2017-08-14T08:33:43-05:00 2016-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2015-10-01 470468078 JEFFERSON COMMUNITY HEALTH CENTER INC JEFF 4027293351 2200 H STREET PO BOX 277 FAIRBURY NE 68352 CHANCE KLASEK CFO 4027293351 2017-08-09 1 BARBARA J FAJEN P00400874 4023302660 2015 2021-01-29 14:40:06Z JEFFERSON COMMUNITY HEALTH & LIFE CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 20261526 0 X HTTP://WWW.JCHEALTHANDLIFE.ORG X 1960 NE INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. 9 7 249 15 0 0 96143 198568 17848635 19208208 127021 167383 127100 142447 18198899 19716606 0 0 0 0 8498185 10186090 0 0 12541 9023229 9033057 17521414 19219147 677485 497459 24742383 25349803 7306442 7407409 17435941 17942394 INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. 0 0 15836682 16665061 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. 1567294 2543147 JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. 17403976 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 7 0 1 249 1 0 0 0 0 0 1 1 0 0 0 0 X 9 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X CHANCE KLASEK 4027296856 2200 H STREET PO BOX 277 FAIRBURY NE 68352 DICK HOPPE CHAIRMAN 1.00 0.00 X X 0 0 0 BRIAN SCHEELE VICE CHAIRMAN 1.00 0.00 X X 0 0 0 BRIAN BLOBAUM SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 LYMON HAMM SECRETARY/TREASURER (THRU DEC. 2015) 1.00 0.00 X X 0 0 0 LINDA BAUER MEMBER 1.00 0.00 X 0 0 0 MARY GLENN MEMBER 1.00 0.00 X 0 0 0 CARMEN HINMAN MEMBER 1.00 0.00 X 0 0 0 DR TED TUCKER MEMBER 1.00 0.00 X 0 0 0 JEREMY CHRISTIANSEN MEMBER (JAN 2016 - PRESENT) 1.00 0.00 X 0 0 0 LOREN DUERKSEN MEMBER (JAN 2016 - PRESENT) 1.00 0.00 X 0 0 0 MIKE STEELE MEMBER (THRU DEC. 2015) 1.00 0.00 X 0 0 0 CHAD JURGENS CEO 40.00 0.00 X 165612 0 23814 CHANCE KLASEK CFO 40.00 0.00 X 105063 0 16780 GARY MITCHELL DIRECTOR OF PHARMACY 40.00 0.00 X 148170 0 21968 DENNIS RUSSEL PHARMACIST 40.00 0.00 X 113883 0 20183 MEGAN LARKINS PHARMACIST 40.00 0.00 X 110702 0 20002 643430 0 102747 5 0 1 0 BECKENHAUER CONSTRUCTION INC 1901 RIVERSIDE BLVD NORFOLK NE 68701 CONSTRUCTION 1218085 FAIRBURY CLINIC PC 825 22ND STREET FAIRBURY NE 68352 ER COVERAGE 601115 SYSCO 900 KINGBIRD ROAD LINCOLN NE 68521 FOOD SERVICE 361319 SOUTHEAST ANESTHESIA SERVICES 8426 W BIRCH CLATONIA NE 68328 CRNA SERVICES 360000 ZIMMER 1800 WEST CENTER STREET WARSAW IN 46581 IMPLANTS 327157 11 12340 10854 175374 10854 198568 MEDICARE/MEDICAID PAYMENTS 624100 11046303 11046303 PATIENT SERVICE REVENUE 624100 7490824 7490824 CEDARWOOD ASSISTED LIVING SVC FEE 623000 532388 532388 CEDARWOOD: EQUITY IN JT VENTURE 623000 82961 82961 EHR INCENTIVE PAYMENTS 624100 42385 42385 13347 13347 19208208 123681 123681 583398 539696 43702 43702 43702 4412 12340 5224 -812 -812 CAFETERIA 722210 143259 143259 143259 19716606 19208208 0 309830 X 311269 311269 167388 167388 7746160 7267440 471400 7320 252136 240043 12093 1156231 1074716 81515 552906 504738 47648 520 48020 48020 59282 59282 19883 19883 1954288 1653735 300272 281 104628 102772 1251 605 1009565 837475 169181 2909 19994 19994 353262 349062 4200 42390 34605 7785 57995 43480 14515 154714 141460 13254 1435583 1312602 122981 79997 79997 MEDICAL SUPPLIES 2600241 2600241 BAD DEBTS EXPENSE 592736 592736 FOOD EXPENSE 385955 385955 DUES AND SUBSCRIPTIONS 70606 33687 36421 498 43918 41847 1663 408 19219147 17403976 1802630 12541 450 450 5027604 5133682 2527847 2792179 372722 447932 152196 198563 25743616 12658170 13096607 13085446 2737100 2836792 424743 507704 0 150824 403114 196231 24742383 25349803 1481643 1533905 5610297 5353665 201645 136926 12857 382913 7306442 7407409 X 17297310 17790171 87877 101469 50754 50754 17435941 17942394 24742383 25349803 497459 8994 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1677 1677 0 PART II-B, LINE 1: JCHC PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 50754 50754 50754 50754 50754 50754 50754 50754 50754 50754 0.00000 1.00000 0.00000 0 0 50943 50943 20038342 8348937 11689405 5503932 4232784 1271148 150399 76449 73950 13085446 ACCRUED INTEREST 12269 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 370644 382913 X 19118205 8994 5224 14218 19103987 19883 592736 612619 19716606 18611752 5224 5224 18606528 19883 592736 612619 19219147 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. GOLF TOURNAMENT 16752 12340 4412 1440 1135 1000 838 811 16752 12340 4412 1440 1135 1000 838 811 5224 -812 1 1 1 X 1 X 1 1 1 0 1 1 132422 0 132422 0.00710 1855956 2062780 -206824 0.00000 1988378 2062780 -74402 0.00710 12975 0 12975 0.00070 8450 0 8450 0.00050 498214 232135 266079 0.01430 16720 16720 0.00090 536359 232135 304224 0.01640 2524737 2294915 229822 0.02350 1 592736 80612 7985501 8082801 -97300 X 1 1 1 1 JEFFERSON COMMUNITY HEALTH CENTER 2200 H STREET FAIRBURY NE 68352 HTTP://WWW.JCHEALTHANDLIFE.ORG 440001 X X X X JEFFERSON COMMUNITY HEALTH CENTER INC 1 0 0 1 X X X X X X X X 15 1 0 0 1 X HTTP://JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 15 1 HTTP://JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 0 1 X 150.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/ X HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/ X HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/ X X X X X 1 X 0 X X X X 1 X 0 0 JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH 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. 1 1 - GARDENSIDE 200 H STREET FAIRBURY NE 68352 LONG TERM CARE FACILITY 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. X 0 0 X X X X 0 0 0 0 0 0 0 0 0 CHAD JURGENS CEO 140931 0 24681 0 0 0 9868 0 13946 0 189426 0 0 0 GARY MITCHELL DIRECTOR OF PHARMACY 148170 0 0 0 0 0 8022 0 13946 0 170138 0 0 0 PART I, LINE 1A JCHC PROVIDES DISCOUNTED OR FREE WELLNESS CENTER MEMBERSHIPS TO ITS EMPLOYEES AND PHYSICIANS. A HOSPITAL AUTHORITY NO 1 OF JEFFERSON COUNTY NE 611683496 2012-12-18 5800000 CONSTRUCTION AND RENOVATION OF FACILITIES 0 0 0 A 446335 5800000 50001 5749999 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 PART IV, LINE 2C: 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. MARY HOPPE EMPLOYEE OF THE HOSPITAL AND SPOUSE OF DICK HOPPE, CHAIRMAN OF THE BOARD 90064 EMPLOYEE COMPENSATION 0 CAROL BLOBAUM EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, SECRETARY/TREASURER 77324 EMPLOYEE COMPENSATION 0 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.