRST BEEN NOMINATED BY WCA. FORM 990, PART VI, SECTION A, LINE 7B THE ARTICLES OF INCORPORATION INDICATE THAT JENNIE EDMUNDSON MEMORIAL HOSPITAL, THE SOLE MEMBER, HAS THE RIGHT TO APPROVE THE APPOINTMENT OF THE BOARD OF DIRECTORS OF THE JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE FORM 990 WAS PROVIDED TO MEMBERS OF THE NEBRASKA METHODIST HEALTH SYSTEM AUDIT AND COMPLIANCE COMMITTEE WHO REVIEWED IT IN DETAIL. THE AUDIT AND COMPLIANCE COMMITTEE APPROVED THE FILING OF THE FORM 990 AND COMMUNICATED THIS APPROVAL TO THE FOUNDATION'S BOARD OF DIRECTORS. ADDITIONALLY, THE BOARD COULD ACCESS A SECURE WEBSITE TO REVIEW THE FORM 990. THE CFO ANNOUNCED THAT A COPY OF THE FORM 990 WAS AVAILABLE AT HIS OFFICE OR IN THE METHODIST HEALTH SYSTEM TAX DEPARTMENT FOR ANYONE TO REVIEW. 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 SYSTEM CONTROLLER REVIEW. IT 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 OF 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 NOT INVOLVED IN THE CONFLICT, AT A MEETING AT WHICH A QUORUM IS PRESENT, THAT THE ARRANGEMENT OR TRANSACTION IS IN THE BEST INTERESTS OF JENNIE EDMUNDSON MEMORIAL HOSPITAL FOUNDATION 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 FOUNDATION IS AN AFFILIATED MEMBER OF THE NEBRASKA METHODIST HEALTH SYSTEM. POLICIES ARE CENTRALIZED AT NEBRASKA METHODIST HEALTH SYSTEM INC. METHODIST HEALTH SYSTEM 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. ALL OFFICER COMPENSATION IS REVIEWED, EVALUATED AND APPROVED BY THIS COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE THESE DOCUMENTS SEPARATELY AVAILABLE TO THE PUBLIC. HOWEVER, THE ARTICLES OF INCORPORATION ARE AVAILABLE THROUGH THE IOWA SECRETARY OF STATE WEBSITE. THE CONFLICT OF INTEREST POLICY IS DISTRIBUTED TO 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 COMMUNITY BENEFITS IT PROVIDES AS PART OF THE METHODIST HEALTH SYSTEM'S ANNUAL COMMUNITY BENEFIT REPORT. THE REPORT IS AVAILABLE TO THE PUBLIC ON THE WEBSITE: BESTCARE.ORG/ABOUT/COMMUNITY-BENEFITS/OUR-COMMUNITY-AND-FINANCIAL-IMPACT. FORM 990, PART XI, LINE 9: AFFILIATE CONTRIBUTIONS CHG IN VALUE OF CHARITABLE REMAINDER TRUSTS AND RELATED ANNUITIES PAYABLE -17,328. NET ASSETS RELEASED FROM RESTRICTIONS FOR USE IN OPERATIONS -375,873. JENNIE EDMUNDSON MEMORIAL HOSPITAL 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51503 420680355 LICENSED HOSPITAL IA 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM INC 0 NEBRASKA METHODIST HEALTH SYSTEM INC 825 S 169TH STREET OMAHA NE 68118 470639839 ADMINISTRATIVE SUPPORT NE 501(C)(3) L12: III-FI N/A 0 NEBRASKA METHODIST HEALTH SYSTEM SELF INSURANCE TRUST FUND 825 S 169TH STREET OMAHA NE 68118 363699672 INSURANCE NE 501(C)(3) L12: III-FI NEBRASKA METHODIST HEALTH SYSTEM INC 0 REAL ESTATE HOLDINGS INC 825 S 169TH STREET OMAHA NE 68118 470649790 PROPERTY MANAGEMENT NE 501(C)(2) N/A NEBRASKA METHODIST HEALTH SYSTEM INC 0 NEBRASKA METHODIST HOSPITAL 825 S 169TH STREET OMAHA NE 68118 470376604 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM INC 0 NEBRASKA METHODIST COLLEGE OF NURSING & ALLIED HEALTH 825 S 169TH STREET OMAHA NE 68118 470724387 NURSING AND HEALTH EDUCATION FACILITY NE 501(C)(3) L2 NEBRASKA METHODIST HOSPITAL 0 PHYSICIANS CLINIC INC 825 S 169TH STREET OMAHA NE 68118 470687317 CLINICAL HEALTH CARE NE 501(C)(3) L10 NEBRASKA METHODIST HEALTH SYSTEM INC 0 NEBRASKA METHODIST HOSPITAL FOUNDATION 825 S 169TH STREET OMAHA NE 68118 470595345 SUPPORT OF NEBRASKA METHODIST HOSPITAL NE 501(C)(3) L7 NEBRASKA METHODIST HEALTH SYSTEM INC 0 METHODIST FREMONT HEALTH 450 E 23RD STREET FREMONT NE 68025 831362276 LICENSED HOSPITAL NE 501(C)(3) L3 NEBRASKA METHODIST HEALTH SYSTEM INC 0 FREMONT HEALTH CLINIC 450 E 23RD STREET FREMONT NE 68025 470717207 CLINICAL HEALTH CARE NE 501(C)(3) L10 METHODIST FREMONT HEALTH 0 SHARED SERVICE SYSTEMS INC & SUBSIDIARY 825 S 169TH STREET OMAHA NE 68118 470649534 MEDICAL SUPPLY DISTRIBUTION & LAUNDRY NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 METHODIST HEALTH PARTNERS 825 S 169TH STREET OMAHA NE 68118 470797563 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 FREMONT HEALTH PARTNERS 450 E 23RD STREET FREMONT NE 68025 460735043 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 HEALTH CHOICE OF NEBRASKA 450 E 23RD STREET FREMONT NE 68025 470783732 MANAGED CARE CONTRACTING NE NEBRASKA METHODIST HEALTH SYSTEM INC C 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0