To Remember Someone with A Memorial Gift or a Gift of Healing and Care

We are grateful for the support and generosity of people like you. Your support means a great deal to the patients and their families who rely upon Kossuth Regional Health Center to provide the care they need close to home.

To make a gift to the Kossuth Regional Health Center Foundation, please print the form below and mail to:

Public Relations/Foundation
Ms. Stacy Simpson/Ms. Joanne Roepke Bode
Kossuth Regional Health Center
1515 S. Phillips St.
Algona, IA 50511

Name:______________________________________________________________________

Address:____________________________________________________________________

City: ______________________________         State: _________     Zip: __________________

Enclosed is my gift of: ________________________________________
(Payable to Kossuth Regional Health Center Foundation)

(Optional)
In Memory Of: _______________________________________________

In Honor Of:_________________________________________________

I would like someone to contact me concerning a gift to the Kossuth Regional Health Center Foundation. My phone number is: ___________________________

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