2026-08-05T14:50:35-05:00 2025-09-30 423603499 EIDE BAILLY ADVISORY LLC 14010 FNB PKWY STE 600 OMAHA NE 681545206 990 2024-10-01 470468078 JEFFERSON COMMUNITY HEALTH CENTER INC JEFF 4027293351 2200 H ST 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 JEFFERSON COMMUNITY HEALTH & LIFE CHANCE KLASEK 2200 H ST FAIRBURY NE 68352 41243181 0 X HTTP://WWW.JCHEALTHANDLIFE.ORG X 1960 NE TO OPERATE AN ACUTE CARE CRITICAL ACCESS HOSPITAL IN FAIRBURY, NEBRASKA. 8 6 291 8 0 0 819603 1195552 33853758 38948851 770490 865843 219655 226698 35663506 41236944 6713 4497 0 0 19750038 20884693 0 0 29170 13591420 16394806 33348171 37283996 2315335 3952948 51704257 56250445 19226488 19355523 32477769 36894922 INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. 0 0 30634205 4497 35435119 JEFFERSON COMMUNITY HEALTH & LIFE OPERATES A 17 BED CRITICAL ACCESS ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH & LIFE ALSO OPERATES A FITNESS CENTER, RURAL HEALTH CLINICS, AND PROVIDES HOME HEALTH SERVICES. 2523600 3513732 JEFFERSON COMMUNITY HEALTH & LIFE OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. 33157805 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 8 0 1 291 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 8 6 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 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 STEVEN SNYDER VICE PRESIDENT 1.00 1.00 X X 0 0 0 DIANE WELLSANDT SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 TREVOR STEINMEYER PRESIDENT (THRU 12/24) 1.00 0.00 X X 0 0 0 GLENDA AUSTIN SECRETARY/TREASURER (THRU 12/24) 1.00 0.00 X X 0 0 0 JUSTIN FULTON BOARD MEMBER 1.00 0.00 X 0 0 0 KENDALL SCHLAKE BOARD MEMBER 1.00 0.00 X 0 0 0 DALLAS CHRIST BOARD MEMBER 1.00 0.00 X 0 0 0 SARA STEWART BOARD MEMBER 1.00 0.00 X 0 0 0 CAROLYN SCHERBARTH BOARD MEMBER 1.00 0.00 X 0 0 0 CHANCE KLASEK CFO 40.00 1.00 X 217506 0 44796 BILL WELCH INTERIM CEO (THRU 01/25) 40.00 1.00 X 53779 0 221 HOLLY WOLFF CEO 40.00 1.00 X 0 0 0 CRAIG SHUMARD PHYSICIAN 40.00 0.00 X 496538 0 54943 REBECCA STROKLUND PHYSICIAN 40.00 0.00 X 354004 0 40725 BRETT WERGIN PHYSICIAN 40.00 0.00 X 335910 0 29840 BRANDON BLEICH PHARMACY DIRECTOR 40.00 0.00 X 191669 0 40455 MADHAV NARAYAN PHYSICIAN 40.00 0.00 X 198838 0 12321 DR BURKE KLINE CEO (THRU 08/24) 40.00 1.00 X 240233 0 30708 2088477 0 254009 27 1 1 0 RUTT'S MECHANICAL SERVICES 1001 W 1ST ST HASTINGS NE 68901 MECHANICAL SERVICES 1126454 CERNER 2800 ROCK CREEK PKWY KANSAS CITY KS 64117 ELECTRONIC HEALTH RECORD SERVICES 901501 FIVE NINES TECHNOLOGY GROUP 5617 THOMPSON CREEK BLVD LINCOLN NE 68516 INFORMATION TECHNOLOGY SERVICES 394548 CHAPPELL ROOFING 302 E ST FAIRBURY NE 68352 ROOFING SERVICES 299197 RURALMED MANAGEMENT RESOURCES 511 WEST AVE HOLDREGE NE 68949 REVENUE CYCLE SERVICES 227115 18 15363 51484 893667 235038 1195552 PATIENT SERVICE REVENUE 624100 35989876 35989876 340B DRUG PRICING PROGRAM 624100 1973383 1973383 CEDARWOOD ASSISTED LIVING SVC FEE 623000 831197 831197 CEDARWOOD: EQUITY IN JT VENTURE 623000 56873 56873 97522 97522 38948851 865843 865843 4525 15363 6237 -1712 -1712 CAFETERIA 722514 228410 228410 228410 41236944 38948851 0 1092541 X 4497 4497 549281 549281 312037 171153 140884 15602763 14899481 676892 26390 515082 484393 30689 2767468 2593307 174161 1138062 1050446 85631 1985 89584 15685 73899 100603 100603 4904902 3897164 1007738 153618 15638 137185 795 1164866 995272 169594 557213 494601 62612 113895 81220 32675 94298 82728 11570 473537 438058 35479 2380832 2202451 178381 503149 503149 MEDICAL SUPPLIES 5013438 5013438 FOOD EXPENSE 501941 497725 4216 DUES AND SUBSCRIPTIONS 219720 99169 120551 MISCELLANEOUS EXPENSES 123210 121379 1831 37283996 33157805 4097021 29170 12078530 14753138 8925672 9066369 586307 521015 681175 638613 39826635 21329348 18841648 18497287 8770393 10033854 1532030 1588903 288502 1151266 51704257 56250445 3251089 3661505 6982715 6660112 8414622 8202214 578062 831692 19226488 19355523 X 32114646 36569517 363123 325405 32477769 36894922 51704257 56250445 3952948 464205 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2911 0 0 0 2911 0 PART II-B, LINE 1: JCH&L PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 363123 41711 19397 98826 325405 50754 335309 14193 37133 363123 50754 50754 50754 50754 50754 50754 0.00000 0.15640 0.84360 0 0 50943 50943 28173773 14731481 13442292 10924163 6390298 4533865 677756 207569 470187 18497287 ACCRUED INTEREST 71692 ESTIMATED THIRD-PARTY PAYOR SETTLEMENT 760000 831692 X PART V, LINE 4: THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE NURSING SCHOLARSHIPS AND CAPITAL IMPROVEMENTS. PART X, LINE 2: THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (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. SCHEDULE D, PART V, LINE 1B, COLUMN (B): PRIOR TO THE PRIOR YEAR, THE ENDOWMENT FUNDS REPORTED ON SCHEDULE D, PART V DID NOT INCLUDE TEMPORARY ENDOWMENTS. IN THE PRIOR YEAR, THE ORGANIZATION INCLUDED THE TEMPORARY ENDOWMENTS. THE PRIOR YEAR CONTRIBUTION AMOUNT REPORTED IN COLUMN B INCLUDES THE BEGINNING BALANCE OF THE TEMPORARY ENDOWMENTS. GOLF TOURNAMENT 19888 15363 4525 1440 1170 2420 625 582 19888 15363 4525 1440 1170 2420 625 582 6237 -1712 1 1 X 1 X 1 X 1 1 0 1 1 410000 410000 0.01100 4483970 4483970 4893970 4483970 410000 0.01100 197155 10250 186905 0.00500 27800 27800 0.00070 10225786 6650845 3574941 0.09590 10047 10047 0.00030 10460788 6661095 3799693 0.10190 15354758 11145065 4209693 0.11290 275 275 0.00000 275 275 0.00000 1 589225 57744 11086452 11141878 -55426 X 1 1 1 1 JEFFERSON COMMUNITY HEALTH CENTER 2200 H STREET FAIRBURY NE 68352 HTTP://WWW.JCHEALTHANDLIFE.ORG 440001 X X X X JEFFERSON COMMUNITY HEALTH CENTER INC 1 0 0 1 X X X X X X X X X 24 1 0 0 1 X JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 24 1 JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 150.000000000000 400.000000000000 X X X X 1 1 X X X 1 X HTTPS://WWW.JCHEALTHANDLIFE.ORG/CARE-SERVICES/PATIENT-RESOURCES/ X HTTPS://WWW.JCHEALTHANDLIFE.ORG/CARE-SERVICES/PATIENT-RESOURCES/ X HTTPS://WWW.JCHEALTHANDLIFE.ORG/CARE-SERVICES/PATIENT-RESOURCES/ X X X X X X 1 X 0 X X X X 1 X 0 0 JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH & LIFE TOOK INTO ACCOUNT INPUT FROM PERSONS AND ORGANIZATIONS REPRESENTING THE BROAD INTERESTS OF JEFFERSON COUNTY, THE COMMUNITY SERVED BY THE HOSPITAL FACILITY. THE 2025 CHNA PROCESS BEGAN IN EARLY 2025 AND INCLUDED FOCUS GROUPS WITH LOCAL ORGANIZATIONS, A COMMUNITY STAKEHOLDERS MEETING AT JCH&L WITH REPRESENTATIVES FROM AREA HEALTH-RELATED AGENCIES, AND A CHURCH-HOSTED COMMUNITY INPUT MEETING. FOCUS GROUPS WERE CONDUCTED WITH KIWANIS, ROTARY, OPTIMISTS, AND ST. MICHAEL'S CATHOLIC CHURCH, WITH A TOTAL OF 34 PEOPLE ATTENDING AND PARTICIPATING IN DISCUSSIONS OF COMMUNITY HEALTH NEEDS. THE REPORT DOES NOT PROVIDE EXACT MEETING DATES BEYOND STATING THAT THE PROCESS BEGAN IN EARLY 2025. ORGANIZATIONS PROVIDING INPUT OR REPRESENTED IN THE CHNA PROCESS INCLUDED PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT, BLUE VALLEY COMMUNITY ACTION PARTNERSHIP, BLUE RIVERS AREA AGENCY ON AGING, FAIRBURY ROTARY CLUB, FAIRBURY OPTIMIST CLUB, FAIRBURY KIWANIS CLUB, FAIRBURY PUBLIC SCHOOLS, ST. PAUL'S LUTHERAN SCHOOL OF PLYMOUTH, FAIRBURY DENTAL ASSOCIATES, JEFFERSON COUNTY COMMISSIONERS, CITY OF FAIRBURY, JEFFERSON COUNTY MINISTERIAL ALLIANCE, LOCAL CHURCHES, JCH&L MEDICAL STAFF/PROVIDERS/CLINICAL STAFF, JCH&L TEAM MANAGERS, AND THE JCH&L BOARD OF DIRECTORS. PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT REPRESENTS THE REQUIRED GOVERNMENTAL PUBLIC HEALTH DEPARTMENT INPUT, SERVING FILLMORE, JEFFERSON, SALINE, GAGE, AND THAYER COUNTIES IN SOUTHEAST NEBRASKA. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 11: THE 2025 COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED A BROAD RANGE OF COMMUNITY HEALTH NEEDS AND CONCERNS IN JEFFERSON COUNTY. AFTER REVIEW AND PRIORITIZATION, JEFFERSON COMMUNITY HEALTH & LIFE SELECTED THE FOLLOWING NEEDS AS THE MOST IMPORTANT FOR THE HOSPITAL TO ADDRESS OVER THE NEXT THREE YEARS:1. INCREASING THE NUMBER OF PRIMARY CARE PROVIDERS 2. MENTAL/BEHAVIORAL HEALTH 3. OBESITY, NUTRITION, AND SEDENTARY LIFESTYLE 4. CHRONIC DISEASES AFFECTED BY OBESITY AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE, AND CANCER BECAUSE THE NEW CHNA WAS COMPLETED DURING THE CURRENT TAX YEAR, THE FACILITY HAD LIMITED TIME TO BEGIN FULLY IMPLEMENTING NEW ACTIVITIES UNDER THE 2025 PLAN. HOWEVER, JCH&L BEGAN OR CONTINUED WORK IN AREAS THAT ALIGN WITH THE NEWLY IDENTIFIED PRIORITIES, INCLUDING PRIMARY CARE ACCESS, MENTAL/BEHAVIORAL HEALTH, OBESITY/NUTRITION/SEDENTARY LIFESTYLE, AND CHRONIC DISEASE PREVENTION AND MANAGEMENT.LTO ADDRESS THE NEED FOR ADDITIONAL PRIMARY CARE PROVIDERS, JCH&L BEGAN A CONCENTRATED RECRUITMENT EFFORT TO ADD AT LEAST TWO PRIMARY CARE FAMILY PRACTICE PHYSICIANS. JCH&L FAIRBURY CLINIC CONTINUED TO PROVIDE PRIMARY CARE SERVICES WITH ONE FAMILY PRACTICE PROVIDER AND FIVE ADVANCED PRACTICE PROVIDERS, INCLUDING FAMILY NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS. JCH&L ALSO WORKED TOWARD IMPLEMENTATION OF AVEL TO PROVIDE TELEHEALTH COVERAGE AND BACKUP FOR THE EMERGENCY DEPARTMENT.TO ADDRESS MENTAL AND BEHAVIORAL HEALTH NEEDS, JCH&L ADDED A PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER AND A PROVISIONALLY LICENSED MENTAL HEALTH PRACTITIONER IN 2025. BEHAVIORAL HEALTH SERVICES BEGAN BEING OFFERED THROUGH JCH&L BEHAVIORAL HEALTH. JCH&L ALSO PARTICIPATED IN LOCAL EFFORTS RELATED TO MENTAL HEALTH AND SUBSTANCE ABUSE, INCLUDING PARTICIPATION IN AN UPSTREAM MAPPING WORKSHOP AND REPRESENTATION ON THE JEFFERSON COMMUNITY COALITION.TO ADDRESS OBESITY, NUTRITION, AND SEDENTARY LIFESTYLE, JCH&L CONTINUED ACTIVITIES AIMED AT ENCOURAGING HEALTHIER LIFESTYLES. SEVERAL KIDS COOKING CLASSES WERE HELD FOR AREA YOUTH AND A PARENT OR GUARDIAN, WITH PARTICIPANTS PREPARING AND SHARING A MEAL UNDER THE DIRECTION OF A DIETITIAN. JCH&L CONTINUED SUPPORTING COMMUNITY WALKING AND BIKING EFFORTS, INCLUDING SUPPORT FOR CITY OF FAIRBURY GRANT EFFORTS TO IMPROVE SIDEWALKS, WALKING ROUTES, AND TRAILS. JCH&L ALSO WORKED WITH THE CITY TO ESTABLISH A WALKING AREA IN THE FAIRBURY COMMUNITY BUILDING AND PROVIDED MONTHLY PRIZES FOR THE FIRST SIX MONTHS TO ENCOURAGE USE OF THE SPACE. THE JCH&L BURKLEY FITNESS CENTER OFFERED YOUTH SWIM EVENTS, FITNESS IS FUN SUMMER ACTIVITIES FOR CHILDREN, AND OTHER YOUTH WELLNESS PROGRAMMING.TO ADDRESS CHRONIC DISEASES AFFECTED BY NUTRITION, OBESITY, AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE, AND CANCER, JCH&L CONTINUED MEN'S AND WOMEN'S HEALTH ACTIVITIES. THE FACILITY PROVIDED INCENTIVES FOR MEN AND WOMEN WHO RECEIVED PHYSICALS AND FOR WOMEN WHO RECEIVED MAMMOGRAMS. WOMEN'S HEALTH DAYS CONTINUED TO BE OFFERED, ALLOWING WOMEN TO RECEIVE A MAMMOGRAM, BLOOD WORK, AND ANNUAL EXAM IN ONE VISIT. JCH&L ALSO CONTINUED PROMOTING MEDICARE WELLNESS VISITS, PROVIDED HEALTH EDUCATION PROGRAMS, AND CONTINUED EFFORTS TO EXPAND CHRONIC CARE COORDINATION AND DIABETES EDUCATION.JCH&L ALSO CONTINUED TO SUPPORT COMMUNITY HEALTH EDUCATION AND PREVENTION ACTIVITIES CONNECTED TO THE PRIOR CHNA PRIORITIES. THESE INCLUDED PROVIDING SCHOOL AND YOUTH EDUCATION PROGRAMS, SUCH AS VAPING EDUCATION DURING RED RIBBON WEEK, PROGRAMS FOR PROGRESSIVE AGRICULTURE SAFETY DAYS, AND A TEDDY BEAR CLINIC FOR AREA CHILDREN AND PARENTS. JCH&L SPORTS MEDICINE AND REHAB SERVICES CONTINUED PROVIDING SIDELINE SERVICES FOR FAIRBURY HIGH SCHOOL FOOTBALL. THE FACILITY ALSO CONTINUED PROVIDING MONTHLY EDUCATIONAL PROGRAMS AT FAIRBURY SENIOR DINERS AND HELPED PROMOTE THE SENIOR DINERS PROGRAM, WHICH PROVIDES NUTRITIOUS MEALS AND SOCIAL INTERACTION FOR ADULTS AGE 60 AND OLDER.OVERALL, DURING THE CURRENT TAX YEAR, JCH&L CONTINUED IMPLEMENTING ACTIVITIES FROM THE PRIOR CHNA WHILE ALSO BEGINNING WORK ON THE PRIORITIES IDENTIFIED IN THE NEWLY COMPLETED 2025 CHNA.DURING THE IMPLEMENTATION STRATEGY PROCESS, JEFFERSON COMMUNITY HEALTH & LIFE REVIEWED THE NEEDS IDENTIFIED THROUGH THE 2025 COMMUNITY HEALTH NEEDS ASSESSMENT AND PRIORITIZED THE AREAS WHERE THE FACILITY DETERMINED IT COULD HAVE THE GREATEST IMPACT BASED ON COMMUNITY NEED, AVAILABLE RESOURCES, THE SEVERITY OF THE ISSUE, THE NUMBER OF PEOPLE AFFECTED, AND THE EXTENT TO WHICH OTHER ORGANIZATIONS ARE ALREADY ADDRESSING OR MAY BE BETTER POSITIONED TO ADDRESS THE NEED.THE FACILITY WILL NOT DIRECTLY ADDRESS SUBSTANCE ABUSE AND SMOKING AS PRIORITY AREAS. JCH&L RECOGNIZES THESE AS IMPORTANT COMMUNITY CONCERNS AND WILL CONTINUE TO SERVE AS A COMMUNITY PARTNER WITH OTHER AGENCIES WORKING IN THESE AREAS. HOWEVER, THESE ISSUES REQUIRE A BROADER COMMUNITY-WIDE APPROACH AND ARE BETTER ADDRESSED THROUGH PARTNERSHIPS AND ORGANIZATIONS SPECIFICALLY FOCUSED ON PREVENTION, TREATMENT, AND COMMUNITY INTERVENTION.SUICIDE PREVENTION WILL ALSO NOT BE ADDRESSED AS A SEPARATE PRIORITY AREA. JCH&L WILL CONTINUE SUPPORTING AND PARTNERING WITH COMMUNITY ORGANIZATIONS WORKING ON SUICIDE PREVENTION AND SUPPORT FOR THOSE AFFECTED BY SUICIDE, BUT THE FACILITY DETERMINED THAT REDUCING SUICIDE REQUIRES A BROADER COMMUNITY RESPONSE BEYOND THE HOSPITAL'S DIRECT RESOURCES.ALZHEIMER'S DISEASE WAS IDENTIFIED AS A NEED BUT WILL NOT BE A MAJOR PRIORITY AREA. JCH&L WILL CONTINUE OFFERING AN ALZHEIMER'S CAREGIVER SUPPORT GROUP, PROVIDING EDUCATIONAL RESOURCES THROUGH THE ALZHEIMER'S ASSOCIATION, AND PARTNERING WITH FAIRBURY HIGH SCHOOL FBLA ON AN ANNUAL ALZHEIMER'S MEMORY WALK. HOWEVER, THE FACILITY DETERMINED THAT THIS LEVEL OF INVOLVEMENT IS APPROPRIATE AT THIS TIME AND WILL NOT MAKE ALZHEIMER'S DISEASE A MAJOR FOCUS AREA.ADDITIONAL SPECIALTIES AND NEW SERVICES WILL CONTINUE TO BE CONSIDERED AS PART OF JCH&L'S ONGOING STRATEGIC PLANNING PROCESS, BUT MOST SPECIALTY AND SERVICE EXPANSION NEEDS WILL NOT BE NAMED AS CHNA PRIORITIES BECAUSE OF STAFFING, PERSONNEL, AND RESOURCE LIMITATIONS. THE FACILITY WILL FOCUS ONLY ON SELECTED AREAS THAT DIRECTLY SUPPORT ITS PRIORITY GOALS.DENTAL HEALTH WILL NOT BE ADDRESSED AS A PRIORITY AREA BECAUSE IT IS OUTSIDE JCH&L'S CURRENT SERVICE OFFERINGS. THE FACILITY WILL CONTINUE TO BE A COMMUNITY PARTNER WITH AGENCIES AND PRACTICES THAT PROVIDE DENTAL SERVICES, BUT IT DOES NOT INTEND TO MAKE DENTAL HEALTH A DIRECT PRIORITY AT THIS TIME.ECONOMIC CONCERNS, HOUSING NEEDS, UNSAFE OR SUBSTANDARD HOUSING, TRANSPORTATION, DAYCARE, BROADBAND EXPANSION, WATER QUALITY CONCERNS, AND HUNGER WILL NOT BE DIRECTLY ADDRESSED AS PRIORITY AREAS. JCH&L RECOGNIZES THAT THESE SOCIAL AND ECONOMIC FACTORS AFFECT HEALTH AND WELL-BEING, BUT THEY ARE BROADER COMMUNITY AND SOCIETAL ISSUES THAT ARE BETTER ADDRESSED BY OTHER AGENCIES, LOCAL GOVERNMENT, COMMUNITY ORGANIZATIONS, AND SERVICE PROVIDERS. JCH&L WILL CONTINUE TO SUPPORT THESE EFFORTS AS A COMMUNITY PARTNER WHERE APPROPRIATE.INSURANCE, UNINSURED, AND UNDERINSURED CONCERNS WILL NOT BE LISTED AS A SEPARATE PRIORITY AREA. JCH&L WILL CONTINUE SEEKING WAYS TO SERVE UNINSURED AND UNDERINSURED PATIENTS, INCLUDING THROUGH CHARITY CARE, BUT THE FACILITY DID NOT SELECT THIS AS ONE OF ITS MAJOR PRIORITY AREAS.COUNTY DEMOGRAPHICS AND THE CHANGING NEEDS OF THE COUNTY'S POPULATION WILL NOT BE A SEPARATE PRIORITY AREA. JCH&L WILL CONTINUE PLANNING FOR DEMOGRAPHIC CHANGES AND WORKING WITH LOCAL PARTNERS SUCH AS THE CITY, COUNTY, CHAMBER OF COMMERCE, AND OTHER ORGANIZATIONS TO SUPPORT COMMUNITY GROWTH AND SERVICE PLANNING.AWARENESS OF SERVICES, GENERAL HEALTH EDUCATION, PARENTING EDUCATION, VETERANS' SERVICES, SERVICES FOR DISABLED RESIDENTS, SCHOOL BEHAVIOR CONCERNS, SCHOOL ACTIVITIES, SOCIALIZATION, WALKABLE COMMUNITY EFFORTS, INCENTIVES TO EXERCISE, SOCIAL ISOLATION, DOMESTIC VIOLENCE, SEATBELT AND CHILD SAFETY SEAT USE, SUPPORT GROUPS, AND IMMUNIZATIONS WILL ALSO NOT BE ADDRESSED AS SEPARATE PRIORITY AREAS. IN MANY OF THESE AREAS, JCH&L WILL CONTINUE PROVIDING EDUCATION, SERVICES, PARTNERSHIPS, SUPPORT GROUPS, CHILD SAFETY SEAT CHECKUPS, IMMUNIZATION PARTNERSHIPS, OR COMMUNITY INFORMATION, BUT THE FACILITY DETERMINED THAT THESE NEEDS ARE EITHER OUTSIDE ITS MAIN FOCUS, ALREADY BEING ADDRESSED BY OTHER ORGANIZATIONS, OR NOT THE HIGHEST PRIORITIES FOR DIRECT FACILITY ACTION DURING THIS IMPLEMENTATION PERIOD.OVERALL, JCH&L DETERMINED THAT WHILE MANY NEEDS IDENTIFIED IN THE CHNA ARE IMPORTANT, THE FACILITY'S DIRECT IMPLEMENTATION STRATEGY WILL FOCUS ON THE NEEDS WHERE IT CAN MAKE THE GREATEST MEASURABLE IMPACT: INCREASING THE NUMBER OF PRIMARY CARE PROVIDERS, MENTAL AND BEHAVIORAL HEALTH, OBESITY/NUTRITION/SEDENTARY LIFESTYLE, AND CHRONIC DISEASES AFFECTED BY OBESITY AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE, AND CANCER. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 13H: SOME INDIVIDUALS OR GUARANTORS MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN EXCESS OF WHAT WOULD HAVE BEEN GRANTED UNDER THE INCOME CRITERIA IF THEY HAD INCURRED CATASTROPHIC MEDICAL COSTS OR OTHER OBLIGATIONS (PRESENTLY OR ONGOING) THAT HAVE SUBSTANTIALLY REDUCED THEIR ABILITY TO PAY. IN SUCH CASES THE INDIVIDUAL OR GUARANTOR MAY BE DETERMINED BY JEFFERSON COMMUNITY HEALTH & LIFE TO BE MEDICALLY INDIGENT AND MAY, AT JEFFERSON COMMUNITY HEALTH & LIFE'S DISCRETION, BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN THE FORM OF FREE OR DISCOUNTED LIABILITIES. THERE ARE INSTANCES WHEN A PATIENT WILL COMPLETE THE FINANCIAL ASSISTANCE APPLICATION, PROVIDES SUPPORTING DOCUMENTATION AND DOES NOT QUALIFY FOR ASSISTANCE. IF THE PATIENT'S BALANCE EXCEEDS MORE THAN 20% OF THEIR TOTAL INCOME, THIS WILL BE DEEMED A CATASTROPHIC BALANCE. IN THESE INSTANCES, THE CHIEF FINANCIAL OFFICER WILL HAVE THE AUTHORITY TO DETERMINE IF A PORTION OF THE BALANCE SHOULD BE FORGIVEN TO FINANCIAL ASSISTANCE. THIS WILL BE HANDLED ON A CASE-BY-CASE BASIS AND THE TOTALITY OF CIRCUMSTANCES WILL BE UTILIZED IN DETERMINING ELIGIBILITY. THE DISCOUNT SHALL NOT EXCEED 20% OF OUTSTANDING BALANCES. 2 1 - GARDENSIDE 200 H STREET FAIRBURY NE 68352 LONG TERM CARE FACILITY 2 - FAIRBURY CLINIC 825 22ND STREET FAIRBURY NE 68352 RURAL HEALTH CLINIC PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, JCH&L USES MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS TO DETERMINE ELIGIBILITY FOR PROVING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. SOME INDIVIDUALS OR GUARANTORS MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN EXCESS OF WHAT WOULD HAVE BEEN GRANTED UNDER THE INCOME CRITERIA IF THEY HAD INCURRED CATASTROPHIC MEDICAL COSTS OR OTHER OBLIGATIONS (PRESENTLY OR ONGOING) THAT HAVE SUBSTANTIALLY REDUCED THEIR ABILITY TO PAY. IN SUCH CASES THE INDIVIDUAL OR GUARANTOR MAY BE DETERMINED BY JEFFERSON COMMUNITY HEALTH & LIFE TO BE MEDICALLY INDIGENT AND MAY, AT JEFFERSON COMMUNITY HEALTH & LIFE'S DISCRETION, BE ELIGIBLE FOR FINANCIAL ASSISTANCE IN THE FORM OF FREE OR DISCOUNTED LIABILITIES. THERE ARE INSTANCES WHEN A PATIENT WILL COMPLETE THE FINANCIAL ASSISTANCE APPLICATION, PROVIDES SUPPORTING DOCUMENTATION AND DOES NOT QUALIFY FOR ASSISTANCE. IF THE PATIENT'S BALANCE EXCEEDS MORE THAN 20% OF THEIR TOTAL INCOME, THIS WILL BE DEEMED A CATASTROPHIC BALANCE. IN THESE INSTANCES, THE CHIEF FINANCIAL OFFICER WILL HAVE THE AUTHORITY TO DETERMINE IF A PORTION OF THE BALANCE SHOULD BE FORGIVEN TO FINANCIAL ASSISTANCE. THIS WILL BE HANDLED ON A CASE-BY-CASE BASIS AND THE TOTALITY OF CIRCUMSTANCES WILL BE UTILIZED IN DETERMINING ELIGIBILITY. THE DISCOUNT SHALL NOT EXCEED 20% OF OUTSTANDING BALANCES. PART I, LINE 7: FINANCIAL ASSISTANCE AT COST, LINE 7A, UNREIMBURSED MEDICAID, LINE 7B, AND SUBSIDIZED HEALTH SERVICES, LINE 7G, ARE CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART I, LINE 7G: THERE ARE COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. TOTAL REVENUE RECEIVED FROM MEDICARE RELATED TO PHYSICIAN CLINICS INCLUDES $496,684 WITH MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS OF $967,897. PART I, LINE 7: JCH&L REACHES OUT TO THE COMMUNITY IN A VARIETY OF WAYS INCLUDING, IN 2025:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMS A. TRADITIONAL CHARITY CARE - JCH&L PROVIDED CHARITY CARE IN FISCAL 2025 FOR ALL JCH&L SERVICES TO THOSE WHO MEET UP TO 400 PERCENT OF FEDERAL POVERTY GUIDELINES. THE HOSPITAL BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS. PATIENTS ASSISTED: 112 VALUE: $410,000 B. UNPAID COSTS OF PUBLIC PROGRAMS C. BAD DEBT - BESIDES OFFICIAL CHARITY CARE, JCH&L WROTE OFF $590,862 IN BAD DEBT DURING FISCAL 2025. II. COMMUNITY BENEFIT SERVICESA. COMMUNITY HEALTH EDUCATION AND OUTREACH. - HEALTHCARE HEROES PIPELINE JEFFERSON COMMUNITY HEALTH & LIFE HAS PARTNERED WITH THE FAIRBURY PUBLIC SCHOOLS, NEBRASKA HOSPITAL ASSOCIATION AND NEBRASKA HEALTHCARE FOUNDATION TO BRING THE HEALTH CARE HEROES LEAGUE TO FAIRBURY THIRD GRADERS IN THE FALL OF FISCAL 2025. THE PROGRAM IS A COLLABORATIVE EFFORT TO PROVIDE FUN, ENGAGING, AND INNOVATIVE APPROACHES TO TEACH STUDENTS ABOUT A MULTITUDE OF DIFFERENT HEALTH CARE CAREER CHOICES. FOUR JCH&L STAFF MEMBERS WERE TRAINED FOR THE PROGRAM, AND ARE TAKING TURNS WORKING WITH A PE TEACHER IN THE SCHOOL TO OFFER THE PROGRAM. STAFF MEMBERS MET WEEKLY WITH SCHOOL CLASSES FROM OCTOBER 2024 THROUGH SEPTEMBER 2025. TOTAL INDIVIDUALS REACHED: 139. ESTIMATED COST OF STAFF TIME: $4,160. - HEALTH FAIR JCH&L PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC., AT COMMUNITY EVENTS. NO HEALTH FAIR WAS HELD IN 2025. - SPEAKERS BUREAU. JCH&L STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 21 PROGRAMS WERE DONE IN FISCAL 2025. TOTAL INDIVIDUALS REACHED: 875. ESTIMATED COST OF STAFF TIME: $1,050. - SUPPORT GROUPS - ALZHEIMER'S ASSOCIATION CAREGIVERS SUPPORT GROUP RESUMED IN FISCAL 2023 AFTER BEING OFF BECAUSE OF COVID. JCH&L STAFF COORDINATE MEETINGS, OFFERING ASSISTANCE TO ANYONE INTERESTED IN MORE INFORMATION ABOUT ALZHEIMER'S AND BEING A CAREGIVER. JCH&L PROVIDES EDUCATIONAL PROGRAMS FOR THE GROUP -- INCLUDING SPEAKER'S FEES IF NEEDED, POSTAGE TO SEND OUT MEETING NOTICES, AND REFRESHMENTS. WE ALSO PROVIDE MEETING SPACE AND DRINKS FOR A GRIEF SUPPORT GROUP COORDINATED BY COTTONWOOD HOSPICE. TOTAL NUMBER REACHED: 81. APPROXIMATE COST OF STAFF TIME SPENT: $3,250. ESTIMATED COST OF POSTAGE: $252 (MEETING NOTICES) ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES, REFRESHMENTS): $600. B. COMMUNITY-BASED CLINICAL SERVICES SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS. - COMPLETE BLOOD PROFILES JCH&L OFFERS PATIENT-REQUESTED BLOOD SCREENINGS FOR THOSE WITH HIGH DEDUCTIBLES OR WHO WOULD LIKE RESULTS MORE OFTEN THAN THEY CAN GET THEM THROUGH INSURANCE COVERAGE. THIS WAS TO TAKE THE PLACE OF COMPLETE BLOOD PROFILES PREVIOUSLY OFFERED TO OUR COMMUNITY AT A REDUCED RATE EACH SPRING. SEVERAL TYPES OF SCREENINGS ARE OFFERED WEEKLY AT A REDUCED RATE. DURING THE FISCAL YEAR WE DID 563 SCREENINGS, AND BROUGHT IN $10,250 IN PAYMENTS FOR THE SERVICE. WHEN COMPARED AGAINST TYPICAL CHARGES THE TOTAL COMMUNITY BENEFIT WAS MORE THAN $180,943. ESTIMATED NUMBER REACHED: 466 VALUE OF ESTIMATED STAFF TIME: $76,354.33. ESTIMATED VALUE OF COMMUNITY BENEFIT: $180,943. - IMMUNIZATION CLINICS. JCH&L COOPERATES WITH BLUE VALLEY COMMUNITY ACTION IN PROVIDING IMMUNIZATION CLINIC FOR CHILDREN TWICE EACH MONTH. JCHC PROVIDES SPACE WHERE IMMUNIZATIONS ARE DONE, NURSING STAFF, THE PATIENT WAITING AREAS, AND JANITORIAL AND SUPPORT SERVICES. NUMBER OF PATIENTS SERVED: 126. TOTAL OF 340 VACCINATIONS PROVIDED. ESTIMATED COST OF NURSES PROVIDED BY JCH&L TO GIVE SHOTS: $6,900.III. MEDICAL EDUCATION A. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS. - PHYSICIAN/MEDICAL STUDENTS, NURSES/NURSING STUDENTS, TECHNICIANS AND OTHER HEALTH PROFESSIONALS. MEDICAL STUDENTS COME REGULARLY FOR RURAL ROTATIONS TO LEARN FROM LOCAL PHYSICIANS. JCH&L PROVIDES AN APARTMENT FOR THE MEDICAL STUDENTS TO STAY IN DURING THEIR TIME IN FAIRBURY, AND ALSO PROVIDES THEM USE OF OUR FITNESS CENTER DURING THEIR STAY. A TOTAL OF 5 PHYSICIAN STUDENTS, 4 PA STUDENTS, 1 NURSE PRACTITIONER STUDENT, AND 2 THERAPY STUDENTS LEARNED AT OUR FACILITY IN FISCAL 2025. JCH&L IS A PARTNER IN OFFERING THE LILLIAN HANSEN REESMAN RN MEMORIAL NURSES SCHOLARSHIP FUND. SCHOLARSHIPS ARE OFFERED FROM THIS FUND, ESTABLISHED IN 1980. ONLY INTEREST IS USED FROM THIS $10,000 PERPETUAL FUND, DONATED BY THE REESMAN FAMILY, TO PROVIDE NURSING SCHOLARSHIPS. SCHOLARSHIPS ARE PROVIDED AS INTEREST FUNDS ARE AVAILABLE. ONE $500 SCHOLARSHIP WAS AWARDED IN FISCAL 2025. THE JCH&L AUXILIARY PROVIDES A SCHOLARSHIP FOR STUDENTS PURSUING AN EDUCATION IN MEDICAL FIELDS. THE $400 SCHOLARSHIP IS GIVEN FROM THE AUXILIARY'S FUNDS, AND THE NUMBER OF SCHOLARSHIPS GIVEN EACH YEAR IS BASED ON THE AUXILIARY'S FUNDING AVAILABILITY AND THE NUMBER OF REQUESTS. ESTIMATED NUMBER REACHED: 11. JCH&L COST (APARTMENT RENT, STAFF TIME, ETC.): $20,000. B. OTHER - JOB SHADOWING. JCH&L TYPICALLY HOSTS JOB SHADOW STUDENTS THROUGH FAIRBURY HIGH SCHOOL'S ANATOMY AND PHYSIOLOGY CLASS, THROUGH THE SOUTHEAST COMMUNITY COLLEGE-FAIRBURY HIGH SCHOOL CAREER ACADEMY PROGRAM, AND FOR INTERESTED INDIVIDUALS. NUMBER REACHED: 28. ESTIMATED COST OF STAFF TIME: $7,800.IV. SUBDIZED HEALTH SERVICES - WELLNESS CENTER SUPPORT. JEFFERSON COMMUNITY HEALTH & LIFE HAS OPERATED THE BURKLEY FITNESS CENTER AS A COMMUNITY FITNESS/WELLNESS CENTER SINCE IT OPENED IN 1996. JCH&L PAYS THE WELLNESS CENTER'S OPERATING EXPENSES THAT EXCEED REVENUES. BECAUSE OF THE HEALTH CENTER'S SUPPORT OF THE FITNESS CENTER'S CASH FLOW, PRICES FOR MEMBERSHIPS AND SERVICES CAN REMAIN REASONABLE FOR COMMUNITY RESIDENTS. IF THE FITNESS CENTER WERE A STAND-ALONE OPERATION, PRICES WOULD HAVE TO RISE CONSIDERABLY TO PAY ALL EXPENSES. TOTAL VISITS FOR FISCAL 2025: 53,828. ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $170,903. - HOME HEALTH SUPPORT. JEFFERSON COMMUNITY HEALTH & LIFE HAS OPERATED A HOME HEALTH AGENCY SINCE 1984. JCH&L PAYS THE AGENCY'S OPERATING EXPENSES THAT EXCEED REVENUES. THE HEALTH CENTER'S SUPPORT MAKES IT POSSIBLE FOR THE HOME HEALTH AGENCY TO CONTINUE TO PROVIDE SKILLED CARE IN THE HOMES OF AREA RESIDENTS. INCOME: $174,784. EXPENSES: $531,968. NET LOSS: $357,184. - GARDENSIDE LONG-TERM CARE. JEFFERSON COMMUNITY HEALTH & LIFE HAS OPERATED GARDENSIDE LONG-TERM CARE SINCE OPENING IN 1963. GARDENSIDE PROVIDES A HOME (SHORT-TERM FOR SKILLED CARE OR LONG-TERM FOR THOSE UNABLE TO LIVE IN THEIR OWN HOME INDEPENDENTLY) FOR UP TO 40 INDIVIDUALS. MOST ARE FROM THIS AREA AND HAVING A LONG-TERM CARE FACILITY NEAR THEIR HOMES AND FAMILIES IS A GREAT BENEFIT TO OUR RESIDENTS, AS WELL AS TO THEIR FAMILIES. INCOME: $3,559,320. EXPENSES: $4,587,257. NET LOSS: $1,027,937.V. RESEARCH. NO RESEARCH DOLLARS EXPENDED.VI. CASH AND IN-KIND DONATIONS.A. CASH DONATIONS. JCH&L MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUTS, SOFTBALL, BASEBALL AND CHURCH CAMP FIRST AID KITS; SPONSORSHIP OF BASEBALL AND SOFTBALL TEAMS; GOLF TOURNAMENTS, AREA HIGH SCHOOL POST PROM ACTIVITIES; AREA COMMUNITY CELEBRATIONS; CHAMBER OF COMMERCE BANQUET, CHAMBER OF COMMERCE NEW TEACHER WELCOME, CHAMBER OF COMMERCE TEACHER RECOGNITION; AND DONATIONS TO TEAMMATES, LIGHT IT UP BLUE, FIVE STAR BIBLE CAMP; STATEBOUND ATHLETES FROM JEFFERSON COUNTY SCHOOLS; BONHAM THEATRE; ROTARY FUND-RAISERS; KGMT-KUTT ANNUAL THANKSGIVING MEAL; BLUE VALLEY COMMUNITY ACTION; BLUE RIVERS AREA AGENCY ON AGING; AND AREA SCHOOLS' WRESTLING PROGRAMS. THESE TOTALED $4,497. JCH&L ALSO CONTRIBUTES ITEMS -- SUCH AS FITNESS CENTER PASSES, JCH&L ITEMS, ETC., TO COMMUNITY EVENTS AS DOOR PRIZES. THESE TOTALED AN ESTIMATED $1,000. DONATIONS DURING FISCAL 2025 TOTALED $5,497. B. IN-KIND DONATIONS. - BLOOD DRIVE SUPPORT JCH&L ASSISTS NEBRASKA COMMUNITY BLOOD BANK BY SCHEDULING APPOINTMENTS FOR SIX BLOOD DRIVES EACH YEAR. THE BLOOD PRODUCTS ULTIMATELY HELP OUR COMMUNITY, AS NEBRASKA COMMUNITY BLOOD BANK IS JCH&L'S SUPPLIER OF BLOOD AND BLOOD PRODUCTS. ESTIMATED STAFF TIME: $1,500. - SAFETY DAY FOR KIDS. JCHL IS ONE OF THE COSPONSORS OF THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 77 KIDS -- AGES KINDERGARTEN THROUGH SIXTH GRADES ATTENDED THE AUGUST 2025 EVENT. STAFF MEMBERS ASSISTED IN PLANNING THE EVENT AND ASSISTED IN COORDINATING AND INSTRUCTING ON THE DAY OF THE CAMP. THE COST OF STAFF TIME DONATED IS ESTIMATED AT: $2,550. TOTAL COST OF SUPPLIES FURNISHED WAS $500. PART II, COMMUNITY BUILDING ACTIVITIES: ECONOMIC DEVELOPMENT. JEFFERSON COMMUNITY HEALTH & LIFE IS ACTIVE IN LOCAL ECONOMIC DEVELOPMENT ACTIVITIES. JCH&L IS A MEMBER OF THE FAIRBURY CHAMBER OF COMMERCE. WE SEEK OPPORTUNITIES TO OFFER TOURS, HEALTH CARE INFORMATION ON COMMUNITY WEBSITES, ETC. COST OF CHAMBER MEMBERSHIP: $275. IN ADDITION TO THESE DIRECT PROGRAMS AND SERVICES, THE EMPLOYEES OF JEFFERSON COMMUNITY HEALTH & LIFE SERVE THEIR COMMUNITY IN MANY WAYS INCLUDING SERVING IN THEIR CHURCHES, AS GIRL AND BOY SCOUT LEADERS, 4-H LEADERS, AS LEADERS IN CIVIC ORGANIZATIONS, AS YOUTH GROUP LEADERS, AS CITY GOVERNMENT MEMBERS, ON COMMUNITY DEVELOPMENT BOARDS, FOR EMERGENCY RESPONSE ORGANIZATIONS, AND OTHERS. JCH&L STAFF MEMBERS ARE A RESOURCE AS COMMUNITY ROLE MODELS.JCH&L IS PROUD OF ITS CONTRIBUTIONS TO THE CITIZENS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. THE CITIZENS OF THIS AREA ALSO HIGHLY REGARD JCH&L'S CONTRIBUTIONS TO THE COMMUNITY.THE GOAL OF THE JCH&L BOARD OF DIRECTORS, ADMINISTRATION AND STAFF IS TO EXPAND THAT PARTNERSHIP WITH AREA RESIDENTS AND FIND MORE WAYS TO SERVE AS A RESOURCE FOR HEALTH AND WELLNESS INFORMATION. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 9.8% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 14 AND 15 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES RENDERED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATIONS PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $76,422.MEDICARE FEE SCHEDULE REVENUE $129,336MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS $205,757NET (SHORTAGE) ($76,422) PART III, LINE 9B: IF A PATIENT IS GRANTED FINANCIAL ASSISTANCE THAT IS FREE CARE, THE WRITTEN NOTICE TO THE PATIENT SHALL SO STATE AND REASONABLE MEASURES SHALL BE TAKEN TO ENSURE THAT ALL ECAS ARE REVERSED. IN ADDITION, ANY AMOUNTS PAID BY THE PATIENT IN EXCESS OF $5 SHALL BE REFUNDED. IF THE PATIENT IS GRANTED FINANCIAL ASSISTANCE THAT IS OTHER THAN FREE CARE, JCH&L WILL:1. PROVIDE THE PATIENT WITH A REVISED BILL SETTING FORTH: (I) THE AMOUNT THE PATIENT OWES FOR CARE PROVIDED AFTER FINANCIAL ASSISTANCE, (II) HOW THE REVISED AMOUNT WAS DETERMINED; AND (III) EITHER THE AGB FOR THE CARE PROVIDED OR INSTRUCTIONS ON HOW THE PATIENT CAN OBTAIN INFORMATION REGARDING THE AGB FOR THE CARE PROVIDED;2. PROVIDE THE PATIENT WITH A REFUND FOR ANY AMOUNT THE PATIENT HAS PAID IN EXCESS OF THE AMOUNT OWED TO JCH&L (UNLESS SUCH AMOUNT IS LESS THAN $5); AND3. TAKE REASONABLE MEASURES TO REVERSE ANY ECAS TAKEN AGAINST THE PATIENT. PART VI, LINE 2: JCH&L ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY JCH&L SERVES IN SEVERAL WAYS. JCH&L UTILIZES SURVEYS BY PUBLIC HEALTH SOLUTIONS OF THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING COMMUNITY. JCH&L VISITS LOCAL COMMUNITY SERVICE ORGANIZATIONS AND SEEKS INPUT ON NEEDS. JCH&L REVIEWS SURVEYS DONE BY THE STATE AND OTHER ORGANIZATIONS ON THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. PART VI, LINE 3: JCH&L INFORMS AND EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE ON AN INDIVIDUAL BASIS WHEN QUESTIONS ARISE. THE PATIENT BOOKLET PROVIDES BUSINESS OFFICE CONTACT INFORMATION FOR PATIENT QUESTIONS ABOUT THEIR BILL. THE SELF-PAY BILLING VENDOR ENGAGED BY JCH&L HAS A SET OF CRITERIA IT USES TO ASSESS WHETHER A PATIENT IS ELIGIBLE FOR ASSISTANCE PROGRAMS, OR IF THEY QUALIFY FOR JCH&L'S CHARITY CARE PROGRAM. PART VI, LINE 4: JCH&L SERVES JEFFERSON COUNTY AND PARTS OF THAYER, FILLMORE, SALINE AND GAGE COUNTIES, ALL IN NEBRASKA; AND PARTS OF WASHINGTON AND MARSHALL COUNTIES IN KANSAS. THE POPULATION OF THE SERVICE AREA IS ESTIMATED AT ABOUT 18,000. REVENUE FROM MEDICARE PATIENTS AVERAGES APPROXIMATELY 50%, AND REVENUE FROM MEDICAID CLIENTS AVERAGES APPROXIMATELY 10%. PART VI, LINE 5: JCH&L OPERATES IN JEFFERSON COUNTY WITH A COMMUNITY BOARD AND OPEN MEDICAL STAFF. ALL SURPLUS FUNDS ARE REINVESTED BACK INTO THE FACILITY THROUGH BUILDING CONSTRUCTION, EQUIPMENT PURCHASES, OR COMMUNITY PROGRAMS PROVIDED. JCH&L PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING A COMMUNITY FITNESS CENTER AT A REASONABLE RATE AND OFFERING SCHOLARSHIPS FOR THE COMMUNITY'S YOUTH WHO HAVE FINANCIAL NEED. THE NET COMMUNITY BENEFIT REPORTED IN PART I RELATING TO THE FITNESS CENTER WAS APPROXIMATELY $143,000. JCH&L PROMOTES THE HEALTH OF THE COMMUNITY BY PROMOTING COMMUNITY-WIDE PROGRAMS SUCH AS LIVE HEALTHY NEBRASKA AND STEP-2-IT (PROGRAMS WHICH ENCOURAGE INCREASING ACTIVITY AND LOSING WEIGHT.) JCH&L IS ALSO INVOLVED IN PROGRESSIVE AG SAFETY DAY AND WORKING WITH BLUE VALLEY COMMUNITY ACTION TO OFFER IMMUNIZATIONS TO AREA CHILDREN. JCH&L PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING PROGRAMS, TOURS, SPEAKERS, AND EDUCATION, INCLUDING SUPPORT GROUPS, EDUCATIONAL PROGRAMS AND PROGRAMS FOR LOCAL ORGANIZATIONS. PART VI, LINE 6: JCH&L IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM BUT DOES WORK TO BE A LEADER IN PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. JCH&L PARTNERS WITH MANY OTHER AREA ORGANIZATIONS, INCLUDING PUBLIC HEALTH SOLUTIONS, FARM SAFETY 4 JUST KIDS, NEBRASKA SAFE KIDS, JEFFERSON COUNTY EXTENSION, BLUE VALLEY COMMUNITY ACTION, FAIRBURY CHAMBER OF COMMERCE, FAIRBURY PUBLIC SCHOOLS, NEBRASKA COMMUNITY BLOOD BANK, RURAL COMPREHENSIVE CARE NETWORK, BLUE RIVER VALLEY NETWORK, HEARTLAND HEALTH ALLIANCE, AND OTHERS. DEPENDING ON THE ACTIVITY, JCH&L MAY BE THE LEAD ORGANIZATION, OR AN ORGANIZATION PROVIDING HELP AND ASSISTANCE. X X X X 1 0 0 1 0 0 0 0 0 CRAIG SHUMARD PHYSICIAN 379241 0 117297 0 0 0 24649 0 30295 0 551482 0 0 0 REBECCA STROKLUND PHYSICIAN 354004 0 0 0 0 0 7910 0 32815 0 394729 0 0 0 BRETT WERGIN PHYSICIAN 335910 0 0 0 0 0 16107 0 13733 0 365750 0 0 0 DR BURKE KLINE CEO (THRU 08/24) 240233 0 0 0 0 0 4798 0 25911 0 270942 0 0 0 CHANCE KLASEK CFO 217506 0 0 0 0 0 11469 0 33327 0 262302 0 0 0 BRANDON BLEICH PHARMACY DIRECTOR 191669 0 0 0 0 0 10387 0 30068 0 232124 0 0 0 MADHAV NARAYAN PHYSICIAN 198838 0 0 0 0 0 720 0 11601 0 211159 0 0 0 PART I, LINE 4A DURING THE YEAR, A SEVERANCE PAYMENT WAS MADE TO BURKE N. KLINE, A FORMER EMPLOYEE OF THE ORGANIZATION. UNDER A SEPARATION AGREEMENT AND RELEASE, THE ORGANIZATION AGREED TO PAY SEVERANCE COMPENSATION IN THE TOTAL GROSS AMOUNT OF $123,760, EQUIVALENT TO 26 WEEKS OF BASE SALARY, FOLLOWING HIS SEPARATION FROM EMPLOYMENT. IN ADDITION, IF THE EMPLOYEE ELECTED COBRA CONTINUATION COVERAGE, THE EMPLOYER AGREED TO CONTRIBUTE TO HEALTH INSURANCE PREMIUMS AT THE SAME LEVEL AS EXISTING EMPLOYEES THROUGH DECEMBER 2024. THE SEVERANCE PAYMENT WAS MADE IN ACCORDANCE WITH THE TERMS OUTLINED IN THE AGREEMENT AND WAS SUBJECT TO STANDARD PAYROLL DEDUCTIONS. THE AGREEMENT INCLUDED CONFIDENTIALITY, NON-DISPARAGEMENT, AND RELEASE OF CLAIMS PROVISIONS. PART I, LINE 5 THE ORGANIZATION PROVIDES INCENTIVE COMPENSATION TO CERTAIN EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS BASED ON INDIVIDUAL PRODUCTIVITY AS MEASURED BY WORK RELATIVE VALUE UNITS (WRVUS). PROVIDERS RECEIVE A BASE SALARY AND ARE ELIGIBLE FOR ADDITIONAL INCENTIVE COMPENSATION FOR WRVUS PERFORMED IN EXCESS OF AN ESTABLISHED THRESHOLD. THE INCENTIVE COMPENSATION IS CALCULATED QUARTERLY AT A FIXED WRVU CONVERSION FACTOR AND RECONCILED AGAINST A BI-WEEKLY DRAW SYSTEM. THIS INCENTIVE STRUCTURE IS BASED ON INDIVIDUAL PHYSICIAN PRODUCTIVITY AND NOT DIRECTLY ON THE OVERALL REVENUES OF THE ORGANIZATION OR ANY RELATED ENTITY. A HOSPITAL AUTHORITY NO 1 OF JEFFERSON COUNTY NE 611683496 2021-12-18 8291780 RENOVATE FACILITY & REF BOND ISSUE (12/18/12) 0 0 0 A 1546361 8291780 4024791 4266989 2022 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 1 0 0 0 1 A 1 DATE THE REBATE COMPUTATION WAS PERFORMED: 03/31/2022 NOTE REGARDING THE REBATE COMPUTATION: SINCE THE BOND PROCEEDS HAVE BEEN SPENT AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE CALCULATIONS ARE NECESSARY. PATRICIA SNYDER EMPLOYEE OF THE HOSPITAL AND SPOUSE OF STEVEN SNYDER, BOARD OF DIRECTOR 81153 EMPLOYEE COMPENSATION 0 JUDD STEWART EMPLOYEE OF THE HOSPITAL AND SPOUSE OF SARA STEWART, BOARD OF DIRECTOR 90000 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, COMPRISED OF THE BOARD PRESIDENT, VICE PRESIDENT, SECRETARY/TREASURER AND ONE OTHER APPOINTED MEMBER OF THE BOARD, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 6 JEFFERSON COMMUNITY HEALTH & LIFE HAS MEMBERS. ANY PERSON, CORPORATION OR OTHER ENTITY MAY BECOME A LIFETIME MEMBER IF A CONTRIBUTION OF $100 OR MORE IS MADE TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A VACANCIES, OCCURRING ON THE BOARD BY EXPIRATION, SHALL BE FILLED THROUGH ELECTION BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE BOARD DEVELOPMENT COMMITTEE SHALL SUBMIT A SLATE OF PROSPECTIVE CANDIDATES TO THE BOARD OF DIRECTORS AT THEIR MEETING PRIOR TO THE ANNUAL MEETING WHICH WILL THEN BE PRESENTED AT THE ANNUAL MEETING FOR CONSIDERATION FOR ELECTION TO THE BOARD. IN ADDITION, MEMBERS OF THE CORPORATION MAY MAKE NOMINATIONS FROM THE FLOOR. FORM 990, PART VI, SECTION A, LINE 7B EACH MEMBER SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO THE VOTE OF THE MEMBERS. 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, 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 B, LINE 15 THE HOSPITAL PARTICIPATES IN THE NEBRASKA COMPDATA SALARY SURVEYS FOR ALL POSITIONS. THE CEO SURVEY DATA IS GIVEN TO THE BOARD TO REVIEW, AND THE BOARD APPROVES THE CEO'S SALARY ON AN ANNUAL BASIS. OTHER OFFICER COMPENSATION IS REVIEWED AND APPROVED BY THE CEO AND HR DIRECTOR. THE BOARD OF DIRECTORS REVIEWS COMPENSATION RANGES PROPOSED BY OR THROUGH THE CEO FOR JCH&L'S OFFICERS AND KEY EMPLOYEES AND DETERMINES THAT SUCH COMPENSATION RANGES ARE REASONABLE AND CONSISTENT WITH FAIR MARKET VALUE. 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, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,888,501. MANAGEMENT AND GENERAL EXPENSES 821,582. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,710,083. FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 35,551. MANAGEMENT AND GENERAL EXPENSES 139,156. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,707. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 895,042. MANAGEMENT AND GENERAL EXPENSES 47,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 942,042. CONSULTING: PROGRAM SERVICE EXPENSES 127,550. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 127,550. ASSESSMENT FEES: PROGRAM SERVICE EXPENSES 557,845. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 557,845. 340B DISPENSING FEE: PROGRAM SERVICE EXPENSES 392,675. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 392,675. FORM 990, PAGE 11, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS 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. JCHC REAL ESTATE INC 2200 H STREET FAIRBURY NE 68352 881755265 REAL ESTATE HOLDINGS NE 501(C)(3) LINE 12C, III-FI JEFFERSON COMMUNITY HEALTH CENTER INC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 JCHC REAL ESTATE INC C 51484 FAIR MARKET VALUE