2026-08-05T14:50:47-05:00 2025-09-30 423603499 EIDE BAILLY ADVISORY LLC 14010 FNB PKWY STE 600 OMAHA NE 681545206 990 2024-10-01 470841274 FAIRBURY ASSISTED LIVING FACILITY FAIR 4027296100 828 22ND STREET FAIRBURY NE 68352 CHANCE KLASEK SECRETARY 4027293351 2026-08-04 1 1 MEGAN L KOZIOL P01544037 4023302660 2026-08-04 2024 2025-03-06 01:10:19Z CEDARWOOD CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 2584983 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 43 8 0 0 64511 59084 2467478 2457387 45785 68512 161370 0 2739144 2584983 0 0 0 0 1086927 1179730 0 0 0 1388772 1328955 2475699 2508685 263445 76298 3432369 3649513 368304 471702 3064065 3177811 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 2145151 2457387 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-SEVEN RESIDENTS WERE SERVED FROM OCTOBER 2024 THROUGH SEPTEMBER 2025. TEN OF THESE RESIDENTS QUALIFIED UNDER THE MEDICAID WAIVER PROGRAM. TOTAL DAYS OF CARE PROVIDED WERE 17,709. 2145151 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 43 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 RICK STANTON PRESIDENT 1.00 X X 0 0 0 STEPHANIE BOLDT VICE PRESIDENT 1.00 X X 0 0 0 CHANCE KLASEK SECRETARY 1.00 X X 0 0 0 JON PEPPMULLER TREASURER 1.00 X X 0 0 0 MIKE GASTON MEMBER 1.00 X 0 0 0 PAT GANYO MEMBER 1.00 X 0 0 0 WILLIAM WELCH INTERIM CEO (THRU 1/25) 1.00 X 0 0 0 HOLLY WOLFF CEO 1.00 X 0 0 0 0 0 0 0 0 0 0 JEFFERSON COMMUNITY HEALTH & LIFE 2200 H STREET FAIRBURY NE 68352 CONTRACT SERVICES 953922 1 58084 1000 59084 RESIDENT REVENUE 623000 2457387 2457387 2457387 68512 68512 2584983 2457387 0 68512 1025613 875082 150531 71757 61225 10532 82360 70272 12088 122953 122953 15851 15851 63730 23263 40467 9889 9780 109 116332 108766 7566 71264 70478 786 6766 6656 110 20612 20385 227 150626 148964 1662 38119 37698 421 RESIDENT MEALS 691906 691906 DUES & SUBSCRIPTIONS 20907 20676 231 2508685 2145151 363534 0 392243 502871 248645 661887 520900 164549 8873 4423 6219539 4672304 1577078 1547235 684630 768548 3432369 3649513 134535 195957 233769 275745 368304 471702 X 3064065 3177811 3064065 3177811 3432369 3649513 76298 37448 0 X X 1 X 0 1 0 X 254486 12430 458634 64511 59084 849145 1862862 1942841 2272485 2467478 2457387 11003053 2117348 1955271 2731119 2531989 2516471 11852198 0 997361 1072038 2069399 997361 1072038 2069399 9782799 24233 44641 26902 45785 68512 210073 24233 44641 26902 45785 68512 210073 3646 25885 161370 190901 2141581 2003558 2783906 2739144 2584983 12253172 0.79840 0.88600 0.01710 0.01270 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 60427 60427 5671914 4319875 1352039 337492 259960 77532 149706 92469 57237 1547235 RESIDENT SECURITY DEPOSITS 119403 DUE TO JEFFERSON COMMUNITY HEALTH CENTER 128378 PREPAID RENT 27964 275745 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, 2025 AND 2024, 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 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.