FAIRBURY ASSISTED LIVING FACILITY: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
FAIRBURY ASSISTED LIVING FACILITY (EIN 47-0841274)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-09
IRS object ID
202212219349302021
Schema version
2020v4.2
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-08-09T15:51:53-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1EIDE BAILLY LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line118081 BURT STREET SUITE 200AddressLine1Txt
CityOMAHACityNm
State AbbreviationNEStateAbbreviationCd
ZIP680224722ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN470841274EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FAIRBURY ASSISTED LIVING FACILITYBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFAIRBusinessNameControlTxt
Phone4027296100PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1828 22ND STREETAddressLine1Txt
CityFAIRBURYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68352ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCHANCE KLASEKPersonNm
Person TitleSECRETARYPersonTitleTxt
Phone4027293351PhoneNum
Signature2022-08-05SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstCHANCEPersonFirstNm
Person LastKLASEKPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMEGAN L KOZIOLPreparerPersonNm
PTINP01544037PTIN
Phone4023302660PhoneNum
Preparation2022-08-05PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer3TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CEDARWOODBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerCHANCE KLASEKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line12200 H STREET PO BOX 277AddressLine1Txt
CityFAIRBURYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68352ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$2,141,581GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTPS://WWW.CEDARWOODAL.ORG/WebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionCEDARWOOD STRIVES TO PROVIDE THE HIGHEST QUALITY OF HOSPITALITY, SERVICES, ACTIVITIES, SECURITY, COMPANIONSHIP AND FREEDOM TO TENANTS IN A CARING AND LOVING ENVIRONMENT THAT THE TENANTS ARE PROUD TO CALL THEIR HOME. CEDARWOOD'S SERVICES ARE PROVIDED TO THE RESIDENTS OF JEFFERSON COUNTY.ActivityOrMissionDesc
Voting Members Governing Body4VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee38TotalEmployeeCnt
Total Volunteers7TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$52,296PYContributionsGrantsAmt
CY Contributions Grants$254,486CYContributionsGrantsAmt
PY Program Service Revenue$2,002,218PYProgramServiceRevenueAmt
CY Program Service Revenue$1,862,862CYProgramServiceRevenueAmt
PY Investment Income$7,992PYInvestmentIncomeAmt
CY Investment Income$24,233CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$2,062,506PYTotalRevenueAmt
CY Total Revenue$2,141,581CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$644,081PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$739,211CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$1,087,299PYOtherExpensesAmt
CY Other Expenses$960,321CYOtherExpensesAmt
PY Total Expenses$1,731,380PYTotalExpensesAmt
CY Total Expenses$1,699,532CYTotalExpensesAmt
PY Revenues Less Expenses$331,126PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$442,049CYRevenuesLessExpensesAmt
Total Assets BOY$2,845,008TotalAssetsBOYAmt
Total Assets EOY$2,727,943TotalAssetsEOYAmt
Total Liabilities BOY$763,218TotalLiabilitiesBOYAmt
Total Liabilities EOY$210,172TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,081,790NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,517,771NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE THE HIGHEST QUALITY OF HOSPITALITY, SERVICES, ACTIVITIES, SECURITY, COMPANIONSHIP AND FREEDOM TO TENANTS IN A CARING AND LOVING ENVIRONMENT THEY ARE PROUD TO CALL HOME.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$1,443,879ExpenseAmt
Revenue$1,862,862RevenueAmt
DescCEDARWOOD ASSISTED LIVING FACILITY WAS CONSTRUCTED ADJACENT TO JEFFERSON COMMUNITY HEALTH CENTER, INC. (JCHC), A NEBRASKA NON-PROFIT HOSPITAL EXEMPT FROM INCOME TAXES UNDER I.R.C. 501(C)(3). THE PURPOSE OF THE 50-UNIT FACILITY IS TO MEET AN IDENTIFIABLE COMMUNITY NEED IN THE FAIRBURY AREA, AND TO DEVELOP A MORE COMPREHENSIVE CONTINUUM OF HEALTH CARE THAT COMPLEMENTS THE HEALTH CARE SERVICES ALREADY AVAILABLE ON THE CAMPUS OF JCHC. FIFTY-NINE RESIDENTS WERE SERVED FROM OCTOBER 2020 THROUGH SEPTEMBER 2021. TWELVE OF THESE RESIDENTS QUALIFIED UNDER THE MEDICAID WAIVER PROGRAM. TOTAL DAYS OF CARE PROVIDED WERE 15,973.Desc
Total Program Service Expenses$1,443,879TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee38EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members4GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCHANCE KLASEKPersonNm
Phone4027296856PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12200 H STREET PO BOX 277AddressLine1Txt
CityFAIRBURYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68352ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (7 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
RICK STANTON
CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
HOMER WARD
CHAIRMAN THRU 9/21/211.00Yes (X)Yes (X)$0$0$0
DAVID REESE
VICE CHAIRMAN1.00Yes (X)Yes (X)$0$0$0
BRYCE BETKE
VICE CHAIRMAN THRU 9/21/211.00Yes (X)Yes (X)$0$0$0
CHANCE KLASEK
SECRETARY5.00Yes (X)Yes (X)$0$0$0
REGINA BERGH
TREASURER1.00Yes (X)Yes (X)$0$0$0
BURKE KLINE
PRESIDENT1.00Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1JEFFERSON COMMUNITY HEALTH CENTER INCBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line12200 H STREET PO BOX 277AddressLine1Txt
CityFAIRBURYCityNm
State AbbreviationNEStateAbbreviationCd
ZIP68352ZIPCd
FieldValueIRS element (for citing)
ServicesCONTRACTED DIETARY, MANAGEMENT, MAINTENAServicesDesc
Compensation$540,122CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
Government Grants$154,200GovernmentGrantsAmt
All Other Contributions$100,286AllOtherContributionsAmt
Noncash Contributions$100,236NoncashContributionsAmt
Total Contributions$254,486TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
RESIDENT REVENUE623000$1,545,509$1,545,509
MEDICAID PAYMENTS623000$311,603$311,603
RENTAL INCOME900002$5,750$5,750
FieldValueIRS element (for citing)
Total Program Service Revenue$1,862,862TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$24,233TotalRevenueColumnAmt
Exclusion$24,233ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,141,581TotalRevenueColumnAmt
Related Or Exempt Func Income$1,862,862RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$24,233ExclusionAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$644,971TotalAmt
Program Services$530,870ProgramServicesAmt
Management And General$114,101ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$42,144TotalAmt
Program Services$34,688ProgramServicesAmt
Management And General$7,456ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$52,096TotalAmt
Program Services$42,880ProgramServicesAmt
Management And General$9,216ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$89,885TotalAmt
Management And General$89,885ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$14,020TotalAmt
Management And General$14,020ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$25,073TotalAmt
Program Services$15,120ProgramServicesAmt
Management And General$9,953ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$7,836TotalAmt
Program Services$7,750ProgramServicesAmt
Management And General$86ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$69,461TotalAmt
Program Services$62,031ProgramServicesAmt
Management And General$7,430ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$64,977TotalAmt
Program Services$64,260ProgramServicesAmt
Management And General$717ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$2,025TotalAmt
Program Services$2,003ProgramServicesAmt
Management And General$22ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,838TotalAmt
Program Services$1,818ProgramServicesAmt
Management And General$20ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$9,243TotalAmt
Program Services$9,141ProgramServicesAmt
Management And General$102ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$189,476TotalAmt
Program Services$187,385ProgramServicesAmt
Management And General$2,091ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$37,239TotalAmt
Program Services$36,828ProgramServicesAmt
Management And General$411ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
RESIDENT MEALS$436,455$436,455
DUES & SUBSCRIPTIONS$12,793$12,650$143

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,699,532TotalAmt
Program Services$1,443,879ProgramServicesAmt
Management And General$255,653ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$301,180BOYAmt
EOY$199,496EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$315,685BOYAmt
EOY$769,956EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$35,791BOYAmt
EOY$27,988EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$14,210BOYAmt
EOY$5,779EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$5,746,966LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,022,242LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,895,414BOYAmt
EOY$1,724,724EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$281,432BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,296BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$2,845,008BOYAmt
EOY$2,727,943EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$68,752BOYAmt
EOY$58,037EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$407,114BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$124,200BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$163,152BOYAmt
EOY$152,135EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$763,218BOYAmt
EOY$210,172EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,081,790BOYAmt
EOY$2,517,771EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,081,790BOYAmt
EOY$2,517,771EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,845,008BOYAmt
EOY$2,727,943EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$442,049ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$6,068NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$632CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$112CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$100CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$52,296CurrentTaxYearMinus1YearAmt
Current Tax Year$254,486CurrentTaxYearAmt
Total$307,626TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,861,517CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,788,255CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,942,276CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,002,218CurrentTaxYearMinus1YearAmt
Current Tax Year$1,862,862CurrentTaxYearAmt
Total$9,457,128TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,862,149CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,788,367CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,942,376CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,054,514CurrentTaxYearMinus1YearAmt
Current Tax Year$2,117,348CurrentTaxYearAmt
Total$9,764,754TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$9,764,754PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,705CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,144CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,639CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,992CurrentTaxYearMinus1YearAmt
Current Tax Year$24,233CurrentTaxYearAmt
Total$51,713TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$3,705CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$7,144CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$8,639CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,992CurrentTaxYearMinus1YearAmt
Current Tax Year$24,233CurrentTaxYearAmt
Total$51,713TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$92,547CurrentTaxYearMinus3YearsAmt
Total$92,547TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$1,865,854CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,888,058CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,951,015CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$2,062,506CurrentTaxYearMinus1YearAmt
Current Tax Year$2,141,581CurrentTaxYearAmt
Total$9,909,014TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.98540PublicSupportCY509Pct
Public Support PY5090.98720PublicSupportPY509Pct
Investment Income CY0.00520InvestmentIncomeCYPct
Investment Income PY0.00320InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$60,427OtherCostOrOtherBasisAmt
Book Value$60,427BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,344,643OtherCostOrOtherBasisAmt
Depreciation$3,713,242DepreciationAmt
Book Value$1,631,401BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$246,362OtherCostOrOtherBasisAmt
Depreciation$221,586DepreciationAmt
Book Value$24,776BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$95,534OtherCostOrOtherBasisAmt
Depreciation$87,414DepreciationAmt
Book Value$8,120BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,724,724TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
RESIDENT SECURITY DEPOSITS$80,590
DUE TO JEFFERSON COMMUNITY HEALTH CENTER$64,871
PREPAID RENT$6,674
FieldValueIRS element (for citing)
Total Liability$152,135TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$2,135,513TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$6,068NetUnrealizedGainsInvstAmt
Revenue Not Reported-$6,068RevenueNotReportedAmt
Revenue Subtotal$2,141,581RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$2,141,581TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$1,699,532TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$1,699,532ExpensesSubtotalAmt
Expenses Not Rpt Fincl Stmt$0ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$1,699,532TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationCEDARWOOD IS A NOT-FOR-PROFIT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE CODE AND HAS RECEIVED A DETERMINATION LETTER THAT THEY ARE 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 CEDARWOOD'S TAX EXEMPT STATUS. CEDARWOOD ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. CEDARWOOD RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2021 AND 2020, CEDARWOOD HAD NO UNCERTAIN TAX POSITIONS ACCRUED.ExplanationTxt

Schedule M IRS990ScheduleM

Securities Publicly Traded SecuritiesPubliclyTradedGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution1ContributionCnt
Noncash Contributions Rpt F990$100,236NoncashContributionsRptF990Amt
Method Of Determining RevenuesHIGH/LOW AVERAGEMethodOfDeterminingRevenuesTxt
FieldValueIRS element (for citing)
Form8283 Received0Form8283ReceivedCnt
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC Gifts0ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE MEMBERS OF THE CORPORATION ARE BRYAN HEALTH AND JEFFERSON COMMUNITY HEALTH CENTER, INC., BOTH NEBRASKA NON-PROFIT CORPORTIONS.
FORM 990, PART VI, SECTION A, LINE 7ATHE MEMBERS OF THE CORPORATION, BRYAN HEALTH, A NEBRASKA NON-PROFIT CORPORATION, AND JEFFERSON COMMUNITY HEALTH CENTER, INC., A NEBRASKA NON-PROFIT CORPORATION, HAVE THE POWER TO APPOINT 3 TRUSTEES EACH, BOTH PERIODICALLY AND AS VACANCIES ARISE.
FORM 990, PART VI, SECTION B, LINE 11BTHE BOARD WILL REVIEW THE FORM 990 AT A REGULARLY SCHEDULED BOARD MEETING, WHICH DOES NOT NECESSARILY OCCUR PRIOR TO THE FILING OF FORM 990. FORM 990 IS REVIEWED BY MR. CHANCE KLASEK, BOARD SECRETARY, PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CON AN ANNUAL BASIS, OFFICERS AND TRUSTEES ARE REQUIRED TO SIGN THE "CONFLICT OF INTEREST STATEMENT." BY SIGNING THIS STATEMENT, THE OFFICERS AND TRUSTEES AGREE NOT TO USE HIS OR HER POSITION FOR PERSONAL PROFIT OR TO GAIN PERSONAL ADVANTAGE. THE OFFICERS AND TRUSTEES ARE REQUIRED TO DISCLOSE IN WRITING TO THE BOARD OF TRUSTEES ANY PERSON TO WHOM HE OR SHE IS CLOSELY RELATED OR ORGANIZATION WITH WHICH HE OR SHE IS AFFILIATED, WHO OR WHICH PRESENTLY TRANSACTS BUSINESS WITH THE CORPORATION OR MIGHT REASONABLY BE EXPECTED TO DO SO IN THE FUTURE. THE OFFICERS AND TRUSTEES ARE REQUIRED TO SUBMIT SUCH DISCLOSURE ON A CASE-BY-CASE BASIS. IT IS UNDERSTOOD THAT AFFILIATION WITH AN ORGANIZATION IS CONSIDERED TO EXIST WHEN AN OFFICER, TRUSTEE OR A MEMBER OF HIS OR HER IMMEDIATE FAMILY OR CLOSE RELATIVE IS AN OFFICER, DIRECTOR, PARTNER, EMPLOYEE OR AGENT OF THE ORGANIZATIONS OR OWNS 5% OF THE VOTING STOCK OR CONTROLLING INTEREST IN THE ORGANIZATION. THE OFFICERS AND TRUSTEES MUST ABSTAIN FROM VOTING ON ANY MOTION REGARDING THE DISCLOSED CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION C, LINE 19FAIRBURY ASSISTED LIVING FACILITY'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII:BURKE KLINE, PRESIDENT, AND CHANCE KLASEK, SECRETARY, ARE EMPLOYEES OF JEFFERSON COMMUNITY HEALTH CENTER, INC., AN UNRELATED ORGANIZATION THAT PROVIDES MANAGEMENT AND CLERICAL SERVICES FOR THE ORGANIZATION. THEREFORE, THE COMPENSATION IS PAID BY JEFFERSON COMMUNITY HEALTH CENTER, INC.
FORM 990, PART XII, 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. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
FORM 990, PART VI, SECTION B, LINE 14:THE ORGANIZATION DOES NOT HAVE A WRITTEN POLICY, BUT IT DOES MAINTAIN DOCUMENTS IN ACCORDANCE WITH FEDERAL AND STATE LAWS.
FORM 990, PART VI, SECTION B, LINE 15:AS NO OFFICER IS PAID BY THIS ORGANIZATION, NO INDEPENDENT REVIEW OR APPROVAL PROCESS IS CONDUCTED BY THIS ORGANIZATION.

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