2024-07-09T11:34:26-05:00 2023-09-30 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2022-10-01 470468078 JEFFERSON COMMUNITY HEALTH CENTER INC JEFF 4027293351 2200 H ST FAIRBURY NE 68352 CHANCE KLASEK CFO 4027293351 2024-07-09 1 CHANCE KLASEK 999009999 1 MEGAN L KOZIOL CPA P01544037 4023302660 2024-07-01 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z JEFFERSON COMMUNITY HEALTH & LIFE CHANCE KLASEK 2200 H ST FAIRBURY NE 68352 36041549 0 X HTTP://WWW.JCHEALTHANDLIFE.ORG X 1960 NE TO OPERATE AN ACUTE CARE CRITICAL ACCESS HOSPITAL IN FAIRBURY, NEBRASKA. 8 7 293 20 0 0 1701710 4444716 30067092 30805464 396876 596086 144131 190135 32309809 36036401 6092 5721 0 0 17086062 18795995 0 0 22317 13209241 12707169 30301395 31508885 2008414 4527516 43752923 48660085 19608458 19681828 24144465 28978257 INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. 0 0 26435145 5721 28093199 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. 2160859 2712265 JEFFERSON COMMUNITY HEALTH & LIFE OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. 28596004 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 0 0 0 1 13 0 1 293 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 8 7 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 CRAIG SHUMARD PHYSICIAN 40.00 0.00 X 370623 0 48299 REBECCA STROKLUND PHYSICIAN 40.00 0.00 X 334751 0 33017 BRETT WERGIN PHYSICIAN 40.00 0.00 X 312952 0 21951 BURKE KLINE CEO 40.00 1.00 X 195082 0 29691 BRANDON BLEICH PHARMACIST 40.00 0.00 X 173042 0 34524 CHANCE KLASEK CFO 40.00 1.00 X 154630 0 33575 REBEKAH KIMBERLIN PHARMACIST 40.00 0.00 X 126237 0 31404 TREVOR STEINMEYER CHAIRMAN 1.00 0.00 X X 0 0 0 ROSS BOECKNER VICE CHAIRMAN 1.00 1.00 X X 0 0 0 GLENDA AUSTIN SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 SHERI SCHULTIS SECRETARY/TREASURER THRU 12/22 1.00 0.00 X X 0 0 0 DALLAS CHRIST MEMBER 1.00 0.00 X 0 0 0 CAROLYN SCHERBARTH MEMBER 1.00 0.00 X 0 0 0 STEVEN SNYDER MEMBER 1.00 1.00 X 0 0 0 SARA STEWART MEMBER 1.00 0.00 X 0 0 0 DIANE WELLSANDT MEMBER 1.00 0.00 X 0 0 0 STEPHEN GRIZZLE MEMBER THRU 12/22 1.00 0.00 X 0 0 0 1667317 0 232461 20 0 1 0 BECKENHAUER CONSTRUCTION 1901 RIVERSIDE BLVD NORFOLK NE 68701 CONSTRUCTION SERVICES 1051863 CERNER CORPORATION 2800 ROCK CREEK PKWY KANSAS CITY KS 64117 ELECTRONIC HEALTH RECORD SERVICES 808642 RURALMED MANAGEMENT RESOURCES 511 WEST AVE HOLDREGE NE 68949 REVENUE CYCLE SERVICES 342383 CHAPPELL ROOFING INC 302 E ST FAIRBURY NE 68352 ROOFING SERVICES 333000 BRYAN HEALTH 1600 S 48TH STREET LINCOLN NE 68506 MEDICAL SERVICES 280230 20 12225 43157 4300061 89273 4444716 MEDICARE/MEDICAID PAYMENTS 624100 18393632 18393632 PATIENT SERVICE REVENUE 624100 10050592 10050592 340B DRUG PRICING PROGRAM 624100 1282191 1282191 CEDARWOOD ASSISTED LIVING SVC FEE 623000 753342 753342 CEDARWOOD: EQUITY IN JT VENTURE 623000 216503 216503 109204 109204 30805464 596086 596086 6490 12225 5148 1342 1342 CAFETERIA 722210 188793 188793 188793 36036401 30805464 0 786221 5721 5721 412978 412978 76061 76061 14431485 13564768 845985 20732 470719 448294 22425 2399924 2258871 141053 1004828 933903 69340 1585 27186 15510 11676 217561 217561 2661538 2209746 451792 168619 27887 140732 1043969 895116 148853 542168 490851 51317 82963 66743 16220 161219 129141 32078 503410 465693 37717 2378593 2200380 178213 188477 188477 MEDICAL SUPPLIES 4022641 4022641 FOOD EXPENSE 459580 457375 2205 DUES AND SUBSCRIPTIONS 188161 86173 101988 MISCELLANEOUS EXPENSES 61084 52653 8431 31508885 28596004 2890564 22317 450 0 10479431 10871578 3871443 8600479 454248 562966 373476 512900 38223410 18608237 20456476 19615173 6908746 6520699 1131508 1348011 77145 628279 43752923 48660085 3071116 3951201 7512933 7214019 8720452 8515754 303957 854 19608458 19681828 X 23848149 28652760 296316 325497 24144465 28978257 43752923 48660085 4527516 306276 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2498 2498 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. 50754 50754 50754 50754 50754 50754 50754 50754 50754 50754 0.00000 1.00000 0.00000 0 0 50943 50943 28562335 13112902 15449433 9106751 5331492 3775259 503381 163843 339538 19615173 ACCRUED INTEREST 854 854 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, 2023, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. GOLF TOURNAMENT 18715 12225 6490 1440 687 1825 564 632 18715 12225 6490 1440 687 1825 564 632 5148 1342 1 1 X 1 X 1 X 0 1 0 1 1 176659 0 176659 0.00560 4226944 3889040 337904 0.01070 4403603 3889040 514563 0.01630 49717 0 49717 0.00160 17500 0 17500 0.00060 4577296 2892747 1684549 0.05350 10022 0 10022 0.00030 4654535 2892747 1761788 0.05600 9058138 6781787 2276351 0.07230 275 0 275 0.00000 275 275 0.00000 1 437764 59536 10485462 10688829 -203367 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 21 1 0 0 1 X JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 21 1 JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 150.000000000000 300.000000000000 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 BEGAN ITS FOURTH COMMUNITY HEALTH NEEDS ASSESSMENT EARLY IN 2022. JCH&L HAS CONDUCTED FOCUS GROUPS WITH LOCAL ORGANIZATIONS, HELD A COMMUNITY STAKEHOLDERS MEETING AND REVIEWED STATISTICS MADE AVAILABLE THROUGH PUBLIC HEALTH SOLUTIONS, THE STATE OF NEBRASKA, US CENSUS, HEALTHY PEOPLE 2030, AND WEBSITES SUCH AS COUNTY HEALTH RANKINGS AND WORLD LIFE EXPECTANCY.A COMMUNITY HEALTH NEEDS ASSESSMENT STAKEHOLDERS MEETING WAS HELD AT JCH&L WITH REPRESENTATIVES FROM AREA AGENCY PARTNERS, AND FOCUS GROUP MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, OPTIMISTS, SENIOR DINERS AND JCH&L'S DEPARTMENT MANAGERS. A TOTAL OF 84 ATTENDED AND PARTICIPATED IN DISCUSSIONS OF COMMUNITY HEALTH NEEDS. HEALTH CARE PROVIDERS WERE ASKED TO SHARE THEIR CONCERNS AND WHAT THEY SEE AS THE COMMUNITY'S GREATEST NEEDS. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 11: PRIORITIZED NEEDS (AS DETERMINED BY COMMUNITY HEALTH NEEDS ASSESSMENT):1) OBESITY2) NUTRITION/SEDENTARY LIFESTYLE3) CHRONIC DISEASES AFFECTED BY OBESITY AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE, AND CANCERAS PART OF OUR PLAN TO INSPIRE OUR COMMUNITY TO A LIFETIME OF HEALTH, WE WERE PART OF THE FOLLOWING ACTIVITIES IN FISCAL 2023: KIDS COOKING CLASSES OFFERED MARCH 10, 2023 (4 STUDENTS PARTICIPATED); APRIL 20, 2023 (4 PARTICIPATED); APRIL 21, 2023 (SCHEDULED, BUT CANCELLED FOR LACK OF PARTICIPANTS). SMART MOVES LIFESTYLE CHANGE PROGRAM APRIL 2022-APRIL 2023 5 ENROLLED. SMART MOVES FOLLOWUP PROGRAM - MEETING AS A SUPPORT GROUP WITH PARTICIPANTS IN THE MAY 2022 CLASS, WITH 8-12 PARTICIPATING; AVERAGE IN 2023 WAS 4-5. HELPED THE CITY OF FAIRBURY COME UP WITH EXERCISES TO OFFER AS PART OF A COMMUNITY BUILDING WALKING PROGRAM, AND DONATED TO THE COMMUNITY BUILDING RENOVATION PROJECT. ASSISTED THE CITY'S EFFORTS TO SEEK GRANT FUNDING FOR THE RENOVATION PROJECT. BEGAN PLANNING COMMUNITY BUILDING WALKING PROGRAM. (THE WALKING PROGRAM STARTED IN FISCAL 2024, WITH JCH&L OFFERING PRIZES FOR THE TOP WALKERS FROM DECEMBER 2023-MAY 2024). JCH&L HELPS TO PROMOTE BLUE RIVERS AREA AGENCY ON AGING'S FAIRBURY SENIOR DINERS PROGRAM. JCH&L OFFERS MONTHLY HEALTH-RELATED PROGRAMS, AND HELPS TO ORGANIZE SERVERS FOR MONTHLY BIRTHDAY PARTIES AND SPECIAL EVENTS. CONTINUED TO FISCAL 2023 TO HAVE THERAPY STAFF AVAILABLE ON THE SIDES OF HOME FAIRBURY FOOTBALL GAMES. WE ALSO OFFER FREE ATHLETE CONSULTATIONS FOR ATHLETES WHO MAY BE INJURED. IN JULY 2023 WE OFFERED A FITNESS IS FUN CLASS FOR K-6 GRADERS. WE HAD 20 K-3 AND 20 4-6TH GRADERS PARTICIPATE IN AFTERNOON COURSES. WE HAD THE ASSISTANCE OF JEFFS GONE M.A.D. FOR THESE SESSIONS. JCH&L BURKLEY FITNESS CENTER OFFERED A 6TH GRADE ADVENTURE DAY TO FAIRBURY PUBLIC SCHOOLS AT BUCKLEY CREEK RECREATION AREA. THE KIDS LEARNED SOME ORIENTEERING, AND DID FITNESS STATIONS, WALKING, RUNNING AND BOATING. JCH&L BURKLEY FITNESS CENTER OFFERED A FITNESS CLASS TO FAIRBURY 2ND GRADERS, FILLING A CLASS PERIOD WITH EXERCISE AND DISCUSSION ABOUT HEALTHY LIFESTYLES. JCH&L BEGAN OFFERING A CHOICE OF A BONHAM THEATRE $5 GIFT CERTIFICATE AND A $5 SHEAR IMPRESSIONS (HAIR SALON) GIFT CERTIFICATE TO MEN AND WOMEN WHO HAD A PHYSICAL, AND WOMEN WHO HAD A MAMMOGRAM. WE BEGAN OFFERING A MEN'S HEALTH CLINIC TO HELP MEN ADDRESS SPECIFIC MEN'S HEALTH ISSUES. WE CONTINUED OFFERING WOMEN'S HEALTH DAYS TO ENCOURAGE WOMEN TO HAVE ALL OF THEIR ANNUAL SCREENINGS. THE PROGRAM ALLOWS THEM TO HAVE ALL OF THEIR ANNUAL SCREENINGS ON THE SAME DAY, AND TYPICALLY GET SAME DAY RESULTS. THEY ALSO GET A FREE MEAL IN OUR CAFETERIA. JCH&L SPONSORED A $1 PER VARSITY PIN PROGRAM WITH ALL COUNTY HIGH SCHOOLS WHO OFFER WRESTLING. JCH&L SPORTS MEDICINE AND REHAB SERVICES SPONSORS HEALTHY SNACKS FOR COUNTY SCHOOL TEAMS HEADING TO STATE TOURNAMENTS. JCH&L BEGAN OFFERING MEDICARE WELLNESS VISITS. THERE HAS BEEN SOME PUSHBACK FROM THE COMMUNITY RESIDENTS WHO PERCEIVE THAT THIS SERVICE IS "LESS THAN" AN ACTUAL PHYSICAL. WE CONTINUE TO WORK ON SOME EDUCATION. IN FISCAL 2023, STAFF MEMBER SAMMIE LANGE BEGAN STUDYING TO BECOME A PERSONAL TRAINER. JCH&L BURKLEY FITNESS CENTER BEGAN OFFERING HER SERVICES AS A PERSONAL TRAINER IN FISCAL 2024. 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 2023: $49,903. ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $143,039. 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 2023 EVENT. STAFF MEMBERS ASSISTED IN PLANNING THE EVENT AND ASSISTED IN COORDINATING AND INSTRUCTING ON THE DAY OF THE CAMP. COMMUNITY EDUCATION. JCH&L STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 22 PROGRAMS WERE DONE IN FISCAL 2023. 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. IN FISCAL 2023, JCH&L CONTINUED DISCUSSING WAYS TO PROVIDE ADDITIONAL MENTAL HEALTH SERVICES FOR THE COMMUNITY. JCH&L HAS REPRESENTATION ON THE JEFFERSON COMMUNITY COALITION, WITH A MISSION OF: TO REDUCE SUBSTANCE ABUSE AMONG YOUTH AND TO DEVELOP A SAFE AND HEALTHY COMMUNITY THROUGH COLLABORATIVE PLANNING, COMMUNITY ACTION, AND POLICY ADVOCACY.NEEDS JEFFERSON COMMUNITY HEALTH & LIFE WILL NOT ADDRESS:THERE WERE NEEDS IDENTIFIED THAT JCH&L DID NOT CHOOSE TO ADDRESS. WHILE THESE NEEDS ARE IMPORTANT TO THE COMMUNITY, THEY WERE NOT CHOSEN BASED ON THE PRIORITIZATION PROCESS.NEEDS WHICH WILL NOT BE ADDRESSED SPECIFICALLY BY JCH&L INCLUDE:*MENTAL HEALTH. WE WILL CONTINUE TO WORK TO BE GOOD COMMUNITY PARTNERS IN IMPROVING OUR COMMUNITY'S MENTAL HEALTH. WE CONTINUE TO OFFER A SPECIALTY CLINIC WITH GENESIS PSYCHIATRIC GROUP; WE CONTINUE TO SEEK OTHER POTENTIAL PROVIDERS WHO COULD OFFER SPECIALTY CLINICS AT OUR FACILITY; AND WE CONTINUE TO KEEP UP TO DATE ON WHAT SERVICES ARE AVAILABLE IN OUR COMMUNITY, SO OUR PROVIDERS CAN REFER AS APPROPRIATE. PRIMARY CARE IS OUR PRIME RESPONSIBILITY AND WE WILL CONTINUE TO FOCUS ON PRIMARY CARE FOR OUR AREA RESIDENTS. WE FEEL A MUCH BROADER COMMUNITY APPROACH WILL BE REQUIRED TO BE SUCCESSFUL IN IMPROVING OUR COMMUNITY'S MENTAL HEALTH STATUS. *SUBSTANCE ABUSE. WE WILL CONTINUE TO WORK TO BE GOOD COMMUNITY PARTNERS TO ALL AREA ENTITIES WORKING TO IMPROVE OUR COMMUNITY'S STATUS WITH SUBSTANCE ABUSE. THIS AREA IS ALSO NOT NAMED IN PRIORITIES BECAUSE WE BELIEVE A MUCH BROADER COMMUNITY APPROACH WILL BE REQUIRED TO BE SUCCESSFUL IN IMPROVING OUR COMMUNITY'S STATUS WITH SUBSTANCE ABUSE.*SUICIDE. WE WILL CONTINUE TO WORK TO BE GOOD COMMUNITY PARTNERS TO ALL AREA ENTITIES WORKING TOWARD SUICIDE PREVENTION AND ASSISTANCE TO THOSE AFFECTED BY SUICIDE. THIS AREA IS NOT NAMED IN PRIORITIES, BECAUSE A MUCH BROADER COMMUNITY APPROACH WILL BE REQUIRED TO BE SUCCESSFUL IN REDUCING THE NUMBER OF SUICIDES. *ALZHEIMER'S DISEASE. WE WILL CONTINUE TO OFFER AN ALZHEIMER'S CAREGIVER'S SUPPORT GROUP AND WE WILL PROVIDE EDUCATIONAL RESOURCES TO OUR COMMUNITY THROUGH THE ALZHEIMER'S ASSOCIATION. THIS IS THE EXTENT OF WHAT WE FEEL OUR INVOLVEMENT CAN BE AT THIS TIME, SO WE DO NOT INTEND TO NAME THIS AS A MAJOR AREA OF ACTIVITY. *ADDITIONAL SPECIALTIES, ACCESS TO CARE, PREVENTATIVE CARE. JCH&L IS ALWAYS SEEKING POSSIBILITIES FOR ADDITIONAL SPECIALTIES, INCREASED ACCESS TO CARE AND INCREASED PREVENTATIVE CARE TO ADDRESS COMMUNITY NEEDS, AND WILL CONTINUE THIS PROCESS AS A PART OF OUR ONGOING STRATEGIC PLANNING PROCESS. HOWEVER, IT IS NOT NAMED IN OUR PRIORITIES BECAUSE OF THE NEED FOR PERSONNEL AND RESOURCES TO ADDRESS PRIORITY AREAS, EXCEPT FOR A FEW SELECT AREAS WHICH DIRECTLY AFFECT OUR PRIORITY GOALS FOR THE NEXT THREE YEARS. *BULLYING, DENTAL HEALTH, CHRONIC PAIN. JCH&L WISHES TO BE A GOOD COMMUNITY PARTNER WITH ALL AREA AGENCIES AND PRACTICES WHICH PROVIDE SERVICES IN ALL OF THESE AREAS, WHICH ARE ALL OUTSIDE OF OUR CURRENT OFFERINGS. WE DO NOT INTEND TO NAME THESE AS PRIORITY AREAS AT THE PRESENT TIME. *ECONOMY, HOUSING. THESE ARE ONGOING SOCIETAL ISSUES WHICH AFFECT OUR BUSINESSES AND SERVICES. WE WILL CONTINUE TO BE A GOOD COMMUNITY PARTNER ON DEALING WITH THESE ISSUES IN OUR AREA, BUT WE DO NOT INTEND TO MAKE THESE AREAS OUR PRIORITY AREAS OF FOCUS. *INSURANCE/UNINSURED/UNDERINSURED. WE CONTINUE TO SEEK WAYS THAT WE AS AN ORGANIZATION CAN BEST SERVE THOSE WHO ARE UNINSURED OR UNDERINSURED, INCLUDING PROVIDING CHARITY CARE. THESE ARE NOT NAMED AS PRIORITY AREAS AT THIS TIME. 3 1 - GARDENSIDE 200 H STREET FAIRBURY NE 68352 LONG TERM CARE FACILITY 2 - FAIRBURY CLINIC 825 22ND STREET FAIRBURY NE 68352 RURAL HEALTH CLINIC 3 - PLYMOUTH CLINIC 316 N MADISON AVE STE 200 PLYMOUTH NE 684144110 RURAL HEALTH CLINIC PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: JEFFERSON COMMUNITY HEALTH & LIFE PREPARES ITS OWN COMMUNITY BENEFIT REPORT. PART I, LINE 7: THE HOSPITAL USED THE WORKSHEETS PROVIDED IN THE FORM 990 INSTRUCTIONS TO HELP CALCULATE THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. PART I, LINE 7: JCH&L REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2023, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMSA. JCH&L PROVIDED CHARITY CARE IN FISCAL 2023 FOR ALL JCH&L SERVICES TO THOSE WHO MEET THE FEDERAL POVERTY GUIDELINES. THE HOSPITAL BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS. PATIENTS ASSISTED: 58 VALUE: $151,000B. . UNPAID COSTS OF PUBLIC PROGRAMS. MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: $337,904C. BAD DEBT: BESIDES OFFICIAL CHARITY CARE, JCH&L WROTE OFF $448,061 IN BAD DEBT DURING FISCAL 2023. II. COMMUNITY BENEFIT SERVICESA. COMMUNITY HEALTH EDUCATION AND OUTREACH: HEALTH FAIR - JCH&L PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC., AT COMMUNITY EVENTS. THE COST OF THE HEALTH FAIR FOR FISCAL 2023 WAS $14,627.SPEAKERS BUREAU - JCH&L STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 22 PROGRAMS WERE DONE IN FISCAL 2023. TOTAL INDIVIDUALS REACHED: 387. ESTIMATED COST OF STAFF TIME: $775.SUPPORT GROUPS - JCH&L'S PARKINSON'S SUPPORT GROUP AND ALZHEIMER'S CAREGIVER'S SUPPORT GROUP WERE PUT ON HOLD IN 2020 BECAUSE OF COVID AND WERE NOT RESTARTED PRIOR TO THE END OF FISCAL 2022. IN PREVIOUS YEARS, JCH&L STAFF MEMBERS COORDINATED MEETINGS OF THESE SUPPORT GROUPS, OFFERING ASSISTANCE TO ANYONE INTERESTED IN MORE INFORMATION ABOUT THE DISEASES. JCH&L PROVIDES EDUCATIONAL PROGRAMS FOR EACH OF THESE GROUPS -- INCLUDING SPEAKER'S FEES OR VIDEO TAPE RENTAL FEES, POSTAGE TO SEND OUT MEETING NOTICES, AND REFRESHMENTS. TOTAL NUMBER REACHED: 55. APPROXIMATE COST OF STAFF TIME SPENT: $572. ESTIMATED COST OF POSTAGE: $200 (TO NOTIFY THOSE INTERESTED THAT MEETINGS WERE STILL SUSPENDED.) ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES): $100B. COMMUNITY-BASED CLINICAL SERVICES: SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS.COMPLETE BLOOD PROFILES - IN THE FALL OF 2021, JCH&L BEGAN OFFERING WELLNESS WEDNESDAYS AND FASTING FRIDAYS, OFFERING 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 410 SCREENINGS, WITH CHARGES OF $7,400. WHEN COMPARED AGAINST TYPICAL CHARGES THE TOTAL COMMUNITY BENEFIT WAS MORE THAN $33,000. ESTIMATED NUMBER REACHED: 410 VALUE OF ESTIMATED STAFF TIME: $14,627. ESTIMATED VALUE OF COMMUNITY BENEFIT: $33,443.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, JANITORIAL AND SUPPORT SERVICES, AND STORAGE OF VACCINES IN OUR PHARMACY. NUMBER OF PATIENTS SERVED: 262. TOTAL OF 792 VACCINATIONS PROVIDED. ESTIMATED COST OF NURSES PROVIDED BY JCH&L TO GIVE SHOTS: $2,300. III. MEDICAL EDUCATIONA. 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 6 PHYSICIAN STUDENTS, 2 PA STUDENTS, 2 NURSE PRACTITIONER STUDENTS, ONE PT STUDENT AND ONE PHARMACY STUDENT UTILIZED OUR FACILITY IN FISCAL 2023. 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 2023. 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. NO SCHOLARSHIPS WERE AWARDED IN 2023. ESTIMATED NUMBER REACHED: 11. JCH&L COST (APARTMENT RENT, STAFF TIME, ETC.): $15,000.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. DURING FISCAL 2023 WE HAD A REQUIREMENT THAT ALL STUDENTS BE VACCINATED FOR COVID (PER CMS REQUIREMENTS.) NUMBER REACHED: 25. ESTIMATED COST OF STAFF TIME: $2,500.IV. SUBSIDIZED HEALTH SERVICESWELLNESS 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 2023: 49,903. ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $143,039. 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: $171,893. EXPENSES: $489,265. NET LOSS: $317,372.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: $ 2,720,854. EXPENSES: $3,943,680. NET LOSS: $ 1,222,826.V. RESEARCH.NO RESEARCH DOLLARS EXPENDED. PART I, LINE 7 (CONTINUED): VI. CASH AND IN-KIND DONATIONSA. 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-RAISER; KGMT-KUTT ANNUAL THANKSGIVING MEAL; BLUE VALLEY COMMUNITY ACTION; BLUE RIVERS AREA AGENCY ON AGING; AND AREA SCHOOLS' WRESTLING PROGRAMS. THESE TOTALED $6,092. 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 2022 TOTALED $7,092. 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: $250.SAFETY DAY FOR KIDS - JCH&L IS ONE OF THE COSPONSORS OF THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 95 KIDS -- AGES KINDERGARTEN THROUGH SIXTH GRADES ATTENDED THE AUGUST 2022 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 HEALTH CENTER DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSIONS BASED ON HISTORICAL COLLECTION EXPERIENCE WITH VARIOUS CLASSES OF PATIENTS. PART III, LINE 3: AS PART OF OUR COMMUNITY NEEDS ASSESSMENT, WE GATHERED INFORMATION ON THE INCOME CHARACTERISTICS OF THE UNINSURED POPULATION. USING THAT DATA, WE ANALYZED WHAT PORTION OF UNINSURED INDIVIDUALS IN THE HOSPITAL'S SERVICE AREA WOULD BE ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THIS PERCENTAGE WAS APPLIED TO THE TOTAL AMOUNT OF IMPLICIT PRICE CONCESSIONS FOR SELF-PAY PATIENTS TO ESTIMATE THE PORTION OF SELF-PAY IMPLICIT PRICE CONCESSIONS THAT WERE LIKELY ATTRIBUTABLE TO INDIVIDUALS ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: JCH&L'S FINANCIAL STATEMENTS DO CONTAIN A SPECIFIC FOOTNOTE, "PATIENT SERVICE REVENUE," DESCRIBING IMPLICIT PRICE CONCESSIONS, WHICH CAN BE FOUND ON PAGES 12 AND 13 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL CALCULATED THE MEDICARE ALLOWABLE COSTS BY ADDING THE INPATIENT, SWING BED AND OUTPATIENT COSTS AS FOUND ON THE MEDICARE COST REPORT FOR SEPTEMBER 30, 2023. THE SHORTFALL IS TREATED AS AN ADDITIONAL COMPONENT OF COMMUNITY BENEFIT, AS CARE IS PROVIDED REGARDLESS IF THE HOSPITAL WILL GET PAID THE ENTIRE AMOUNT. PART III, LINE 9B: ONCE IT IS DETERMINED THAT A PATIENT MAY NOT HAVE THE MEANS TO PAY, AN ASSISTANCE APPLICATION IS PROVIDED. JCH&L STAFF WILL APPLY THE RECOMMENDED PERCENTAGE DISCOUNT TO THE PATIENT'S ACCOUNT. 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. PART VI, LINE 7: JCH&L DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATES. X 1 1 X X X X 0 0 0 1 0 0 0 1 0 CRAIG SHUMARD PHYSICIAN 246581 0 124042 0 0 0 24263 0 24036 0 418922 0 0 0 REBECCA STROKLUND PHYSICIAN 317935 0 16816 0 0 0 8331 0 24686 0 367768 0 0 0 BRETT WERGIN PHYSICIAN 266478 0 46474 0 0 0 11197 0 10754 0 334903 0 0 0 BURKE KLINE CEO 195082 0 0 0 0 0 5655 0 24036 0 224773 0 0 0 BRANDON BLEICH PHARMACIST 173042 0 0 0 0 0 9838 0 24686 0 207566 0 0 0 CHANCE KLASEK CFO 154630 0 0 0 0 0 8889 0 24686 0 188205 0 0 0 REBEKAH KIMBERLIN PHARMACIST 126237 0 0 0 0 0 7368 0 24036 0 157641 0 0 0 PART I, LINE 1A JCH&L PROVIDES DISCOUNTED OR FREE FITNESS CENTER MEMBERSHIPS TO ITS EMPLOYEES AND PHYSICIANS. PART I, LINE 5 PHYSICIANS RECEIVE INCENTIVE COMPENSATION BASED ON PHYSICIAN'S NET COLLECTIONS IN EXCESS OF THE MONTHLY THRESHOLDS SET PER CONTRACT. "NET COLLECTIONS" MEANS CASH ACTUALLY RECEIVED FROM PATIENTS OR THIRD PARTY PAYORS FOR PERSONALLY PERFORMED PROFESSIONAL SERVICES OF PHYSICIAN. NET COLLECTIONS SHALL BE ADJUSTED BY ANY REDUCTIONS FOR PATIENT ACCOUNT ADJUSTMENTS, RECOVERED OVERPAYMENTS, OFFSETS AND ANY FEES EXPENDED ON AMOUNTS RECOVERED THROUGH COLLECTION AGENCIES. NET COLLECTIONS SHALL NOT INCLUDE THE TECHNICAL FEES ASSOCIATED WITH ANY COLLECTIONS FOR LAB, X-RAY, ANCILLARY SERVICES, DESIGNATED HEALTH SERVICES UNDER STARK, ANY SERVICES NOT RENDERED PERSONALLY BY PHYSICIAN, OR THE TECHNICAL COMPONENT OF ANY OTHER SERVICES. WHEN A GLOBAL PAYMENT IS RECEIVED THAT INCLUDES PROFESSIONAL SERVICES AND ANY SUCH EXCLUDED SERVICES, HOSPITAL SHALL MAKE A REASONABLE ALLOCATION OF SUCH RECEIPT BETWEEN SUCH CATEGORIES. PART I, LINE 7 UPON COMPLETION OF EACH CONTRACT YEAR, THE HOSPITAL SHALL DETERMINE PHYSICIAN'S QUALIFICATION TO RECEIVE QUALITY INCENTIVE COMPENSATION BASED ON ANNUAL GOALS ESTABLISHED AT THE BEGINNING OF THE CONTRACT YEAR. IN ORDER TO QUALIFY TO RECEIVE QUALITY INCENTIVE COMPENSATION, PHYSICIAN SHALL REMAIN EMPLOYED IN GOOD STANDING AT THE END OF THE CONTRACT YEAR. THE QUALITY INCENTIVE COMPENSATION SHALL NOT EXCEED FIVE PERCENT (5%) OF BASE SALARY. 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 964487 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 76061 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, 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 PO BOX 277 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