2019-08-12T14:12:44-05:00 2018-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2017-10-01 470468078 JEFFERSON COMMUNITY HEALTH CENTER INC JEFF 4027293351 2200 H STREET PO BOX 277 FAIRBURY NE 68352 CHANCE KLASEK CFO 4027293351 2019-08-12 1 MEGAN L KOZIOL P01544037 4023302660 209.34.201.180 2019-08-12 11:24:58 CD P A532DB5264189C1BF118C5B3DB29FD281B4BE385 B319C935D5CD5DD24452FA9CD51ABCBD1A9C8C2C 2017 2019-02-21 02:37:17Z JEFFERSON COMMUNITY HEALTH & LIFE CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 24599851 0 X HTTP://WWW.JCHEALTHANDLIFE.ORG X 1960 NE INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. 8 7 271 15 0 0 110794 101000 22402357 22519391 84433 382952 146228 157721 22743812 23161064 0 0 0 0 12699895 12890550 0 0 10605 9185343 9346726 21885238 22237276 858574 923788 26296240 25914225 7387389 6362427 18908851 19551798 INSPIRING HEALTHY LIVING BY PROVIDING EXCEPTIONAL HEALTH AND LIFE SERVICES FOR EVERY PERSON, EVERY TIME. 0 0 18619550 19959270 JEFFERSON COMMUNITY HEALTH & LIFE OPERATES A 17 BED CRITICAL ACCESS ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH & LIFE ALSO OPERATES A FITNESS CENTER, RURAL HEALTH CLINICS, AND PROVIDES HOME HEALTH SERVICES. 1560288 2560121 JEFFERSON COMMUNITY HEALTH & LIFE OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. 20179838 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 5 0 1 271 1 0 0 0 0 0 1 1 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X CHANCE KLASEK 4027296856 2200 H STREET PO BOX 277 FAIRBURY NE 68352 BRIAN SCHEELE CHAIRMAN 1.00 0.00 X X 0 0 0 MARY GLENN VICE CHAIRMAN 1.00 0.00 X X 0 0 0 BRIAN BLOBAUM SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 LINDA BAUER MEMBER 1.00 0.00 X 0 0 0 JEREMY CHRISTIANSEN MEMBER THRU 04/18 1.00 0.00 X 0 0 0 LOREN DUERKSEN MEMBER 1.00 0.00 X 0 0 0 STEPHEN GRIZZLE MEMBER 1.00 0.00 X 0 0 0 SHERI SCHULTIS MEMBER 1.00 0.00 X 0 0 0 TREVOR STEINMEYER MEMBER 1.00 0.00 X 0 0 0 CHAD JURGENS CEO 40.00 0.00 X 178582 0 23039 CHANCE KLASEK CFO 40.00 0.00 X 111704 0 16966 RICHARD BLATNY JR PHYSICIAN 40.00 0.00 X 447305 0 37446 CRAIG SHUMARD PHYSICIAN 40.00 0.00 X 390256 0 37446 RICHARD BLATNY SR PHYSICIAN 40.00 0.00 X 378269 0 26071 TED TUCKER PHYSICIAN 40.00 0.00 X 308387 0 35523 BRANDON BLEICH PHARMACIST 40.00 0.00 X 145063 0 14535 1959566 0 191026 10 0 1 0 SOUTHEAST ANESTHSIA SERVICES 8426 W BIRCH CLATONIA NE 68328 CRNA SERVICES 360000 BRYAN MEDICAL CENTER 1600 S 48TH STREET LINCOLN NE 68506 HEALTH SERVICES 292241 MEDHOST 6550 CAROTHERS PKWY FRANKLIN TN 37067 EHR SERVICES 226544 MIDLANDS MECHANICAL 8425 WIRT STREET OMAHA NE 68134 HVAC SERVICES 164038 CONVERGEONE NW 5806 MINNEAPOLIS MN 55485 IT SERVICES 142894 7 13879 9000 78121 7300 101000 MEDICARE/MEDICAID PAYMENTS 624100 12637977 12637977 PATIENT SERVICE REVENUE 624100 8416977 8416977 340B DRUG PRICING PROGRAM 624100 792547 792547 CEDARWOOD ASSISTED LIVING SVC FEE 623000 541007 541007 CEDARWOOD: EQUITY IN JT VENTURE 623000 113571 113571 17312 17312 22519391 145568 145568 1670681 1433297 237384 237384 237384 4371 13879 5490 -1119 -1119 CAFETERIA 722210 158840 158840 158840 23161064 22519391 0 540673 330291 330291 82901 82901 10166572 9590709 568034 7829 357119 338781 18338 1252279 1175088 77191 701388 645335 55443 610 19868 19868 57685 57685 3271 3271 1632412 1276998 355373 41 130848 129958 55 835 1310583 1050637 259154 792 16434 16434 368424 363624 4800 59324 52124 7200 78258 70564 7694 138240 126397 11843 1405529 1285122 120407 107681 22143 85538 MEDICAL SUPPLIES 3214366 3214366 FOOD EXPENSE 384743 384743 BAD DEBTS EXPENSE 268095 268095 DUES AND SUBSCRIPTIONS 116598 51758 64342 498 34367 34061 306 22237276 20179838 2046833 10605 450 450 5715504 4593852 2700701 3085923 434714 381817 221952 308379 25664853 14139353 12364722 11525500 4109473 4958727 601865 715435 64639 0 82220 344142 26296240 25914225 1468657 1638906 4970948 4708050 71557 5532 876227 9939 7387389 6362427 X 18744356 19344987 113741 156057 50754 50754 18908851 19551798 26296240 25914225 923788 -280841 0 X X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1623 1623 0 PART II-B, LINE 1: JCH&L PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 50754 50754 50754 50754 50754 50754 50754 50754 50754 50754 0.00000 1.00000 0.00000 0 0 50943 50943 19749461 9551130 10198331 5596863 4471550 1125313 267586 116673 150913 11525500 ACCRUED INTEREST 9939 9939 X 22614347 -280841 5490 -275351 22889698 3271 268095 271366 23161064 21971400 5490 5490 21965910 3271 268095 271366 22237276 PART V, LINE 4: THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE NURSING SCHOLARSHIPS AND CAPITAL IMPROVEMENTS. PART X, LINE 2: THE HEALTH CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN THE HEALTH CENTER'S TAX EXEMPT STATUS. IN GENERAL, SUCH STANDARDS REQUIRE THE HEALTH CENTER TO MEET A COMMUNITY BENEFITS STANDARD AND COMPLY WITH VARIOUS LAWS AND REGULATIONS. THE HEALTH CENTER ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HEALTH CENTER RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT SEPTEMBER 30, 2018 AND 2017, THE HEALTH CENTER HAD NO UNCERTAIN TAX POSITIONS ACCRUED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 5,490. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 268,095. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 5,490. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 268,095. GOLF TOURNAMENT 18250 13879 4371 1440 966 1000 965 1119 18250 13879 4371 1440 966 1000 965 1119 5490 -1119 1 1 X 1 X 1 X 1 1 0 1 1 103520 0 103520 0.00470 1902862 1902862 2006382 1902862 103520 0.00470 20231 0 20231 0.00090 7400 0 7400 0.00030 441340 247341 193999 0.00880 8919 0 8919 0.00040 477890 247341 230549 0.01040 2484272 2150203 334069 0.01510 275 275 0.00000 275 275 0.00000 1 268095 36461 9470455 9720757 -250302 X 1 1 1 1 JEFFERSON COMMUNITY HEALTH CENTER 2200 H STREET FAIRBURY NE 68352 HTTP://WWW.JCHEALTHANDLIFE.ORG 440001 X X X X JEFFERSON COMMUNITY HEALTH CENTER INC 1 0 0 1 X X X X X X X X 15 1 0 0 1 X HTTP://JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ X 1 15 1 HTTP://JCHEALTHANDLIFE.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ 0 1 X 150.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/FINANCIAL-ASSISTANCE-P X HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/FINANCIAL-ASSISTANCE-P X HTTP://WWW.JCHEALTHANDLIFE.ORG/I-WANT-TO/PAY-MY-BILL/FINANCIAL-ASSISTANCE-P X X X X X X 1 X 0 X X X X 1 X 0 0 JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 5: JEFFERSON COMMUNITY HEALTH & LIFE BEGAN ITS SECOND COMMUNITY HEALTH NEEDS ASSESSMENT IN JANUARY 2016. JCH&L WORKED WITH PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT, CONDUCTED FOCUS GROUPS WITH LOCAL ORGANIZATIONS, HELD A COMMUNITY STAKEHOLDERS LUNCHEON, CONDUCTED AN INFORMAL SURVEY AT THE JEFFERSON COUNTY FAIR, AND REVIEWED STATISTICS MADE AVAILABLE THROUGH PUBLIC HEALTH SOLUTIONS, STATE OF NEBRASKA, US CENSUS, HEALTH PEOPLE 2020, AND WEBSITES SUCH AS COUNTY HEALTH RANKINGS AND WORLD LIFE EXPECTANCY.A COMMUNITY HEALTH NEEDS ASSESSMENT MEETING WAS HELD AT JCH&L WITH REPRESENTATIVES FROM AREA AGENCY PARTNERS, AND MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, AND SENIOR DINERS. A TOTAL OF 89 ATTENDED AND PARTICIPATED IN DISCUSSING COMMUNITY HEALTH NEEDS. IN ADDITION, 59 PARTICIPATED IN AN INFORMAL SURVEY AT THE 2016 JEFFERSON COUNTY FAIR TO GATHER INFORMATION ON EXERCISE AND PERCEIVED HEALTH NEEDS.FOR PURPOSES OF THIS ASSESSMENT AND REPORT, THE PRIMARY SERVICE AREA OF JEFFERSON COMMUNITY HEALTH & LIFE WAS CONSIDERED TO BE JEFFERSON COUNTY. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 11: PRIORITIZED NEEDS (AS DETERMINED BY COMMUNITY HEALTH NEEDS ASSESSMENT):1) OBESITY:OBESITY WAS MENTIONED BY EVERY GROUP ASKED ABOUT HEALTH CONCERNS AND PRIORITIES FOR JEFFERSON COUNTY. LACK OF PHYSICAL ACTIVITY WAS ALSO A COMMON RESPONSE AS A HEALTH CONCERN. OBESITY AND LACK OF PHYSICAL ACTIVITY ARE DIRECTLY RELATED TO MANY OF THE TOP HEALTH CONCERNS FOR OUR COUNTY INCLUDING HEART DISEASE/CEREBROVASCULAR PROBLEMS AND DIABETES.JEFFERSON COUNTY HAS A 35 PERCENT RATE OF COUNTY RESIDENTS WHO ARE OBESE, ACCORDING TO COUNTYHEALTHRANKINGS.ORG, HIGHER THAN THE STATE RATE OF 30 PERCENT.FOR THE FIVE-COUNTY PUBLIC HEALTH SOLUTIONS DISTRICT, JEFFERSON COUNTY HAD THE HIGHEST PERCENTAGE OF RESIDENTS WITH BMI GREATER THAN 30. A TOTAL OF 35.6 PERCENT OF JEFFERSON COUNTY ADULT RESIDENTS SELF-REPORTED IN THE BEHAVIORAL RISK FACTOR SURVEY THAT THEY HAD BMI GREATER THAN 30. THE FIVE-COUNTY DISTRICT AVERAGE WAS 33.7 PERCENT, NEBRASKA AVERAGE 29.4 PERCENT AND THE US AVERAGE 27.1 PERCENT.2) SEDENTARY LIFESTYLE:IN THE PHS AREA, 30 PERCENT OF JEFFERSON COUNTY ADULTS REPORT THEY ARE PHYSICALLY INACTIVE. RESPONSES WERE BASED ON THE QUESTION: "DURING THE PAST MONTH, OTHER THAN YOUR REGULAR JOB, DID YOU PARTICIPATE IN ACTIVITIES OR EXERCISES SUCH AS RUNNING, CALISTHENICS, GOLF, GARDENING OR WALKING FOR EXERCISE?" JEFFERSON COUNTY'S RATE OF PHYSICAL INACTIVITY WAS NEARLY THE HIGHEST IN THE FIVE-COUNTY DISTRICT AREA, AND WAS HIGHER THAN THE DISTRICT AVERAGE OF 28.5 PERCENT.ACCORDING TO THE COUNTYHEALTHRANKINGS.ORG DATA, JEFFERSON COUNTY HAD 32 PERCENT INACTIVITY RATE, COMPARED TO THE STATE RATE OF 24 PERCENT.NUTRITION IS ALSO A FACTOR IN OBESITY. IN THE FIVE-COUNTY PUBLIC HEALTH SOLUTIONS AREA, 76.8 PERCENT OF ADULTS IN JEFFERSON COUNTY REPORTED INADEQUATE FRUIT/VEGETABLE CONSUMPTION (LESS THAN 5 SERVINGS OF FRUITS AND VEGETABLES EACH DAY.) JEFFERSON COUNTY WAS BETTER THAN THE FIVE-COUNTY AREA RATE OF 79.1 PERCENT REPORTING INADEQUATE FRUIT AND VEGETABLE CONSUMPTION, BETTER THAN THE STATE AVERAGE OF 78.2 PERCENT, AND WORSE THAN THE UNITED STATES' AVERAGE OF 75.7 PERCENT.3) CHRONIC DISEASES AFFECTED BY OBESITY AND SEDENTARY LIFESTYLE, INCLUDING DIABETES, HEART DISEASE, STROKE AND CANCER:PARKINSON'S DISEASE: JEFFERSON COUNTY HAD THE FIFTH HIGHEST RATE OF DEATH FROM PARKINSON'S DISEASE AMONG NEBRASKA'S 93 COUNTIES, ACCORDING TO NEBRASKALIFEEXPECTANCY.COM. JEFFERSON COUNTY HAD A RATE OF 11.54 DEATHS PER 100,000 FOR 2014, COMPARED TO THE STATE RATE OF 8.85 PER 100,000 AND THE NATIONAL RATE OF 7.38.ACCIDENTAL DEATHS: JEFFERSON COUNTY EXCEEDED THE STATE RATES PER 100,000 POPULATION FOR ACCIDENTAL DEATHS IN 2014. JEFFERSON COUNTY HAD SIX ACCIDENTAL DEATHS IN 2014, FOR A CRUDE RATE OF 81.8 (PER 100,000 POPULATION) COMPARED TO THE STATE CRUDE RATE OF 41.3. AGE ADJUSTED RATE WAS 66.4 FOR JEFFERSON COUNTY, COMPARED TO 38.3 AGE ADJUSTED RATE FOR THE STATE. FOR 2010-2014, JEFFERSON COUNTY HAD 28 ACCIDENTAL DEATHS, FOR A RATE OF 74.7 CRUDE RATE AND 64.3 AGE ADJUSTED. THE STATE RATES FOR THE SAME TIME PERIOD WERE 39.2 CRUDE AND 36.4 AGE ADJUSTED.HEART DISEASE: ACCORDING TO THE 2014 NEBRASKA VITAL STATISTICS REPORT, JEFFERSON COUNTY EXCEEDED THE STATE RATE (PER 100,000 POPULATION) FOR HEART DISEASE DEATHS FOR BOTH 2014 AND 2010-2014. JEFFERSON COUNTY HAD 132 DEATHS ATTRIBUTED TO HEART DISEASE IN 2010-2014, FOR A CRUDE RATE OF 352.2 (STATE CRUDE RATE OF 178.8) AND AN AGE-ADJUSTED RATE OF 172.1 (STATE RATE OF 147.8.) FOR 2014, JEFFERSON COUNTY HAD 28 HEART DISEASE DEATHS, FOR A CRUDE RATE OF 354.5 AND AN AGE ADJUSTED RATE OF 176.2. THE STATE'S RATES FOR THE SAME YEAR WERE 174.9 CRUDE RATE AND 142.7 AGE ADJUSTED.CANCER: ACCORDING TO THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES CANCER REGISTRY FOR 2012 (THE NEWEST INFORMATION CURRENTLY AVAILABLE), JEFFERSON COUNTY'S RATE FOR CANCER DEATHS (ALL SITES) WAS 224.2, AND FOR 2008-2012 THE DEATH RATE WAS 187.6. THE STATE RATE FOR 2012 WAS 164.7, AND THE US RATE WAS 166.4. FOR 2008-2012, THE STATE RATE WAS 165.9 AND THE US RATE WAS 171.2. JEFFERSON COUNTY'S RATES WERE HIGHER THAN BOTH STATE AND NATIONAL RATES FOR BOTH 2012 AND THE PERIOD OF 2008-2012.DIABETES: JEFFERSON COUNTY SLIGHTLY EXCEEDED THE STATE RATE (PER 100,000 POPULATION) FOR DIABETES DEATHS FOR 2010-2014 ACCORDING TO THE NEBRASKA VITAL STATISTICS REPORT. JEFFERSON COUNTY HAD 20 DIABETES DEATHS IN 2010-2014, WHICH CALCULATES TO A CRUDE RATE OF 53.4 AND AN AGE ADJUSTED RATE OF 25.3 (PER 100,000 POPULATION) COMPARED TO THE STATE CRUDE RATE OF 24.7 AND AGE ADJUSTED RATE OF 21.4. FOR 2014, JEFFERSON COUNTY HAD ONLY 1 DIABETES DEATH, MAKING THE CRUDE RATE 13.6 AND THE AGE ADJUSTED RATE 5.4, BETTER THAN THE STATE CRUDE RATE OF 25.1 AND THE AGE ADJUSTED RATE OF 25.5.CHRONIC LUNG: JEFFERSON COUNTY WAS AT ABOUT THE SAME AGE ADJUSTED DEATH RATE AS THE STATE FOR CHRONIC LUNG FOR 2010-2014. JEFFERSON COUNTY HAD 34 DEATHS ATTRIBUTED TO CHRONIC LUNG FOR THAT TIME PERIOD, FOR A CRUDE RATE OF 90.7 PER 100,000 AND AN AGE ADJUSTED RATE OF 49.3 PER 100,000. THE STATE AVERAGE MORTALITY RATE WAS 45.3 PER 100,000.CEREBROVASCULAR: JEFFERSON COUNTY EXCEEDED THE STATE RATE (PER 100,000 POPULATION) FOR CEREBROVASCULAR (STROKE) DEATHS FOR 2014 AND FOR 2008-2014. JEFFERSON COUNTY HAD 10 CEREBROVASCULAR DEATHS IN 2014, AND 35 IN THE PERIOD OF 2008-2014. THIS CALCULATES TO A CRUDE RATE OF 65.0 PER 100,000 POPULATION FOR THE YEAR, AND 44.5 PER 100,000 POPULATION FOR 2008-2014. THE STATE RATE WAS 34.7 AND 36.7 RESPECTIVELY.ALZHEIMER'S DISEASE: JEFFERSON COUNTY EXCEEDED THE STATE RATE FOR DEATHS FROM ALZHEIMER'S DISEASE FOR BOTH THE 2014 DATA AND THE 2010-2014 DATA PERIOD. FOR 2014, JEFFERSON COUNTY HAD 4 DEATHS FROM ALZHEIMER'S, FOR A CRUDE RATE OF 54.5 PER 100,000 AND AN AGE ADJUSTED RATE OF 24.4 PER 100,000, COMPARED TO THE STATE RATES OF 24.7 CRUDE AND 21.9 AGE ADJUSTED FOR 2014. FOR 2010-2014, JEFFERSON COUNTY HAD 25 DEATHS ATTRIBUTED TO ALZHEIMER'S, FOR A CRUDE RATE OF 66.7 AND AN AGE ADJUSTED RATE OF 31.1, COMPARED TO THE STATE'S RATES OF 30.2 AND 24.1 PER 100,000 RESPECTIVELY.4) MENTAL AND BEHAVIORAL HEALTH:MENTAL HEALTH WAS AN AREA MENTIONED IN MOST COMMUNITY SURVEY GROUPS AS AN AREA OF NEED. JEFFERSON COUNTY HAS BLUE VALLEY BEHAVIORAL HEALTH AND BEHAVIORAL MEDICINE CLINIC SERVING OUR AREA, BOTH WHICH OFFER PSYCHOLOGISTS. THERE IS NOT A PSYCHIATRIST SERVING JEFFERSON COUNTY.THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES AND SERVICES ADMINISTRATION LISTS JEFFERSON COUNTY AS A PSYCHIATRY AND MENTAL HEALTH SHORTAGE AREA AS OF 2013.THE FEDERAL HRSA - DIVISION OF POLICY AND SHORTAGE DESIGNATION LISTS CATCHMENT 5 (WHICH INCLUDES JEFFERSON COUNTY ALONG WITH OTHER SOUTHEAST NEBRASKA COUNTIES) AS A FEDERAL MENTAL HEALTH SHORTAGE AREA.NEEDS JEFFERSON COMMUNITY HEALTH & LIFE WILL NOT ADDRESS:THERE WERE NEEDS IDENTIFIED THAT JCH&L DID NOT CHOOSE TO ADDRESS. WHILE THESE NEEDS ARE IMPORTANT TO THE COMMUNITY, THEY WERE NOT CHOSEN BASED ON THE PRIORITIZATION PROCESS.NEEDS WHICH WILL NOT BE ADDRESSED SPECIFICALLY BY JCH&L INCLUDE:*ALZHEIMER'S DISEASE. WE WILL CONTINUE TO OFFER AN ALZHEIMER'S CAREGIVER'S SUPPORT GROUP AND BE A PART OF THE ANNUAL WALK TO END ALZHEIMER'S, AND WE WILL PROVIDE EDUCATIONAL RESOURCES TO OUR COMMUNITY THROUGH THE ALZHEIMER'S ASSOCIATION. THIS IS THE EXTENT OF WHAT WE FEEL OUR INVOLVEMENT CAN BE AT THIS TIME, SO WE DO NOT INTEND TO NAME THIS AS A MAJOR AREA OF ACTIVITY.*ADDITIONAL SPECIALTIES, ACCESS TO CARE, PREVENTATIVE CARE. JCH&L IS ALWAYS SEEKING POSSIBILITIES FOR ADDITIONAL SPECIALTIES, INCREASED ACCESS TO CARE AND INCREASED PREVENTATIVE CARE TO ADDRESS COMMUNITY NEEDS, AND WILL CONTINUE THIS PROCESS AS A PART OF OUR ONGOING STRATEGIC PLANNING PROCESS. HOWEVER, IT IS NOT NAMED IN OUR PRIORITIES BECAUSE OF THE NEED FOR PERSONNEL AND RESOURCES TO ADDRESS PRIORITY AREAS.*BULLYING, SUICIDE, DENTAL HEALTH, CHRONIC PAIN. JCH&L WISHES TO BE A GOOD COMMUNITY PARTNER WITH ALL AREA AGENCIES AND PRACTICES WHICH PROVIDE SERVICES IN ALL OF THESE AREAS, WHICH ARE ALL OUTSIDE OF OUR CURRENT OFFERINGS. WE DO NOT INTEND TO NAME THESE AS PRIORITY AREAS AT THE PRESENT TIME.*POVERTY, TRANSPORTATION, DECLINING POPULATION, HOUSING. THESE ARE ONGOING SOCIETAL ISSUES WHICH AFFECT OUR BUSINESSES AND SERVICES. WE WILL CONTINUE TO BE A GOOD COMMUNITY PARTNER ON DEALING WITH THESE ISSUES IN OUR AREA, BUT WE DO NOT INTEND TO MAKE THESE AREAS OUR PRIORITY AREAS OF FOCUS.*INSURANCE/UNINSURED/UNDERINSURED. WE CONTINUE TO SEEK WAYS THAT WE AS AN ORGANIZATION CAN BEST SERVE THOSE WHO ARE UNINSURED OR UNDERINSURED, INCLUDING CHARITY CARE. THESE ARE NOT NAMED AS PRIORITY AREAS AT THIS TIME.*LEAD, RADON. THESE CONCERNS ALSO AFFECT OUR PATIENTS, AND WE WILL ASSIST IN EDUCATION AND PROMOTIONS UNDERTAKEN BY OTHER COMMUNITY/NATIONAL AGENCIES. THESE WILL NOT BE AREAS OF FOCUS IN OUR CURRENT PLAN. 3 1 - GARDENSIDE 200 H STREET FAIRBURY NE 68352 LONG TERM CARE FACILITY 2 - FAIRBURY CLINIC 825 22ND STREET FAIRBURY NE 68352 RURAL HEALTH CLINIC 3 - PLYMOUTH CLINIC 316 N MADISON AVE STE 200 PLYMOUTH NE 684144110 RURAL HEALTH CLINIC 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 & LIFE PREPARES ITS OWN COMMUNITY BENEFIT REPORT. PART I, LINE 7: THE HOSPITAL USED THE WORKSHEETS PROVIDED IN THE FORM 990 INSTRUCTIONS TO HELP CALCULATE THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $268,095. PART I, LINE 7: JCH&L REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2018, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMSA. TRADITIONAL CHARITY CARE: JCH&L PROVIDED CHARITY CARE IN FISCAL 2018 TO THOSE WHO MEET THE FEDERAL POVERTY GUIDELINES. THE BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS. PATIENTS ASSISTED: 47. VALUE: $99,000.B. UNPAID COSTS OF PUBLIC PROGRAMS: MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: $0C. BAD DEBT: BESIDES OFFICIAL CHARITY CARE, JCH&L WROTE OFF $268,095 IN BAD DEBT DURING FISCAL 2018. II. COMMUNITY BENEFIT SERVICESA. COMMUNITY HEALTH EDUCATION AND OUTREACH: HEALTH FAIR - JCH&L PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC., AT COMMUNITY EVENTS. IN SEPTEMBER JCH&L HOSTED ITS FIRST EVER WOMEN'S HEALTH FAIR, WHICH HAD 250 PARTICIPANTS. WE ALSO HAD A BOOTH AT THE JEFFERSON COUNTY FAIR, WHICH ALSO DRAWS SEVERAL HUNDRED PEOPLE. FOR 2018, THE COST OF BOOTHS, GIVEAWAYS, STAFF TIME, ETC., ARE ESTIMATED AT $4,000. ESTIMATED NUMBER REACHED: 400+.SPEAKERS BUREAU. JCH&L STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 29 PROGRAMS WERE DONE IN FISCAL 2018. TOTAL INDIVIDUALS REACHED: 1,366. ESTIMATED COST OF STAFF TIME: $900.SUPPORT GROUPS - IN 2018, JCH&L COORDINATED A PARKINSON'S SUPPORT GROUP AND ALZHEIMER'S CAREGIVER'S SUPPORT GROUP. JCH&L 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 2018 WAS 34. A SUPPORT GROUP FOR CAREGIVER'S OF ALZHEIMER'S PATIENTS MEETS MONTHLY AND HAD ATTENDANCE OF 40 THROUGHOUT THE YEAR. JCH&L 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. JCH&L ALSO PROVIDES SPACE FOR A MONTHLY GRIEF SUPPORT GROUP COORDINATED BY ASERACARE HOSPICE. ATTENDANCE DURING THE YEAR IS ESTIMATED AT 60. TOTAL NUMBER REACHED: 134. APPROXIMATE COST OF STAFF TIME SPENT: $1,000. ESTIMATED COST OF POSTAGE: $325. ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES, DRINKS, ETC.): $200.HEALTH PROMOTION PROGRAMS. JCH&L OFFERS SMOKING CESSATION INFORMATION TO PATIENTS AND THE PUBLIC. EACH INPATIENT WHO IS A SMOKER IS PROVIDED INFORMATION ON SMOKING CESSATION. ESTIMATED NUMBER REACHED: 79; ESTIMATED COST OF PROMOTIONAL MATERIALS PROVIDED: $402.11. COOKING CLASSES FOR KIDS. JCH&L BEGAN OFFERING COOKING CLASSES FOR KIDS AND AN ADULT PARTNER (PARENT OR GUARDIAN). THE CLASSES ARE OFFERED FOR A SMALL FEE WHICH DOES NOT COVER THE TOTAL AMOUNT OF STAFF TIME OR SUPPLIES. ESTIMATED NUMBER REACHED: 60. ESTIMATED COST OF STAFF TIME AND MATERIALS: $3,584.ELEMENTARY FAMILY NIGHT WITH FAIRBURY PUBLIC SCHOOLS. PROVIDED EDUCATIONAL SESSIONS, ACTIVITIES AND FOOD FOR ELEMENTARY FAMILY NIGHT FOR FAMILIES WITH CHILDREN AT CENTRAL AND JEFFERSON SCHOOLS AT THE FAIRBURY PUBLIC SCHOOLS. ESTIMATED NUMBER PARTICIPATING: 150 ESTIMATED COST OF STAFF TIME, FOOD, MATERIALS, ETC.: $2,000.GROCERY STORE TOUR. WE PARTNERED WITH PUBLIC HEALTH SOLUTIONS TO OFFER A GROCERY STORE TOUR FOR AREA RESIDENTS. TOTAL NUMBER REACHED: 15 ESTIMATED COST: $500.CORNHOLE TOURNAMENT. WE OFFERED A CORNHOLE TOURNAMENT FOR 3RD THROUGH 6TH GRADERS. ESTIMATED NUMBER REACHED: 20. ESTIMATED COST OF STAFF TIME AND PRIZES: $500.B. COMMUNITY-BASED CLINICAL SERVICES: SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS.COMPLETE BLOOD PROFILES - COMPLETE BLOOD PROFILES WERE OFFERED IN THE SPRING OF 2018 AT A REDUCED RATE. A TOTAL OF 59 BLOOD PROFILES WERE OFFERED. PARTICIPANTS PAID $45, WHICH IS A FRACTION OF THE ESTIMATED VALUE OF THE TESTING. ESTIMATED STAFF TIME: $1,200.IMMUNIZATION CLINICS. JCH&L COOPERATES WITH BLUE VALLEY COMMUNITY ACTION IN PROVIDING IMMUNIZATION CLINIC FOR CHILDREN TWICE EACH MONTH. JCH&L PROVIDES SPACE WHERE IMMUNIZATIONS ARE DONE, NURSING STAFF, THE PATIENT WAITING AREAS, JANITORIAL AND SUPPORT SERVICES, AND STORAGE OF VACCINES IN OUR PHARMACY. NUMBER OF CHILDREN SERVED: 262. TOTAL OF 792 VACCINATIONS PROVIDED. ESTIMATED COST OF NURSES PROVIDED BY JCH&L TO GIVE SHOTS: $1,620. C. HEALTH CARE SUPPORT SERVICESENROLLMENT ASSISTANCE IN PUBLIC PROGRAMS - JCH&L OFFERED A COMMUNITY PROGRAM ON MEDICARE PART D DRUG PROGRAM PROVIDED BY JCH&L EMPLOYEES TRAINED AS SCHIIP VOLUNTEERS, AND AN ENROLLMENT DAY INCLUDING JCH&L EMPLOYEES AND OTHER SCHIIP VOLUNTEERS (200). JCH&L ALSO OFFERED PRENATAL CLASSES TO EXPECTANT PARENTS DURING THE YEAR (6). ESTIMATED NUMBER OF PEOPLE REACHED: 206. ESTIMATED COST OF PROGRAMS, FOOD, AND STAFF TIME: $4,000. III. MEDICAL EDUCATIONA. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS.PHYSICIAN/MEDICAL STUDENTS, NURSES/NURSING STUDENTS, TECHNICIANS AND OTHER HEALTH PROFESSIONALS. JCH&L WORKS WITH SOUTHEAST COMMUNITY COLLEGE IN BEATRICE AS A SITE FOR LPN PRACTICAL NURSING TRAINING. AN ESTIMATED 60 STUDENTS LEARNED IN OUR FACILITY IN 2018. NURSING STUDENTS UTILIZE MEETING ROOM SPACE AT JCH&L, AS WELL AS TAKE PART IN CLINICAL PRACTICE. MEDICAL STUDENTS COME REGULARLY FOR RURAL ROTATIONS TO LEARN FROM LOCAL PHYSICIANS. JCH&L PROVIDES AN APARTMENT FOR THE MEDICAL STUDENTS TO STAY IN DURING THEIR TIME IN FAIRBURY, AND ALSO PROVIDES THEM USE OF OUR FITNESS CENTER DURING THEIR STAY. FOUR MEDICAL STUDENTS UTILIZED OUR FACILITY IN 2018. JCH&L 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 2018. THE JCH&L AUXILIARY PROVIDES A SCHOLARSHIP FOR STUDENTS PURSUING AN EDUCATION IN MEDICAL FIELDS. THE $400 SCHOLARSHIP IS GIVEN FROM THE AUXILIARY'S FUNDS, AND THE NUMBER OF SCHOLARSHIPS GIVEN EACH YEAR IS BASED ON THE AUXILIARY'S FUNDING AVAILABILITY AND THE NUMBER OF REQUESTS. NO SCHOLARSHIPS WERE AWARDED IN 2018. ESTIMATED NUMBER REACHED: 65. JCH&L (APARTMENT RENT, STAFF TIME, ETC.): $4,600.B. OTHER: JOB SHADOWING- JCH&L 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. A TOTAL OF 16 STUDENTS PARTICIPATED IN SHADOWING OPPORTUNITIES IN FISCAL 2018. NUMBER REACHED: 16. ESTIMATED COST OF STAFF TIME: $1,600.VIDEOCONFERENCE- CONTINUED OFFERING VIDEOCONFERENCING CAPABILITIES, INCLUDING POSSIBLE PROGRAMS FOR PROFESSIONALS IN THE COMMUNITY. AVAILABILITY COSTS $100 PER MONTH. A TOTAL OF 48 EDUCATIONAL AND ADMINISTRATIVE PROGRAMS WERE OFFERED IN 2017. THIS INCLUDED A NUMBER OF OPPORTUNITIES FOR STAFF EDUCATION, MEETINGS, AND CLINICAL VISITS. ESTIMATED NUMBER REACHED: 65. COST FOR 2017: $1,200.IV. SUBSIDIZED HEALTH SERVICESWELLNESS CENTER SUPPORT. JEFFERSON COMMUNITY HEALTH & LIFE HAS OPERATED THE BURKLEY FITNESS CENTER AS A COMMUNITY FITNESS/WELLNESS CENTER SINCE IT OPENED IN 1996. JCH&L PAYS THE WELLNESS CENTER'S OPERATING EXPENSES THAT EXCEED REVENUES. BECAUSE OF THE HEALTH CENTER'S SUPPORT OF THE FITNESS CENTER'S CASH FLOW, PRICES FOR MEMBERSHIPS AND SERVICES CAN REMAIN REASONABLE FOR COMMUNITY RESIDENTS. IF THE FITNESS CENTER WERE A STAND-ALONE OPERATION, PRICES WOULD HAVE TO RISE CONSIDERABLY TO PAY ALL EXPENSES. NUMBER OF PERSONS SERVED: 1244 (MEMBERS AS OF FISCAL YEAR-END 2018.) ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $193,979 V. RESEARCH.NO RESEARCH DOLLARS EXPENDED.VI. CASH AND IN-KIND DONATIONS.A. CASH DONATIONS:JCH&L MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUTS, BOY SCOUTS, SOFTBALL, BASEBALL AND CHURCH CAMP FIRST AID KITS, SPONSORSHIP OF BASEBALL AND SOFTBALL TEAMS, GOLF TOURNAMENTS, AREA HIGH SCHOOL POST PROM ACTIVITIES, AREA COMMUNITY CELEBRATIONS, A LOCAL DANCE RECITAL, AN AREA RODEO, CHAMBER OF COMMERCE BANQUET, CHAMBER OF COMMERCE NEW TEACHER WELCOME, CHAMBER OF COMMERCE TEACHER RECOGNITION, LOANING OUT CPR MANNEQUINS, PLYMOUTH SPLASH PAD, 5 STAR BIBLE CAMP, AND DONATIONS TO RELAY FOR LIFE, TEAMMATES, GO RED FOR WOMEN, CATTLEMAN'S BALL, FAIRBURY HIGH SCHOOL GRAY OUT, ETC. JCH&L RECOGNIZED AREA WRESTLING PROGRAMS BY DONATING $1 FOR EACH PIN DURING THE WRESTLING SEASON. THESE TOTALED $6,119. JCH&L ALSO CONTRIBUTES ITEMS -- SUCH AS FITNESS CENTER PASSES, JCH&L ITEMS, ETC., TO COMMUNITY EVENTS AS DOOR PRIZES. THESE TOTALED AN ESTIMATED $500. DONATIONS DURING FISCAL 2018 TOTALED $6,619. PART I, LINE 7 (CONTINUED): B. IN-KIND DONATIONS:SAFE KIDS CHAPTER -JEFFERSON COMMUNITY HEALTH & LIFE IS A MEMBER OF THE SAFE KIDS COALITION. THREE JCH&L STAFF MEMBERS PARTICIPATE IN THE ORGANIZATION. THEY ARE JOINED BY A VARIETY OF OUTSIDE AGENCIES IN THE COMMUNITY WHO BELIEVE STRONGLY IN CHILDHOOD SAFETY. SAFE KIDS OFFERS SAFETY SEAT CHECK UP EVENTS AND OTHER SAFETY PROMOTIONS. ESTIMATED STAFF TIME: $800. BLOOD DRIVE SUPPORT - JCH&L 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 JCH&L'S SUPPLIER OF BLOOD AND BLOOD PRODUCTS. ESTIMATED STAFF TIME: $250.SAFETY DAY FOR KIDS. JCH&L WAS ONE OF THE CO-SPONSORS FOR THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 85 KIDS -- AGES KINDERGARTEN THROUGH SIXTH GRADES -- ATTENDED. STAFF MEMBERS ASSISTED IN PLANNING THE EVENT AND ASSISTED IN COORDINATING AND INSTRUCTING ON THE DAY OF THE CAMP. THE COST OF STAFF TIME DONATED IS ESTIMATED AT: $1,150. TOTAL COST OF SUPPLIES FURNISHED WAS $250. GO RED FOR WOMEN. JCH&L STAFF WERE A PART OF A LOCAL GO RED FOR WOMEN GROUP WHICH ORGANIZED THE ANNUAL GO RED FOR WOMEN FUND-RAISING EVENT FOR THE AMERICAN CANCER SOCIETY IN 2018. THE EVENT RAISED $16,000 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $500. NUMBER ATTENDING EVENT: 140.RELAY FOR LIFE JCH&L, GARDENSIDE AND CEDARWOOD HAVE A RELAY FOR LIFE TEAM. IN 2018, THIS TEAM RAISED $1,550 FOR THE AMERICAN CANCER SOCIETY. COST OF STAFF TIME DONATED IS ESTIMATED AT: $500. ESTIMATED NUMBER ATTENDING EVENT: 250 PART II, COMMUNITY BUILDING ACTIVITIES: JEFFERSON COMMUNITY HEALTH & LIFE IS ACTIVE IN LOCAL ECONOMIC DEVELOPMENT ACTIVITIES. JCH&L IS A MEMBER OF THE FAIRBURY CHAMBER OF COMMERCE. JCH&L SEEKS OPPORTUNITIES TO OFFER TOURS, HEALTH CARE INFORMATION ON COMMUNITY WEBSITES, ETC. COST OF CHAMBER MEMBERSHIP: $275. IN ADDITION TO THESE DIRECT PROGRAMS AND SERVICES, THE EMPLOYEES OF JEFFERSON COMMUNITY HEALTH & LIFE SERVE THEIR COMMUNITY IN MANY WAYS INCLUDING SERVING IN THEIR CHURCHES, AS GIRL AND BOY SCOUT LEADERS, AS 4-H LEADERS, FFA ALUMNI, AS LEADERS IN CIVIC ORGANIZATIONS, AS YOUTH GROUP LEADERS, AS CITY GOVERNMENT MEMBERS, ON COMMUNITY DEVELOPMENT BOARDS, FOR EMERGENCY RESPONSE ORGANIZATIONS AND OTHERS. JCH&L STAFF MEMBERS ARE A RESOURCE AS COMMUNITY ROLE MODELS.JCH&L IS PROUD OF ITS CONTRIBUTIONS TO THE CITIZENS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. THE CITIZENS OF THIS AREA ALSO HIGHLY REGARD JCH&L'S CONTRIBUTIONS TO THE COMMUNITY.THE GOAL OF THE JCH&L 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 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTYCOVERAGE, 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. PART III, LINE 3: AS PART OF OUR COMMUNITY NEEDS ASSESSMENT, WE GATHERED INFORMATION ON THE INCOME CHARACTERISTICS OF THE UNINSURED POPULATION. USING THAT DATA, WE ANALYZED WHAT PORTION OF UNINSURED INDIVIDUALS IN THE HOSPITAL'S SERVICE AREA WOULD BE ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. THIS PERCENTAGE WAS APPLIED TO THE TOTAL AMOUNT OF BAD DEBT FOR SELF-PAY PATIENTS TO ESTIMATE THE PORTION OF SELF-PAY BAD DEBT THAT WAS LIKELY ATTRIBUTABLE TO INDIVIDUALS ELIGIBLE FOR THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: JCH&L'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT EXPENSE. HOWEVER, PAGES 7 AND 8 OF THE ATTACHED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE, NET," "NET PATIENT SERVICE REVENUE AND "FINANCIAL ASSISTANCE/CHARITY CARE". PART III, LINE 8: THE HOSPITAL CALCULATED THE MEDICARE ALLOWABLE COSTS BY ADDING THE INPATIENT, SWING BED AND OUTPATIENT COSTS AS FOUND ON THE MEDICARE COST REPORT FOR SEPTEMBER 30, 2018. NO SHORTFALL IS TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: ONCE IT IS DETERMINED THAT A PATIENT MAY NOT HAVE THE MEANS TO PAY, AN ASSISTANCE APPLICATION IS PROVIDED. IN ADDITION, ALL ACCOUNTS THAT OUR SELF-PAY RECEIVABLE VENDOR DID NOT RECEIVE PAYMENT ON/AFTER 75 DAYS WILL BE RUN THROUGH A PRESUMPTIVE CHARITY CRITERIA PROCESS. THIS PROCESS ASSISTS IN THE DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY. JCH&L STAFF WILL APPLY THE RECOMMENDED PERCENTAGE DISCOUNT TO THE PATIENT'S ACCOUNT. PART VI, LINE 2: JCH&L ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY JCH&L SERVES IN SEVERAL WAYS. JCH&L UTILIZES SURVEYS BY PUBLIC HEALTH SOLUTIONS OF THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING COMMUNITY. JCH&L VISITS LOCAL COMMUNITY SERVICE ORGANIZATIONS AND SEEKS INPUT ON NEEDS. JCH&L CONDUCTED A COMMUNITY PERCEPTION SURVEY IN 2015, WHICH INCLUDES QUESTIONS ON COMMUNITY HEALTH NEEDS. JCH&L 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: JCH&L INFORMS AND EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE ON AN INDIVIDUAL BASIS WHEN QUESTIONS ARISE. THE PATIENT BOOKLET PROVIDES BUSINESS OFFICE CONTACT INFORMATION FOR PATIENT QUESTIONS ABOUT THEIR BILL. THE SELF-PAY BILLING VENDOR ENGAGED BY JCH&L HAS A SET OF CRITERIA IT USES TO ASSESS WHETHER A PATIENT IS ELIGIBLE FOR ASSISTANCE PROGRAMS, OR IF THEY QUALIFY FOR JCH&L'S CHARITY CARE PROGRAM. PART VI, LINE 4: JCH&L SERVES JEFFERSON COUNTY AND PARTS OF THAYER, FILLMORE, SALINE AND GAGE COUNTIES, ALL IN NEBRASKA; AND PARTS OF WASHINGTON AND MARSHALL COUNTIES IN KANSAS. THE POPULATION OF THE SERVICE AREA IS ESTIMATED AT ABOUT 18,000. REVENUE FROM MEDICARE PATIENTS AVERAGES APPROXIMATELY 50%, AND REVENUE FROM MEDICAID CLIENTS AVERAGES APPROXIMATELY 10%. PART VI, LINE 5: JCH&L 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. JCH&L PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING A COMMUNITY FITNESS 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 FITNESS CENTER WAS APPROXIMATELY $193,000. JCH&L 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.) JCH&L 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. JCH&L 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: JCH&L 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. JCH&L PARTNERS WITH MANY OTHER AREA ORGANIZATIONS, INCLUDING PUBLIC HEALTH SOLUTIONS, FARM SAFETY 4 JUST KIDS, NEBRASKA SAFE KIDS, JEFFERSON COUNTY EXTENSION, BLUE VALLEY COMMUNITY ACTION, FAIRBURY CHAMBER OF COMMERCE, FAIRBURY PUBLIC SCHOOLS, FAIRBURY CLINIC, NEBRASKA COMMUNITY BLOOD BANK, RURAL COMPREHENSIVE CARE NETWORK, BLUE RIVER VALLEY NETWORK, HEARTLAND HEALTH ALLIANCE, AND OTHERS. DEPENDING ON THE ACTIVITY, JCH&L MAY BE THE LEAD ORGANIZATION, OR AN ORGANIZATION PROVIDING HELP AND ASSISTANCE. PART VI, LINE 7: JCH&L DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATES. X 0 0 X X X X 0 0 0 1 0 0 0 1 0 CHAD JURGENS CEO 178582 0 0 0 0 0 9093 0 13946 0 201621 0 0 0 RICHARD BLATNY JR PHYSICIAN 281011 0 166294 0 0 0 23500 0 13946 0 484751 0 0 0 CRAIG SHUMARD PHYSICIAN 277976 0 112280 0 0 0 23500 0 13946 0 427702 0 0 0 RICHARD BLATNY SR PHYSICIAN 293854 0 84415 0 0 0 23500 0 2571 0 404340 0 0 0 TED TUCKER PHYSICIAN 242326 0 66061 0 0 0 21577 0 13946 0 343910 0 0 0 BRANDON BLEICH PHARMACIST 145063 0 0 0 0 0 589 0 13946 0 159598 0 0 0 PART I, LINE 1A JCHC PROVIDES DISCOUNTED OR FREE FITNESS CENTER MEMBERSHIPS TO ITS EMPLOYEES AND PHYSICIANS. PART I, LINE 5 PHYSICIANS RECEIVE INCENTIVE COMPENSATION BASED ON PHYSICIAN'S NET COLLECTIONS IN EXCESS OF THE MONTHLY THRESHOLDS SET PER CONTRACT. "NET COLLECTIONS" MEANS CASH ACTUALLY RECEIVED FROM PATIENTS OR THIRD PARTY PAYORS FOR PERSONALLY PERFORMED PROFESSIONAL SERVICES OF PHYSICIAN. NET COLLECTIONS SHALL BE ADJUSTED BY ANY REDUCTIONS FOR PATIENT ACCOUNT ADJUSTMENTS, RECOVERED OVERPAYMENTS, OFFSETS AND ANY FEES EXPENDED ON AMOUNTS RECOVERED THROUGH COLLECTION AGENCIES. NET COLLECTIONS SHALL NOT INCLUDE THE TECHNICAL FEES ASSOCIATED WITH ANY COLLECTIONS FOR LAB, X-RAY, ANCILLARY SERVICES, DESIGNATED HEALTH SERVICES UNDER STARK, ANY SERVICES NOT RENDERED PERSONALLY BY PHYSICIAN, OR THE TECHNICAL COMPONENT OF ANY OTHER SERVICES. WHEN A GLOBAL PAYMENT IS RECEIVED THAT INCLUDES PROFESSIONAL SERVICES AND ANY SUCH EXCLUDED SERVICES, HOSPITAL SHALL MAKE A REASONABLE ALLOCATION OF SUCH RECEIPT BETWEEN SUCH CATEGORIES. PART I, LINE 7 UPON COMPLETION OF EACH CONTRACT YEAR, THE HOSPITAL SHALL DETERMINE PHYSICIAN'S QUALIFICATION TO RECEIVE QUALITY INCENTIVE COMPENSATION BASED ON ANNUAL GOALS ESTABLISHED AT THE BEGINNING OF THE CONTRACT YEAR. IN ORDER TO QUALIFY TO RECEIVE QUALITY INCENTIVE COMPENSATION, PHYSICIAN SHALL REMAIN EMPLOYED IN GOOD STANDING AT THE END OF THE CONTRACT YEAR. THE QUALITY INCENTIVE COMPENSATION SHALL NOT EXCEED FIVE PERCENT (5%) OF BASE SALARY. A HOSPITAL AUTHORITY NO 1 OF JEFFERSON COUNTY NE 611683496 2012-12-18 5800000 CONSTRUCTION AND RENOVATION OF FACILITIES 0 0 0 A 981297 5800000 50001 5749999 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 1 A 1 PART IV, COLUMN A, LINE 2C: THE REBATE COMPUTATION WAS PERFORMED ON JANUARY 19, 2016. THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND AMOUNTS WERE DRAWN AS PROJECT COSTS WERE INCURRED. AS NO REBATABLE ARBITRAGE WAS EARNED AND THE DEBT SERVICE FUND WAS OPERATED ON A BONA FIDE BASIS, NO FURTHER REBATE ANALYSIS IS NECESSARY. CAROL BLOBAUM EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, SECRETARY/TREASURER 82901 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 6 JEFFERSON COMMUNITY HEALTH & LIFE 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 11B THE BOARD WILL REVIEW THE FORM 990 AT A REGULARLY SCHEDULED BOARD MEETING, WHICH DOES NOT NECESSARILY OCCUR PRIOR TO THE FILING OF FORM 990. FORM 990 IS REVIEWED BY MR. CHANCE KLASEK, CFO, PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED, BY THE ARTICLES AND BYLAWS, TO REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. A BOARD MEMBER WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING ON ANY MOTION FOR WHICH HE HAS A CONFLICT OF INTEREST. BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER AND WOULD BE AWARE OF ANY PERSONAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL PARTICIPATES IN THE NEBRASKA COMPDATA SALARY SURVEYS FOR ALL POSITIONS. THE CEO SURVEY DATA IS GIVEN TO THE BOARD TO REVIEW, AND THE BOARD APPROVES THE CEO'S SALARY ON AN ANNUAL BASIS. OTHER OFFICER COMPENSATION IS REVIEWED AND APPROVED BY THE CEO AND HR DIRECTOR. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 11, PART XI, LINE 2C: THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE FINANCE COMMITTEE. THERE HAVE BEEN NO CHANGES TO THIS PROCESS FROM THE PRIOR YEAR.