JEFFERSON COMMUNITY HEALTH CENTER INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- JEFFERSON COMMUNITY HEALTH CENTER INC (EIN 47-0468078)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-05-01
- IRS object ID
- 201401219349300945
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-01T17:00:08-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 476097913 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470468078 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFERSON COMMUNITY HEALTH CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JEFF | NameControl |
| Phone | 4027293351 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 H STREET PO BOX 277 | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHANCE KLASEK | Name |
| Title | CFO | Title |
| Phone | 4027293351 | Phone |
| Date Signed | 2014-05-01 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIE M GERKEN | Name |
| PTIN | P00400882 | PTIN |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHANCE KLASEK | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 H STREET PO BOX 277 | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 15499902 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.JCHC.US | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1960 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 4 | NbrIndependentVotingMembers |
| Total Nbr Employees | 229 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 73155 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 69131 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 15683811 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14958633 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 77348 | InvestmentIncomePriorYear |
| Investment Income Current Year | 68301 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 411340 | OtherRevenuePriorYear |
| Other Revenue Current Year | 274965 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 16245654 | TotalRevenuePriorYear |
| Total Revenue Current Year | 15371030 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7950812 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8194442 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 49671 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7270763 | OtherExpensePriorYear |
| Other Expenses Current Year | 7160145 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 15221575 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15354587 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1024079 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 16443 | RevenuesLessExpensesCY |
| Total Assets BOY | 17873822 | TotalAssetsBOY |
| Total Assets EOY | 18395033 | TotalAssetsEOY |
| Total Liabilities BOY | 1899397 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2386539 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 15974425 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 16008494 | NetAssetsOrFundBalancesEOY |
| Mission Description | JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12245696 | Expense |
| Revenue | 12864324 | Revenue |
| Description | JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 25 BED ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH CENTER ALSO OPERATES A WELLNESS CENTER AND PROVIDES HOME HEALTH SERVICES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1319954 | Expense |
| Revenue | 2266543 | Revenue |
| Description | JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 39 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 13565650 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 5 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 229 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 4 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHANCE KLASEK | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4027296856 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 H STREET PO BOX 277 | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DICK HOPPE | ||||||||
| CHAIRMAN | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| DR CRAIG SHUMARD | ||||||||
| VICE CHAIRMAN | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| LYMON HAMM | ||||||||
| SECRETARY/TREASURER | 1.00 | 0.00 | X | X | 0 | 0 | 0 | |
| MARY GLENN | ||||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JULIE KNIGGE | ||||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| RYAN PARKER | ||||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| BRIAN SCHEELE | ||||||||
| MEMBER (1/13-PRESENT) | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| MIKE STEEL | ||||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| JACK WESCH | ||||||||
| MEMBER | 1.00 | 0.00 | X | 0 | 0 | 0 | ||
| TRENA ROGGE | ||||||||
| MEMBER | 10.00 | 0.00 | X | 6103 | 0 | 0 | ||
| WILLIAM WELCH | ||||||||
| CEO (10/12-7/13) | 40.00 | 0.00 | X | 163438 | 0 | 22607 | ||
| CHAD JURGENS | ||||||||
| CFO(10/12-7/13)/CEO(7/13-PRESENT) | 40.00 | 0.00 | X | 135801 | 0 | 21202 | ||
| CHANCE KLASEK | ||||||||
| CFO (8/13-PRESENT) | 40.00 | 0.00 | X | 0 | 0 | 0 | ||
| GARY MITCHELL | ||||||||
| DIRECTOR OF PHARMACY | 40.00 | 0.00 | 144215 | 0 | 18994 | X | ||
| DENNIS RUSSELL | ||||||||
| PHARMACIST | 40.00 | 0.00 | 113014 | 0 | 13489 | X | ||
| MEGAN LARKINS | ||||||||
| PHARMACIST | 40.00 | 0.00 | 105345 | 0 | 10472 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 667916 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 86764 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FAIRBURY CLINIC PC | |||||
| 825 22ND STREET | FAIRBURY | NE | 68352 | ER COVERAGE | 601502 |
| HUSKER REHAB | |||||
| 2320 N 6TH STREET | BEATRICE | NE | 68310 | THERAPY SERVICES | 404159 |
| SOUTHEAST ANESTHESIA SERVICES | |||||
| 8426 W BIRCH | CLATONIA | NE | 68328 | CRNA SERVICES | 360000 |
| SYSCO | |||||
| 900 KINGBIRD ROAD | LINCOLN | NE | 68521 | FOOD SERVICES | 319832 |
| BEATRICE MECHANICAL | |||||
| 2403 CENTENNIAL DRIVE | BEATRICE | NE | 68310 | MAINTENANCE SERVICES | 310615 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 13 | NumberOfContractorsGT100K |
| All Other Contributions | 69131 | AllOtherContributions |
| Total Contributions | 69131 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 624100 | 8564116 | 8564116 |
| PATIENT SERVICE REVENUE | 624100 | 4521748 | 4521748 |
| PHARMACY | 446110 | 835086 | 835086 |
| CEDARWOOD ASSISTED LIVING FEES | 561000 | 441870 | 441870 |
| LAB | 621500 | 424114 | 424114 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 171699 | TotalRevenueColumn |
| Related Or Exempt Function Income | 171699 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14958633 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 67173 | TotalRevenueColumn |
| Exclusion | $67,173 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 130000 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 128872 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1128 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1128 | TotalRevenueColumn |
| Exclusion | $1,128 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|---|
| MISCELLANEOUS INCOME | 624100 | 164070 | 164070 | |
| CAFETERIA | 722210 | 102731 | $102,731 | |
| OCCUPATIONAL HEALTH COMMUNITY OUT | 624200 | 3827 | 3827 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4337 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4337 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 274965 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 15371030 | TotalRevenueColumn |
| Related Or Exempt Function Income | 15130867 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $171,032 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 349151 | Total |
| Management And General | 349151 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192491 | Total |
| Program Services | 192491 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6059803 | Total |
| Program Services | 5480380 | ProgramServices |
| Management And General | 543117 | ManagementAndGeneral |
| Fundraising | 36306 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 211368 | Total |
| Program Services | 195768 | ProgramServices |
| Management And General | 14347 | ManagementAndGeneral |
| Fundraising | 1253 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 919982 | Total |
| Program Services | 843528 | ProgramServices |
| Management And General | 76444 | ManagementAndGeneral |
| Fundraising | 10 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 461647 | Total |
| Program Services | 403173 | ProgramServices |
| Management And General | 55997 | ManagementAndGeneral |
| Fundraising | 2477 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7866 | Total |
| Management And General | 7866 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43230 | Total |
| Management And General | 43230 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11767 | Total |
| Management And General | 11767 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1958339 | Total |
| Program Services | 1957148 | ProgramServices |
| Management And General | 710 | ManagementAndGeneral |
| Fundraising | 481 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77843 | Total |
| Program Services | 38251 | ProgramServices |
| Management And General | 39037 | ManagementAndGeneral |
| Fundraising | 555 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 977576 | Total |
| Program Services | 720123 | ProgramServices |
| Management And General | 254704 | ManagementAndGeneral |
| Fundraising | 2749 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 270446 | Total |
| Program Services | 241481 | ProgramServices |
| Management And General | 28965 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26805 | Total |
| Program Services | 18062 | ProgramServices |
| Management And General | 8743 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4542 | Total |
| Program Services | 4542 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1093293 | Total |
| Program Services | 976201 | ProgramServices |
| Management And General | 117092 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137381 | Total |
| Management And General | 137381 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| MEDICAL SUPPLIES | 2149049 | 2149049 | ||
| BAD DEBTS EXPENSE | 303229 | 303229 | ||
| DUES AND SUBSCRIPTIONS | 62049 | 18863 | 42688 | 498 |
| OUTSIDE TRAINING | 25639 | 17612 | 8027 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11091 | Total |
| Program Services | 5749 | ProgramServices |
| Fundraising | 5342 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15354587 | Total |
| Program Services | 13565650 | ProgramServices |
| Management And General | 1739266 | ManagementAndGeneral |
| Fundraising | 49671 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 973213 | BOY |
| EOY | 3758444 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2789424 | BOY |
| EOY | 2175713 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 321856 | BOY |
| EOY | 287419 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 152342 | BOY |
| EOY | 160644 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 20228819 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10697200 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7996440 | BOY |
| EOY | 9531619 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1970802 | BOY |
| EOY | 2054053 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3500000 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156491 | BOY |
| EOY | 220317 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13254 | BOY |
| EOY | 206824 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17873822 | BOY |
| EOY | 18395033 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1079832 | BOY |
| EOY | 2001762 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 435516 | BOY |
| EOY | 384777 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 384049 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1899397 | BOY |
| EOY | 2386539 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15851129 | BOY |
| EOY | 15871588 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72542 | BOY |
| EOY | 86152 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50754 | BOY |
| EOY | 50754 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15974425 | BOY |
| EOY | 16008494 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17873822 | BOY |
| EOY | 18395033 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 16443 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 17626 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,561 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1561 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | JCHC PAID DUES TO THE NEBRASKA ASSOCIATION OF HOSPITALS AND HEALTH SYSTEMS AND AMERICAN HOSPITAL ASSOCIATION WHICH WERE USED FOR LOBBYING ACTIVITIES. | Explanation |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 50754 | BeginningOfYearBalance |
| End Of Year Balance | 50754 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 50754 | BeginningOfYearBalance |
| End Of Year Balance | 50754 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 50754 | BeginningOfYearBalance |
| End Of Year Balance | 50754 | EndOfYearBalance |
Current Year Minus3 Years CurrentYearMinus3Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 50754 | Contributions |
| Investment Earnings Or Losses | 250 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 250 | GrantsOrScholarships |
| End Of Year Balance | 50754 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13943 | OtherCostOrOtherBasis |
| Book Value | 13943 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 12117865 | OtherCostOrOtherBasis |
| Depreciation | 6347264 | Depreciation |
| Book Value | 5770601 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5820106 | OtherCostOrOtherBasis |
| Depreciation | 4284623 | Depreciation |
| Book Value | 1535483 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2276905 | OtherCostOrOtherBasis |
| Depreciation | 65313 | Depreciation |
| Book Value | 2211592 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9531619 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 15376889 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 17626 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | 17626 | RevenueNotRptdF990 |
| Revenue Subtotal | 15359263 | RevenueSubtotal |
| Investment Expenses Not Included | 11767 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 11767 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 15371030 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 15342820 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 15342820 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 11767 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 11767 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 15354587 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE NURSING SCHOLARSHIPS AND CAPITAL IMPROVEMENTS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | 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, 2013, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. THE HEALTH CENTER IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS FOR FISCAL YEARS ENDED PRIOR TO SEPTEMBER 30, 2010. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 129761 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 129761 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 845706 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 649545 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 196161 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01300 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 975467 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 649545 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 325922 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02160 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 19543 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 19543 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8040 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 8040 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 471571 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 211456 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 260115 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01730 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7216 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 7216 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 506370 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 211456 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 294914 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1481837 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 861001 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 620836 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04120 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $303,229 | BadDebtExpenseAmount |
| Amount Attributable To | 50000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6178220 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6553140 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -374920 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFERSON COMMUNITY HEALTH CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 H STREET | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFERSON COMMUNITY HEALTH CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Other | X | Other |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Average Negotiated Rates | X | AverageNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GARDENSIDE | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 H STREET | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | LONG TERM CARE FACILITY | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (23 entries)
| ExplanationExplanation | Return ReferenceReturnReference | IdentifierIdentifier |
|---|---|---|
| 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. | ||
| PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. | ||
| PART I, L7 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 $303,229. | ||
| A. COMMUNITY HEALTH EDUCATION AND OUTREACH(1) 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 61 SEATS WERE CHECKED IN AT 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.(2) DIABETES CONFERENCE - A DIABETES CONFERENCE WAS HELD FOR THE COMMUNITY IN NOVEMBER 2012 WITH 36 ATTENDING THE HALF-DAY SEMINAR. THE COST OF $10 FOR PARTICIPANTS IN ADDITION TO SPONSORSHIP RECEIVED HELPED TO OFFSET THE COST OF SPEAKERS AND SUPPLIES. (3) HEALTH FAIR - JCHC PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC., AT THE JEFFERSON COUNTY HOME AND GARDEN SHOW AND THE JEFFERSON COUNTY FAIR. AN ESTIMATED 500 TOOK PART IN OFFERINGS FROM JCHC AT THESE EVENTS. JCHC ALSO PARTICIPATED IN THE SECOND COMMUNITY SAFETY FAIR OFFERED BY LOVELAND INDUSTRIES. THE COMMUNITY SAFETY FAIR WAS ATTENDED BY ABOUT 200 PEOPLE.(4) SPEAKERS BUREAU - JCHC STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 11 PROGRAMS WERE DONE IN FISCAL 2013. (5) SUPPORT GROUPS - IN 2013, 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 2013 WAS 35. A SUPPORT GROUP FOR CAREGIVER'S OF ALZHEIMER'S PATIENTS MEETS MONTHLY AND HAD ATTENDANCE OF 57 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.(6) EDUCATIONAL PROGRAMS - JEFFERSON COMMUNITY HEALTH CENTER OFFERS EDUCATIONAL PROGRAMS TO THE COMMUNITY AT BREAK-EVEN PRICES. HEALTH TODAY WAS HELD IN OCTOBER, NOVEMBER AND DECEMBER 2012, WITH A TOTAL OF 51 ATTENDING.(7) 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.B. COMMUNITY-BASED CLINICAL SERVICES (SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS.)(1) BLOOD PRESSURE CLINICS - HOME HEALTH OFFERED COMMUNITY BLOOD PRESSURE SCREENING 4 TIMES IN 2013 AT PARKVIEW MANOR. (2) COMPLETE BLOOD PROFILES - COMPLETE BLOOD PROFILES WERE OFFERED IN THE SPRING AT A REDUCED RATE. A TOTAL OF 90 BLOOD PROFILES WERE OFFERED. PARTICIPANTS PAID $45 WHICH IS A FRACTION OF THE ESTIMATED VALUE OF THE TESTING. (3) IMMUNIZATION CLINICS - JCHC COOPERATES WITH BLUE VALLEY COMMUNITY ACTION AND PUBLIC HEALTH SOLUTIONS 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. (4) DIABETES ALERT DAY SCREENINGS - OFFERED FREE BLOOD SUGAR SCREENINGS ON DIABETES ALERT DAY IN MARCH WITH A "DIABETES ON THE SQUARE" EVENT IN DOWNTOWN FAIRBURY. C. HEALTH CARE SUPPORT SERVICES(1) 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 (350) AND PRENATAL CLASSES (20). | PART I, LINE 7E: | |
| A. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS.(1) 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 2013. 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 A ROOM FOR THE MEDICAL STUDENTS TO STAY IN DURING THEIR TIME IN FAIRBURY AND ALSO PROVIDES THEM USE OF OUR WELLNESS CENTER DURING THEIR STAY. THREE MEDICAL STUDENTS UTILIZED OUR FACILITY IN 2013. 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 2013. 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 2013. B. OTHER (1) 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 28 STUDENTS PARTICIPATED IN SHADOWING OPPORTUNITIES IN FISCAL 2013. (2) VIDEOCONFERENCE - JCHC CONTINUED TO OFFER 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 2013. THIS INCLUDED A NUMBER OF OPPORTUNITIES FOR STAFF AND COMMUNITY EDUCATION, MEETINGS AND CLINICAL VISITS. | PART I, LINE 7F: | |
| 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. | PART I, LINE 7G: | |
| A. CASH DONATIONS - JCHC MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUT AND BOY SCOUT FIRST AID KITS, 4-H FIRST AID PROJECT, FREE LOAN OF HOME BILLIRUBEN 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, EMT TRAINING CONFERENCE, CHAMBER OF COMMERCE BANQUET, CHAMBER OF COMMERCE NEW TEACHER WELCOME, CHAMBER OF COMMERCE TEACHER RECOGNITION, LOANING OUT CPR MANNEQUINS, ETC. JCHC ALSO CONTRIBUTES ITEMS SUCH AS WELLNESS CENTER PASSES, JCHC GLASSES AND DUFFLE BAGS, ETC., TO COMMUNITY EVENTS AS DOOR PRIZES. THESE TOTALED $646.39. USE OF A BILIBLANKET WAS DONATED FOR NEWBORNS WITH JAUNDICE FOR 33 DAYS OF IN-KIND USE FOR A VALUE OF $3,630. B. IN-KIND DONATIONS. (1) 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 $3,800 FOR THE ALZHEIMER'S ASSOCIATION. (2) SAFE KIDS CHAPTER - THE LEAD AGENCY FOR SAFE KIDS WAS CHANGED TO PUBLIC HEALTH SOLUTIONS IN 2013, BUT JEFFERSON COMMUNITY HEALTH CENTER CONTINUES TO BE INVOLVED. FOUR 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 CHECK UP EVENTS, OTHER SAFETY PROMOTIONS WERE OFFERED. (3) 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. (4) SAFETY DAY FOR KIDS - JCHC WAS ONE OF THE CO-SPONSORS FOR THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 67 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. | PART I, LINE 7I: | |
| PART II: 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 4: BAD DEBT INCLUDES PATIENT ACCOUNTS SENT TO THE COLLECTION AGENCY AFTER BEING RETURNED AS UNCOLLECTABLE FROM THE HOSPITAL'S "EARLY OUT" COLLECTION VENDOR. BAD DEBT EXPENSE IS ADJUSTED FOR ALLOWANCES AND RECOVERIES. ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THE PATIENT ACCOUNTS PRIOR TO ANY BAD DEBT WRITE-OFF AND THUS ARE NOT INCLUDED IN BAD DEBT EXPENSE.JCHC'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, THE FOLLOWING IS TEXT OF THE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE" AND "CHARITY CARE":PATIENT ACCOUNTS RECEIVABLE:THE HEALTH CENTER REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS, AND OTHERS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR THOSE ACCOUNTS OVER A CERTAIN AGE BASED ON DISCHARGE THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.CHARITY CARE:THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE HEALTH CENTER IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE HEALTH CENTER PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST.THE HEALTH CENTER PROVIDES CHARITY CARE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR THE HEALTHCARE SERVICES THEY RECEIVE. IT IS THE POLICY OF THE HEALTH CENTER NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. ACCORDINGLY, THE HEALTH CENTER DOES NOT REPORT THESE AMOUNTS IN NET OPERATING REVENUE OR IN THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HEALTH CENTER DETERMINES THE COSTS ASSOCIATED WITH PROVIDING CHARITY CARE BY AGGREGATING THE DIRECT AND INDIRECT COSTS, INCLUDING SALARIES, BENEFITS, SUPPLIES, AND OTHER OPERATING EXPENSES, BASED ON AN OVERALL COST TO CHARGE RATIO. THE COSTS OF CARING FOR THESE PATIENTS FOR THE YEARS ENDED SEPTEMBER 30, 2013 AND 2012 WERE APPROXIMATELY $134,000 AND $157,000, RESPECTIVELY.THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CONSERVATIVELY BASED ON THE BELIEF THAT MANY POTENTIALLY ELIGIBLE PATIENTS DID NOT TAKE THE TIME OR EFFORT TO COMPLETE AN APPLICATION FOR CHARITY CARE. NO PORTION OF BAD DEBT IS INCLUDED AS A COMMUNITY BENEFIT. | ||
| 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 (WORKSHEET D) FOR SEPTEMBER 30, 2013. | ||
| PART III, LINE 9B: ONCE IT IS DETERMINED THAT A PATIENT MAY NOT HAVE THE MEANS TO PAY, AN ASSISTANCE APPLICATION SHOULD BE 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 V, SECTION B, LINE 1J: OTHER ITEMS ADDRESSED IN THE NEEDS ASSESSMENT ARE IMPLEMENTATION STRATEGY AND NEEDS THAT WILL NOT BE ADDRESSED BY JCHC. | JEFFERSON COMMUNITY HEALTH CENTER, INC. | |
| PART V, SECTION B, LINE 3: JEFFERSON COMMUNITY HEALTH CENTER BEGAN ITS HEALTH NEEDS ASSESSMENT IN DECEMBER 2012 AND 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 ALSO PARTICIPATED.PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT CONDUCTED ITS COMMUNITY HEALTH IMPROVEMENT PLAN STUDY OF ALL FIVE COUNTIES WITH THE ASSISTANCE OF LANE GEWECKE CONSULTING IN NOVEMBER 2012. | JEFFERSON COMMUNITY HEALTH CENTER, INC. | |
| PART V, SECTION B, LINE 7: 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. 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. | |
| JCHS'S COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT HTTP://JCHC.US/WP-CONTENT/UPLOADS/2014/01/2013-JCHC-COMMUNITY-HEALTH- NEEDS-ASSESSMENT.DOCX. | PART V, SECTION B, LINE 5A: | |
| 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 THAT IS HANDED OUT EXPLAINS WHO IN THE BUSINESS OFFICE TO CONTACT IF THE PATIENT HAS QUESTIONS ABOUT THEIR BILL. THE SELF-PAY BILLING VENDOR JCHC USES NOW HAS A SET OF CRITERIA IT ASSESSES TO DETERMINE IF A PATIENT MIGHT BE ELIGIBLE FOR ASSISTANCE PROGRAMS THE PATIENT IS NOT ALREADY UTILIZING, OR IF THEY MIGHT QUALIFY FOR JCHC'S CHARITY CARE. | ||
| 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 IS OVER 50% ON AVERAGE, AND REVENUE FROM MEDICAID CLIENTS IS OVER 10% ON AVERAGE. | ||
| 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 $242,101. 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 - 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. | ||
| JCHC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATES. | PART VI, LINE 7: |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WILLIAM WELCH | ||||||||||||||
| CEO (10/12-7/13) | 163438 | 0 | 0 | 0 | 0 | 0 | 8169 | 0 | 14438 | 0 | 186045 | 0 | 0 | 0 |
| CHAD JURGENS | ||||||||||||||
| CFO(10/12-7/13)/CEO(7/13-PRESENT) | 135801 | 0 | 0 | 0 | 0 | 0 | 6764 | 0 | 14438 | 0 | 157003 | 0 | 0 | 0 |
| GARY MITCHELL | ||||||||||||||
| DIRECTOR OF PHARMACY | 144215 | 0 | 0 | 0 | 0 | 0 | 7209 | 0 | 11785 | 0 | 163209 | 0 | 0 | 0 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| FAIRBURY CLINIC PC | |||
| DR. CRAIG SHUMARD, BOARD MEMBER, OWNS MORE THAN 5% OF FAIRBURY CLINIC P.C. | 601502 | FAIRBURY CLINIC P.C. PROVIDED EMERGENCY ROOM COVERAGE SERVICES TO JEFFERSON COMMUNITY HEALTH CENTER. | 0 |
| MARY HOPPE | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF DICK HOPPE, CHAIRMAN OF THE BOARD | 79656 | EMPLOYEE'S W-2 WAGES | 0 |
| STACY SHUMARD | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF DR. CRAIG SHUMARD, BOARD MEMBER | 33980 | EMPLOYEE'S W-2 WAGES | 0 |
| SANDRA SCHEELE | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF BRIAN SCHEELE, BOARD MEMBER | 11923 | EMPLOYEE'S W-2 WAGES | 0 |
| JANET STEELE | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF MIKE STEELE, BOARD MEMBER | 42473 | EMPLOYEE'S W-2 WAGES | 0 |
| JACQUELINE WESCH | |||
| EMPLOYEE OF ORGANIZATION AND SPOUSE OF JACK WESCH, BOARD MEMBER | 24459 | EMPLOYEE'S W-2 WAGES | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 990 IS REVIEWED AT THE REGULAR BOARD MEETING. | |
| 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 REGARDING DISCLOSED CONFLICT OF INTEREST. BOARD MEMBERS ARE WELL ACQUAINTED AND WOULD BE AWARE OF ANY PERSONAL CONFLICTS OF INTEREST. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE HOSPITAL PARTICIPATES IN THE NEBRASKA COMPDATA SALARY SURVEYS FOR ALL POSITIONS. THE CEO SURVEY DATA IS GIVEN TO THE BOARD TO REVIEW AND APPROVE THE CEO SALARY ON AN ANNUAL BASIS. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATIONS 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 1,354,548. MANAGEMENT AND GENERAL EXPENSES 710. FUNDRAISING EXPENSES 481. TOTAL EXPENSES 1,355,739. EMERGENCY ROOM PHYSICIANS: PROGRAM SERVICE EXPENSES 602,600. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 602,600. | OTHER FEES |
| FORM 990, PAGE 11, PART XI, LINE 2C: | THERE HAVE BEEN NO CHANGES FROM THE PRIOR YEAR. 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. |