JEFFERSON COMMUNITY HEALTH CENTER INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: JEFFERSON COMMUNITY HEALTH CENTER INC (EIN 47-0468078)
Tax period: 2020-10-01 to 2021-09-30
Filed: 2022-08-09
IRS object ID: 202222219349301937
Schema version: 2020v4.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule G
Schedule H
Schedule J
Schedule K
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-08-09T15:51:35-05:00	ReturnTs
Tax Period End	2021-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	450250958	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	EIDE BAILLY LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	18081 BURT STREET SUITE 200	AddressLine1Txt
City	OMAHA	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	680224722	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2020-10-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	470468078	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	JEFFERSON COMMUNITY HEALTH CENTER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	JEFF	BusinessNameControlTxt
Phone	4027293351	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2200 H STREET PO BOX 277	AddressLine1Txt
City	FAIRBURY	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	68352	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CHANCE KLASEK	PersonNm
Person Title	CFO	PersonTitleTxt
Phone	4027293351	PhoneNum
Signature	2022-08-05	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	CHANCE	PersonFirstNm
Person Last	KLASEK	PersonLastNm

Field	Value	IRS element (for citing)
SSN	999009999	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	MEGAN L KOZIOL	PreparerPersonNm
PTIN	P01544037	PTIN
Phone	4023302660	PhoneNum
Preparation	2022-08-05	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	3	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	JEFFERSON COMMUNITY HEALTH & LIFE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	CHANCE KLASEK	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2200 H STREET PO BOX 277	AddressLine1Txt
City	FAIRBURY	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	68352	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$31,212,397	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	HTTP://WWW.JCHEALTHANDLIFE.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1960	FormationYr
Legal Domicile State	NE	LegalDomicileStateCd
Activity Or Mission	INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME.	ActivityOrMissionDesc
Voting Members Governing Body	8	VotingMembersGoverningBodyCnt
Voting Members Independent	7	VotingMembersIndependentCnt
Total Employee	295	TotalEmployeeCnt
Total Volunteers	15	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$2,396,146	PYContributionsGrantsAmt
CY Contributions Grants	$4,837,105	CYContributionsGrantsAmt
PY Program Service Revenue	$23,846,246	PYProgramServiceRevenueAmt
CY Program Service Revenue	$25,932,298	CYProgramServiceRevenueAmt
PY Investment Income	$247,073	PYInvestmentIncomeAmt
CY Investment Income	$132,196	CYInvestmentIncomeAmt
PY Other Revenue	$164,855	PYOtherRevenueAmt
CY Other Revenue	$145,222	CYOtherRevenueAmt
PY Total Revenue	$26,654,320	PYTotalRevenueAmt
CY Total Revenue	$31,046,821	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$13,351,917	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$15,149,591	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$24,519	CYTotalFundraisingExpenseAmt
PY Other Expenses	$9,885,858	PYOtherExpensesAmt
CY Other Expenses	$11,986,054	CYOtherExpensesAmt
PY Total Expenses	$23,237,775	PYTotalExpensesAmt
CY Total Expenses	$27,135,645	CYTotalExpensesAmt
PY Revenues Less Expenses	$3,416,545	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$3,911,176	CYRevenuesLessExpensesAmt
Total Assets BOY	$40,682,105	TotalAssetsBOYAmt
Total Assets EOY	$40,230,021	TotalAssetsEOYAmt
Total Liabilities BOY	$16,129,159	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$11,373,908	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$24,552,946	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$28,856,113	NetAssetsOrFundBalancesEOYAmt
Mission	INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$23,126,446	ExpenseAmt
Revenue	$23,422,045	RevenueAmt
Desc	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.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$1,890,639	ExpenseAmt
Revenue	$2,510,253	RevenueAmt
Desc	JEFFERSON COMMUNITY HEALTH & LIFE OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$25,017,085	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	Yes (1)	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	Yes (1)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	Yes (1)	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (1)	TaxExemptBondsInd
Invest Tax Exempt Bonds	0	InvestTaxExemptBondsInd
Escrow Account	0	EscrowAccountInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (1)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	11	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	295	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	Yes (1)	QuidProQuoContributionsInd
Quid Pro Quo Contri Discl	Yes (1)	QuidProQuoContriDisclInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	8	GoverningBodyVotingMembersCnt
Independent Voting Member	7	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	0	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	CHANCE KLASEK	PersonNm
Phone	4027296856	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2200 H STREET PO BOX 277	AddressLine1Txt
City	FAIRBURY	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	68352	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
LINDA BAUER
CHAIRMAN	1.00	Yes (X)	Yes (X)	$0	$0	$0
BRIAN BLOBAUM
VICE CHAIRMAN	1.00	Yes (X)	Yes (X)	$0	$0	$0
SHERI SCHULTIS
SECRETARY/TREASURER	1.00	Yes (X)	Yes (X)	$0	$0	$0
BRIAN SCHEELE
MEMBER THRU 12/20	1.00	Yes (X)		$0	$0	$0
STEPHEN GRIZZLE
MEMBER	1.00	Yes (X)		$0	$0	$0
TREVOR STEINMEYER
MEMBER	1.00	Yes (X)		$0	$0	$0
DR JEFF JOHNSON
MEMBER	1.00	Yes (X)		$0	$0	$0
ROSS BOECKNER
MEMBER	1.00	Yes (X)		$0	$0	$0
GLENDA AUSTIN
MEMBER	1.00	Yes (X)		$0	$0	$0
CHANCE KLASEK
CFO	40.00		Yes (X)	$132,939	$0	$24,664
BURKE KLINE
CEO	40.00		Yes (X)	$109,224	$0	$8,400
CRAIG SHUMARD
PHYSICIAN	40.00			$476,717	$0	$41,650	Yes (X)
RICHARD BLATNY JR
PHYSICIAN	40.00			$452,092	$0	$41,650	Yes (X)
BRETT WERGIN
PHYSICIAN	40.00			$298,991	$0	$16,096	Yes (X)
BRANDON BLEICH
PHARMACIST	40.00			$156,989	$0	$21,520	Yes (X)
REBEKAH KIMBERLIN
PHARMACIST	40.00			$110,588	$0	$19,961	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,737,540	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$173,941	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	15	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	Yes (1)	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
BECKENHAUER CONSTRUCTION
1901 RIVERSIDE BLVD	NORFOLK	NE	68701	CONSTRUCTION SERVICES	$865,508
BRYAN HEALTH
1600 S 48TH STREET	LINCOLN	NE	68506	MEDICAL SERVICES	$391,784
CERNER CORPORATION
2800 ROCK CREEK PKWY	KANSAS CITY	KS	64117	ELECTRONIC HEALTH RECORD SERVICES	$391,386
MEDHOST
6550 CAROTHERS PARKWAY SUITE 160	FRANKLIN	TN	37067	ELECTRONIC HEALTH RECORDS	$273,110
CHAPPELL ROOFING INC
302 E STREET	FAIRBURY	NE	68352	CONSTRUCTION SERVICES	$194,080

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	13	CntrctRcvdGreaterThan100KCnt
Fundraising	$13,293	FundraisingAmt
Government Grants	$4,662,433	GovernmentGrantsAmt
All Other Contributions	$161,379	AllOtherContributionsAmt
Total Contributions	$4,837,105	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICARE/MEDICAID PAYMENTS	624100	$14,989,266	$14,989,266
PATIENT SERVICE REVENUE	624100	$9,336,977	$9,336,977
340B DRUG PRICING PROGRAM	624100	$773,403	$773,403
CEDARWOOD ASSISTED LIVING SVC FEE	623000	$540,122	$540,122
CEDARWOOD: EQUITY IN JT VENTURE	623000	$217,992	$217,992

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$74,538	TotalRevenueColumnAmt
Related Or Exempt Func Income	$74,538	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$25,932,298	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$292,805	TotalRevenueColumnAmt
Exclusion	$292,805	ExclusionAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$160,609	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	-$160,609	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$160,609	TotalRevenueColumnAmt
Exclusion	-$160,609	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$6,792	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$13,293	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$4,967	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,825	TotalRevenueColumnAmt
Exclusion	$1,825	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA	Desc
Business	722210	BusinessCd
Total Revenue Column	$143,397	TotalRevenueColumnAmt
Exclusion	$143,397	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$143,397	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$31,046,821	TotalRevenueColumnAmt
Related Or Exempt Func Income	$25,932,298	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$277,418	ExclusionAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$275,227	TotalAmt
Management And General	$275,227	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$93,237	TotalAmt
Program Services	$93,237	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$11,922,138	TotalAmt
Program Services	$11,338,116	ProgramServicesAmt
Management And General	$564,030	ManagementAndGeneralAmt
Fundraising	$19,992	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$399,327	TotalAmt
Program Services	$379,530	ProgramServicesAmt
Management And General	$19,797	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,633,952	TotalAmt
Program Services	$1,549,154	ProgramServicesAmt
Management And General	$84,798	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$825,710	TotalAmt
Program Services	$769,207	ProgramServicesAmt
Management And General	$55,047	ManagementAndGeneralAmt
Fundraising	$1,456	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$32,666	TotalAmt
Management And General	$32,666	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$66,778	TotalAmt
Program Services	$1,897	ProgramServicesAmt
Management And General	$64,881	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$2,441,297	TotalAmt
Program Services	$2,109,179	ProgramServicesAmt
Management And General	$332,118	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$153,737	TotalAmt
Program Services	$47,913	ProgramServicesAmt
Management And General	$104,453	ManagementAndGeneralAmt
Fundraising	$1,371	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,535,155	TotalAmt
Program Services	$1,427,846	ProgramServicesAmt
Management And General	$106,830	ManagementAndGeneralAmt
Fundraising	$479	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$159,814	TotalAmt
Program Services	$159,814	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$514,774	TotalAmt
Program Services	$472,910	ProgramServicesAmt
Management And General	$41,864	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$20,078	TotalAmt
Program Services	$18,839	ProgramServicesAmt
Management And General	$1,239	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$139,577	TotalAmt
Program Services	$119,582	ProgramServicesAmt
Management And General	$18,774	ManagementAndGeneralAmt
Fundraising	$1,221	FundraisingAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$137,118	TotalAmt
Program Services	$127,442	ProgramServicesAmt
Management And General	$9,676	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,542,654	TotalAmt
Program Services	$1,433,794	ProgramServicesAmt
Management And General	$108,860	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$146,276	TotalAmt
Management And General	$146,276	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$3,586,050	$3,586,050
BAD DEBTS EXPENSE	$781,984	$781,984
FOOD EXPENSE	$362,627	$360,400	$2,227
DUES AND SUBSCRIPTIONS	$253,500	$143,694	$109,806

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$111,969	TotalAmt
Program Services	$96,497	ProgramServicesAmt
Management And General	$15,472	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$27,135,645	TotalAmt
Program Services	$25,017,085	ProgramServicesAmt
Management And General	$2,094,041	ManagementAndGeneralAmt
Fundraising	$24,519	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$450	BOYAmt
EOY	$450	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$13,526,882	BOYAmt
EOY	$7,190,539	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$3,755,258	BOYAmt
EOY	$4,148,689	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$407,826	BOYAmt
EOY	$399,209	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$347,551	BOYAmt
EOY	$144,358	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$34,240,492	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$15,271,882	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$12,383,856	BOYAmt
EOY	$18,968,610	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$8,172,221	BOYAmt
EOY	$8,043,214	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$1,040,895	BOYAmt
EOY	$1,258,887	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,047,166	BOYAmt
EOY	$76,065	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$40,682,105	BOYAmt
EOY	$40,230,021	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$1,913,899	BOYAmt
EOY	$2,828,309	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$4,156,049	BOYAmt
EOY	$3,917,528	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$1,468,320	BOYAmt
EOY	$1,284,781	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$2,308,912	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$6,281,979	BOYAmt
EOY	$3,343,290	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$16,129,159	BOYAmt
EOY	$11,373,908	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$24,336,516	BOYAmt
EOY	$28,651,958	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$216,430	BOYAmt
EOY	$204,155	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$24,552,946	BOYAmt
EOY	$28,856,113	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$40,682,105	BOYAmt
EOY	$40,230,021	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$3,911,176	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$391,991	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$2,044	OtherActivitiesAmt
Total Lobbying Expenditures	$2,044	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	JCH&L PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES.	ExplanationTxt

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$50,754	BeginningYearBalanceAmt
End Year Balance	$50,754	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$50,754	BeginningYearBalanceAmt
End Year Balance	$50,754	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$50,754	BeginningYearBalanceAmt
End Year Balance	$50,754	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$50,754	BeginningYearBalanceAmt
End Year Balance	$50,754	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$50,754	BeginningYearBalanceAmt
End Year Balance	$50,754	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Board Designated Balance EOY	0.00000	BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY	0.00000	TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org	0	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	0	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$50,943	OtherCostOrOtherBasisAmt
Book Value	$50,943	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$20,813,390	OtherCostOrOtherBasisAmt
Depreciation	$11,939,489	DepreciationAmt
Book Value	$8,873,901	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,760,422	OtherCostOrOtherBasisAmt
Depreciation	$3,212,263	DepreciationAmt
Book Value	$3,548,159	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$6,615,737	OtherCostOrOtherBasisAmt
Depreciation	$120,130	DepreciationAmt
Book Value	$6,495,607	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$18,968,610	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
ACCRUED INTEREST	$9,224
REFUNDABLE ADVANCES	$3,218,897
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS - MEDICARE AND MEDICAID	$115,169

Field	Value	IRS element (for citing)
Total Liability	$3,343,290	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$30,661,795	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$391,991	NetUnrealizedGainsInvstAmt
Other Revenue	$4,967	OtherRevenueAmt
Revenue Not Reported	$396,958	RevenueNotReportedAmt
Revenue Subtotal	$30,264,837	RevenueSubtotalAmt
Other Revenues Not Included	$781,984	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$781,984	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$31,046,821	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$26,358,628	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$4,967	OtherExpensesIncludedAmt
Expenses Not Reported	$4,967	ExpensesNotReportedAmt
Expenses Subtotal	$26,353,661	ExpensesSubtotalAmt
Other Expenses Not Included	$781,984	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$781,984	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$27,135,645	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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 IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HEALTH CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HEALTH CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. 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, 2021, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EXPENSES 4,967.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS 781,984.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EXPENSES 4,967.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS 781,984.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	GOLF TOURNAMENT	Event1Nm
Gross Receipts Event1	$20,085	GrossReceiptsEvent1Amt
Charitable Contri Event1	$13,293	CharitableContriEvent1Amt
Gross Revenue Event1	$6,792	GrossRevenueEvent1Amt
Cash Prizes Event1	$1,440	CashPrizesEvent1Amt
Non Cash Prizes Event1	$906	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$1,000	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$717	FoodAndBeverageEvent1Amt
Other Direct Expenses Event1	$904	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$20,085	GrossReceiptsTotalAmt
Charitable Contributions Tot	$13,293	CharitableContributionsTotAmt
Gross Revenue Total Events	$6,792	GrossRevenueTotalEventsAmt
Cash Prizes Total Events	$1,440	CashPrizesTotalEventsAmt
Non Cash Prizes Total Events	$906	NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$1,000	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$717	FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events	$904	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$4,967	DirectExpenseSummaryEventsAmt
Net Income Summary	$1,825	NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent150	Yes (X)	Percent150Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent300	Yes (X)	Percent300Ind
Free Care Medically Indigent	0	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	0	ExpensesExceedBudgetInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$130,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$130,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00490	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,922,391	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,643,073	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$279,318	NetCommunityBenefitExpnsAmt
Total Expense	0.01060	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,052,391	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,643,073	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$409,318	NetCommunityBenefitExpnsAmt
Total Expense	0.01550	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,938	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,938	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,000	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$12,000	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,309,718	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,801,368	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,508,350	NetCommunityBenefitExpnsAmt
Total Expense	0.05720	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,144	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,144	NetCommunityBenefitExpnsAmt
Total Expense	0.00020	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$4,330,800	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,801,368	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,529,432	NetCommunityBenefitExpnsAmt
Total Expense	0.05810	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,383,191	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,444,441	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,938,750	NetCommunityBenefitExpnsAmt
Total Expense	0.07360	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$275	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$275	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$500	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$500	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$775	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$775	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$781,984	BadDebtExpenseAmt
Bad Debt Expense Attributable	$106,350	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$10,187,254	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$10,258,342	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$71,088	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	JEFFERSON COMMUNITY HEALTH CENTER	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2200 H STREET	AddressLine1Txt
City	FAIRBURY	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	68352	ZIPCd

Field	Value	IRS element (for citing)
Website Address	HTTP://WWW.JCHEALTHANDLIFE.ORG	WebsiteAddressTxt
State License	440001	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	JEFFERSON COMMUNITY HEALTH CENTER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	18	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	150.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	300.000000000000	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/FINANCIAL-ASSISTANCE-POLICY	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/FINANCIAL-ASSISTANCE-POLICY	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/FINANCIAL-ASSISTANCE-POLICY	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Prospective Medicare Medicaid	Yes (X)	ProspectiveMedicareMedicaidInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

JEFFERSON COMMUNITY HEALTH CENTER, INC.

PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH & LIFE BEGAN ITS THIRD COMMUNITY HEALTH NEEDS ASSESSMENT EARLY IN 2019. JCH&L HAS CONDUCTED FOCUS GROUPS WITH LOCAL ORGANIZATIONS, HELD A COMMUNITY STAKEHOLDERS LUNCHEON, AND REVIEWED STATISTICS MADE AVAILABLE THROUGH PUBLIC HEALTH SOLUTIONS, STATE OF NEBRASKA, US CENSUS, HEALTH PEOPLE 2020, AND WEBSITES SUCH AS COUNTY HEALTH RANKINGS AND WORLD LIFE EXPECTANCY.A COMMUNITY HEALTH NEEDS ASSESSMENT MEETING WAS HELD AT JCH&L WITH REPRESENTATIVES FROM AREA AGENCY PARTNERS, AND MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, OPTIMISTS, AND SENIOR DINERS. A TOTAL OF 96 ATTENDED AND PARTICIPATED IN DISCUSSING COMMUNITY HEALTH NEEDS.

JEFFERSON COMMUNITY HEALTH CENTER, INC.

PART V, SECTION B, LINE 11: PRIORITIZED NEEDS (AS DETERMINED BY COMMUNITY HEALTH NEEDS ASSESSMENT):1) OBESITY2) SEDENTARY LIFESTYLE3) CHRONIC DISEASES AFFECTED BY OBESITY AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE, AND CANCERTHE HOSPITAL IS DOING THE FOLLOWING TO ADDRESS THESE NEEDS:*THE SMART MOVES PROGRAM OFFERS A YEAR-LONG CLASS TO TEACH THOSE AT RISK FOR DEVELOPING PRE-DIABETES TO MAKE HEALTHY LIFESTYLE CHOICES. CONTINUE TO EXPAND, PROMOTE, AND INCREASE UTILIZATION OF SMART MOVES LIFESTYLE CHANGE PROGRAM (A PROGRAM OF THE NATIONAL DIABETES PREVENTION PROGRAM).*CONTINUE TO BE AN ACTIVE PART OF COMMUNITY PARTNERSHIPS WORKING TO ESTABLISH WALKABLE COMMUNITY AND WALKING/BIKE TRAILS IN FAIRBURY. ESTABLISH HISTORIC TRAIL WALK. ENHANCE COMMUNITY'S SIDEWALKS AND SAFE WALKING/BIKING ROUTES. ENCOURAGE ACTIVITY LIFESTYLES FOR THOSE OF ALL AGES.*CONTINUE TO PARTNER WITH SCHOOLS AND OTHER YOUTH ORGANIZATIONS, OFFER SIDELINES SERVICES FOR ATHLETES, AND OFFER YOUTH EVENTS AT THE BURKLEY FITNESS CENTER, AND PROVIDE EDUCATION AND INFORMATION AS NEEDED BY AREA SCHOOLS.*CONTINUE SUPPORT OF GO RED FOR WOMEN EVENT IN COMMUNITY (SUPPORT OF AMERICAN HEART ASSOCIATION) AND CONTINUE AS HOST OF THIRD ANNUAL WOMEN'S HEALTH FAIR THIS YEAR AND THE EXPANSION OF THE FAIR.*DETERMINE WAY TO REACH MEN WITH SOME TYPE OF MEN'S HEALTH EVENT.*PROVIDE CONTINUED EDUCATION REGARDING AREAS OF INCREASED RISK IN OUR COUNTRY: OBESITY, SEDENTARY LIFESTYLE, TOBACCO USE, CHRONIC HEALTH CONDITIONS, MENTAL HEALTH.*CONTINUE PARTICIPATION IN MEDICARE ACO & BLUE CROSS PATIENT-CENTERED MEDICAL PROGRAM.*ENHANCE USE OF MEDICARE WELLNESS VISIT PROGRAM.*CONTINUE DEVELOPMENT AND EXPANSION OF CHRONIC CARE COORDINATION PROGRAM.*ENHANCE ABILITY TO TRACK COMMUNITY MEDICAL NEEDS BY MOVING TO ELECTRONIC HEALTH RECORD SYSTEM.*CONSIDER ADDITION OF TELEHEALTH SERVICES FOR PULMONOLOGY, ENDOCRINOLOGY, AND NEPHROLOGY (AREAS WHICH WE DO NOT CURRENTLY HAVE SPECIALISTS).*ADD CERTIFIED PERSONAL TRAINERS TO FITNESS CENTER STAFF.*CONTINUE TO PROVIDE FINANCIAL SUPPORT FOR BURKLEY FITNESS CENTER.*CONSIDER ADDING QUALITY INCENTIVES TO PHYSICIAN CONTRACTS TO ADDRESS PRIORITIZED COMMUNITY NEEDS.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/SUICIDE. WE WILL CONTINUE TO WORK TO BE GOOD COMMUNITY PARTNERS TO ALL AREA ENTITIES WORKING TOWARD IMPROVING OUR COMMUNITY'S MENTAL HEALTH SERVICES AND SUICIDE PREVENTION AND ASSISTANCE TO THOSE AFFECTED BY SUICIDE.*ALZHEIMER'S DISEASE. WE WILL CONTINUE TO OFFER AN ALZHEIMER'S CAREGIVER'S SUPPORT GROUP AND BE A PART OF THE ANNUAL WALK TO END ALZHEIMER'S, 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, SUICIDE, 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.*POVERTY, TRANSPORTATION, DECLINING POPULATION, 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 CHARITY CARE. THESE ARE NOT NAMED AS PRIORITY AREAS AT THIS TIME.

Field	Value	IRS element (for citing)
Facility	3	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
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

Supplemental Information Detail SupplementalInformationDetail (18 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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, LN 7 COL(F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $781,984.
PART I, LINE 7:	JCH&L REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2021, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMSA. JCH&L PROVIDED CHARITY CARE IN FISCAL 2021 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: 35 VALUE: $130,000B. . UNPAID COSTS OF PUBLIC PROGRAMS. MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: $ 279,318.45C. BAD DEBT: BESIDES OFFICIAL CHARITY CARE, JCH&L WROTE OFF $ 781,984 IN BAD DEBT DURING FISCAL 2021. 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. IN 2021, WE WERE NOT ABLE TO HOLD A HEALTH FAIR BECAUSE OF COVID-19.SPEAKERS BUREAU - JCH&L STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 9 PROGRAMS WERE DONE IN FISCAL 2021. TOTAL INDIVIDUALS REACHED: 375. ESTIMATED COST OF STAFF TIME: $300.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 2021. 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: 0. APPROXIMATE COST OF STAFF TIME SPENT: $0. ESTIMATED COST OF POSTAGE: $25 (TO NOTIFY THOSE INTERESTED THAT MEETINGS WERE STILL SUSPENDED.) ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES): $0.HEALTH PROMOTION PROGRAMS - JCH&L OFFERS SMOKING CESSATION INFORMATION TO PATIENTS AND THE PUBLIC. EACH INPATIENT WHO IS A SMOKER IS PROVIDED INFORMATION ON SMOKING CESSATION. ESTIMATED NUMBER REACHED: 30; ESTIMATED COST OF PROMOTIONAL MATERIALS PROVIDED: $152.69. ESTIMATED COST OF STAFF TIME TO PREPARE AND DISTRIBUTE: $250.B. COMMUNITY-BASED CLINICAL SERVICES: SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS.COMPLETE BLOOD PROFILES - COMPLETE BLOOD PROFILES WERE OFFERED TO OUR COMMUNITY AT A REDUCED RATE IN THE SPRING OF 2021. STAFF TIME IS INCLUDED FOR THE PLANNING, SCHEDULING AND PUBLICIZING, IN ADDITION TO REGISTRATION AND BLOOD DRAW. BLOOD DRAWS ARE OFFERED FOR $45, WHICH IS A TREMENDOUS DISCOUNT FROM THE NORMAL PRICE. ESTIMATED NUMBER REACHED: 55 VALUE OF ESTIMATED STAFF TIME: $750IMMUNIZATION 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: 617. TOTAL OF 1,544 VACCINATIONS PROVIDED. ESTIMATED COST OF NURSES PROVIDED BY JCH&L TO GIVE SHOTS: $1,460. C. HEALTH CARE SUPPORT SERVICESCOVID MASKS - OFFERED FREE CLOTH MASKS TO THE COMMUNITY DURING COVID. ESTIMATED COST: $2,000.COVID TESTING - OFFERED FREE COVID TESTING THROUGH TESTNEBRASKA, AT VARIOUS INTERVALS DEPENDING ON THE COMMUNITY NEED (SOMETIMES MONTHLY, WEEKLY, OR TWICE WEEKLY.) WE WERE REIMBURSED FOR STAFF TIME THROUGH TESTNEBRASKA. COST OF STAFF TIME AFTER REIMBURSEMENT FROM TESTNEBRASKA: $0.COVID CLINICS AND BOOSTER CLINICS - JCH&L OFFERED COVID VACCINE CLINICS EVERY FRIDAY FROM FEB. 5 THROUGH APRIL 23. WE OFFERED SCHOOL-AGE CLINICS ON TWO FRIDAYS IN AUGUST AND SEPTEMBER. WE RECEIVED AN ADMINISTRATION FEE THROUGH INSURANCE FOR MOST OF THE VACCINES GIVEN. COST OF STAFF TIME AFTER ADMINISTRATION FEES: $0III. MEDICAL EDUCATIONA. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS.PHYSICIAN/MEDICAL STUDENTS, NURSES/NURSING STUDENTS, TECHNICIANS AND OTHER HEALTH PROFESSIONALS. JCH&L WORKS WITH SOUTHEAST COMMUNITY COLLEGE IN BEATRICE AS A SITE FOR LPN PRACTICAL NURSING TRAINING. NORMALLY, NURSING STUDENTS UTILIZE MEETING ROOM SPACE AT JCH&L, AS WELL AS TAKE PART IN CLINICAL PRACTICE. THIS WAS NOT OFFERED IN FISCAL 2021 BECAUSE OF COVID. JCH&L SPORTS MEDICINE AND REHAB SERVICES HOSTED 2 THERAPY STUDENTS. THERAPY STUDENTS ARE TYPICALLY HOUSED IN A PATIENT ROOM DURING THEIR STAY. 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 AND 2 PA STUDENTS UTILIZED OUR FACILITY IN FISCAL 2021. 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 2021. 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 2021. ESTIMATED NUMBER REACHED: 10. JCH&L COST (APARTMENT RENT, STAFF TIME, ETC.): $12,000.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 2021 WE WERE NOT ALLOW JOB SHADOWS BECAUSE OF COVID. WE RESUMED JOB SHADOWING IN EARLY 2022, WITH THE REQUIREMENT THAT ALL STUDENTS BE VACCINATED FOR COVID (PER CMS REQUIREMENTS.) NUMBER REACHED: 0. ESTIMATED COST OF STAFF TIME: $0.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. IN FISCAL 2020, THE FITNESS CENTER WAS CLOSED FOR SEVERAL MONTHS, AND OPERATED WITH LIMITED NUMBERS AND WITHOUT GROUP FITNESS CLASSES CLASS FOR SEVERAL MORE MONTHS. TOTAL VISITS FOR FISCAL 2021: 28,736. ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $254,646. 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: $148,547. EXPENSES: $431,986.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: $2,534,650. EXPENSES: $3,494,878.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 SCOUT, 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, AN AREA RODEO, 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, RURAL FIRE TRAINING, STATEBOUND ATHLETES FROM JEFFERSON COUNTY SCHOOLS, BONHAM THEATRE, ROTARY TANK PAINTING PROJECT, AREA POST PROMS, KGMT-KUTT ANNUAL THANKSGIVING MEAL, BLUE VALLEY COMMUNITY ACTION, AREA COMMUNITIES' EVENTS, AND AREA WRESTLING PROGRAMS, ETC. THESE TOTALED $2,894.48 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 2021 TOTALED $3,894.48. B. IN-KIND DONATIONS: SAFE KIDS CHAPTER - JCH&L IS A MEMBER OF THE SAFE KIDS COALITION. SAFE KIDS OFFERS SAFETY SEAT CHECK UP EVENTS AND OTHER SAFETY PROMOTIONS. NO SAFETY SEAT EVENTS WERE HELD IN FISCAL 2021. ESTIMATED STAFF TIME: $0. 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 TYPICALLY ONE OF THE COSPONSORS OF THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. THE EVENT WAS NOT HELD IN 2021 BECAUSE OF COVID. VII. 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. PARK IMPROVEMENT - JCH&L WORKED WITH JEFFCO ON THE MOVE AND MANY OTHER ORGANIZATIONS TO UPDATE THE ISAAC OUTDOOR GAME CENTER IN THE FAIRBURY CITY PARK. THE PROJECT WAS SUBSTANTIALLY COMPLETED IN JULY; A RIBBON CUTTING WAS HELD IN OCTOBER. JCH&L STAFF MEMBER EMCEED THE GRAND OPENING. ESTIMATED COST OF STAFF TIME INVOLVED: $500IN 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 II, COMMUNITY BUILDING ACTIVITIES:	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:	GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HEALTH CENTER PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HEALTH CENTER ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE. FOR THE YEAR ENDED SEPTEMBER 30, 2021 NO SIGNIFICANT ADJUSTMENTS TO REVENUE WERE RECOGNIZED DUE TO CHANGES IN ESTIMATES OF IMPLICIT PRICE CONCESSIONS FOR PERFORMANCE OBLIGATIONS SATISFIED IN PRIOR YEARS. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE.
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 BAD DEBT FOR SELF-PAY PATIENTS TO ESTIMATE THE PORTION OF SELF-PAY BAD DEBT THAT WAS LIKELY ATTRIBUTABLE TO INDIVIDUALS ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY.
PART III, LINE 4:	JCH&L'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, PAGES 8, 10 AND 11 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT RECEIVABLE," "PATIENT SERVICE REVENUE AND "FINANCIAL ASSISTANCE/CHARITY CARE".
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, 2021. NO SHORTFALL IS TREATED AS COMMUNITY BENEFIT.
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 CONDUCTED A COMMUNITY PERCEPTION SURVEY IN 2015, WHICH INCLUDES QUESTIONS ON COMMUNITY HEALTH 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 $255,000. 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 CAR SAFETY SEAT CHECKS, 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.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	Yes (1)	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (5 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CRAIG SHUMARD
PHYSICIAN	$331,475	$0	$145,242	$0	$0	$0	$24,250	$0	$17,400	$0	$518,367	$0	$0	$0
RICHARD BLATNY JR
PHYSICIAN	$322,150	$0	$129,942	$0	$0	$0	$24,250	$0	$17,400	$0	$493,742	$0	$0	$0
BRETT WERGIN
PHYSICIAN	$271,484	$0	$27,507	$0	$0	$0	$7,096	$0	$9,000	$0	$315,087	$0	$0	$0
BRANDON BLEICH
PHARMACIST	$156,989	$0	$0	$0	$0	$0	$4,120	$0	$17,400	$0	$178,509	$0	$0	$0
CHANCE KLASEK
CFO	$132,939	$0	$0	$0	$0	$0	$7,264	$0	$17,400	$0	$157,603	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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.
SCHEDULE J, PART II	VIC LEE, INTERIM CEO THRU MAY OF 2020 WAS PAID BY AN UNRELATED ORGANIZATION, BRYAN HEALTH. TOTAL COMPENSATION AND BENEFITS PAID TO MR. LEE FOR 2020 WERE $102,000.

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	HOSPITAL AUTHORITY NO 1 OF JEFFERSON COUNTY NE	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	611683496	BondIssuerEIN
Bond Issued	2020-12-18	BondIssuedDt
Issue Price	$8,291,780	IssuePriceAmt
Purpose	RENOVATE FACILITY & REF BOND ISSUE (12/18/12)	PurposeDesc
Defeased	0	DefeasedInd
On Behalf Of Issuer	0	OnBehalfOfIssuerInd
Pool Financing	0	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$225,000	RetiredAmt
Total Proceeds	$4,266,989	TotalProceedsAmt
Other Spent Proceeds	$4,266,989	OtherSpentProceedsAmt
Refunding Tax Exempt Bonds	Yes (1)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	0	RefundingTaxableBondsInd
Final Allocation Made	0	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (1)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	0	OwningBondFinancedPropertyInd
Any Lease Arrangements	0	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	0	MgmtContractBondFincdPropInd
Any Research Agreements	0	AnyResearchAgreementsInd
Private Bus Use By Others	0.00000	PrivateBusUseByOthersPct
Private Bus Concerning UBI	0.00000	PrivateBusConcerningUBIPct
Total Private Business Use	0.00000	TotalPrivateBusinessUsePct
Bond Iss Meet Prvt Sec Pymt Test	0	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	0	ChangeInUseBondFinancedPropInd
Procs Nonqualified Bond Remdtd	0	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	0	Form8038TFiledInd
Rebate Not Due Yet	Yes (1)	RebateNotDueYetInd
Exception To Rebate	Yes (1)	ExceptionToRebateInd
No Rebate Due	0	NoRebateDueInd
Variable Rate Issue	Yes (1)	VariableRateIssueInd
Hedge Identified In Bks And Rec	0	HedgeIdentifiedInBksAndRecInd
Gross Proceeds Invested In GIC	0	GrossProceedsInvestedInGICInd
Gross Proceeds Invested	0	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (1)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (1)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II, LINE 3:	FormAndLineReferenceDesc
Explanation	THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) AS THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND THE TOTAL PRINCIPAL AVAILABLE HAS NOT YET BEEN DRAWN	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	CAROL BLOBAUM	PersonNm

Field	Value	IRS element (for citing)
Relationship Description	EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, VICE CHAIRMAN	RelationshipDescriptionTxt
Transaction	$93,237	TransactionAmt
Transaction	EMPLOYEE COMPENSATION	TransactionDesc
Sharing Of Revenues	0	SharingOfRevenuesInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
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.