JEFFERSON COMMUNITY HEALTH CENTER INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: JEFFERSON COMMUNITY HEALTH CENTER INC (EIN 47-0468078)
Tax period: 2015-10-01 to 2016-09-30
Filed: 2017-08-14
IRS object ID: 201712269349300916
Schema version: 2015v3.0
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	2017-08-14T08:33:43-05:00	ReturnTs
Tax Period End	2016-09-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	476097913	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	SEIM JOHNSON 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	2015-10-01	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	2017-08-09	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	BARBARA J FAJEN	PreparerPersonNm
PTIN	P00400874	PTIN
Phone	4023302660	PhoneNum

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2021-01-29 14:40:06Z	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	$20,261,526	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	9	VotingMembersGoverningBodyCnt
Voting Members Independent	7	VotingMembersIndependentCnt
Total Employee	249	TotalEmployeeCnt
Total Volunteers	15	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$96,143	PYContributionsGrantsAmt
CY Contributions Grants	$198,568	CYContributionsGrantsAmt
PY Program Service Revenue	$17,848,635	PYProgramServiceRevenueAmt
CY Program Service Revenue	$19,208,208	CYProgramServiceRevenueAmt
PY Investment Income	$127,021	PYInvestmentIncomeAmt
CY Investment Income	$167,383	CYInvestmentIncomeAmt
PY Other Revenue	$127,100	PYOtherRevenueAmt
CY Other Revenue	$142,447	CYOtherRevenueAmt
PY Total Revenue	$18,198,899	PYTotalRevenueAmt
CY Total Revenue	$19,716,606	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	$8,498,185	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$10,186,090	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$12,541	CYTotalFundraisingExpenseAmt
PY Other Expenses	$9,023,229	PYOtherExpensesAmt
CY Other Expenses	$9,033,057	CYOtherExpensesAmt
PY Total Expenses	$17,521,414	PYTotalExpensesAmt
CY Total Expenses	$19,219,147	CYTotalExpensesAmt
PY Revenues Less Expenses	$677,485	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$497,459	CYRevenuesLessExpensesAmt
Total Assets BOY	$24,742,383	TotalAssetsBOYAmt
Total Assets EOY	$25,349,803	TotalAssetsEOYAmt
Total Liabilities BOY	$7,306,442	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$7,407,409	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$17,435,941	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$17,942,394	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	$15,836,682	ExpenseAmt
Revenue	$16,665,061	RevenueAmt
Desc	JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 17 BED ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH CENTER ALSO OPERATES A WELLNESS CENTER, RURAL HEALTH CLINIC, AND PROVIDES HOME HEALTH SERVICES.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$1,567,294	ExpenseAmt
Revenue	$2,543,147	RevenueAmt
Desc	JEFFERSON COMMUNITY HEALTH CENTER 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	$17,403,976	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
Temp Or Permanent Endowments	Yes (1)	TempOrPermanentEndowmentsInd
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 With Officer Ent	0	BusinessRlnWithOfficerEntInd
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	7	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	249	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
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	9	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	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
DICK HOPPE
CHAIRMAN	1.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
BRIAN SCHEELE
VICE CHAIRMAN	1.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
BRIAN BLOBAUM
SECRETARY/TREASURER	1.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
LYMON HAMM
SECRETARY/TREASURER (THRU DEC. 2015)	1.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
LINDA BAUER
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
MARY GLENN
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
CARMEN HINMAN
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
DR TED TUCKER
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
JEREMY CHRISTIANSEN
MEMBER (JAN 2016 - PRESENT)	1.00	0.00	Yes (X)		$0	$0	$0
LOREN DUERKSEN
MEMBER (JAN 2016 - PRESENT)	1.00	0.00	Yes (X)		$0	$0	$0
MIKE STEELE
MEMBER (THRU DEC. 2015)	1.00	0.00	Yes (X)		$0	$0	$0
CHAD JURGENS
CEO	40.00	0.00		Yes (X)	$165,612	$0	$23,814
CHANCE KLASEK
CFO	40.00	0.00		Yes (X)	$105,063	$0	$16,780
GARY MITCHELL
DIRECTOR OF PHARMACY	40.00	0.00			$148,170	$0	$21,968	Yes (X)
DENNIS RUSSEL
PHARMACIST	40.00	0.00			$113,883	$0	$20,183	Yes (X)
MEGAN LARKINS
PHARMACIST	40.00	0.00			$110,702	$0	$20,002	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$643,430	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$102,747	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	5	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1Txt	CityContractorAddress/USAddress/CityNm	State AbbreviationContractorAddress/USAddress/StateAbbreviationCd	ZIPContractorAddress/USAddress/ZIPCd	ServicesServicesDesc	CompensationCompensationAmt
BECKENHAUER CONSTRUCTION INC
1901 RIVERSIDE BLVD	NORFOLK	NE	68701	CONSTRUCTION	$1,218,085
FAIRBURY CLINIC PC
825 22ND STREET	FAIRBURY	NE	68352	ER COVERAGE	$601,115
SYSCO
900 KINGBIRD ROAD	LINCOLN	NE	68521	FOOD SERVICE	$361,319
SOUTHEAST ANESTHESIA SERVICES
8426 W BIRCH	CLATONIA	NE	68328	CRNA SERVICES	$360,000
ZIMMER
1800 WEST CENTER STREET	WARSAW	IN	46581	IMPLANTS	$327,157

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	11	CntrctRcvdGreaterThan100KCnt
Fundraising	$12,340	FundraisingAmt
Government Grants	$10,854	GovernmentGrantsAmt
All Other Contributions	$175,374	AllOtherContributionsAmt
Noncash Contributions	$10,854	NoncashContributionsAmt
Total Contributions	$198,568	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICARE/MEDICAID PAYMENTS	624100	$11,046,303	$11,046,303
PATIENT SERVICE REVENUE	624100	$7,490,824	$7,490,824
CEDARWOOD ASSISTED LIVING SVC FEE	623000	$532,388	$532,388
CEDARWOOD: EQUITY IN JT VENTURE	623000	$82,961	$82,961
EHR INCENTIVE PAYMENTS	624100	$42,385	$42,385

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$13,347	TotalRevenueColumnAmt
Related Or Exempt Func Income	$13,347	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$19,208,208	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$123,681	TotalRevenueColumnAmt
Exclusion	$123,681	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$583,398	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$539,696	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$43,702	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$43,702	TotalRevenueColumnAmt
Exclusion	$43,702	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$4,412	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$12,340	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$5,224	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$812	TotalRevenueColumnAmt
Exclusion	-$812	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA	Desc
Business	722210	BusinessCd
Total Revenue Column	$143,259	TotalRevenueColumnAmt
Exclusion	$143,259	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$143,259	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$19,716,606	TotalRevenueColumnAmt
Related Or Exempt Func Income	$19,208,208	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$309,830	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$311,269	TotalAmt
Management And General	$311,269	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$167,388	TotalAmt
Program Services	$167,388	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$7,746,160	TotalAmt
Program Services	$7,267,440	ProgramServicesAmt
Management And General	$471,400	ManagementAndGeneralAmt
Fundraising	$7,320	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$252,136	TotalAmt
Program Services	$240,043	ProgramServicesAmt
Management And General	$12,093	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,156,231	TotalAmt
Program Services	$1,074,716	ProgramServicesAmt
Management And General	$81,515	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$552,906	TotalAmt
Program Services	$504,738	ProgramServicesAmt
Management And General	$47,648	ManagementAndGeneralAmt
Fundraising	$520	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$48,020	TotalAmt
Management And General	$48,020	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$59,282	TotalAmt
Management And General	$59,282	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$19,883	TotalAmt
Management And General	$19,883	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$1,954,288	TotalAmt
Program Services	$1,653,735	ProgramServicesAmt
Management And General	$300,272	ManagementAndGeneralAmt
Fundraising	$281	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$104,628	TotalAmt
Program Services	$102,772	ProgramServicesAmt
Management And General	$1,251	ManagementAndGeneralAmt
Fundraising	$605	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,009,565	TotalAmt
Program Services	$837,475	ProgramServicesAmt
Management And General	$169,181	ManagementAndGeneralAmt
Fundraising	$2,909	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$19,994	TotalAmt
Program Services	$19,994	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$353,262	TotalAmt
Program Services	$349,062	ProgramServicesAmt
Management And General	$4,200	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$42,390	TotalAmt
Program Services	$34,605	ProgramServicesAmt
Management And General	$7,785	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$57,995	TotalAmt
Program Services	$43,480	ProgramServicesAmt
Management And General	$14,515	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$154,714	TotalAmt
Program Services	$141,460	ProgramServicesAmt
Management And General	$13,254	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,435,583	TotalAmt
Program Services	$1,312,602	ProgramServicesAmt
Management And General	$122,981	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$79,997	TotalAmt
Management And General	$79,997	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
MEDICAL SUPPLIES	$2,600,241	$2,600,241
BAD DEBTS EXPENSE	$592,736	$592,736
FOOD EXPENSE	$385,955	$385,955
DUES AND SUBSCRIPTIONS	$70,606	$33,687	$36,421	$498

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$43,918	TotalAmt
Program Services	$41,847	ProgramServicesAmt
Management And General	$1,663	ManagementAndGeneralAmt
Fundraising	$408	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$19,219,147	TotalAmt
Program Services	$17,403,976	ProgramServicesAmt
Management And General	$1,802,630	ManagementAndGeneralAmt
Fundraising	$12,541	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	$5,027,604	BOYAmt
EOY	$5,133,682	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,527,847	BOYAmt
EOY	$2,792,179	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$372,722	BOYAmt
EOY	$447,932	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$152,196	BOYAmt
EOY	$198,563	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$25,743,616	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$12,658,170	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$13,096,607	BOYAmt
EOY	$13,085,446	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$2,737,100	BOYAmt
EOY	$2,836,792	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$424,743	BOYAmt
EOY	$507,704	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$150,824	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$403,114	BOYAmt
EOY	$196,231	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$24,742,383	BOYAmt
EOY	$25,349,803	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$1,481,643	BOYAmt
EOY	$1,533,905	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$5,610,297	BOYAmt
EOY	$5,353,665	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$201,645	BOYAmt
EOY	$136,926	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$12,857	BOYAmt
EOY	$382,913	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,306,442	BOYAmt
EOY	$7,407,409	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$17,297,310	BOYAmt
EOY	$17,790,171	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$87,877	BOYAmt
EOY	$101,469	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$50,754	BOYAmt
EOY	$50,754	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$17,435,941	BOYAmt
EOY	$17,942,394	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$24,742,383	BOYAmt
EOY	$25,349,803	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$497,459	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$8,994	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	0	FederalGrantAuditRequiredInd

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	$1,677	OtherActivitiesAmt
Total Lobbying Expenditures	$1,677	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	JCHC 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	$20,038,342	OtherCostOrOtherBasisAmt
Depreciation	$8,348,937	DepreciationAmt
Book Value	$11,689,405	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,503,932	OtherCostOrOtherBasisAmt
Depreciation	$4,232,784	DepreciationAmt
Book Value	$1,271,148	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$150,399	OtherCostOrOtherBasisAmt
Depreciation	$76,449	DepreciationAmt
Book Value	$73,950	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$13,085,446	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDesc	AmtAmt
ACCRUED INTEREST	$12,269
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS	$370,644

Field	Value	IRS element (for citing)
Total Liability	$382,913	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$19,118,205	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	$8,994	NetUnrealizedGainsInvstAmt
Other Revenue	$5,224	OtherRevenueAmt
Revenue Not Reported	$14,218	RevenueNotReportedAmt
Revenue Subtotal	$19,103,987	RevenueSubtotalAmt
Investment Expenses Not Incld	$19,883	InvestmentExpensesNotIncldAmt
Other Revenues Not Included	$592,736	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$612,619	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$19,716,606	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$18,611,752	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$5,224	OtherExpensesIncludedAmt
Expenses Not Reported	$5,224	ExpensesNotReportedAmt
Expenses Subtotal	$18,606,528	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$19,883	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$592,736	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$612,619	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$19,219,147	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 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, 2016 AND 2015, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	GOLF TOURNAMENT	Event1Nm
Gross Receipts Event1	$16,752	GrossReceiptsEvent1Amt
Charitable Contri Event1	$12,340	CharitableContriEvent1Amt
Gross Revenue Event1	$4,412	GrossRevenueEvent1Amt
Cash Prizes Event1	$1,440	CashPrizesEvent1Amt
Non Cash Prizes Event1	$1,135	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$1,000	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$838	FoodAndBeverageEvent1Amt
Other Direct Expenses Event1	$811	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$16,752	GrossReceiptsTotalAmt
Charitable Contributions Tot	$12,340	CharitableContributionsTotAmt
Gross Revenue Total Events	$4,412	GrossRevenueTotalEventsAmt
Cash Prizes Total Events	$1,440	CashPrizesTotalEventsAmt
Non Cash Prizes Total Events	$1,135	NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$1,000	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$838	FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events	$811	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$5,224	DirectExpenseSummaryEventsAmt
Net Income Summary	-$812	NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
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	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
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	$132,422	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$132,422	NetCommunityBenefitExpnsAmt
Total Expense	0.00710	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,855,956	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,062,780	DirectOffsettingRevenueAmt
Net Community Benefit Expns	-$206,824	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,988,378	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,062,780	DirectOffsettingRevenueAmt
Net Community Benefit Expns	-$74,402	NetCommunityBenefitExpnsAmt
Total Expense	0.00710	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$12,975	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$12,975	NetCommunityBenefitExpnsAmt
Total Expense	0.00070	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$8,450	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,450	NetCommunityBenefitExpnsAmt
Total Expense	0.00050	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$498,214	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$232,135	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$266,079	NetCommunityBenefitExpnsAmt
Total Expense	0.01430	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$16,720	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$16,720	NetCommunityBenefitExpnsAmt
Total Expense	0.00090	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$536,359	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$232,135	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$304,224	NetCommunityBenefitExpnsAmt
Total Expense	0.01640	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,524,737	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$2,294,915	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$229,822	NetCommunityBenefitExpnsAmt
Total Expense	0.02350	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$592,736	BadDebtExpenseAmt
Bad Debt Expense Attributable	$80,612	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$7,985,501	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$8,082,801	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$97,300	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
CHNA Conducted	15	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	HTTP://JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTP://JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/	StrategyWebsiteURLTxt
Strategy Attached	0	StrategyAttachedInd
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
Income Level Criteria	Yes (X)	IncomeLevelCriteriaInd
Asset Level Criteria	Yes (X)	AssetLevelCriteriaInd
Medical Indigency Criteria	Yes (X)	MedicalIndigencyCriteriaInd
Insurance Status Criteria	Yes (X)	InsuranceStatusCriteriaInd
Underinsurance Stat Criteria	Yes (X)	UnderinsuranceStatCriteriaInd
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	HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/	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
FAP Notice Displayed	Yes (X)	FAPNoticeDisplayedInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
FAP Notified Upon Admission	Yes (X)	FAPNotifiedUponAdmissionInd
FAP Notified Before Discharge	Yes (X)	FAPNotifiedBeforeDischargeInd
FAP Notified All Patients	Yes (X)	FAPNotifiedAllPatientsInd
Documented Elig Determination	Yes (X)	DocumentedEligDeterminationInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
JEFFERSON COMMUNITY HEALTH CENTER, INC.	PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH CENTER BEGAN ITS SECOND COMMUNITY HEALTH NEEDS ASSESSMENT IN JANUARY 2016. JCHC WORKED WITH PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT, CONDUCTED FOCUS GROUPS WITH LOCAL ORGANIZATIONS, HELD A COMMUNITY STAKEHOLDERS LUNCHEON, CONDUCTED AN INFORMAL SURVEY AT THE JEFFERSON COUNTY FAIR, 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 JCHC WITH REPRESENTATIVES FROM AREA AGENCY PARTNERS, AND MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, AND SENIOR DINERS. A TOTAL OF 89 ATTENDED AND PARTICIPATED IN DISCUSSING COMMUNITY HEALTH NEEDS. IN ADDITION, 59 PARTICIPATED IN AN INFORMAL SURVEY AT THE 2016 JEFFERSON COUNTY FAIR TO GATHER INFORMATION ON EXERCISE AND PERCEIVED HEALTH NEEDS.FOR PURPOSES OF THIS ASSESSMENT AND REPORT, THE PRIMARY SERVICE AREA OF JEFFERSON COMMUNITY HEALTH CENTER WAS CONSIDERED TO BE JEFFERSON COUNTY.
JEFFERSON COMMUNITY HEALTH CENTER, INC.	PART V, SECTION B, LINE 11: PRIORITIZED NEEDS (AS DETERMINED BY COMMUNITY HEALTH NEEDS ASSESSMENT):1) OBESITY:OBESITY WAS MENTIONED BY EVERY GROUP ASKED ABOUT HEALTH CONCERNS AND PRIORITIES FOR JEFFERSON COUNTY. LACK OF PHYSICAL ACTIVITY WAS ALSO A COMMON RESPONSE AS A HEALTH CONCERN. OBESITY AND LACK OF PHYSICAL ACTIVITY ARE DIRECTLY RELATED TO MANY OF THE TOP HEALTH CONCERNS FOR OUR COUNTY INCLUDING HEART DISEASE/CEREBROVASCULAR PROBLEMS AND DIABETES.JEFFERSON COUNTY HAS A 35 PERCENT RATE OF COUNTY RESIDENTS WHO HAVE ARE OBESE, ACCORDING TO COUNTYHEALTHRANKINGS.ORG, HIGHER THAN THE STATE RATE OF 30 PERCENT.FOR THE FIVE-COUNTY PUBLIC HEALTH SOLUTIONS DISTRICT, JEFFERSON COUNTY HAD THE HIGHEST PERCENTAGE OF RESIDENTS WITH BMI GREATER THAN 30. A TOTAL OF 35.6 PERCENT OF JEFFERSON COUNTY ADULT RESIDENTS SELF-REPORTED IN THE BEHAVIORAL RISK FACTOR SURVEY THAT THEY HAD BMI GREATER THAN 30. THE FIVE-COUNTY DISTRICT AVERAGE WAS 33.7 PERCENT, NEBRASKA AVERAGE 29.4 PERCENT AND THE US AVERAGE 27.1 PERCENT.2) SEDENTARY LIFESTYLE:IN THE PHS AREA, 30 PERCENT OF JEFFERSON COUNTY ADULTS REPORT THEY ARE PHYSICALLY INACTIVE. RESPONSES WERE BASED ON THE QUESTION: "DURING THE PAST MONTH, OTHER THAN YOUR REGULAR JOB, DID YOU PARTICIPATE IN ACTIVITIES OR EXERCISES SUCH AS RUNNING, CALISTHENICS, GOLF, GARDENING OR WALKING FOR EXERCISE?" JEFFERSON COUNTY'S RATE OF PHYSICAL INACTIVITY WAS NEARLY THE HIGHEST IN THE FIVE-COUNTY DISTRICT AREA, AND WAS HIGHER THAN THE DISTRICT AVERAGE OF 28.5 PERCENT.ACCORDING TO THE COUNTYHEALTHRANKINGS.ORG DATA, JEFFERSON COUNTY HAD 32 PERCENT INACTIVITY RATE, COMPARED TO THE STATE RATE OF 24 PERCENT.NUTRITION IS ALSO A FACTOR IN OBESITY. IN THE FIVE-COUNTY PUBLIC HEALTH SOLUTIONS AREA, 76.8 PERCENT OF ADULTS IN JEFFERSON COUNTY REPORTED INADEQUATE FRUIT/VEGETABLE CONSUMPTION (LESS THAN 5 SERVINGS OF FRUITS AND VEGETABLES EACH DAY.) JEFFERSON COUNTY WAS BETTER THAN THE FIVE-COUNTY AREA RATE OF 79.1 PERCENT REPORTING INADEQUATE FRUIT AND VEGETABLE CONSUMPTION, BETTER THAN THE STATE AVERAGE OF 78.2 PERCENT, AND WORSE THAN THE UNITED STATES' AVERAGE OF 75.7 PERCENT.3) CHRONIC DISEASES AFFECTED BY OBESITY AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE AND CANCER:PARKINSON'S DISEASE: JEFFERSON COUNTY HAD THE FIFTH HIGHEST RATE OF DEATH FROM PARKINSON'S DISEASE AMONG NEBRASKA'S 93 COUNTIES, ACCORDING TO NEBRASKALIFEEXPECTANCY.COM. JEFFERSON COUNTY HAD A RATE OF 11.54 DEATHS PER 100,000 FOR 2014, COMPARED TO THE STATE RATE OF 8.85 PER 100,000 AND THE NATIONAL RATE OF 7.38.ACCIDENTAL DEATHS: JEFFERSON COUNTY EXCEEDED THE STATE RATES PER 100,000 POPULATION FOR ACCIDENTAL DEATHS IN 2014. JEFFERSON COUNTY HAD SIX ACCIDENTAL DEATHS IN 2014, FOR A CRUDE RATE OF 81.8 (PER 100,000 POPULATION) COMPARED TO THE STATE CRUDE RATE OF 41.3. AGE ADJUSTED RATE WAS 66.4 FOR JEFFERSON COUNTY, COMPARED TO 38.3 AGE ADJUSTED RATE FOR THE STATE. FOR 2010-2014, JEFFERSON COUNTY HAD 28 ACCIDENTAL DEATHS, FOR A RATE OF 74.7 CRUDE RATE AND 64.3 AGE ADJUSTED. THE STATE RATES FOR THE SAME TIME PERIOD WERE 39.2 CRUDE AND 36.4 AGE ADJUSTED.HEART DISEASE: ACCORDING TO THE 2014 NEBRASKA VITAL STATISTICS REPORT, JEFFERSON COUNTY EXCEEDED THE STATE RATE (PER 100,000 POPULATION) FOR HEART DISEASE DEATHS FOR BOTH 2014 AND 2010-2014. JEFFERSON COUNTY HAD 132 DEATHS ATTRIBUTED TO HEART DISEASE IN 2010-2014, FOR A CRUDE RATE OF 352.2 (STATE CRUDE RATE OF 178.8) AND AN AGE-ADJUSTED RATE OF 172.1 (STATE RATE OF 147.8.) FOR 2014, JEFFERSON COUNTY HAD 28 HEART DISEASE DEATHS, FOR A CRUDE RATE OF 354.5 AND AN AGE ADJUSTED RATE OF 176.2. THE STATE'S RATES FOR THE SAME YEAR WERE 174.9 CRUDE RATE AND 142.7 AGE ADJUSTED.CANCER: ACCORDING TO THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES CANCER REGISTRY FOR 2012 (THE NEWEST INFORMATION CURRENTLY AVAILABLE), JEFFERSON COUNTY'S RATE FOR CANCER DEATHS (ALL SITES) WAS 224.2, AND FOR 2008-2012 THE DEATH RATE WAS 187.6. THE STATE RATE FOR 2012 WAS 164.7, AND THE US RATE WAS 166.4. FOR 2008-2012, THE STATE RATE WAS 165.9 AND THE US RATE WAS 171.2. JEFFERSON COUNTY'S RATES WERE HIGHER THAN BOTH STATE AND NATIONAL RATES FOR BOTH 2012 AND THE PERIOD OF 2008-2012.DIABETES: JEFFERSON COUNTY SLIGHTLY EXCEEDED THE STATE RATE (PER 100,000 POPULATION) FOR DIABETES DEATHS FOR 2010-2014 ACCORDING TO THE NEBRASKA VITAL STATISTICS REPORT. JEFFERSON COUNTY HAD 20 DIABETES DEATHS IN 2010-2014, WHICH CALCULATES TO A CRUDE RATE OF 53.4 AND AN AGE ADJUSTED RATE OF 25.3 (PER 100,000 POPULATION) COMPARED TO THE STATE CRUDE RATE OF 24.7 AND AGE ADJUSTED RATE OF 21.4. FOR 2014, JEFFERSON COUNTY HAD ONLY 1 DIABETES DEATH, MAKING THE CRUDE RATE 13.6 AND THE AGE ADJUSTED RATE 5.4, BETTER THAN THE STATE CRUDE RATE OF 25.1 AND THE AGE ADJUSTED RATE OF 25.5.CHRONIC LUNG: JEFFERSON COUNTY WAS AT ABOUT THE SAME AGE ADJUSTED DEATH RATE AS THE STATE FOR CHRONIC LUNG FOR 2010-2014. JEFFERSON COUNTY HAD 34 DEATHS ATTRIBUTED TO CHRONIC LUNG FOR THAT TIME PERIOD, FOR A CRUDE RATE OF 90.7 PER 100,000 AND AN AGE ADJUSTED RATE OF 49.3 PER 100,000. THE STATE AVERAGE MORTALITY RATE WAS 45.3 PER 100,000.CEREBROVASCULAR: JEFFERSON COUNTY EXCEEDED THE STATE RATE (PER 100,000 POPULATION) FOR CEREBROVASCULAR (STROKE) DEATHS FOR 2014 AND FOR 2008-2014. JEFFERSON COUNTY HAD 10 CEREBROVASCULAR DEATHS IN 2014, AND 35 IN THE PERIOD OF 2008-2014. THIS CALCULATES TO A CRUDE RATE OF 65.0 PER 100,000 POPULATION FOR THE YEAR, AND 44.5 PER 100,000 POPULATION FOR 2008-2014. THE STATE RATE WAS 34.7 AND 36.7 RESPECTIVELY.ALZHEIMER'S DISEASE: JEFFERSON COUNTY EXCEEDED THE STATE RATE FOR DEATHS FROM ALZHEIMER'S DISEASE FOR BOTH THE 2014 DATA AND THE 2010-2014 DATA PERIOD. FOR 2014, JEFFERSON COUNTY HAD 4 DEATHS FROM ALZHEIMER'S, FOR A CRUDE RATE OF 54.5 PER 100,000 AND AN AGE ADJUSTED RATE OF 24.4 PER 100,000, COMPARED TO THE STATE RATES OF 24.7 CRUDE AND 21.9 AGE ADJUSTED FOR 2014. FOR 2010-2014, JEFFERSON COUNTY HAD 25 DEATHS ATTRIBUTED TO ALZHEIMER'S, FOR A CRUDE RATE OF 66.7 AND AN AGE ADJUSTED RATE OF 31.1, COMPARED TO THE STATE'S RATES OF 30.2 AND 24.1 PER 100,000 RESPECTIVELY.4) MENTAL AND BEHAVIORAL HEALTH:MENTAL HEALTH WAS AN AREA MENTIONED IN MOST COMMUNITY SURVEY GROUPS AS AN AREA OF NEED. JEFFERSON COUNTY HAS BLUE VALLEY BEHAVIORAL HEALTH AND BEHAVIORAL MEDICINE CLINIC SERVING OUR AREA, BOTH WHICH OFFER PSYCHOLOGISTS. THERE IS NOT A PSYCHIATRIST SERVING JEFFERSON COUNTY.THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION LISTS JEFFERSON COUNTY AS A PSYCHIATRY AND MENTAL HEALTH SHORTAGE AREA AS OF 2013.THE FEDERAL HRSA - DIVISION OF POLICY AND SHORTAGE DESIGNATION LISTS CATCHMENT 5 (WHICH INCLUDES JEFFERSON COUNTY ALONG WITH OTHER SOUTHEAST NEBRASKA COUNTIES) AS A FEDERAL MENTAL HEALTH SHORTAGE AREA.NEEDS JEFFERSON COMMUNITY HEALTH CENTER WILL NOT ADDRESS:THERE WERE NEEDS IDENTIFIED THAT JCHC 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 JCHC INCLUDE: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. JCHC 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.BULLYING, SUICIDE, DENTAL HEALTH, CHRONIC PAIN. JCHC 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 INTENT 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.LEAD, RADON. THESE CONCERNS ALSO AFFECT OUR PATIENTS, AND WE WILL ASSIST IN EDUCATION AND PROMOTIONS UNDERTAKEN BY OTHER COMMUNITY/NATIONAL AGENCIES. THESE WILL NOT BE AREAS OF FOCUS IN OUR CURRENT PLAN.
JEFFERSON COMMUNITY HEALTH CENTER, INC.	PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED TO ANY INDIVIDUAL FOR EMERGENCY AND ALL OTHER MEDICALLY NECESSARY CARE WILL BE BASED ON AMOUNTS GENERALLY BILLED (AGB) TO INDIVIDUALS WHO HAVE INSURANCE COVERING SUCH CARE AT JCHC. AN ADDITIONAL DISCOUNT OPPORTUNITY FOR PROMPT PAYMENT IS AVAILABLE TO SELF-PAY PATIENTS. JCHC WILL DETERMINE ITS AGB BY DETERMINING AN AGB PERCENTAGE AND MULTIPLYING THAT PERCENTAGE BY THE GROSS CHARGES FOR THE SERVICES PROVIDED TO THE INDIVIDUAL. JCHC WILL UTILIZE THE LOOK-BACK METHOD AS DESCRIBED IN 1.501(R)-5(B) TO DETERMINE AGB. JCHC DETERMINES AGB BASED ON ALL MEDICARE, MEDICAID AND PRIVATE INSURANCE CLAIMS PAID IN FULL TO JCHC OVER A 12-MONTH PERIOD, DIVIDED BY THE ASSOCIATED GROSS CHARGES FOR THOSE CLAIMS.

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

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Business Name Line1	1 - GARDENSIDE	BusinessNameLine1Txt

US Address USAddress

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Address Line1	200 H STREET	AddressLine1Txt
City	FAIRBURY	CityNm
State Abbreviation	NE	StateAbbreviationCd
ZIP	68352	ZIPCd

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Facility	LONG TERM CARE FACILITY	FacilityTxt

Supplemental Information Detail SupplementalInformationDetail (17 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 CENTER 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 $592,736.
PART I, LINE 7:	JCHC REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2016, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMSA. TRADITIONAL CHARITY CARE: JCHC PROVIDED CHARITY CARE IN FISCAL 2016 TO THOSE WHO MEET THE FEDERAL POVERTY GUIDELINES. THE BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS. PATIENTS ASSISTED: 159. VALUE: $132,000.B. UNPAID COSTS OF PUBLIC PROGRAMS: MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: $0C. BAD DEBT: BESIDES OFFICIAL CHARITY CARE, JCHC WROTE OFF $592,736 IN BAD DEBT DURING FISCAL 2016. II. COMMUNITY BENEFIT SERVICESA.COMMUNITY HEALTH EDUCATION AND OUTREACH: CHILD SAFETY SEAT PROGRAM- JCHC IS A PART OF A CHILD SAFETY SEAT COALITION AND HOLDS CHILD SAFETY SEAT CHECK UP EVENTS DURING THE YEAR, AS WELL AS OFFERING INDIVIDUAL INSTRUCTION IN PROPER USE OF SEATS. A TOTAL OF 48 SEATS WERE CHECKED IN INDIVIDUAL APPOINTMENTS. GRANTS ARE RECEIVED TO PURCHASE SEATS TO HAVE AVAILABLE, BUT STAFF TIME IS DONATED BY JEFFERSON COMMUNITY HEALTH CENTER. ESTIMATED VALUE OF STAFF TIME: $850.HEALTH FAIR- JCHC PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC., AT THE JEFFERSON COUNTY SPRING EXPO AND THE JEFFERSON COUNTY FAIR. AN ESTIMATED 400+ TOOK PART IN OFFERINGS FROM JCHC AT THESE EVENTS. FOR 2016, THE COST OF BOOTHS, GIVEAWAYS, STAFF TIME, ETC., ARE ESTIMATED AT $2,500. ESTIMATED NUMBER REACHED: 400+.SPEAKERS BUREAU- JCHC STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 25 PROGRAMS WERE DONE IN FISCAL 2016. TOTAL INDIVIDUALS REACHED: 1,266. ESTIMATED COST OF STAFF TIME: $900.SUPPORT GROUPS - IN 2016, JCHC COORDINATED A PARKINSON'S SUPPORT GROUP AND ALZHEIMER'S CAREGIVER'S SUPPORT GROUP. JCHC STAFF MEMBERS COORDINATED MEETINGS OF THESE SUPPORT GROUPS, OFFERING ASSISTANCE TO ANYONE INTERESTED IN MORE INFORMATION ABOUT THE DISEASES. THE PARKINSON'S SUPPORT GROUP MEETS MONTHLY. TOTAL ATTENDANCE DURING FISCAL 2016 WAS 54. A SUPPORT GROUP FOR CAREGIVER'S OF ALZHEIMER'S PATIENTS MEETS MONTHLY AND HAD ATTENDANCE OF 26 THROUGHOUT THE YEAR. JCHC 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: 80. APPROXIMATE COST OF STAFF TIME SPENT: $1,000. ESTIMATED COST OF POSTAGE: $325. ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES): $100.HEALTH PROMOTION PROGRAMS- JCHC OFFERS SMOKING CESSATION INFORMATION TO PATIENTS AND THE PUBLIC. EACH INPATIENT WHO IS A SMOKER IS PROVIDED INFORMATION ON SMOKING CESSATION. ESTIMATED NUMBER REACHED: 94; ESTIMATED COST OF PROMOTIONAL MATERIALS PROVIDED: $480.34. B. COMMUNITY-BASED CLINICAL SERVICES SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS: COMPLETE BLOOD PROFILES- COMPLETE BLOOD PROFILES WERE OFFERED IN THE SPRING AT A REDUCED RATE. A TOTAL OF 50 BLOOD PROFILES WERE OFFERED. PARTICIPANTS PAID $45, WHICH IS A FRACTION OF THE ESTIMATED VALUE OF THE TESTING. ESTIMATED STAFF TIME: $1,200.IMMUNIZATION CLINICS- JCHC 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 CHILDREN SERVED: 267. TOTAL OF 821 VACCINATIONS PROVIDED. ESTIMATED COST OF NURSES PROVIDED BY JCHC TO GIVE SHOTS: $1,620. C. HEALTH CARE SUPPORT SERVICES: ENROLLMENT ASSISTANCE IN PUBLIC PROGRAMS- JCHC OFFERED A COMMUNITY EDUCATION PROGRAM ON MEDICARE PART D DRUG PROGRAM PROVIDED BY JCHC EMPLOYEES TRAINED AS SCHIIP VOLUNTEERS (200), AND PRENATAL CLASSES (10). ESTIMATED NUMBER OF PEOPLE REACHED: 210. ESTIMATED COST OF PROGRAMS, FOOD, AND STAFF TIME: $4,000. III. MEDICAL EDUCATIONA. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS: PHYSICIAN/MEDICAL STUDENTS, NURSES/NURSING STUDENTS, TECHNICIANS AND OTHER HEALTH PROFESSIONALS. JCHC WORKS WITH SOUTHEAST COMMUNITY COLLEGE IN BEATRICE AS A SITE FOR LPN PRACTICAL NURSING TRAINING. AN ESTIMATED 60 STUDENTS LEARNED IN OUR FACILITY IN 2016. NURSING STUDENTS UTILIZE MEETING ROOM SPACE AT JCHC, AS WELL AS TAKE PART IN CLINICAL PRACTICE. MEDICAL STUDENTS COME REGULARLY FOR RURAL ROTATIONS TO LEARN FROM LOCAL PHYSICIANS. JCHC PROVIDES AN APARTMENT FOR THE MEDICAL STUDENTS TO STAY IN DURING THEIR TIME IN FAIRBURY, AND ALSO PROVIDES THEM USE OF OUR WELLNESS CENTER DURING THEIR STAY. FIVE MEDICAL STUDENTS UTILIZED OUR FACILITY IN 2016. JCHC OFFERS 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 2016. THE JCHC 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 2016. ESTIMATED NUMBER REACHED: 66. JCHC COST (APARTMENT RENT, STAFF TIME, ETC.): $4,600.B. OTHER: JOB SHADOWING- JCHC 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. THIS YEAR, SHADOWING OPPORTUNITIES WERE ALSO ARRANGED FOR STUDENTS AS A PART OF THE SCC CAREER ACADEMY, AND OTHER INDIVIDUALS WHO WERE INTERESTED. A TOTAL OF 36 STUDENTS PARTICIPATED IN SHADOWING OPPORTUNITIES IN FISCAL 2016. NUMBER REACHED: 36. ESTIMATED COST OF STAFF TIME: $2,650.VIDEOCONFERENCE- CONTINUED OFFERING VIDEOCONFERENCING CAPABILITIES, INCLUDING POSSIBLE PROGRAMS FOR PROFESSIONALS IN THE COMMUNITY. AVAILABILITY COSTS $100 PER MONTH. A TOTAL OF 71 EDUCATIONAL AND ADMINISTRATIVE PROGRAMS WERE OFFERED IN 2016. THIS INCLUDED A NUMBER OF OPPORTUNITIES FOR STAFF EDUCATION, MEETINGS, AND CLINICAL VISITS. ESTIMATED NUMBER REACHED: 110. COST FOR 2016: $1,200.IV. SUBDIZED HEALTH SERVICESWELLNESS CENTER SUPPORT: JEFFERSON COMMUNITY HEALTH CENTER HAS OPERATED THE BOB AND WAUNETA BURKLEY WELLNESS CENTER AS A COMMUNITY WELLNESS CENTER SINCE IT OPENED IN 1996. JCHC PAYS THE WELLNESS CENTER'S OPERATING EXPENSES THAT EXCEED REVENUES. BECAUSE OF THE HEALTH CENTER'S SUPPORT OF THE WELLNESS CENTER'S CASH FLOW, PRICES FOR MEMBERSHIPS AND SERVICES CAN REMAIN REASONABLE FOR COMMUNITY RESIDENTS. IF THE WELLNESS CENTER WERE A STAND-ALONE OPERATION, PRICES WOULD HAVE TO RISE CONSIDERABLY TO PAY ALL EXPENSES. NUMBER OF PERSONS SERVED: 1,257 (MEMBERS AS OF FISCAL YEAR-END 2016.) ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $267,258. V. RESEARCH.NO RESEARCH DOLLARS EXPENDED.VI. CASH AND IN-KIND DONATIONS.A. CASH DONATIONS: JCHC MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUT AND BOY SCOUT FIRST AID KITS, FREE LOAN OF HOME BILLIRUBEN BLANKET, SPONSORSHIP OF BASEBALL AND SOFTBALL TEAMS, SOFTBALL FIRST AID KITS, GOLF TOURNAMENTS, AREA HIGH SCHOOL POST PROM ACTIVITIES, AREA COMMUNITY CELEBRATIONS, A LOCAL DANCE RECITAL, AN AREA RODEO, CHAMBER OF COMMERCE BANQUET, CHAMBER OF COMMERCE NEW TEACHER WELCOME, CHAMBER OF COMMERCE TEACHER RECOGNITION, LOANING OUT CPR MANNEQUINS, DONATION TO AN AREA COMMUNITY'S NEW FITNESS ROOM AT THEIR SCHOOL, AND DONATIONS TO RELAY FOR LIFE, TEAMMATES, GO RED FOR WOMEN, ETC. THESE TOTALED $3,233.43. JCHC ALSO CONTRIBUTES ITEMS -- SUCH AS WELLNESS CENTER PASSES, JCHC GLASSES AND DUFFLE BAGS, ETC., TO COMMUNITY EVENTS AS DOOR PRIZES. THESE TOTALED AN ESTIMATED $500. USE OF A BILIBLANKET WAS DONATED FOR NEWBORNS WITH JAUNDICE FOR 3 FAMILIES FOR 30 DAYS OF IN-KIND USE, FOR A VALUE OF $3,300. DONATIONS DURING FISCAL 2016 TOTALED $3,233.43. $7,033. B.IN-KIND DONATIONS: WALK TO END ALZHEIMER'S- JEFFERSON COMMUNITY HEALTH CENTER SUPPORTS THE ANNUAL WALK TO END ALZHEIMER'S BY PROVIDING STAFF TIME AND POSTAGE TO SEND OUT SPONSORSHIP LETTERS AND NEWS RELEASES PROMOTING THE EVENT, STAFF TIME TO ASSIST IN PLANNING THE EVENT, AND STAFF TIME THE DAY OF THE EVENT. A TOTAL OF 16 WALKERS PARTICIPATED AND THE EVENT RAISED $3,200 FOR THE ALZHEIMER'S ASSOCIATION. ESTIMATED POSTAGE: $22. ESTIMATED STAFF TIME: $240.SAFE KIDS CHAPTER- JEFFERSON COMMUNITY HEALTH CENTER IS A MEMBER OF THE SAFE KIDS COALITION. THREE JCHC STAFF MEMBERS PARTICIPATE IN THE ORGANIZATION. THEY ARE JOINED BY A VARIETY OF OUTSIDE AGENCIES IN THE COMMUNITY WHO BELIEVE STRONGLY IN CHILDHOOD SAFETY. SAFE KIDS OFFERS SAFETY SEAT CHECK UP EVENTS AND OTHER SAFETY PROMOTIONS. ESTIMATED STAFF TIME: $800.
PART I, LINE 7 (CONTINUED):	BLOOD DRIVE SUPPORT- JCHC 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 JCHC'S SUPPLIER OF BLOOD AND BLOOD PRODUCTS. ESTIMATED STAFF TIME: $250.SAFETY DAY FOR KIDS- JCHC WAS ONE OF THE CO-SPONSORS FOR THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 97 KIDS -- AGES KINDERGARTEN THROUGH SIXTH GRADES -- ATTENDED. 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: $1,150. TOTAL COST OF SUPPLIES FURNISHED WAS $250. GO RED FOR WOMEN- JCHC STAFF ORGANIZED THE SECOND GO RED FOR WOMEN FUND-RAISING EVENT FOR THE AMERICAN CANCER SOCIETY IN 2016. THE EVENT RAISED $6,500 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $500. NUMBER ATTENDING EVENT: 112. RELAY FOR LIFE- JCHC, GARDENSIDE AND CEDARWOOD HAVE A RELAY FOR LIFE TEAM. IN 2016, THIS TEAM RAISED $5,100 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $6,000. ESTIMATED NUMBER ATTENDING EVENT: 250LIGHT UP THE DARKNESS- JCHC PROVIDED THE LOCATION FOR THE FIRST EVER LIGHTING UP THE DARKNESS EVENT IN FAIRBURY, ORGANIZED BY TWO LOCAL VOLUNTEERS. COST OF STAFF TIME DONATED IS ESTIMATED AT: $200. ESTIMATED NUMBER ATTENDING EVENT: 50.
PART II, COMMUNITY BUILDING ACTIVITIES:	JEFFERSON COMMUNITY HEALTH CENTER IS ACTIVE IN LOCAL ECONOMIC DEVELOPMENT ACTIVITIES. JCHC IS A MEMBER OF THE FAIRBURY CHAMBER OF COMMERCE. JCHC SEEKS 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 CENTER SERVE THEIR COMMUNITY IN MANY WAYS INCLUDING SERVING IN THEIR CHURCHES, AS GIRL AND BOY SCOUT LEADERS, AS 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. JCHC STAFF MEMBERS ARE A RESOURCE AS COMMUNITY ROLE MODELS.JCHC IS PROUD OF ITS CONTRIBUTIONS TO THE CITIZENS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. THE CITIZENS OF THIS AREA ALSO HIGHLY REGARD JCHC'S CONTRIBUTIONS TO THE COMMUNITY.THE GOAL OF THE JCHC 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 3:	AS PART 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:	JCHC'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, PAGES 7 AND 8 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLES, NET," "NET PATIENT SERVICE REVENUE AND "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, 2016. 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. IN ADDITION, ALL ACCOUNTS THAT OUR SELF-PAY RECEIVABLE VENDOR DID NOT RECEIVE PAYMENT ON/AFTER 75 DAYS WILL BE RUN THROUGH A PRESUMPTIVE CHARITY CRITERIA PROCESS. THIS PROCESS ASSISTS IN THE DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY. JCHC STAFF WILL APPLY THE RECOMMENDED PERCENTAGE DISCOUNT TO THE PATIENT'S ACCOUNT.
PART VI, LINE 2:	JCHC ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY JCHC SERVES IN SEVERAL WAYS. JCHC UTILIZES SURVEYS BY PUBLIC HEALTH SOLUTIONS OF THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING COMMUNITY. JCHC VISITS LOCAL COMMUNITY SERVICE ORGANIZATIONS AND SEEKS INPUT ON NEEDS. JCHC CONDUCTED A COMMUNITY PERCEPTION SURVEY IN 2006, WHICH INCLUDES QUESTIONS ON COMMUNITY HEALTH NEEDS. JCHC 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:	JCHC 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 JCHC HAS A SET OF CRITERIA IT USES TO ASSESS WHETHER A PATIENT IS ELIGIBLE FOR ASSISTANCE PROGRAMS, OR IF THEY QUALIFY FOR JCHC'S CHARITY CARE PROGRAM.
PART VI, LINE 4:	JCHC 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:	JCHC 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. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING A COMMUNITY WELLNESS 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 WELLNESS CENTER WAS APPROXIMATELY $267,000. JCHC 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.) JCHC 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. JCHC 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:	JCHC 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. JCHC 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, FAIRBURY CLINIC, NEBRASKA COMMUNITY BLOOD BANK, RURAL COMPREHENSIVE CARE NETWORK, BLUE RIVER VALLEY NETWORK, HEARTLAND HEALTH ALLIANCE, AND OTHERS. DEPENDING ON THE ACTIVITY, JCHC MAY BE THE LEAD ORGANIZATION, OR AN ORGANIZATION PROVIDING HELP AND ASSISTANCE.
PART VI, LINE 7:	JCHC 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	0	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	0	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	0	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	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 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
CHAD JURGENS
CEO	$140,931	$0	$24,681	$0	$0	$0	$9,868	$0	$13,946	$0	$189,426	$0	$0	$0
GARY MITCHELL
DIRECTOR OF PHARMACY	$148,170	$0	$0	$0	$0	$0	$8,022	$0	$13,946	$0	$170,138	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 1A	FormAndLineReferenceDesc
Explanation	JCHC PROVIDES DISCOUNTED OR FREE WELLNESS CENTER MEMBERSHIPS TO ITS EMPLOYEES AND PHYSICIANS.	ExplanationTxt

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	2012-12-18	BondIssuedDt
Issue Price	$5,800,000	IssuePriceAmt
Purpose	CONSTRUCTION AND RENOVATION OF FACILITIES	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	$446,335	RetiredAmt
Total Proceeds	$5,800,000	TotalProceedsAmt
Issuance Costs From Proceeds	$50,001	IssuanceCostsFromProceedsAmt
Capital Expenditures	$5,749,999	CapitalExpendituresAmt
Substantial Completion	2015	SubstantialCompletionYr
Current Refunding	0	CurrentRefundingInd
Advance Refunding	0	AdvanceRefundingInd
Final Allocation Made	Yes (1)	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	0	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	Yes (1)	NoRebateDueInd
Variable Rate Issue	0	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 IV, LINE 2C:	FormAndLineReferenceDesc
Explanation	THE REBATE COMPUTATION WAS PERFORMED ON JANUARY 19, 2016. THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND AMOUNTS WERE DRAWN AS PROJECT COSTS WERE INCURRED. AS NO REBATABLE ARBITRAGE WAS EARNED AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE ANALYSIS IS NECESSARY.	ExplanationTxt

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
MARY HOPPE
EMPLOYEE OF THE HOSPITAL AND SPOUSE OF DICK HOPPE, CHAIRMAN OF THE BOARD	$90,064	EMPLOYEE COMPENSATION	0
CAROL BLOBAUM
EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, SECRETARY/TREASURER	$77,324	EMPLOYEE COMPENSATION	0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6	JEFFERSON COMMUNITY HEALTH CENTER 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 11	A COPY OF THE 990 WILL BE E-MAILED TO EACH BOARD MEMBER. 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.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,554,429. MANAGEMENT AND GENERAL EXPENSES 255,963. FUNDRAISING EXPENSES 281. TOTAL EXPENSES 1,810,673. FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 46,764. MANAGEMENT AND GENERAL EXPENSES 26,664. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 73,428. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 42,761. MANAGEMENT AND GENERAL EXPENSES 4,282. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,043. CONSULTING: PROGRAM SERVICE EXPENSES 9,781. MANAGEMENT AND GENERAL EXPENSES 13,363. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,144.
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.