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A newsletter from Winneshiek Medical Center Foundation

The Community Heartbeat is published by Winneshiek Medical Center Foundation.

Questions and suggestions may be submitted by contacting: Winneshiek Medical Center Community Relations, 901 Montgomery St., Decorah, IA 52101

563-382-2911 or communityrelations@winmedical.org

Winneshiek Medical Center does not exclude

discriminate against any person on the basis of race, color, gender, sexual orientation, gender identity, age, national origin, religion, or disability in admission to,

any of its programs and activities or in employment. If assistive or communication aids for impaired hearing,

vision, speech, or manual skills are needed, Winneshiek Medical Center will make reasonable accommodations.

A heartfelt thank you to all of you who have already donated to this year’s Annual Fund.

We have a very ambitious goal this year - to buy a new ambulance! We are very fortunate in Winneshiek County to have a great ambulance service staffed by

responders. To help them do their job, and to provide the latest in equipment for the care and comfort for their patients, a new ambulance costs over $230,000. Hopefully, you or your loved ones will never need to ride in an ambulance. But we all know that accidents and medical emergencies can happen at any time to anyone, and you may someday appreciate the availability of a well-equipped ambulance. So, if you haven’t already done so, please consider contributing to the Annual Fund to help us reach our goal. The people in Winneshiek County are thankful for your support.

Signs of autumn are in sharp contrast to the warm summer day (well, yes, let’s just say it was indeed hot) that the WMC Community Picnic was held. But nevertheless, there was a good turnout of folks who enjoyed checking out the helicopter and ambulance, listening to and watching the variety of entertainment, visiting with friends, and of course the food. It’s always good for us to have happy reasons to bring people together. Thanks to the WMC staff for all of their efforts to make this event happen.

John Noel WMC Foundation President

John NoelWMC Foundation

President

Annual Fund to purchase a new ambulance

Winneshiek Medical Center Board of TrusteesRick Burras, Chair

Roger Huinker, Vice-Chair Clark Goltz, Sec./Treasurer

Sherry GribbleSteve Hildebrand

Karl JacobsenJudith Robinson

WMC Foundation Board DirectorsKeri Bodensteiner

Amy BrueningKarla Erdman

Dan Fretheim, Secretary/TreasurerDawn Muhlbauer, Vice President

John Noel, PresidentBrad Orvis, M.D.Chris RedeniusJerry Samuelson

Wendy Mihm-HeroldDan Ryan

Karl Jacobsen & Steve Hildebrand - WMC Board of Trustees Liaisons

Holly Kanengieter, Foundation Coordinator

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The Community Heartbeat is published byWinneshiek Medical Center Foundation

support. John Noel WMC Foundation Presid

insideYour Community Heartbeat Delivering providers atWinneshiek Medical Center 4 Seasonal affective disorder 5 Diabetes tips and Betty’s determination 7 Improving mental health with exercise 9 Donor spotlight:Decorah Bank & Trust Company 11 Foundation donor listing 12-15

Visit us online at

winmedical.org3

Finley Fouts is a cuddly, cheerful baby whose smile lights up a room. However, his baby antics had a rocky start when his birth

did not go quite as planned. Living just a stone’s throw away from Winneshiek Medical Center,

Cassie and Jacob Fouts of Decorah were in no hurry to check in after Cassie’s labor started. “I began to experience contractions a little after midnight, and we arrived at the medical center the next morning around 6:30,” says Cassie. Later that evening, as Cassie and Jacob continued to anticipate their new baby’s arrival (with the thankful assistance of an epidural), Cassie’s doctor, Tyler Menke, M.D., noticed worrisome changes in the baby’s heart rate. Using assistive technology, Finley was born in under one minute.

“When I saw him, Finley’s skin was gray and he wasn’t moving his arms or legs,” says Cassie. “The OB team split into two – most went with Finley into the nursery, while a nurse stayed with me.” For two hours, the couple waited to meet their new son, encouraged only by

When the birth of their son, Finley, took an unexpected turn, Jacob and Cassie Fouts felt blessed to have skilled medical professionals in their community at Winneshiek Medical Center.

Experienced OB care gives parents piece of mind

___________________________________BABY: continued on page 4

Cover photo: Finley Fouts is all smiles as his parents, Cassie and Jacob, share the story of this birth at Winneshiek Medical Center.

newborn cries from the nursery. They learned the umbilical cord had wrapped around Finley’s shoulders and was being squeezed as contractions became more

off Finley’s oxygen source. “That is what was causing the heart rate changes – the rise and fall of his oxygen levels,” says Cassie.

Under the careful attention of Dr. Menke and the OB team, Finley began to perk up and soon he was in the arms of his mother. Jacob says, “We felt nervous after Finley was born, but we remained calm because we knew he was in the good hands of Dr. Menke and the OB staff.” Cassie adds, “The nurses commented on how calm we both were after Finley’s birth, but we knew Dr. Menke would take the best care of him.”

Mayo Clinic Health System family medicine physician, Tyler Menke, M.D., is one of nine Mayo Clinic Health System and Gundersen Health System providers who deliver babies at Winneshiek Medical Center. The OB department is a private,

exclusive unit with a dedicated staff of registered nurses, including breastfeeding experts and car seat technicians. It is equipped to handle planned and emergency c-sections, offers respiratory therapy available 24-hours a day/seven days a week, aromatherapy for before, during and post-delivery, and is equipped with a central fetal monitoring system

along with tele-medicine for immediate neonatologist consultation, if needed. In addition, Winneshiek Medical Center delivers more babies than other area hospitals, and is the only hospital in the area to offer epidurals on a 24-hour basis for every OB patient.

Two days later, the Fouts family made the short trek home, healthy baby in tow. Cassie says, “We greatly enjoyed our time at Winneshiek Medical Center – from pre-natal care to labor and delivery – and we couldn’t have asked for a

to Winneshiek Medical Center for future deliveries because of the remarkable care we receive from Dr. Menke and the nursing staff. We feel blessed to have

amazing people, who gave us the greatest gift of our lives – a healthy baby boy.”

to Winneshiek Medical Center for future deliveries because of the

remarkable care we receive from Dr. Menke and the nursing staff. We feel blessed to have such a

staffed with amazing people, who gave us the greatest gift of our

lives – a healthy baby boy.”~Cassie Fouts

Mayo Clinic recently honored the Winneshiek Medical Center Obstetrics department for scoring in the top 10% of hospitals nationwide for overall patient satisfaction. Dawn Sanderman, RN, MAN, director of Inpatient Services at Winneshiek Medical Center says, “At WMC our OB team understands that the birth of a baby is an incredibly personal experience. It is our goal to provide expert medical care with the personal touches only found at a rural hospital, and our providers and staff are honored to celebrate each birth alongside the new families.”

BABY: continued from page 3________________________________________________________________

Mayo Clinic Health System and Gundersen Health System providers deliver at Winneshiek Medical Center: Seated (left-right): Sarah Wymer, M.D., and Matthew Thompson, D.O. Standing (left-right): Kevin Locke, M.D., Janet Ryan, M.D., Tyler Menke, M.D., Andy Goodner, M.D., and Emily Young Johnson, C.N.M. Not pictured: Kristy Schilling, M.D., and Kurt Swanson, D.O.

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Rehab & Sports Medicine563-387-3031 winmedical.org/dementia

Seeing the Person

Dementia Care Program• Designed to improve the quality of life for people with any stage

of dementia and their family.• Available to anyone who has been diagnosed with dementia,

whether they live in their own home or in a long term care facility.• Teaching coping strategies for early onset dementia and

techniques to manage undesirable behavior in late stage dementia.

• Medicare, Medicaid and most insurance will cover dementia care programs. Patients should check with their insurance carrier to be sure.

Contact your doctor for a referral to WMC’s Dementia Care Program.

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According to Bridgette Hensley, Psy.D.,L.P, Mayo Clinic Health System Clinical

Psychologist at Winneshiek Medical Center, seasonal affective disorder (SAD) is a type of depression that’s related to changes in seasons. A recent National Institute of Mental Health (NIMH) funded study found that SAD symptoms stem from daily body rhythms that have gone out of sync with the sun.

SAD tends to affect people in northern latitudes in winter, especially young women. “Most

depression usually begins and ends the same time each year,” says Dr. Hensley. “Although, symptoms

start in the fall and continue into the winter months, SAD can also cause depression in the spring or early summer.”

is likely that that the pineal gland, which is located in the middle of the brain and responds to darkness by secreting melatonin is involved. The lack of light may upset your “biological clock,” which controls your light/dark cycle, which in turn res-sets the sleep/wake cycle and other daily rhythms. A lack of light may also cause problems with serotonin, a brain chemical that affects mood.

Symptoms of fall and winter SAD may include:• Irritability• Tiredness or low energy• Problems getting along with other people• Hypersensitivity to rejection

• Heavy, “leaden” feeling in the arms or legs• Oversleeping• Appetite changes, especially a craving for

foods high in carbohydrates• Weight gain

“We don’t want people do simply brush off that feeling of the ‘winter blues,’” says Dr. Hensley. “While it is normal to feel down some days, when that feeling lasts for several days you should make an appointment with your family doctor to talk about how you can take steps to keep your mood and motivation steady throughout the entire year. This is especially important if you feel hopeless, think about suicide, or turn to drinking alcohol for comfort.” To make an appointment with a local Mayo Clinic Health System family medicine provider, contact Winneshiek Medical Center Clinic at 563-382-2911. If you are having thoughts of suicide, please reach out for help and call the National Suicide Prevention Lifeline at 1-800-273-TALK or the local crisis line at 563-382-3649. If you are in imminent danger of hurting or killing yourself call 911 or go to your local emergency room.

Seasonal AffectiveDisorder

Bridgette Hensley, Psy.D., L.P., Mayo

Clinic HealthSystem clinical psychologist

at Winneshiek Medical Center

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Changing your lifestyle could be a big step toward diabetes prevention — and it's never too late to start. Consider these tips. When it comes to type 2 diabetes — the most common type of diabetes — prevention is a big deal. It's especially important to make diabetes prevention a priority if you're at increased risk of diabetes, for example, if you're overweight or have a family history of the disease.

Diabetes prevention is as basic as eating more healthfully, becoming more physically active and losing a few extra pounds — and it's never too late to start. Making a few simple changes in your lifestyle now may help you avoid the serious health complications of diabetes down the road, such as nerve, kidney and heart damage. Consider the latest diabetes prevention tips from the American Diabetes Association.

Get more physical activity

physical activity. Exercise can help you: • Lose weight• Lower your blood sugar

• Boost your sensitivity to insulin — which helps keep your blood sugar within a normal range

Research shows that both aerobic exercise and resistance training can help control diabetes, but the

includes both.

Get plenty of fiberIt's rough, it's tough — and it may help

you: • Reduce your risk of diabetes by improving your blood sugar control

• Lower your risk of heart disease • Promote weight loss by helping you feel full

beans, whole grains, nuts and seeds.

Go for whole grainsAlthough it's not clear why, whole

grains may reduce your risk of diabetes and help maintain blood sugar levels.

Try to make at least half your grains whole grains. Many foods made from whole grains come ready to eat, including various breads, pasta products and many cereals. Look for the word "whole" on

ingredient list.

Lose extra weightIf you're overweight, diabetes prevention may hinge on weight loss. Every pound you lose can improve your health, and you may be surprised by how much.

Participants in one large study who lost a modest amount of weight — around 7 percent of initial body weight — and exercised regularly reduced the risk of developing diabetes by almost 60 percent.

Skip fad diets and just make healthier choices

Low-carb diets, the glycemic index diet or other fad diets may help you lose

preventing diabetes isn't known nor are their long-term effects. And by excluding or strictly limiting a particular food group, you may be giving up essential nutrients. Instead, think variety and portion control as part of an overall healthy-eating plan.

When to see your doctorIf you're older than age 45 and your weight

is normal, ask your doctor if diabetes testing is appropriate for you. The American Diabetes Association recommends blood glucose screening if:

• You're age 45 or older and overweight• You're younger than age 45 and overweight

with one or more additional risk factors for type 2 diabetes — such as a sedentary lifestyle or a family history of diabetes

Share your concerns about diabetes prevention with your doctor. He or she will applaud your efforts to keep diabetes at bay, and perhaps offer additional suggestions based on your medical history or other factors.

tips for taking control5Diabetes prevention By Mayo Clinic Staff

5Tip

4Tip

1Tip

2Tip

3Tip

Betty Hebrink of Cresco was surprised when she was told by her doctor that her blood

glucose levels were high and she had type 2 diabetes.To learn about diabetes and how to manage the

disease, Betty took diabetes education classes at Winneshiek Medical Center from Registered Nurse and Diabetes Educator Jean Irvin and Registered Dietitian Nutritionist, Licensed Dietitian Angie Kerndt. There, she learned about carbohydrate counting and how to control her blood glucose levels by making healthy food choices and engaging in regular exercise. Kerndt says, “The diabetes education classes at Winneshiek Medical Center provide information to help people make positive decisions for their health to manage their diabetes.” Diabetes can lead to other serious health issues; however, with education, healthy lifestyle choices, and regular medical care, type 2 diabetes can be managed successfully.

Betty did not have an attitude of defeat, but one of possibility. She says, “Two years ago I had breast cancer. When you have cancer, you are at the mercy of the disease and available treatments. I couldn’t control the cancer… but I could control this.”

Betty’s mindset shaped her actions that followed.

She says, “Although I already exercised every day, I accepted it was not enough and increased my time walking and on my bike. I also adjusted how I ate so my portions were smaller.”

In just four months, Betty has lost 27 pounds and her blood glucose levels are back in check. She is able to manage her diabetes without any medication

Irvin says, “Unfortunately, people with pre-diabetes or type 2 diabetes can live for years without realizing they have the disease.” In fact, the Centers for Disease Control and Prevention (CDC) estimates that 86 million American adults have pre-diabetes (1 out of 3), which places them at increased risk for developing type 2 diabetes.

About her decision to improve her lifestyle choices instead of relying on medication therapy, Betty says, “I have never felt deprived or starved, I have a tremendous energy level, and I feel and sleep better.” Her recommendation for others with diabetes is: “If you have it, take care of it.”

For more information on diabetes education at Winneshiek Medical Center, talk to your doctor or call 563-382-2911. Information is also available online: www.winmedical.org/diabetes-education.

Betty takes control of her type 2 diabetes

Betty Hebrink (center) took diabetes education classes at Winneshiek Medical Center from Registered Nurse and Diabetes Educator Jean Irvin (left) and Registered Dietitian Nutritionist, Licensed Dietitian Angie Kerndt (right). There, she learned about carbohydrate counting and how to control her blood glucose levels by making healthy food choices and engaging in regular exercise.

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Depending on your situation, you may want to

you trust. Here are a few examples:Consent to Treat a Minor Parents or guardians can give consent for treatment

of a minor. This may apply if you are leaving town without your children for a few days, have children in

someone else listed to help out with appointments or other non-urgent needs. Adults listed on the Consent to Treat a Minor form can authorize diagnostic and/or medical treatment, as recommended by the attending health care provider. Consent to Treat a Minor expires on December 31 of each year, and must be re-instated on an annual basis. Note: Anyone can bring a minor child into the 24/7 ER for emergent care.

Authorization for Verbal Communication of Health Information

This type of authorization allows adults to give consent for others to receive verbal-only communication on their health care. You may choose to allow all information to be shared, or you can limit it to certain things. Common applications of this authorization include parents who pay the medical bills of their college-age children and want the ability

to ask questions, people who manage someone else’s health care (such as an elderly parent), and anyone who is on medications that require frequent testing and adjustment. Authorization for Verbal Communication of Health Information also must be reinstated each year.

Medical Durable Power of AttorneyIn case you are unable to make decisions in the

event of an accident, illness or injury, you may want to consider naming someone you trust as your medical power of attorney. This person will make medical decisions on your behalf, as recommended by the attending health care provider, and according to your wishes. Medical Power of Attorney only needs to be re-visited if you are changing the person you have named. If you share the signed Medical Power of Attorney document with us, WMC includes it in your medical record. It is appropriate for adults of all ages to choose a medical power of attorney.

For more information on the various consents available and if they are right for you, talk to your primary health care provider, or call Winneshiek Medical Center at 563-382-2911 and ask to speak with Health Information Management.

Can someone help you manage your health care?

True or false: The flu vaccine can give you the flu

False:

for other reasons, such as:True: Reaction to the vaccine. Muscle aches and a fever

runny nose, headache and sore throat.True: The 2-week window. It takes up to two weeks for the vaccine to become effective, so you could develop the

True: vaccine doesn’t match the viruses circulating during the

True: Other illnesses. Other illnesses, including the

Adapted from www.mayoclinic.org.

any one of the convenient WMC Clinic locations in Decorah, Ossian or Mabel: 563-382-2911.

Rub your hands vigorously

for at least 20 seconds.

the best way to avoid developing a cold

hands.

Last November, Winneshiek Medical Center

or agencies working to serve the mental health needs in the community. Northeast Iowa Behavioral Health (NEIBH) was a recipient of the grant program.

“If you feel good on the outside, you will feel good on the inside,” says Judy Holthaus, a peer support specialist at NEIBH. Judy sought to make this a reality for members of their integrated health program, and NEIBH Director Marcia Oltrogge applied for a community mental health grant from the Winneshiek Medical Center Foundation. Their goal: to promote physical activity to individuals with a mental health diagnosis and limited resources by

for members to exercise close to their home. Judy says, “The reality is, people will rarely commit to driving an hour each way to exercise at our Decorah behavioral health center; we needed to make the program more accessible if members were going to realistically participate.”

Judy set out to pairing exercise centers with members who had expressed interest in increasing

Cresco Fitness Center, Lime Springs Fitness Center, Luana Recreation Center, Postville YMCA, Waukon Wellness Center and Winneshiek Medical Center.

Members who accepted the one-month passes were held accountable for their participation in the program. In addition to signing a contract agreeing they would utilize the exercise facility at least 12 times a month, members had to report the previous week’s activity back to NEIBH staff. Judy says, “We noticed that the program started to impact more than physical health. Members reported feeling safe exercising in a staffed facility rather than walking alone on a sidewalk. They shared that their feelings of anxiety were reduced, and that they were feeling more independent.”

“The Foundation is pleased to be part of innovative programs like the physical health improvement project at Northeast Iowa Behavioral Health,” says Holly Kanengieter, coordinator of the WMC Foundation. “It is truly exciting for the Foundation and our donors to hear about how our gifts made a real impact for individuals and families.”

Judy is thankful for Winneshiek Medical Center Foundation for supporting the exercise program. She says, “By funding the program, members were given something they did not know was possible for them. Through exercise, they were given feelings of safety, freedom, peace, friendship, and possibility. At NEIBH, we consider that a success.”

To learn more about or donate to the WMC Foundation, visit www.winmedical.org/giving or call 563-387-3129.

Improving mental health with exercise

Judy Holthaus, peer support specialist at Northeast Iowa Behavioral Health, walks weekly with Larry Sells, a member of the integrated health program. Larry received a pass to a local

physical health – a program supported by the Winneshiek Medical Center Foundation.

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Jason Engelken, DPT, ATC, Physical TherapistJason Engelken, DPT, ATC, has joined the Rehab

& Sports Medicine Department at Winneshiek Medical Center. A doctor of physical therapy and an athletic trainer, Engelken works closely with athletes on injury prevention, recovery and performance. Before joining WMC, Engelken graduated from Luther College in 2012. He then completed graduate

school at Washington University in St. Louis in May 2015. In 2014, Engelken interned in Dallas, TX with EXOS, a performance training and physical therapy facility for elite and professional athletes. During his time with EXOS, Engelken provided services for NFL, MLB, and major league soccer players.

WelcomeNEW Providers & Staff

Physical therapy services continue to expand at Winneshiek medical Center with the addition of Alexandra (Alex) Engelken, DPT. Alex graduated from Luther College with a Bachelor of Arts in health, and received her Doctor of Physical Therapy from Washington University in St. Louis,

Missouri. Alex provides inpatient and outpatient physical therapy, and has specialized training in vestibular rehabilitation (Vestibular rehabilitation is a specialized form of therapy designed to alleviate both primary and secondary symptoms of vestibular disorders such as dizziness and disequilibrium), fall prevention and pediatrics.

Lisa J. Barnes, MS, PA-C, Physician Assistant/ENTLisa J. Barnes, MS, PA-C, recently joined the

ear, nose and throat (ENT) specialty at Winneshiek Medical Center.

Lisa received her Bachelor of Arts in Psychology and Social Studies from Hamline University in St. Paul, and her Master of Science in Physician Assistant Practice from Rosalind Franklin University

of Medicine and Science (formerly known as Finch University of Health Sciences/The Chicago Medical School) in North Chicago, Illinois in 1998. She has experience in dermatology, and most recently, worked as a hospitalist in thoracic surgery at Mayo Clinic-Rochester.

Winneshiek Medical Center Rehab & Sports Medicine has added their sixth occupational therapist: Stacey Quam, OTR/L. Quam provides services that help patients restore function and participate in activities of daily living following illness

or injury. Originally from Des Moines, Quam attended University of Northern Iowa, receiving her Bachelor of Arts degree in biology. She then went on to receive her Master of Arts in Occupational Therapy from the University of Minnesota.

Stacey Quam, OTR/L, Occupational Therapist

has joined Rehabilitation and Sports Medicine at Winneshiek Medical Center. Derek received his Bachelor of Science degree in athletic training from Upper Iowa University on 2001. He has practiced as an

athletic trainer in northeast Iowa since 2002. Rausch provides athletic training services to Turkey Valley Schools. WMC athletic trainers serve seven area schools: Decorah, South Winneshiek, Turkey Valley, Postville, MFL, Mabel-Canton, Spring Grove; and is part of the team that provides athletic training services at Luther College.

Derek Rausch, ATC, Certified Athletic Trainer

Alexandra Engelken, DPT, Physical Therapist

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Donor spotlightDecorah Bank & Trust Company

Decorah Bank & Trust Company has been a faithful supporter of Winneshiek Medical

Center Foundation for many years. In addition to

employees to volunteer their time and talents by serving on Winneshiek Medical Center boards.

“We feel fortunate to have such a gracious community partner,” says Holly Kanengieter, WMC Foundation Coordinator. “The bank’s commitment to our mission is evident each year. With their help, along with gifts from other community members and businesses, the Foundation is able to support

meet the health care needs of our community.”This year’s WMC Foundation Annual Fund goal

is to raise $232,000 for a fully-equipped ambulance.

to join the campaign and give their gift of $15,000 toward this community need.

“High quality emergency services are essential to a community,” says Ben Grimstad, president of Decorah Bank & Trust Company. “The decision to

Fund is an investment in the care of our families, neighbors, and visitors. Community commitment continues to be an important part of our mission,

inspire others to donate in an effort to bring a new ambulance unit to Winneshiek County.”

the 2015 Annual Fund campaign and give their gift of $15,000 toward a new ambulance. Pictured left-right: Lisa Radtke, chief

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Benefactor - $5,000 & aboveArp, Dave & Candace ..................Bev Schuman - Hospice Contributions Marion Jerome Foundation - Hospice

ContributionsSchuldt, Dennis, M.D. ..................Annual Fund 2015

Investor - $2,500-$4,999Calmar Corvette Club ..................Diabetes Education

Associate - $1,000-$2,499Donations .....................................Hospice Ride - Hospice ContributionsHove, Paula ..................................Steve Hove - Hospice Contributions

Patron - $500-$999Dostal, JoAnn ...............................Gerald Dostal - Annual Fund 2015Fidelity Bank & Trust ..................Annual Fund 2015Munkel, Julie ................................Lawrence Munkel - Hospice

ContributionsRockwell Collins ..........................Norma Hilberg - Hospice

Contributions Donation - Hospice Contributions Meryln Helland - Hospice

Contributions Noah Dietrich - Memorials - ObSchuman, W.R. .............................Bev Schuman - Hospice Contributions

Sponsor - $250-$499Bradish Family Scholarship Fund Bradish ContributionBrockman, Bradley ......................Arlene Brockman - MemorialsHageman, Herbert ........................Mary Ellen Hageman - Hospice

ContributionsHellend, Marilyn ..........................Merlyn Helland - Hospice

ContributionsJohnson, Guy ................................Parkinsons Fund Riha, Frank & Jo ..........................Annual Fund 2014

Friend - $100-$249Balik Funeral Home .....................Hospice Ride - Hospice ContributionsBappe, Norma ..............................David Bappe - Hospice ContributionsBrevig, Brandon & Nikki .............Annual Fund 2014Bullard, Dr. James & Jane ............Lawrence Munkel - Hospice

Contributions Maddy Wise - Hospice ContributionsBulman, Laurie & Tom ................Annual Fund 2014Casa Guadalupe Education Center ..........................Cheryl Grinna - Hospice ContributionsFencl, Katie ..................................Hospice Ride - Hospice ContributionsFriends & Family of Germaine Holthaus .......................................Germaine Holthaus - Hospice

ContributionsGander, Thomas & Bernadine Ann..............................Ossian Clinic & WMC NutritionGessing, Rebecca .........................Merlin Gessing - Hospice

ContributionsGoggin, Jack.................................Ossian Clinic & Dr. John GogginGrinna, John .................................Cheryl Grinna - Hospice ContributionsHageman, Kathy...........................Annual Fund 2015Huinker, Roger & Pat ...................Annual Fund 2014 Bev Schuman - Hospice Contributions Maddy Wise - Hospice Contributions Margaret “Peggy” Graves - Hospice

Contributions Gerald Dostal - Hospice ContributionsMartini, B. & R. ...........................Margaret “Peggy” Graves - Hospice

Contributions

Nagel, Philip & Cynthia ...............Merlyn Helland - Hospice Contributions

National Association of Letter Carriers ..............................Lawrence Munkel - Hospice

ContributionsPrairie Patterns, Dawn Deines Christensen ............Annual Fund 2015Seaton, Robyn ..............................Lawrence Munkel - Hospice

ContributionsStreet, Clista Joyce .......................Donation - Hospice Contributions Donation - Hospice Contributions Annual Fund 2015Taylor, Michael ............................Hospice Ride - Hospice ContributionsTekippe, Debra .............................Annual Fund 2014White, Steve & Connie ................Lawrence Munkel - Hospice

ContributionsWiemerslage, Tom & Judy ...........Evelyn Wiemerslage - Hospice

ContributionsWise, Daniel & Eva Lou ..............Maddy Wise - Hospice ContributionsZaring, Alan .................................Annual Fund 2015

Donor - $25-$99Abbe, Dwaine & Mavis ...............Bev Schuman - Hospice ContributionsAckerman, John & Kathy.............Bev Schuman - Hospice ContributionsAlcock, Sherry .............................Lawrence Munkel - Hospice

ContributionsAlexander, Janet & Hagen, Louise ..............................Eleanor Holm - Hospice ContributionsAnonymous .................................. Jerry Stortz - Hospice ContributionsAswegan, Charlette ......................Norma Hilberg - Hospice

ContributionsAustin, Sylvia ...............................Norma Hilberg - Hospice

ContributionsBacon, Jerry .................................Mildred Brooks - Hospice

ContributionsBader, Keith & Larabeth ..............Bev Schuman - Hospice ContributionsBahr, Vernon & Donna .................Kenneth Qualley - Hospice

ContributionsBakken, Karla...............................Annual Fund 2014Banks, Nancy ...............................Mildred Brooks - Hospice

ContributionsBarta, Joyce ..................................Hospice Ride - Hospice ContributionsBeatty, Marion ..............................Bev Schuman - Hospice ContributionsBerland, Larry & Vicki ................Bev Schuman - Hospice Contributions Maddy Wise - Hospice ContributionsBernhard, Dean & Linda ..............Mildred Brooks - Hospice

ContributionsBietzenbach, Vernon & Bernice ...Donation - Hospice ContributionsBirdsell, Audrey ...........................Maddy Wise - Hospice ContributionsBischel, Kevin ..............................Hospice Ride - Hospice ContributionsBishop, Kent & Alison .................Margaret “Peggy” Graves - Hospice

ContributionsBlake, Dennis & MacDuff, MariAnn .......................................Kenneth Qualley - Hospice

ContributionsBlekeberg, Helen ..........................Kenneth Qualley - Hospice

ContributionsBoege, Mary & John ....................Delores Lynch - Hospice ContributionsBolson, Nancy ..............................Lawrence Munkel - Hospice

ContributionsBoos, Duane & Kimberly.............Germaine Holthaus - Hospice

ContributionsBorowski, Dianne & Joel .............Bev Schuman - Hospice ContributionsBouska, Patricia ...........................Alice Fretheim - Memorial

WMC Foundation GiftsGifts from thru April 1, 2015 thru October 1, 2015 Annual Fund Contributions are 2015 unless otherwise noted.

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Brodericks, Susie .........................Lawrence Munkel - Hospice Contributions

Grace Torresdahl - Hospice Contributions

Brown, William & Karen ............. Jerry Stortz - Hospice Contributions Merlyn Helland - Hospice

Contributions Ordell Sorum - Hospice Contributions Don & Wilma Olsen - Hospice

Contributions Ray Ransom - Hospice ContributionsBruening Rock Products, Inc .......Lawrence Munkel - Hospice

ContributionsBruening, Duane & Eileen ...........Bev Schuman - Hospice Contributions Wayne Thomas - Hospice

ContributionsBurras, Rick & Lori .....................Maddy Wise - Hospice ContributionsBurreson, Lorraine .......................Ken Steine - Hospice ContributionsCasterton, Paul & Patty ................Maddy Wise - Hospice ContributionsCasterton, Stephen .......................Maddy Wise - Hospice ContributionsChihak, J.A. & A. J. .....................Maddy Wise - Hospice ContributionsChoate, Thomas & Jean ...............Germaine Holthaus - Hospice

ContributionsChristopher, D Edward & Sharon Maddy Wise - Hospice ContributionsChristopher, Timon & Laurie .......Hospice Ride - Hospice ContributionsChristianson, C. Owen & Linda ...Maddy Wise - Hospice ContributionsCitizen’s Savings Bank ................Hospice Ride - Hospice ContributionsClabaugh, Jean Brenno ................Kenneth Qualley - Hospice

ContributionsCollins, S.E. & L.L. .....................Bev Schuman - Hospice ContributionsCreamer, Leander & Odelia .........Germaine Holthaus - Hospice

ContributionsCreger, September ........................Kenneth Qualley - Hospice

ContributionsDahlen, Arnold & Nannette .........Maddy Wise - Hospice Contributions Margaret “Peggy” Graves - Hospice

Contributions Rulan Hansen - Hospice ContributionsDecorah Chevrolet, Cadillac, Inc. ................................Hospice Ride - Hospice ContributionsDecorah Electric ...........................Cheryl Grinna - Hospice ContributionsDeeney, Timothy & Carol ............Hospice Ride - Hospice ContributionsDick, Ed & Lauri ..........................Gerald Dostal - Hospice ContributionsDickman, Jean ..............................Bev Schuman - Hospice ContributionsDietrich, Angela & Danny ...........Margaret “Peggy” Graves - Hospice

ContributionsDovenberg, Rick & Kaehler, Marian .......................................Maddy Wise - Hospice ContributionsEclips Salon & Day Spa ...............Cheryl Grinna - Hospice ContributionsEllickson, Alan & Susan ..............Margaret “Peggy” Graves - Hospice

ContributionsEmerson, Randy & Shelly ............Bev Schuman - Hospice ContributionsFalck, Lynette & Duane ...............Norma Hilberg - Hospice

ContributionsFinholt, David & Jill ....................Maddy Wise - Hospice ContributionsFish, Wayne & Sandra ..................Hospice Ride - Hospice ContributionsFisher, Erlene ...............................Maddy Wise - Hospice ContributionsFlage, Delois ................................ Jerry Stortz - MemorialsFripps, The Farr Side ..................Hospice Ride - Hospice ContributionsFoltz, Dale & Arlene ....................Cheryl Grinna - Hospice ContributionsForde, Wesley & Bette .................Bev Schuman - Hospice Contributions Rulan Hansen - Hospice Contributions Marleen Mather - Hospice

ContributionsFranz, Brian & Lori ......................Germaine Holthaus - Hospice

ContributionsFriends & Family of Juanita Bruening ..........................Hospice ContributionsFriends & Family of Eloise Bakke ................................Hospice Contributions

Friends & Family of Margaret “Peggy” Graves ............Hospice ContributionsFriends & Family of Ray Ransom .................................Hospice ContributionsFriends & Family of Virgil Denk ................................... Hospice ContributionsFrontier Mudjacking ....................Hospice Ride - Hospice ContributionsFrye, Cheryl .................................Norma Hilberg - Hospice

ContributionsGjere, Curt & Linda .....................Norma Hilberg - Hospice

ContributionsGlesne, Ann & John .....................Maddy Wise - Hospice ContributionsGrapes, Thomas & Christina ........Cheryl Grinna - Hospice ContributionsGreen, Tim & Kathy.....................Mary Ellen Hageman - Hospice

ContributionsGregory, Jean ...............................Mildred Brooks - Hospice

ContributionsGrimstad, Ben & Padrin ...............Maddy Wise - Hospice ContributionsGrimstad, Larry & Diane .............Maddy Wise - Hospice ContributionsGuilgot, Richard ...........................Bev Schuman - Hospice ContributionsGuzwicus, Mary & Zulkofske, Marion ........................Lawrence Munkel - Hospice

ContributionsHalpin, William & Mary ..............Bev Schuman - Hospice ContributionsHalverson, Ellen ...........................Bev Schuman - Hospice ContributionsHanken, Margaret & Gervase ......Germaine Holthaus - Hospice

ContributionsHanneman, Beatrice & Sladky, Janet .................................Kenneth Qualley - Hospice

Contributions Margaret “Peggy” Graves - Hospice

ContributionsHanson, Laurie & Doug ...............Norma Hilberg - Hospice

ContributionsHardy, Philip & Marcia ................Lawrence Munkel - Hospice

ContributionsHayek, Dan...................................Hospice Ride - Hospice ContributionsHeadington, Elaine .......................Cheryl Grinna - Hospice Contributions Wayne Thomas - Hospice

ContributionsHeadington, Larry & Dianne .......Maddy Wise - Hospice Contributions Laureen Halverson - Hospice

Contributions Zola Whalen - Hospice Contributions John Rybvik - Hospice ContributionsHeins, Deb ....................................Mildred Brooks - Hospice

ContributionsHeins, Joyce .................................Mildred Brooks - Hospice

ContributionsHeins, Lynn & Rosaleta ...............Mildred Brooks - Hospice

ContributionsHenning, Mark & Stephanie ........Kenneth Qualley - Hospice

ContributionsHenry, Lois ...................................Margaret “Peggy” Graves - Hospice

ContributionsHolkesvik, Bonnie ........................Norma Hilberg - Hospice

ContributionsHolstad, Inez ................................David Ottesen - Hospice ContributionsHomewood, Jerry & Diane ..........Germaine Holthaus - Hospice

Contributions Maddy Wise - Hospice ContributionsHopperstad, Betty.........................Kenneth Qualley - Hospice

ContributionsHoey, Mary Anne .........................Cheryl Grinna - Hospice ContributionsHover, Jean A. & Mark ................Maddy Wise - Hospice ContributionsHowards Tire & Repair, Howard Lensing ...........................Hospice Ride - Hospice ContributionsHubbard, Steve & Borske-Hubbard, Lindy ...............Lawrence Munkel - Hospice

Contributions

14

Hubka, Shirley .............................Gerald Dostal - MemorialsHumpal, Karen .............................Annual Fund 2014Humpal, Karlene & Ronald .........Gerald Dostal - MemorialsIverson, R.E. & K.L. ....................Maddy Wise - Hospice ContributionsJacobsen, Karl ..............................Bev Schuman - MemorialsJens, Dan & Jody .........................Cheryl Grinna - Hospice ContributionsJevne, James & Marsha ................Hospice Ride - Hospice ContributionsJohnson, Del & Fran ....................Margaret “Peggy” Graves - Hospice

ContributionsKanengieter, Holly .......................Annual Fund 2014Kern, Rita .....................................Cheryl Grinna - Hospice ContributionsKlimesh,Thomas ..........................Hospice Ride - Hospice ContributionsKlotzbach, Ardis...........................Maddy Wise - Hospice ContributionsKlotzbach, Maxine .......................Annual Fund 2014Knight, Mary Lou ........................Mildred Brooks - Hospice

ContributionsKnoke, Earl & Marian ..................Bev Schuman - Hospice Contributions Maddy Wise - Hospice Contributions Ordell Sorum - Hospice Contributions Virgil Denk - Hospice ContributionsKnoke, Karl & Kimberly .............Hospice Ride - Hospice ContributionsKnutson, Diane.............................Bev Schuman - Hospice ContributionsKoop, Kenneth & Sally ................Bev Schuman - Hospice ContributionsKrivachek, Carmen ......................Annual Fund 2014Krull, DeAnne ..............................Norma Hilberg - Hospice

ContributionsKruse, Lynnette ............................Annual Fund 2014Kuhn, Kenneth .............................Maddy Wise - Hospice Contributions Lawrence Munkel - Hospice

ContributionsLadwag, Susan .............................Kenneth Qualley - Hospice

ContributionsLang, Scott & Lang, Iva Nell .......Bev Schuman - Hospice ContributionsLarsen, Kirk & Shirley .................Maddy Wise - Hospice ContributionsLarson, Caryl ................................Mary Ellen Hageman - Hospice

ContributionsLee, Karen ....................................Bev Schuman - Hospice ContributionsLeistikow, Donald & Joanne ........Lawrence Munkel - Hospice

ContributionsLensch, Brian & Elly ...................Hospice Ride - Hospice ContributionsLentz Financial & Insurance ........Hospice Ride - Hospice ContributionsLenz, Mark & Sue ........................Norma Hilberg - Hospice

ContributionsLerstrom, Kristin ..........................Cheryl Grinna - Hospice ContributionsLien, Patricia ................................ Jerry Stortz - Hospice Contributions David Bappe - Hospice Contributions Margaret “Peggy” Graves - Hospice

Contributions Mary Ellen Hageman - Hospice

ContributionsLillegraven, John & Wanda .......... Jerry Stortz - Hospice Contributions David Ottesen - Hospice ContributionsLillibridge, Renee & James ..........Cheryl Grinna - Hospice ContributionsLinderbaum, Viola........................Grace Torresdahl - Hospice

Contributions Marlene Nesvik - Hospice

Contributions Catherine Huinker - Hospice

ContributionsLittle, Thomas ..............................Hazel Wangsness - Hospice

Contributions Ordell Sorum - Hospice Contributions Howard Wangsness - Hospice

ContributionsLonning, Rev ................................Mildred Brooks - Hospice

Contributions

Losen, Alton & Violette ...............Merlyn Helland - Hospice Contributions

Lowe, Max & Gwen.....................Mildred Brooks - Hospice Contributions

Macal, David & Karen .................Margaret “Peggy” Graves - Hospice Contributions

McGinn, Connie & Mark, Brown, Corinne & Larry ..............Lawrence Munkel - Hospice

ContributionsMcKinney, Spencer & Kathleen ..Bev Schuman - Hospice ContributionsMcNamara, Don & Diane ............Bev Schuman - Hospice ContributionsMeyer, Charles & Kathleen ..........Germaine Holthaus - Hospice

ContributionsMikkelson, Carolyn ...................... Jerry Stortz - Memorials Germaine Holthaus - Hospice

ContributionsMikkelson, Judith .........................Bev Schuman - Hospice ContributionsMilligan, Tim & Dawn .................Maddy Wise - Hospice ContributionsMoellers, Stanley & Debra...........Bev Schuman - Hospice ContributionsMotley, Gene & Miriam ...............Bev Schuman - Hospice ContributionsMunkel, Harold & Betty ..............Lawrence Munkel - Hospice

ContributionsMunkel, Jon & Connie .................Lawrence Munkel - Hospice

ContributionsMurphy, Linda ..............................Kenneth Qualley - Hospice

ContributionsMurphy, Maureen .........................Mildred Brooks - Hospice

ContributionsMyer, Jack & Janeen ....................Cheryl Grinna - Hospice ContributionsNelson, Kerry & Patricia ..............Mildred Brooks - Hospice

ContributionsNeubauer, Justin & Hally .............Cheryl Grinna - Hospice ContributionsNickel, Jo & Deter .......................Mildred Brooks - Hospice

ContributionsNorden, Dennis & Bergan, Karen ..............................Maddy Wise - Hospice ContributionsNovotny, Jackie ............................Norma Hilberg - Hospice

ContributionsNumedahl, Janice .........................Norma Hilberg - Hospice

Contributions Bev Schuman - Hospice ContributionsO’Laughlin, Kim & Darcy ...........Germaine Holthaus - Hospice

ContributionsOlson, Helen.................................Bev Schuman - Hospice Contributions Maddy Wise - Hospice Contributions Margaret “Peggy” Graves - Hospice

ContributionsOlson, Randy & Renee.................Bev Schuman - Hospice ContributionsOrvella, Willard & Eloise.............Bev Schuman - Hospice Contributions Grace Torresdahl - Hospice

ContributionsOtteson, David & Sarah ...............Norma Hilberg - Hospice

ContributionsOttesen, Kenneth & Janet.............Norma Hilberg - Hospice

ContributionsOtteson, Thomas & Cheryl ..........Maddy Wise - Hospice ContributionsPanos, Dave ..................................Hospice Ride - Hospice ContributionsPost, Barb & William ...................Annual Fund 2015Praska, Angela ..............................Kenneth Qualley - Hospice

ContributionsPrestsater, Roy & Debra ...............Lawrence Munkel - Hospice

Contributions Cheryl Grinna - Hospice ContributionsQuam, Karen & Steve ..................Norma Hilberg - Hospice

ContributionsQuam, Tina & Dennis ..................Norma Hilberg - Hospice

ContributionsRamsey, LaVerne .........................Norma Hilberg - Hospice

ContributionsRanson, Kathy & Steven ..............Bev Schuman - Hospice ContributionsReed, Roger & Cheryl ..................Norma Hilberg - Hospice

Contributions

2315

Refsal, Harley & Norma ..............Maddy Wise - Hospice ContributionsRonan, James ...............................Norma Hilberg - Hospice

ContributionsRooney, David & Annette ............Annual Fund 2014Rosendahl, Leona .........................Margaret “Peggy” Graves - Hospice

Contributions Leo Starla - Hospice Contributions Gale Ludeking - Hospice Contributions Ray Ransom - Hospice ContributionsRotach, Roberta & Julia ...............Hospice Ride - Hospice ContributionsRottinghaus, Robert & Darleen, Clever Tech^2 ................Hospice Ride - Hospice ContributionsRotto, Curtis & Ann .....................Merlin Gessing - Hospice

ContributionsRovang, June ................................Kenneth Qualley - Hospice

Contributions Dave Ottesen - Hospice ContributionsRucker, Steve & Schaden, Linda .Lawrence Munkel - Hospice

ContributionsRucker, Verda ...............................Lawrence Munkel - Hospice

Contributions Maddy Wise - Hospice ContributionsRude, William & Rovang-Rude, Marian ..................Norma Hilberg - Hospice

ContributionsRue, Loren & Amy .......................Kenneth Qualley - Hospice

ContributionsRustad, Kristie ..............................Annual Fund 2014 Margaret “Peggy” Graves - Hospice

ContributionsSacquitne, John & Ruth ...............Maddy Wise - Hospice Contributions Lawrence Munkel - Hospice

ContributionsSacquitne, Virginia .......................Rulan Hansen - Hospice ContributionsSauer, M. Ellen .............................Roy Quaas - Hospice ContributionsSchempp, Lucy.............................Maddy Wise - Hospice ContributionsSchneberger, Marie ......................Annual Fund 2014Schroeder, Karl ............................Carroll Lansing - MemorialsSchuman, Bruce & Betty .............Margaret “Peggy” Graves - Hospice

Contributions Gust Lechtenberg - Hospice

Contributions Ronnie Rustad - Hospice Contributions Martha Graves - Hospice ContributionsSchwan, Brenda ...........................Annual Fund 2014Schwan, Jim .................................Annual Fund 2014Sender, Mary & Chuck ................Annual Fund 2014Sheridan, Beverly .........................Bev Schuman - Hospice ContributionsSide Street Cycles ........................Hospice Ride - Hospice ContributionsSims, Christine .............................Annual Fund 2014Skoda, Jerald & Linda ..................Bev Schuman - Hospice ContributionsSmith, Louise ...............................Norma Hilberg - Hospice

ContributionsSmock, Reva ................................Maddy Wise - Hospice ContributionsSnell, David & Susan ...................Maddy Wise - Hospice Contributions Gary Finholt - MemorialsSobolik, Jim & Sharon .................Gerald Dostal - Hospice ContributionsSorum, Bonnie & Ordell ..............Norma Lund - Memorials Cheryl Grinna - MemorialsSpalla, Larry & Steven - S.S. Weldling ................................Hospice Ride - Hospice ContributionsSpohn, Teresa ...............................Mildred Brooks - Hospice

ContributionsSynder, Georgia ............................Norma Hilberg - Hospice

ContributionsSpilde, Craig & Jeanette...............Bev Schuman - Hospice ContributionsSpilde, Vernon .............................Bev Schuman - Hospice ContributionsStanbrough, Carol ........................Germaine Holthaus - Hospice

ContributionsSteine, Sylvia & Clair ..................Cheryl Grinna - Hospice Contributions

Stephenson, Syd & Dick ..............Norma Hilberg - Hospice Contributions

Storla, Betty .................................Leo Starla - Hospice Contributions Norma Hilberg - Hospice

Contributions Lauren Storla - Hospice Contributions George KozelkaStorla, Patsy .................................Norma Hilberg - Hospice

ContributionsStrand, Morten & Connie .............Cheryl Grinna - Hospice ContributionsSvenson, David & Donna.............Margaret “Peggy” Graves - Hospice

Contributions Dave Ottesen - MemorialsSvobodny, D.R. ............................Mildred Brooks - Hospice

ContributionsSweeney, Matthew .......................Hospice Ride - Hospice ContributionsSwiggum, Eunice .........................Buel Swiggum - Hospice ContributionsThompson, James & Jeanette .......Carole Wendlant - Hospice

ContributionsThornton, Glen & Deloris ............Maddy Wise - Hospice ContributionsTieskoetter, James & Sally ...........Ronnie Rustad - Hospice Contributions Martha Graves - Hospice ContributionsTimmerman, Deborah ..................Ray Ransom - AmbulanceTimmerman, Kenneth & Mary .....Annual Fund 2015Tollefsrud, Bernell & Kathy .........Garry Wiltgen - Hospice Contributions Merlyn Helland - Hospice

Contributions Wallace Christopherson - Hospice

Contributions Zola Whalen - Hospice Contributions Al White - Hospice ContributionsTomkins, Harold & Ellie ..............Mildred Brooks - Hospice

ContributionsTveter, Marcella & David ............Germaine Holthaus - Hospice

ContributionsTyrell, Rebecca & Ellingson, Dennis .........................Cheryl Grinna - Hospice ContributionsUsgaard, Robert & Patricia ..........Kermit Hendrickson - MemorialsVangness, Lee & Shirley ..............Maddy Wise - Hospice ContributionsVanGorp, Bob & Wendy ..............Bev Schuman - Hospice ContributionsVotsmier, Charles & Lois .............Hospice Ride - Hospice ContributionsVrzak, Tammy ..............................Norma Hilberg - Hospice

ContributionsVsetecka, David & Robyn ...........Hospice Ride - Hospice ContributionsWahlberg, Marilyn .......................Cheryl Grinna - Hospice ContributionsWaukon Tire Center .....................Bev Schuman - Hospice ContributionsWelcher, Jon & Maxine ................Mildred Brooks - Hospice ContributionsWest Side Study Club...................Hospice ContributionsWestin, Elaine & Ken ...................Rulan Hansen - AmbulanceWheatman, Charlotte ...................Norma Hilberg - Hospice

ContributionsWillford-Martin, Gloria ................Bev Schuman - Hospice ContributionsWillson, Gordon & Dorothy ........Maddy Wise - Hospice ContributionsWinkie, Darrell & Joylene ...........Mary Ellen Hageman - Hospice

ContributionsWomeldorf, Lilly ..........................Germaine Holthaus - Hospice

ContributionsWyatt, Ben & Dianne ...................Gerald Dostal - MemorialsYahr, Maureen & Ervin ................Maddy Wise - Hospice ContributionsYoung, Donna ..............................Gary Finholt - Hospice ContributionsZollman, Mary Lou ......................Merlyn Helland - Hospice

ContributionsZweibohmer, Brian ......................Hospice Ride - Hospice Contributions

Winneshiek Medical Center Foundation901 Montgomery St.Decorah, IA 52101,

F o u n d a t i o n

Yes, I/we want to make a gift to the Annual FundName:__________________________________________________________________________________________Address:______________________________________ City: _____________________ State:____ Zip:___________Phone: _________________ Cell Phone:_______________ E-mail: ________________________________________

In HONOR of: ______________________________ In MEMORY of: _____________________________ Check enclosed for $_________________________ Credit Card Payment

MasterCard Visa Exp. Date: ___/____ Card # _______________________________________________

Security Code:____________ Signature: _______________________________________ Date:____________

Print name as it appears on credit card: ________________________________________________________________

Yes, I/we want to make a MONTHLY GIFT. Please transfer my/our monthly gift of $___________ each month. From my/our checking account

I hereby authorize my bank or credit card company to charge my account each month beginning _____/_____/____ and ending _____/_____/____ or continuing until further notice Signature: _______________________________________ Date:____________

From my credit card MasterCard Visa Exp. Date: ___/____ Card # ____________________________________________

Security Code:____________ Signature: _______________________________________Date:____________

Print name as it appears on credit card: __________________________________________________________

Annual Fund PledgeBenefactor $5,000 + Investor $2,500 - $4,999Associate $1,000 - $2,499

Patron $500 - $999Sponsor $250 - $499 Friend $100 - $249

Donor $25 - $99Other Amount (listed below)

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