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Exhibit143:SampleLeadGift ProposalAPROPOSAL to THEJEFFREYB.SMITHFOUNDATIONand HANNA.SMITHFOUNDATIONfrom LESTERGENERALHOSPITALLester, Pennsylvania January 3, 2008THEREQUEST Option1. WomensHealthPavilion We×are×pleased×to invite×the×Jeffrey×B. Smith×and×the×Anna×F. SmithFoundations×to consider×making×a lead×gift×for×the×construction×of×new×Women×and×Babies×Hospital×in Lester×County.×This×new
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To fill out the form for Women and Babies Hospital that will cost $17,000,000, follow these steps:
02
Obtain the form from the hospital administration.
03
Fill in your personal information, including your name, address, contact number, and email.
04
Provide details about the hospital project, such as the purpose of the funding, the number of beds, the facilities it will have, and any specialized services.
05
Include a breakdown of the estimated costs, mentioning the different expenses like construction, medical equipment, staffing, and other operational needs.
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Provide a timeline for the project, indicating the expected start and completion dates.
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Some forms may require additional attachments, such as architectural plans, feasibility studies, or financial reports. Make sure to attach these documents if necessary.
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Review the completed form to ensure all information is accurate and complete.
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Submit the form to the designated authority, either through online submission or by physical submission at the hospital administration office.
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Keep a copy of the filled-out form for your records.
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Await further communication from the hospital regarding the status and outcome of your funding request.

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Any organization or individual planning to undertake the Women and Babies Hospital project that will cost $17,000,000 could require the form. This could include government health departments, private healthcare providers, NGOs, or community organizations.
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Individuals or organizations seeking funding or support for the hospital project may need to fill out the form to convey their plans and financial requirements to funding bodies or potential donors or partners.
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The form is for reporting the total cost of the hospital dedicated to women and babies, which will amount to 17,000,000.
All individuals or organizations responsible for the hospital's finances are required to file the form.
The form can be filled out by providing the necessary financial information and details related to the hospital's costs for women and babies.
The purpose of the form is to accurately report the total costs associated with the hospital dedicated to women and babies.
The form requires reporting of all financial details and specific costs related to the hospital's services for women and babies.
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