JEFFERSON COMMUNITY HEALTH CENTER INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization: JEFFERSON COMMUNITY HEALTH CENTER INC (EIN 47-0468078)
Tax period: 2014-10-01 to 2015-09-30
Filed: 2016-08-04
IRS object ID: 201622179349300447
Schema version: 2014v6.0
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	2016-08-04T10:51:24-05:00	ReturnTs
Tax Period End	2015-09-30	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	2014-10-01	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	2016-08-03	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	2014	TaxYr
Build TS	2016-12-15 16:53:06Z	BuildTS

Form 990 IRS990

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	$18,411,560	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	HTTP://JCHC.US	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1960	FormationYr
Legal Domicile State	NE	LegalDomicileStateCd
Activity Or Mission	JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME.	ActivityOrMissionDesc
Voting Members Governing Body	9	VotingMembersGoverningBodyCnt
Voting Members Independent	4	VotingMembersIndependentCnt
Total Employee	253	TotalEmployeeCnt
Total Volunteers	15	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$122,707	PYContributionsGrantsAmt
CY Contributions Grants	$96,143	CYContributionsGrantsAmt
PY Program Service Revenue	$16,849,719	PYProgramServiceRevenueAmt
CY Program Service Revenue	$17,848,635	CYProgramServiceRevenueAmt
PY Investment Income	$80,652	PYInvestmentIncomeAmt
CY Investment Income	$127,021	CYInvestmentIncomeAmt
PY Other Revenue	$112,227	PYOtherRevenueAmt
CY Other Revenue	$127,100	CYOtherRevenueAmt
PY Total Revenue	$17,165,305	PYTotalRevenueAmt
CY Total Revenue	$18,198,899	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	$8,435,125	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$8,498,185	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$12,181	CYTotalFundraisingExpenseAmt
PY Other Expenses	$7,927,061	PYOtherExpensesAmt
CY Other Expenses	$9,023,229	CYOtherExpensesAmt
PY Total Expenses	$16,362,186	PYTotalExpensesAmt
CY Total Expenses	$17,521,414	CYTotalExpensesAmt
PY Revenues Less Expenses	$803,119	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$677,485	CYRevenuesLessExpensesAmt
Total Assets BOY	$24,138,736	TotalAssetsBOYAmt
Total Assets EOY	$24,742,383	TotalAssetsEOYAmt
Total Liabilities BOY	$7,298,657	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$7,306,442	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$16,840,079	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$17,435,941	NetAssetsOrFundBalancesEOYAmt
Mission	JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$14,332,277	ExpenseAmt
Revenue	$15,376,307	RevenueAmt
Desc	JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 17 BED ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH CENTER ALSO OPERATES A WELLNESS CENTER AND PROVIDES HOME HEALTH SERVICES.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$1,450,718	ExpenseAmt
Revenue	$2,472,328	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	$15,782,995	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	Yes (1)	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	8	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	253	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	0	QuidProQuoContributionsInd
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	4	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

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CHANCE KLASEK	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
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 (15 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
LYMON HAMM
SECRETARY/TREASURER	1.00	0.00	Yes (X)	Yes (X)	$0	$0	$0
LINDA BAUER
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
BRIAN BLOBAUM
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 (01/01/15 - PRESENT)	1.00	0.00	Yes (X)		$0	$0	$0
MIKE STEELE
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
DR TED TUCKER
MEMBER	1.00	0.00	Yes (X)		$0	$0	$0
JACK WESCH
MEMBER (10/01/14 - 12/31/14)	1.00	0.00	Yes (X)		$0	$0	$0
CHAD JURGENS
CEO	40.00	0.00		Yes (X)	$152,165	$0	$22,020
CHANCE KLASEK
CFO	40.00	0.00		Yes (X)	$98,046	$0	$14,776
GARY MITCHELL
DIRECTOR OF PHARMACY	40.00	0.00			$138,426	$0	$21,458	Yes (X)
DENNIS RUSSEL
PHARMACIST	40.00	0.00			$105,956	$0	$19,790	Yes (X)
MEGAN LARKINS
PHARMACIST	40.00	0.00			$102,714	$0	$19,620	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$597,307	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$97,664	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	4	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
FAIRBURY CLINIC PC
825 22ND STREET	FAIRBURY	NE	68352	ER COVERAGE	$603,198
SIEMENS MEDICAL SOLUTIONS
40 LIBERTY VOULEVARD	MALVERN	PA	19355	XRAY MACHINE	$601,115
SYSCO
900 KINGBIRD ROAD	LINCOLN	NE	68521	FOOD SERVICE	$364,096
SOUTHEAST ANESTHESIA SERVICES
8426 W BIRCH	CLATONIA	NE	68328	CRNA SERVICES	$360,000
MEDHOST OF TENNESSEE
6550 CAROTHERS PARKWAY 100	FRANKLIN	TN	37067	HEALTHCARE INFORMATION TECHNOLOGY	$223,407

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	15	CntrctRcvdGreaterThan100KCnt
Fundraising	$10,768	FundraisingAmt
All Other Contributions	$85,375	AllOtherContributionsAmt
Noncash Contributions	$13,267	NoncashContributionsAmt
Total Contributions	$96,143	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEDICARE/MEDICAID PAYMENTS	624100	$10,133,122	$10,133,122
PATIENT SERVICE REVENUE	624100	$7,021,711	$7,021,711
CEDARWOOD ASSISTED LIVING SVC FEE	623000	$477,116	$477,116
CEDARWOOD: EQUITY IN JT VENTURE	623000	$152,064	$152,064
EHR INCENTIVE PAYMENTS	624100	$51,541	$51,541

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$13,081	TotalRevenueColumnAmt
Related Or Exempt Func Income	$13,081	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$17,848,635	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$120,743	TotalRevenueColumnAmt
Exclusion	$120,743	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$213,992	SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Securities	$207,714	SecuritiesAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$6,278	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$6,278	TotalRevenueColumnAmt
Exclusion	$6,278	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$5,259	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$10,768	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$4,947	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$312	TotalRevenueColumnAmt
Exclusion	$312	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	CAFETERIA	Desc
Business	722210	BusinessCd
Total Revenue Column	$126,788	TotalRevenueColumnAmt
Exclusion	$126,788	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$126,788	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$18,198,899	TotalRevenueColumnAmt
Related Or Exempt Func Income	$17,848,635	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$254,121	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	$287,006	TotalAmt
Management And General	$287,006	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$192,738	TotalAmt
Program Services	$192,738	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$6,576,075	TotalAmt
Program Services	$6,049,399	ProgramServicesAmt
Management And General	$519,848	ManagementAndGeneralAmt
Fundraising	$6,828	FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$215,947	TotalAmt
Program Services	$199,107	ProgramServicesAmt
Management And General	$16,840	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$726,177	TotalAmt
Program Services	$668,267	ProgramServicesAmt
Management And General	$57,910	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$500,242	TotalAmt
Program Services	$450,936	ProgramServicesAmt
Management And General	$48,847	ManagementAndGeneralAmt
Fundraising	$459	FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$3,547	TotalAmt
Management And General	$3,547	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$45,904	TotalAmt
Management And General	$45,904	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$19,477	TotalAmt
Management And General	$19,477	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$2,018,056	TotalAmt
Program Services	$1,837,004	ProgramServicesAmt
Management And General	$180,771	ManagementAndGeneralAmt
Fundraising	$281	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$131,998	TotalAmt
Program Services	$128,962	ProgramServicesAmt
Management And General	$2,458	ManagementAndGeneralAmt
Fundraising	$578	FundraisingAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,182,300	TotalAmt
Program Services	$918,418	ProgramServicesAmt
Management And General	$261,108	ManagementAndGeneralAmt
Fundraising	$2,774	FundraisingAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$18,634	TotalAmt
Program Services	$18,634	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$333,968	TotalAmt
Program Services	$318,316	ProgramServicesAmt
Management And General	$15,652	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$32,642	TotalAmt
Program Services	$27,994	ProgramServicesAmt
Management And General	$4,648	ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$44,251	TotalAmt
Program Services	$31,422	ProgramServicesAmt
Management And General	$12,829	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$138,774	TotalAmt
Program Services	$128,330	ProgramServicesAmt
Management And General	$10,444	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$1,514,917	TotalAmt
Program Services	$1,400,901	ProgramServicesAmt
Management And General	$114,016	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$81,937	TotalAmt
Management And General	$81,937	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt	FundraisingFundraisingAmt
MEDICAL SUPPLIES	$2,519,538	$2,519,538
BAD DEBTS EXPENSE	$458,902	$458,902
FOOD EXPENSE	$393,954	$393,954
DUES AND SUBSCRIPTIONS	$72,526	$32,886	$39,142	$498

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$11,904	TotalAmt
Program Services	$7,287	ProgramServicesAmt
Management And General	$3,854	ManagementAndGeneralAmt
Fundraising	$763	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$17,521,414	TotalAmt
Program Services	$15,782,995	ProgramServicesAmt
Management And General	$1,726,238	ManagementAndGeneralAmt
Fundraising	$12,181	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	$5,265,213	BOYAmt
EOY	$5,027,604	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$2,106,663	BOYAmt
EOY	$2,527,847	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$347,415	BOYAmt
EOY	$372,722	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$95,038	BOYAmt
EOY	$152,196	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$24,676,500	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$11,579,893	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$13,082,293	BOYAmt
EOY	$13,096,607	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$2,769,345	BOYAmt
EOY	$2,737,100	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$272,679	BOYAmt
EOY	$424,743	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$199,640	BOYAmt
EOY	$403,114	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$24,138,736	BOYAmt
EOY	$24,742,383	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$1,912,338	BOYAmt
EOY	$1,481,643	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$4,209,501	BOYAmt
EOY	$5,610,297	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$265,720	BOYAmt
EOY	$201,645	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$911,098	BOYAmt
EOY	$12,857	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$7,298,657	BOYAmt
EOY	$7,306,442	EOYAmt

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

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$16,704,973	BOYAmt
EOY	$17,297,310	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$84,352	BOYAmt
EOY	$87,877	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	$16,840,079	BOYAmt
EOY	$17,435,941	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$24,138,736	BOYAmt
EOY	$24,742,383	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$677,485	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	-$81,623	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	$1,601	OtherActivitiesAmt
Total Lobbying Expenditures	$1,601	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	$13,943	OtherCostOrOtherBasisAmt
Book Value	$13,943	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$19,138,953	OtherCostOrOtherBasisAmt
Depreciation	$6,953,268	DepreciationAmt
Book Value	$12,185,685	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,369,683	OtherCostOrOtherBasisAmt
Depreciation	$4,548,335	DepreciationAmt
Book Value	$821,348	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$153,921	OtherCostOrOtherBasisAmt
Depreciation	$78,290	DepreciationAmt
Book Value	$75,631	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$13,096,607	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	ACCRUED INTEREST	Desc
Amt	$12,857	Amt

Field	Value	IRS element (for citing)
Total Liability	$12,857	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$17,643,844	TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst	-$81,623	NetUnrealizedGainsInvstAmt
Other Revenue	$4,947	OtherRevenueAmt
Revenue Not Reported	-$76,676	RevenueNotReportedAmt
Revenue Subtotal	$17,720,520	RevenueSubtotalAmt
Investment Expenses Not Incld	$19,477	InvestmentExpensesNotIncldAmt
Other Revenues Not Included	$458,902	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$478,379	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$18,198,899	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$17,047,982	TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included	$4,947	OtherExpensesIncludedAmt
Expenses Not Reported	$4,947	ExpensesNotReportedAmt
Expenses Subtotal	$17,043,035	ExpensesSubtotalAmt
Investment Expenses Not Incld2	$19,477	InvestmentExpensesNotIncld2Amt
Other Expenses Not Included	$458,902	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$478,379	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$17,521,414	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART V, LINE 4:	THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE NURSING SCHOLARSHIPS AND CAPITAL IMPROVEMENTS.
PART X, LINE 2:	THE HEALTH CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HEALTH CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HEALTH CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2015, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EXPENSES 4,947.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS 458,902.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	FUNDRAISING EXPENSES 4,947.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	PROVISION FOR BAD DEBTS 458,902.

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

Field	Value	IRS element (for citing)
Event1	GOLF TOURNAMENT	Event1Nm
Gross Receipts Event1	$16,027	GrossReceiptsEvent1Amt
Charitable Contri Event1	$10,768	CharitableContriEvent1Amt
Gross Revenue Event1	$5,259	GrossRevenueEvent1Amt
Cash Prizes Event1	$1,440	CashPrizesEvent1Amt
Non Cash Prizes Event1	$1,135	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$1,130	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$810	FoodAndBeverageEvent1Amt
Other Direct Expenses Event1	$432	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$16,027	GrossReceiptsTotalAmt
Charitable Contributions Tot	$10,768	CharitableContributionsTotAmt
Gross Revenue Total Events	$5,259	GrossRevenueTotalEventsAmt
Cash Prizes Total Events	$1,440	CashPrizesTotalEventsAmt
Non Cash Prizes Total Events	$1,135	NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$1,130	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$810	FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events	$432	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$4,947	DirectExpenseSummaryEventsAmt
Net Income Summary	$312	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	$132,001	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$132,001	NetCommunityBenefitExpnsAmt
Total Expense	0.00770	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,601,730	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,727,510	DirectOffsettingRevenueAmt
Net Community Benefit Expns	-$125,780	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,733,731	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,727,510	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$6,221	NetCommunityBenefitExpnsAmt
Total Expense	0.00770	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$13,175	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$13,175	NetCommunityBenefitExpnsAmt
Total Expense	0.00080	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,250	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$7,250	NetCommunityBenefitExpnsAmt
Total Expense	0.00040	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$474,120	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$227,865	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$246,255	NetCommunityBenefitExpnsAmt
Total Expense	0.01440	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$14,287	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$14,287	NetCommunityBenefitExpnsAmt
Total Expense	0.00080	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$508,832	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$227,865	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$280,967	NetCommunityBenefitExpnsAmt
Total Expense	0.01640	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$2,242,563	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,955,375	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$287,188	NetCommunityBenefitExpnsAmt
Total Expense	0.02410	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$458,902	BadDebtExpenseAmt
Bad Debt Expense Attributable	$62,411	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$7,303,210	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$7,373,577	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$70,367	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://JCHC.US	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
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
CHNA Conducted	12	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://JCHC.US	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	12	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTP://JCHC.US	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
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://JCHC.US	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	HTTP://JCHC.US	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	HTTP://JCHC.US	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 (7 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
JEFFERSON COMMUNITY HEALTH CENTER, INC.	PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH CENTER (JCHC) BEGAN ITS HEALTH NEEDS ASSESSMENT IN DECEMBER 2012. JCHC WORKED WITH PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT, REVIEWED INTERVIEWS CONDUCTED BY PUBLIC HEALTH SOLUTIONS, CONDUCTED INTERVIEWS WITH LOCAL ORGANIZATIONS, CONDUCTED INTERVIEWS WITH JCHC STAFF AND REVIEWED STATISTICS MADE AVAILABLE THROUGH PUBLIC HEALTH SOLUTIONS AND THE STATE OF NEBRASKA. MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, AGRICULTURE REPRESENTATIVES AND SENIOR DINERS. A TOTAL OF 83 ATTENDED AND PARTICIPATED. IN ADDITION, MEETINGS WERE HELD WITH JEFFERSON COMMUNITY HEALTH CENTER STAFF WHO ALSO REPRESENT THE AREA IN WHICH THEY LIVE. A TOTAL OF 71 JCHC STAFF MEMBERS PARTICIPATED.PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT CONDUCTED ITS COMMUNITY HEALTH IMPROVEMENT PLAN STUDY OF A FIVE COUNTY AREA WITH THE ASSISTANCE OF LANE GEWECKE CONSULTING IN NOVEMBER 2012.
JEFFERSON COMMUNITY HEALTH CENTER, INC.	PART V, SECTION B, LINE 11: PRIORITIZED NEEDS (AS DETERMINED BY COMMUNITY HEALTH NEEDS ASSESSMENT):1) MAJOR DISEASE FACTORS FOR OUR COUNTY- CARDIAC/CEREBROVASCULAR HEALTH, DIABETES, CHRONIC LUNG, CANCER; 2) LIFESTYLE ISSUES- OBESITY, SEDENTARY LIFESTYLE, NUTRITION EDUCATION AND INFORMATION, PERSONAL RESPONSIBILITY/HEALTHY LIFESTYLE; 3) ADDITIONAL SPECIALTY CLINICS NEEDED IN OUR COMMUNITY: DERMATOLOGY, PULMONOLOGY, OBSTETRICS; 4) DENTAL CARE; 5) MENTAL HEALTH1)MAJOR DISEASE FACTORS- CARDIO/CEREBROVASCULAR HEALTH, DIABETES, CHRONIC LUNG, CANCER:IN PRIORITIZING NEEDS, THESE MAJOR DISEASE FACTORS WERE ALL GROUPED TOGETHER BECAUSE ANY PROGRAMS WHICH MAY ASSIST WITH ONE AREA HAS A POTENTIAL IN ASSISTING IN SEVERAL AREAS: A) REVIEW ALL PROGRAMS WHICH ARE CURRENTLY BEING OFFERED IN THE COMMUNITY WHICH CAN HAVE A POSITIVE EFFECT ON THESE MAJOR DISEASE FACTORS (FOR EXAMPLE, BLOOD PROFILE SCREENINGS HELD ANNUALLY AT A REDUCED COST TO HELP AREA RESIDENTS DETERMINE WHAT THEIR MAJOR HEALTH NEEDS ARE, SIMPLYWELL OFFERED TO ALL EMPLOYEES TO RAISE AWARENESS FOR THEIR PERSONAL HEALTH NEEDS, CARDIAC REHABILITATION OFFERED, DIABETES EDUCATION OFFERED AND EXPANDING, CARE TRANSITIONS TEAMS WORKING ON PATIENT EDUCATION AND CONGESTIVE HEART FAILURE AND COPD); B) PROVIDE DATA FOR ALL AREAS SHOWING THE COMMUNITY'S HEALTH NEEDS IN EACH OF THESE AREAS, AND ENCOURAGE THE CONTINUATION AND/OR EXPANSION OF EXISTING PROGRAMS, AND THE DEVELOPMENT OF NEW PROGRAMS TO RAISE AWARENESS AND IMPROVE THE HEALTH AND WELLNESS OF INDIVIDUALS IN THESE AREAS; C) PARTNER WITH PROGRAMS SUCH AS PUBLIC HEALTH SOLUTIONS, QUALITY ORGANIZATIONS; D) REVIEW NEW DATA AS IT BECOMES AVAILABLE ON OUR EFFECTIVENESS AT PROVIDING CARE TO VARIOUS DISEASE FACTORS, AS WELL AS OUR IMPACT ON REDUCING THESE DISEASE FACTORS; E) UTILIZE LIFESTYLE IMPROVEMENT PROGRAMS TO AFFECT THE HEALTH OF OUR PATIENTS WITH THESE CHRONIC DISEASES, AND TO PREVENT THESE CHRONIC DISEASES FROM DEVELOPING.2)LIFESTYLE ISSUES- OBESITY, SEDENTARY LIFESTYLE, NUTRITION EDUCATION AND INFORMATION, PERSONAL RESPONSIBILITY/HEALTHY LIFESTYLE: A) CONTINUE TO DETERMINE WAYS JCHC CAN BENEFIT THE COMMUNITY'S LIFESTYLE ISSUES THROUGH ITS SERVICES AND PROGRAMS (BOB AND WAUNETA BURKLEY WELLNESS CENTER, DIETITIAN SERVICES, WALKING AND WEIGHT LOSS PROGRAMS SUCH AS LIVEWELL SERIES, AND SIMPLYWELL PROGRAMMING FOR STAFF); B) PURSUE PARTNERSHIPS WITH PUBLIC HEALTH SOLUTIONS, AREA PUBLIC SCHOOLS, BLUE VALLEY COMMUNITY ACTION AND OTHER AREA SERVICE AGENCIES AND BUSINESSES TO REACH AREA RESIDENTS; C) PROVIDE COMMUNITY EDUCATION THROUGH ANNUAL SAFETY FAIR, JEFFERSON COUNTY EXPO (INCLUDING HEALTH FAIR OFFERINGS), AND JEFFERSON COUNTY FAIR. 3) ADDITIONAL SPECIALTY CLINICS NEEDED IN OUR COMMUNITY- DERMATOLOGY, PULMONOLOGY, OBSTETRICS:A) DETERMINE NUMBER OF PEOPLE WHO MIGHT BENEFIT FROM ADDITIONAL SPECIALTY CLINICS; B) WORK WITH LOCAL PHYSICIANS TO DETERMINE THEIR PERCEPTION OF NEED FOR ADDITIONAL SPECIALTY CLINICS; C) IF NEED IS VERIFIED, WORK WITH LOCAL PHYSICIANS AND SPECIALISTS TO IMPLEMENT NEW SPECIALTY CLINICS. 4) DENTAL CARE:A) COLLABORATE WITH PUBLIC HEALTH SOLUTIONS IN PROGRAMS IT IS WORKING ON REGARDING DENTAL CARE AVAILABILITY IN JEFFERSON COUNTY. 5) MENTAL HEALTH:A) DETERMINE HOW JEFFERSON COMMUNITY HEALTH CENTER MIGHT BE ABLE TO MEET THE COMMUNITY'S MENTAL HEALTH NEEDS; I) OBTAIN INFORMATION FROM OTHER RURAL CRITICAL ACCESS HOSPITALS ON WAYS THEY HAVE MET THEIR COMMUNITY'S MENTAL HEALTH NEEDS; II) CONTACT AREA MENTAL HEALTH PROVIDERS TO FIND OUT WHETHER THEY BELIEVE JCHC COULD HELP TO MEET THE COMMUNITY NEEDS; III) POSSIBLE OPTIONS: COULD WE OFFER TELEHEALTH CONNECTIONS BRINGING PATIENTS AND PROVIDERS TOGETHER? COULD WE OFFER A SPECIALTY CLINIC OFFERING MENTAL HEALTH ASSISTANCE?THERE WERE NEEDS IDENTIFIED THAT JCHC DID NOT ADDRESS. WHILE THESE NEEDS ARE IMPORTANT TO THE COMMUNITY, THEY WERE NOT CHOSEN BASED ON THE PRIORITIZATION PROCESS. THESE NEEDS INCLUDE: ALZHEIMER'S DISEASE, UNINTENTIONAL INJURIES, HEALTH CARE PROVIDER COVERAGE WHEN EXISTING PHYSICIANS RETIRE, FUTURE OF HEALTH CARE, WEAKENING FAMILY STRUCTURE/PARENTING, LACK OF DOCTORS/HEALTH CARE, DRUG/ALCOHOL USE AND THE AGING POPULATION.
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.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 16A WEBSITE:	HTTP://JCHC.US
JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 16B WEBSITE:	HTTP://JCHC.US
JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 16C WEBSITE:	HTTP://JCHC.US

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

Field	Value	IRS element (for citing)
Facility	LONG TERM CARE FACILITY	FacilityTxt

Supplemental Information Detail SupplementalInformationDetail (18 entries)

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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, LINE 7G:	THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G.
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 $458,902.
PART I, LINE 7:	JCHC REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2015, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMS A. TRADITIONAL CHARITY CARE: JCHC PROVIDED CHARITY CARE IN FISCAL 2015 TO THOSE WHO MEET THE FEDERAL POVERTY GUIDELINES. THE BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS.PATIENTS ASSISTED: 125. VALUE: $132,000. B. UNPAID COSTS OF PUBLIC PROGRAMS: MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: $0 C. BAD DEBT: BESIDES OFFICIAL CHARITY CARE, JCHC WROTE OFF $458,902 IN BAD DEBT DURING FISCAL 2015. 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 CHECKUP EVENTS DURING THE YEAR, AS WELL AS OFFERING INDIVIDUAL INSTRUCTION IN PROPER USE OF SEATS. A TOTAL OF 76 SEATS WERE CHECKED IN CHECK-UP EVENTS AND 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: $1,050.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 450+ TOOK PART IN OFFERINGS FROM JCHC AT THESE EVENTS. FOR 2015, THE COSTS OF BOOTHS, GIVEAWAYS, STAFF TIME, ETC., ARE ESTIMATED AT $2,500. ESTIMATED NUMBER REACHED: 450.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 2015. TOTAL INDIVIDUALS REACHED: 1,100. ESTIMATED COST OF STAFF TIME: $900.SUPPORT GROUPS - IN 2015, 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 2015 WAS 57. A SUPPORT GROUP FOR CAREGIVER'S OF ALZHEIMER'S PATIENTS MEETS MONTHLY AND HAD ATTENDANCE OF 51 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: 108. 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 82 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: 414. TOTAL OF 1,361 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: 220. ESTIMATED COST OF PROGRAMS, FOOD, AND STAFF TIME: $4,000. III. MEDICAL EDUCATION A. 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 2015. NURSING STUDENTS UTILIZE MEETING ROOM SPACE AT JCHC, AS WELL AS TAKE PART IN CLINICAL PRACTICE. IN FISCAL 2015, ONE PHARMACY STUDENT ALSO DID A ROTATION AT JEFFERSON COMMUNITY HEALTH CENTER AS A PART OF THE EDUCATIONAL EXPERIENCE. 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. FOUR MEDICAL STUDENTS UTILIZED OUR FACILITY IN 2015. 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 2015. 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. ONE SCHOLARSHIP WAS AWARDED IN 2015. 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 31 STUDENTS PARTICIPATED IN SHADOWING OPPORTUNITIES IN FISCAL 2015. NUMBER REACHED: 31. 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 56 EDUCATIONAL AND ADMINISTRATIVE PROGRAMS WERE OFFERED IN 2014. THIS INCLUDED A NUMBER OF OPPORTUNITIES FOR STAFF AND COMMUNITY EDUCATION, MEETINGS, AND CLINICAL VISITS. ESTIMATED NUMBER REACHED: 80. COST FOR 2014: $1,200.IV. SUBSIDIZED HEALTH SERVICESA. WELLNESS 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: 1,153 (MEMBERS AS OF FISCAL YEAR-END 2015.) ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $247,171. V. RESEARCH. NO RESEARCH DOLLARS EXPENDED.VI. CASH AND IN-KIND DONATIONSA. CASH DONATIONS: JCHC MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUT AND BOY SCOUT FIRST AID KITS, FREE LOAN OF HOME BILIRUBIN BLANKET, SPONSORSHIP OF BASEBALL AND SOFTBALL TEAMS, GOLF TOURNAMENTS, AREA HIGH SCHOOL POST PROM ACTIVITIES, AN AREA COMMUNITY PICNIC, 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, ETC. THESE TOTALED $924.70. 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 $450. USE OF A BILIRUBIN BLANKET 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 2015 TOTALED $4,674.70. 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 19 WALKERS PARTICIPATED AND THE EVENT RAISED $3,920 FOR THE ALZHEIMER'S ASSOCIATION. ESTIMATED POSTAGE: $22. ESTIMATED STAFF TIME: $240.
PART I, LINE 7 (CONTINUED):	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. IN ADDITION TO SAFETY SEAT CHECKUP EVENTS, OTHER SAFETY PROMOTIONS WERE OFFERED. ESTIMATED STAFF TIME: $1,200. 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 84 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 FIRST GO RED FOR WOMEN FUND-RAISING EVENT FOR THE AMERICAN CANCER SOCIETY IN 2015. THE EVENT RAISED $3,675 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $500. NUMBER ATTENDING EVENT: 52 RELAY FOR LIFE- JCHC, GARDENSIDE AND CEDARWOOD HAVE A RELAY FOR LIFE TEAM. IN 2015, THIS TEAM RAISED $2,500 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $6,000. ESTIMATED NUMBER ATTENDING EVENT: 250
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. 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 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, 2015. 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 $237,000. 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	$152,128	$0	$0	$0	$37	$0	$8,074	$0	$13,946	$0	$174,185	$0	$0	$0
GARY MITCHELL
DIRECTOR OF PHARMACY	$138,402	$0	$0	$0	$24	$0	$7,512	$0	$13,946	$0	$159,884	$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	$189,703	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	Yes (1)	RebateNotDueYetInd
Exception To Rebate	0	ExceptionToRebateInd
No Rebate Due	0	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

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (4 entries)

Relationship DescriptionRelationshipDescriptionTxt	TransactionTransactionAmt	TransactionTransactionDesc	Sharing Of RevenuesSharingOfRevenuesInd
MARY HOPPE
EMPLOYEE OF THE HOSPITAL AND SPOUSE OF DICK HOPPE, CHAIRMAN OF THE BOARD	$86,528	EMPLOYEE COMPENSATION	0
CAROL BLOBAUM
EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, BOARD MEMBER	$76,840	EMPLOYEE COMPENSATION	0
JACQUELINE WESCH
EMPLOYEE OF THE HOSPITAL AND SPOUSE OF JACK WESCH, BOARD MEMBER	$29,370	EMPLOYEE COMPENSATION	0
FAIRBURY CLINIC PC
DR. TED TUCKER, BOARD MEMBER, OWNS MORE THAN 5% OF FAIRBURY CLINIC P.C.	$603,198	FAIRBURY CLINIC P.C. PROVIDED EMERGENCY ROOM COVERAGE SERVICES TO JEFFERSON COMMUNITY HEALTH CENTER.	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	THE FORM 990 IS REVIEWED BY THE CFO PRIOR TO SUBMISSION TO THE IRS AND BY THE BOARD MEMBERS AT A REGULAR BOARD MEETING FOLLOWING SUBMISSION TO THE IRS.
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 1,756,478. MANAGEMENT AND GENERAL EXPENSES 153,291. FUNDRAISING EXPENSES 281. TOTAL EXPENSES 1,910,050. FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 33,751. MANAGEMENT AND GENERAL EXPENSES 19,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,543. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 46,398. MANAGEMENT AND GENERAL EXPENSES 3,745. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,143. CONSULTING: PROGRAM SERVICE EXPENSES 377. MANAGEMENT AND GENERAL EXPENSES 3,943. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,320.
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.