2026-08-05T14:51:08-05:00 2025-09-30 423603499 EIDE BAILLY ADVISORY LLC 14010 FNB PKWY STE 600 OMAHA NE 681545206 990 2024-10-01 881755265 JCHC REAL ESTATE INC JCHC 4027293351 2200 H STREET PO BOX 277 FAIRBURY NE 68352 CHANCE KLASEK CFO 4027293351 2026-08-04 1 1 MEGAN L KOZIOL P01544037 4023302660 2026-08-04 2024 2025-03-06 01:10:19Z CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 51585 0 X N/A X 2022 NE TO SUPPORT JEFFERSON COMMUNITY HEALTH CENTER, INC. IN CONSTRUCTING A NEW CLINIC FACILITY. 4 4 0 4 0 0 0 0 0 0 51610 51585 0 0 51610 51585 51537 51484 0 0 0 0 0 0 0 0 0 51537 51484 73 101 5174666 5174767 0 0 5174666 5174767 NONE 0 0 51484 51484 TO SUPPORT JEFFERSON COMMUNITY HEALTH CENTER, INC. FOR THE PURPOSE OF CONSTRUCTING A NEW CLINIC FACILITY. 51484 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 4 4 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 0 0 0 X CHANCE KLASEK 4027296856 2200 H STREET PO BOX 277 FAIRBURY NE 68352 ROSS BOECKNER PRESIDENT 1.00 1.00 X X 0 0 0 LINDA BAUER VICE PRESIDENT 1.00 0.00 X X 0 0 0 STEVEN SNYDER SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 JACK WESCH MEMBER 1.00 0.00 X 0 0 0 CHANCE KLASEK CFO 1.00 40.00 X 0 217506 44796 WILLIAM WELCH INTERIM CEO (THRU 01/25) 1.00 40.00 X 0 53779 221 HOLLY WOLFF CEO 1.00 40.00 X 0 0 0 BURKE KLINE CEO (THRU 08/24) 1.00 40.00 X 0 240233 30708 0 511518 75725 0 1 1 0 0 51585 51585 51585 0 0 51585 51484 51484 51484 51484 0 0 12977 13078 5161689 5161689 5174666 5174767 0 0 X 5174666 5174767 5174666 5174767 5174666 5174767 101 0 X X 0 1 X 1 0 X X X 1 JEFFERSON COMMUNITY HEALTH CENTER INC 470468078 3 1 51484 0 1 51484 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION D, LINE 3: JEFFERSON COMMUNITY HEALTH CENTER, INC., THE SUPPORTED ORGANIZATION, HAS A SIGNIFICANT VOICE IN THE ORGANIZATION'S INVESTMENT POLICIES AND IN DIRECTING THE USE OF THE ORGANIZATION'S INCOME OR ASSETS AT ALL TIMES DURING THE YEAR BY THEIR CLOSE RELATIONSHIP WITH THE ORGANIZATION. JEFFERSON COMMUNITY HEALTH CENTER, INC. HAS THE ABILITY TO ELECT ALL MEMBERS OF THE GOVERNING BODY. PART IV, SECTION E, LINE 2A: THIS ORGANIZATION WAS FORMED TO USE THE NEW MARKET TAX CREDITS FOR THE PURPOSES OF CONSTRUCTING A NEW CLINIC FACILITY FOR JEFFERSON COMMUNITY HEALTH CENTER, INC., THE SUPPORTED ORGANIZATION. THE NEW CLINIC FACILITY WILL FURTHER THE EXEMPT PURPOSE OF JEFFERSON COMMUNITY HEALTH CENTER, INC. BY ALLOWING THE ORGANIZATION TO PROVIDE EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. PART IV, SECTION E, LINE 2B: JEFFERSON COMMUNITY HEALTH CENTER, INC., THE SUPPORTED ORGANIZATION, WOULD HAVE ACQUIRED THE FUNDING FOR CONSTRUCTING A NEW CLINIC FACILITY WITHOUT THE FORMATION OF THE ORGANIZATION. HOWEVER, FORMING THE ORGANIZATION HAS ALLOWED FOR SEVERAL FEDERAL AND STATE QUALIFIED LOW INCOME COMMUNITY INVESTMENT FINANCING AGREEMENTS THAT WOULD NOT BE OTHERWISE AVAILABLE TO THE SUPPORTED ORGANIZATION. 0 X PART X, LINE 2: THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER 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, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 JEFFERSON COMMUNITY HEALTH CENTER INC 2200 H STREET PO BOX 277 FAIRBURY NE 68352 470468078 501(C)(3) 51484 0 PROGRAM SUPPORT 1 0 PART I, LINE 2: JCHC REAL ESTATE, INC. ONLY MAKES GRANTS TO JEFFERSON COMMUNITY HEALTH CENTER, INC., A RELATED ORGANIZATION. DIRECTORS SERVING ON BOTH BOARDS MONITOR THE USE OF THE FUNDS. 0 0 0 0 0 0 0 0 0 BURKE KLINE CEO (THRU 08/24) 0 240233 0 0 0 0 0 4798 0 25911 0 270942 0 0 CHANCE KLASEK CFO 0 217506 0 0 0 0 0 11469 0 33327 0 262302 0 0 PART I, LINE 3 BURKE KLINE, CEO THROUGH AUGUST 2024, WILLIAM WELCH, INTERIM CEO THROUGH JANUARY 2025, AND HOLLY WOLFF, CEO STARTING JANUARY 2025, SERVED AS THE TOP MANAGEMENT OFFICIAL OF JCHC REAL ESTATE, INC. THE CEO IS COMPENSATED BY JEFFERSON COMMUNITY HEALTH CENTER, INC. (JCHC), A RELATED ORGANIZATION. JCHC USES THE FOLLOWING TO DETERMINE COMPENSATION: COMPENSATION COMMITTEE, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7A JEFFERSON COMMUNITY HEALTH CENTER, INC., A RELATED ENTITY, HAS THE POWER TO ELECT ALL MEMBERS OF THE GOVERNING BODY. 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, CFO OF JEFFERSON COMMUNITY HEALTH CENTER, INC., A RELATED ENTITY, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED, BY THE ARTICLES AND BYLAWS, TO REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. A BOARD MEMBER WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING ON ANY MOTION FOR WHICH HE HAS A CONFLICT OF INTEREST. BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER AND WOULD BE AWARE OF ANY PERSONAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 11, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS OF JEFFERSON COMMUNITY HEALTH CENTER, INC., A RELATED ENTITY, SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE FINANCE COMMITTEE. THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM THE PRIOR YEAR. JEFFERSON COMMUNITY HEALTH CENTER INC 2200 H STREET PO BOX 277 FAIRBURY NE 68352 470468078 HEALTH CARE NE 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0