2024-07-09T11:34:34-05:00 2023-09-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-10-01 470841274 FAIRBURY ASSISTED LIVING FACILITY FAIR 4027296100 828 22ND STREET FAIRBURY NE 68352 CHANCE KLASEK SECRETARY 4027293351 2024-07-09 1 CHANCE KLASEK 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-06-19 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CEDARWOOD CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 3043823 0 X HTTPS://WWW.CEDARWOODAL.ORG/ X 2001 NE TO PROVIDE THE HIGHEST QUALITY OF CARE AND HOSPITALITY TO TENANTS IN JEFFERSON COUNTY. 6 6 36 7 0 0 12430 458634 1942841 2272485 44641 -56104 3646 25885 2003558 2700900 0 0 0 0 910177 1077737 0 0 0 1135101 1298468 2045278 2376205 -41720 324695 2570376 3007640 307356 311615 2263020 2696025 TO PROVIDE THE HIGHEST QUALITY OF HOSPITALITY, SERVICES, ACTIVITIES, SECURITY, COMPANIONSHIP AND FREEDOM TO TENANTS IN A CARING AND LOVING ENVIRONMENT THEY ARE PROUD TO CALL HOME. 0 0 2034789 2272485 CEDARWOOD ASSISTED LIVING FACILITY WAS CONSTRUCTED ADJACENT TO JEFFERSON COMMUNITY HEALTH CENTER, INC. (JCHC), A NEBRASKA NON-PROFIT HOSPITAL EXEMPT FROM INCOME TAXES UNDER I.R.C. 501(C)(3). THE PURPOSE OF THE 50-UNIT FACILITY IS TO MEET AN IDENTIFIABLE COMMUNITY NEED IN THE FAIRBURY AREA, AND TO DEVELOP A MORE COMPREHENSIVE CONTINUUM OF HEALTH CARE THAT COMPLEMENTS THE HEALTH CARE SERVICES ALREADY AVAILABLE ON THE CAMPUS OF JCHC. SIXTY-FOUR RESIDENTS WERE SERVED FROM OCTOBER 2022 THROUGH SEPTEMBER 2023. TEN OF THESE RESIDENTS QUALIFIED UNDER THE MEDICAID WAIVER PROGRAM. TOTAL DAYS OF CARE PROVIDED WERE 18,838. 2034789 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 36 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 X CHANCE KLASEK 4027296856 2200 H STREET PO BOX 277 FAIRBURY NE 68352 X X RICK STANTON CHAIRMAN 1.00 X X 0 0 0 DAVID REESE VICE CHAIRMAN 1.00 X X 0 0 0 CHANCE KLASEK SECRETARY 5.00 X X 0 0 0 REGINA BERGH TREASURER 1.00 X X 0 0 0 PAT GANYO MEMBER 1.00 X 0 0 0 DICK HOPPE MEMBER 1.00 X 0 0 0 BURKE KLINE PRESIDENT 1.00 X 0 0 0 0 0 0 0 0 0 0 JEFFERSON COMMUNITY HEALTH CENTER INC 2200 H STREET PO BOX 277 FAIRBURY NE 68352 CONTRACTED DIETARY, MANAGEMENT, MAINTENA 749455 1 458634 458634 RESIDENT REVENUE 623000 1991060 1991060 MEDICAID PAYMENTS 623000 281425 281425 2272485 26902 26902 259917 302278 40645 -42361 -40645 -83006 -83006 INSURANCE PROCEEDS 524298 25885 25885 25885 2700900 2272485 0 -30219 934494 802340 132154 66073 56729 9344 77170 66257 10913 113279 113279 26794 26794 43164 18832 24332 9016 8917 99 126467 105827 20640 79601 78807 794 5871 5813 58 6759 6684 75 205006 202744 2262 44262 43774 488 RESIDENT MEALS 621531 621531 DUES & SUBSCRIPTIONS 16718 16534 184 2376205 2034789 341416 0 169161 286149 701441 786834 22153 458463 24008 23232 5816376 4363414 1653613 1452962 2570376 3007640 126619 112080 180737 199535 307356 311615 X 2263020 2696025 2263020 2696025 2570376 3007640 324695 108310 0 X X 1 X 0 1 0 X 100 52296 254486 12430 458634 777946 1942276 2002218 1862862 1942841 2272485 10022682 1942376 2054514 2117348 1955271 2731119 10800628 0 0 0 10800628 8639 7992 24233 44641 26902 112407 8639 7992 24233 44641 26902 112407 3646 25885 29531 1951015 2062506 2141581 2003558 2783906 10942566 0.98700 0.98120 0.01030 0.00920 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60427 60427 5380760 4039110 1341650 279655 235294 44361 95534 89010 6524 1452962 RESIDENT SECURITY DEPOSITS 100162 DUE TO JEFFERSON COMMUNITY HEALTH CENTER 99373 199535 X PART X, LINE 2: CEDARWOOD ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. CEDARWOOD RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2023 AND 2022, CEDARWOOD HAD NO UNCERTAIN TAX POSITIONS ACCRUED. FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF THE CORPORATION ARE BRYAN HEALTH AND JEFFERSON COMMUNITY HEALTH CENTER, INC., BOTH NEBRASKA NON-PROFIT CORPORTIONS. FORM 990, PART VI, SECTION A, LINE 7A THE MEMBERS OF THE CORPORATION, BRYAN HEALTH, A NEBRASKA NON-PROFIT CORPORATION, AND JEFFERSON COMMUNITY HEALTH CENTER, INC., A NEBRASKA NON-PROFIT CORPORATION, HAVE THE POWER TO APPOINT 3 TRUSTEES EACH, BOTH PERIODICALLY AND AS VACANCIES ARISE. FORM 990, PART VI, SECTION A, LINE 8B THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B THE BOARD WILL REVIEW THE FORM 990 AT A REGULARLY SCHEDULED BOARD MEETING, WHICH DOES NOT NECESSARILY OCCUR PRIOR TO THE FILING OF FORM 990. FORM 990 IS REVIEWED BY MR. CHANCE KLASEK, BOARD SECRETARY, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, OFFICERS AND TRUSTEES ARE REQUIRED TO SIGN THE "CONFLICT OF INTEREST STATEMENT." BY SIGNING THIS STATEMENT, THE OFFICERS AND TRUSTEES AGREE NOT TO USE HIS OR HER POSITION FOR PERSONAL PROFIT OR TO GAIN PERSONAL ADVANTAGE. THE OFFICERS AND TRUSTEES ARE REQUIRED TO DISCLOSE IN WRITING TO THE BOARD OF TRUSTEES ANY PERSON TO WHOM HE OR SHE IS CLOSELY RELATED OR ORGANIZATION WITH WHICH HE OR SHE IS AFFILIATED, WHO OR WHICH PRESENTLY TRANSACTS BUSINESS WITH THE CORPORATION OR MIGHT REASONABLY BE EXPECTED TO DO SO IN THE FUTURE. THE OFFICERS AND TRUSTEES ARE REQUIRED TO SUBMIT SUCH DISCLOSURE ON A CASE-BY-CASE BASIS. IT IS UNDERSTOOD THAT AFFILIATION WITH AN ORGANIZATION IS CONSIDERED TO EXIST WHEN AN OFFICER, TRUSTEE OR A MEMBER OF HIS OR HER IMMEDIATE FAMILY OR CLOSE RELATIVE IS AN OFFICER, DIRECTOR, PARTNER, EMPLOYEE OR AGENT OF THE ORGANIZATIONS OR OWNS 5% OF THE VOTING STOCK OR CONTROLLING INTEREST IN THE ORGANIZATION. THE OFFICERS AND TRUSTEES MUST ABSTAIN FROM VOTING ON ANY MOTION REGARDING THE DISCLOSED CONFLICT OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 CEDARWOOD'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII: BURKE KLINE, PRESIDENT, AND CHANCE KLASEK, SECRETARY, ARE EMPLOYEES OF JEFFERSON COMMUNITY HEALTH CENTER, INC., AN UNRELATED ORGANIZATION THAT PROVIDES MANAGEMENT AND CLERICAL SERVICES FOR THE ORGANIZATION. THEREFORE, THE COMPENSATION IS PAID BY JEFFERSON COMMUNITY HEALTH CENTER, INC. FORM 990, PART XII, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE REVIEW. UPON CONCLUSION OF THE REVIEW, THE ACCOUNTING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE FINANCE COMMITTEE. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. FORM 990, PART VI, SECTION B, LINE 14: THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY, BUT IT DOES MAINTAIN DOCUMENTS IN ACCORDANCE WITH FEDERAL AND STATE LAWS. FORM 990, PART VI, SECTION B, LINE 15: AS NO OFFICER IS PAID BY THIS ORGANIZATION, NO INDEPENDENT REVIEW OR APPROVAL PROCESS IS CONDUCTED BY THIS ORGANIZATION.