2015-04-03T15:11:47-05:00 2014-09-30 476097913 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2013-10-01 470468078 JEFFERSON COMMUNITY HEALTH CENTER INC JEFF 4027293351 2200 H STREET PO BOX 277 FAIRBURY NE 68352 CHANCE KLASEK CFO 4027293351 2015-04-03 1 BARBARA J FAJEN P00400874 4023302660 2013 2016-03-07 17:11:31Z CHANCE KLASEK 2200 H STREET PO BOX 277 FAIRBURY NE 68352 17265202 0 X HTTP://JCHC.US X 1960 NE JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME. 9 3 241 15 0 0 69131 122707 14958633 16849719 68301 80652 274965 112227 15371030 17165305 0 0 0 0 8194442 8435125 0 0 27942 7160145 7927061 15354587 16362186 16443 803119 18395033 24138736 2386539 7298657 16008494 16840079 JCHC WILL PROVIDE AN EXCEPTIONAL HEALTHCARE EXPERIENCE FOR EVERY PATIENT, EVERY TIME. 0 0 13539719 14465301 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. 1414336 2384418 JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 40 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. 14954055 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 6 0 1 241 1 0 0 0 0 0 0 0 0 0 0 X 9 3 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHANCE KLASEK 4027296856 2200 H STREET PO BOX 277 FAIRBURY NE 68352 DICK HOPPE CHAIRMAN 1.00 X X 0 0 0 BRIAN SCHEELE VICE CHAIRMAN 1.00 X X 0 0 0 DR CRAIG SHUMARD VICE CHAIRMAN (10/1/13 - 12/31/13) 1.00 X X 0 0 0 LYMON HAMM SECRETARY/TREASURER 1.00 X X 0 0 0 LINDA BAUER MEMBER (1/1/14 - PRESENT) 1.00 X 0 0 0 BRIAN BLOBAUM MEMBER (1/1/14 - PRESENT) 1.00 X 0 0 0 MARY GLENN MEMBER 1.00 X 0 0 0 JULIE KNIGGE MEMBER (10/1/13 - 12/31/13) 1.00 X 0 0 0 RYAN PARKER MEMBER (10/1/13 - 12/31/13) 1.00 X 0 0 0 MIKE STEELE MEMBER 1.00 X 0 0 0 DR TED TUCKER MEMBER (1/1/14 - PRESENT) 1.00 X 0 0 0 JACK WESCH MEMBER 1.00 X 0 0 0 CHAD JURGENS CEO 40.00 X 143712 0 22068 CHANCE KLASEK CFO 40.00 X 34240 0 5338 GARY MITCHELL DIRECTOR OF PHARMACY 40.00 X 142681 0 20825 DENNIS RUSSEL PHARMACIST 40.00 X 105038 0 19202 BILL WELCH FORMER CEO 0.00 X 112844 0 14758 538515 0 82191 3 1 1 0 BECKENHAUER CONSTRUCTION 1901 RIVERSIDE BLVD NORFOLK NE 68702 CONSTRUCTION 2580721 FAIRBURY CLINIC PC 825 22ND STREET FAIRBURY NE 68352 ER COVERAGE 601115 MEDHOST OF TENNESSEE 2739 MOMENTUM PLACE CHICAGO IL 60689 IT CONSULTING 430494 HUSKER REHAB 2320 N 6TH STREET BEATRICE NE 68310 THERAPY SERVICES 361942 SOUTHEAST ANESTHESIA SERVICES 8426 W BIRCH CLATONIA NE 68328 CRNA SERVICES 360000 11 122707 20468 122707 MEDICARE/MEDICAID PAYMENTS 624100 8951268 8951268 PATIENT SERVICE REVENUE 624100 7253720 7253720 CEDARWOOD ASSISTED LIVING FEES 623000 413940 413940 EHR INCENTIVE PAYMENTS 624100 165634 165634 GAIN ON EQUITY IN JOINT VENTURE 623000 52362 52362 12795 12795 16849719 78936 78936 101613 99897 1716 1716 1716 CAFETERIA 722210 112227 112227 112227 17165305 16849719 0 192879 X 205359 205359 266522 266522 6466455 5977247 472862 16346 214766 201235 13531 786793 730831 55962 495230 451249 42914 1067 6178 6178 44000 44000 15051 15051 1881771 1724196 157094 481 60361 58313 1478 570 1262275 1065534 194189 2552 7330 7330 351413 319699 31714 33250 26976 6274 51869 44871 6998 3044 3044 1273355 1273355 87847 87847 MEDICAL SUPPLIES 2022368 2022368 BAD DEBTS EXPENSE 373584 373584 FOOD EXPENSE 370865 370865 DUES AND SUBSCRIPTIONS 61237 22534 38703 21263 14302 35 6926 16362186 14954055 1380189 27942 3758444 450 0 5265213 2175713 2106663 287419 347415 160644 95038 23314963 10232670 9531619 13082293 2054053 2769345 220317 272679 206824 199640 18395033 24138736 2001762 1912338 0 4209501 384777 265720 0 911098 2386539 7298657 X 15871588 16704973 86152 84352 50754 50754 16008494 16840079 18395033 24138736 803119 28466 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1572 1572 0 PART II-B, LINE 1: JCHC PAID DUES TO THE NEBRASKA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 50754 50754 50754 50754 50754 50754 50754 50754 50754 250 250 50754 0.00000 1.00000 0.00000 0 0 13943 13943 16047936 6113071 9934865 6072995 4044118 2028877 1180089 75481 1104608 13082293 ESTIMATED THIRD-PARTY PAYOR SETTLEMENT 911098 911098 X 16805136 28466 28466 16776670 15051 373584 388635 17165305 15973551 0 15973551 15051 373584 388635 16362186 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, 2014, 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, 2011. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 373,584. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 373,584. 1 1 1 X 1 X 1 1 1 0 1 1 77099 0 77099 0.00480 1470211 1661596 -191385 0.00000 1547310 1661596 -114286 0.00480 12945 0 12945 0.00080 8450 0 8450 0.00050 448690 211398 237292 0.01480 6213 0 6213 0.00040 476298 211398 264900 0.01650 2023608 1872994 150614 0.02130 1 373584 50000 6553096 6488213 64883 X 1 1 1 1 JEFFERSON COMMUNITY HEALTH CENTER 2200 H STREET FAIRBURY NE 68352 HTTP://JCHC.US 440001 X X X X JEFFERSON COMMUNITY HEALTH CENTER INC 1 1 X X X X X X X X 12 1 0 1 X HTTP://JCHC.US X X X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 JEFFERSON COMMUNITY HEALTH CENTER, INC. 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 (JCHC) BEGAN ITS HEALTH NEEDS ASSESSMENT IN DECEMBER 2012. JCHC WORKED WITH PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT, REVIEWED INTERVIEWS CONDUCTED BY PUBLIC HEALTH SOLUTIONS, CONDUCTED INTERVIEWS WITH LOCAL ORGANIZATIONS, CONDUCTED INTERVIEWS WITH JCHC STAFF AND REVIEWED STATISTICS MADE AVAILABLE THROUGH PUBLIC HEALTH SOLUTIONS AND THE STATE OF NEBRASKA. MEETINGS WERE CONDUCTED WITH LOCAL COMMUNITY ORGANIZATIONS INCLUDING KIWANIS, ROTARY, AGRICULTURE REPRESENTATIVES AND SENIOR DINERS. A TOTAL OF 83 ATTENDED AND PARTICIPATED. IN ADDITION, MEETINGS WERE HELD WITH JEFFERSON COMMUNITY HEALTH CENTER STAFF WHO ALSO REPRESENT THE AREA IN WHICH THEY LIVE. A TOTAL OF 71 JCHC STAFF MEMBERS PARTICIPATED.PUBLIC HEALTH SOLUTIONS DISTRICT HEALTH DEPARTMENT CONDUCTED ITS COMMUNITY HEALTH IMPROVEMENT PLAN STUDY OF A FIVE COUNTY AREA WITH THE ASSISTANCE OF LANE GEWECKE CONSULTING IN NOVEMBER 2012. JEFFERSON COMMUNITY HEALTH CENTER, INC. PART V, SECTION B, LINE 7: THERE WERE NEEDS IDENTIFIED THAT JCHC DID NOT ADDRESS. WHILE THESE NEEDS ARE IMPORTANT TO THE COMMUNITY, THEY WERE NOT CHOSEN BASED ON THE PRIORITIZATION PROCESS. THESE NEEDS INCLUDE: ALZHEIMER'S DISEASE, UNINTENTIONAL INJURIES, HEALTH CARE PROVIDER COVERAGE WHEN EXISTING PHYSICIANS RETIRE, FUTURE OF HEALTH CARE, WEAKENING FAMILY STRUCTURE/PARENTING, LACK OF DOCTORS/HEALTH CARE, DRUG/ALCOHOL USE AND THE AGING POPULATION. 1 GARDENSIDE 200 H STREET FAIRBURY NE 68352 LONG TERM CARE FACILITY PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. PART I, LINE 6A: JEFFERSON COMMUNITY HEALTH CENTER PREPARES ITS OWN COMMUNITY BENEFIT REPORT. PART I, LINE 7: THE HOSPITAL USED THE WORKSHEETS PROVIDED IN THE FORM 990 INSTRUCTIONS TO HELP CALCULATE THE FINANCIAL ASSISTANCE AND CERTAIN OTHER COMMUNITY BENEFITS AT COST. PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $373,584. PART I, LINE 7: JCHC REACHED OUT TO THE COMMUNITY IN A VARIETY OF WAYS IN FISCAL YEAR 2014, INCLUDING:I. BENEFITS FOR THE POOR/PUBLIC PROGRAMS A. TRADITIONAL CHARITY CARE CHARITY CARE - JCHC PROVIDED CHARITY CARE IN FISCAL 2014 TO THOSE WHO MEET THE FEDERAL POVERTY GUIDELINES. THE BUSINESS OFFICE STAFF MEMBERS FILE INSURANCE CLAIMS FOR PATIENTS.PATIENTS ASSISTED: 120. VALUE: $127,264. B. UNPAID COSTS OF PUBLIC PROGRAMS. MEDICAID SHORTFALL - SHORTFALL BASED ON COSTS: 0. C. BAD DEBT. BESIDES OFFICIAL CHARITY CARE, JCHC WROTE OFF $373,584 IN BAD DEBT DURING FISCAL 2014. II. COMMUNITY BENEFIT SERVICESA.COMMUNITY HEALTH EDUCATION AND OUTREACH.CHILD SAFETY SEAT PROGRAM - JCHC IS A PART OF A CHILD SAFETY SEAT COALITION AND HOLDS CHILD SAFETY SEAT CHECK UP EVENTS DURING THE YEAR, AS WELL AS OFFERS INDIVIDUAL INSTRUCTION IN PROPER USE OF SEATS. A TOTAL OF 46 SEATS WERE CHECKED AT CHECK-UP EVENTS OR INDIVIDUAL APPOINTMENTS. GRANTS ARE RECEIVED TO PURCHASE SEATS TO HAVE AVAILABLE, BUT STAFF TIME IS DONATED BY JEFFERSON COMMUNITY HEALTH CENTER. ESTIMATED VALUE OF STAFF TIME: $925.HEALTH FAIR - JCHC PROVIDES EDUCATIONAL BOOTHS, FREE HEALTH SCREENINGS, HANDOUTS, INFORMATION, ETC. AT THE JEFFERSON COUNTY SPRING EXPO AND THE JEFFERSON COUNTY FAIR. AN ESTIMATED 700+ TOOK PART IN OFFERINGS FROM JCHC AT THESE EVENTS. FOR 2014, THE COST OF BOOTHS, GIVEAWAYS, STAFF TIME, ETC. ARE ESTIMATED AT $2,500. ESTIMATED NUMBER REACHED: 700.SPEAKERS BUREAU - JCHC STAFF MEMBERS PROVIDE EDUCATIONAL PROGRAMS FOR COMMUNITY ORGANIZATIONS ON A VARIETY OF TOPICS. A TOTAL OF 26 PROGRAMS WERE PRESENTED IN FISCAL 2014. TOTAL INDIVIDUALS REACHED: 1150. ESTIMATED COST OF STAFF TIME: $800.SUPPORT GROUPS - IN 2014, JCHC COORDINATED A PARKINSON'S SUPPORT GROUP AND ALZHEIMER'S CAREGIVERS SUPPORT GROUP. JCHC STAFF MEMBERS COORDINATED MEETINGS OF THESE SUPPORT GROUPS, AND OFFERED ASSISTANCE TO ANYONE INTERESTED IN MORE INFORMATION ABOUT THE DISEASES. THE PARKINSON'S SUPPORT GROUP MEETS MONTHLY. TOTAL ATTENDANCE DURING FISCAL 2014 WAS 40. A SUPPORT GROUP FOR CAREGIVERS OF ALZHEIMER'S PATIENTS MEETS MONTHLY AND HAD ATTENDANCE OF 28 THROUGHOUT THE YEAR. JCHC PROVIDES EDUCATIONAL PROGRAMS FOR EACH OF THESE GROUPS -- INCLUDING SPEAKER'S FEES OR VIDEO TAPE RENTAL FEES, POSTAGE TO SEND OUT MEETING NOTICES, AND REFRESHMENTS. TOTAL NUMBER REACHED: 68. APPROXIMATE COST OF STAFF TIME SPENT: $1,000. ESTIMATED COST OF POSTAGE: $325. ESTIMATED OTHER COSTS (MATERIALS, SPEAKER FEES): $100. HEALTH PROMOTION PROGRAMS. JCHC OFFERS SMOKING CESSATION INFORMATION TO PATIENTS AND THE PUBLIC. EACH INPATIENT WHO IS A SMOKER IS PROVIDED INFORMATION ON SMOKING CESSATION. ESTIMATED NUMBER REACHED: 93; ESTIMATED COST OF PROMOTIONAL MATERIALS PROVIDED: $475. B. COMMUNITY-BASED CLINICAL SERVICES SCREENINGS AND ONE-TIME OR OCCASIONALLY HELD CLINICS. COMPLETE BLOOD PROFILES - COMPLETE BLOOD PROFILES WERE OFFERED IN THE SPRING AT A REDUCED RATE. A TOTAL OF 50 BLOOD PROFILES WERE OFFERED. PARTICIPANTS PAID $45, WHICH IS A FRACTION OF THE ESTIMATED VALUE OF THE TESTING. ESTIMATED STAFF TIME: $1,200. IMMUNIZATION CLINICS. JCHC COOPERATES WITH BLUE VALLEY COMMUNITY ACTION AND PUBLIC HEALTH SOLUTIONS IN PROVIDING AN IMMUNIZATION CLINIC FOR CHILDREN TWICE EACH MONTH. JCHC PROVIDES SPACE WHERE IMMUNIZATIONS ARE GIVEN, NURSING STAFF, PATIENT WAITING AREAS, JANITORIAL AND SUPPORT SERVICES, AND STORAGE OF VACCINES IN OUR PHARMACY. NUMBER OF CHILDREN SERVED: 203 BY BLUE VALLEY COMMUNITY ACTION. TOTAL OF 686 VACCINATIONS PROVIDED (375 PUBLIC, 311 PRIVATE.) ESTIMATED COST OF NURSES PROVIDED BY JCHC TO GIVE SHOTS: $1,620. TOTAL CHILDREN IMMUNIZED: 203. C. HEALTH CARE SUPPORT SERVICESENROLLMENT ASSISTANCE IN PUBLIC PROGRAMS - JCHC OFFERED A COMMUNITY EDUCATION EVENT ON THE MEDICARE PART D DRUG PROGRAM. THE PROGRAM WAS PROVIDED BY JCHC EMPLOYEES TRAINED AS SHIIP VOLUNTEERS (250). JCHC ALSO OFFERED PRENATAL CLASSES (10). ESTIMATED NUMBER OF PEOPLE REACHED: 260. ESTIMATED COST OF PROGRAMS, FOOD, AND STAFF TIME: $4,000. III. MEDICAL EDUCATION A. SCHOLARSHIP FUNDING FOR HEALTH PROFESSIONS. SCHOLARSHIPS ARE PROVIDED FOR 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 2014. 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 LODGING FOR THE MEDICAL STUDENTS DURING THEIR TIME IN FAIRBURY, AND ALSO PROVIDES THE STUDENTS USE OF THE WELLNESS CENTER DURING THEIR STAY. FIVE MEDICAL STUDENTS UTILIZED OUR FACILITY IN 2014. JCHC OFFERS THE LILLIAN HANSEN REESMAN RN MEMORIAL NURSES SCHOLARSHIP 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 2014. THE JCHC AUXILIARY PROVIDES A SCHOLARSHIP FOR A STUDENT PURSUING AN EDUCATION IN A MEDICAL FIELD. 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 2014. ESTIMATED NUMBER REACHED: 66. JCHC COST (APARTMENT RENT, STAFF TIME, ETC.): $4,600. B. OTHER JOB SHADOWING. JCHC HOSTS JOB SHADOW STUDENTS FROM FAIRBURY HIGH SCHOOL'S ANATOMY AND PHYSIOLOGY CLASSES, 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 FOR OTHER INTERESTED INDIVIDUALS. A TOTAL OF 34 STUDENTS PARTICIPATED IN SHADOWING OPPORTUNITIES IN FISCAL 2014. NUMBER REACHED: 34. ESTIMATED COST OF STAFF TIME: $2,650. VIDEOCONFERENCE. CONTINUED OFFERING VIDEOCONFERENCING CAPABILITIES, INCLUDING POSSIBLE PROGRAMS FOR PROFESSIONALS IN THE COMMUNITY. AVAILABILITY COSTS $100 PER MONTH. A TOTAL OF 56 EDUCATIONAL AND ADMINISTRATIVE PROGRAMS WERE OFFERED IN 2014. THIS INCLUDED A NUMBER OF OPPORTUNITIES FOR STAFF AND COMMUNITY EDUCATION, MEETINGS, AND CLINICAL VISITS. ESTIMATED NUMBER REACHED: 80. COST FOR 2014: $1,200.IV. SUBDIZED HEALTH SERVICES WELLNESS CENTER SUPPORT. JEFFERSON COMMUNITY HEALTH CENTER HAS OPERATED THE BOB AND WAUNETA BURKLEY WELLNESS CENTER AS A COMMUNITY WELLNESS CENTER SINCE IT OPENED IN 1996. JCHC PAYS THE WELLNESS CENTER'S OPERATING EXPENSES THAT EXCEED REVENUES. BECAUSE OF THE HEALTH CENTER'S SUPPORT OF THE WELLNESS CENTER'S CASH FLOW, PRICES FOR MEMBERSHIPS AND SERVICES CAN REMAIN REASONABLE FOR COMMUNITY RESIDENTS. IF THE WELLNESS CENTER WERE A STAND-ALONE OPERATION, PRICES WOULD HAVE TO RISE CONSIDERABLY TO PAY ALL EXPENSES. NUMBER OF PERSONS SERVED: 1,116 (MEMBERS AS OF FISCAL YEAR-END 2013.) ESTIMATED AMOUNT OF WELLNESS CENTER SUPPORT: $237,000. V. RESEARCH. NO RESEARCH DOLLARS EXPENDED.VI. CASH AND IN-KIND DONATIONS.A. CASH DONATIONS. JCHC MAKES DONATIONS TO VARIOUS CHARITABLE CAUSES, INCLUDING GIRL SCOUT AND BOY SCOUT FIRST AID KITS, FREE LOAN OF HOME BILLIRUBEN BLANKET, SPONSORSHIP OF BASEBALL AND SOFTBALL TEAMS, 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. THESE TOTALED $574. JCHC ALSO CONTRIBUTES ITEMS -- SUCH AS MATTRESS COVERS TO CAMP JEFFERSON ($297), WELLNESS CENTER PASSES, JCHC GLASSES AND DUFFLE BAGS, ETC., TO COMMUNITY EVENTS AS DOOR PRIZES. THESE TOTALED AN ESTIMATED $450. USE OF A BILIBLANKET WAS DONATED FOR NEWBORNS WITH JAUNDICE FOR 4 FAMILIES FOR 28 DAYS OF IN-KIND USE, FOR A VALUE OF $3,080. DONATIONS DURING FISCAL 2014 TOTALED $4,400. B. IN-KIND DONATIONS. WALK TO END ALZHEIMER'S - JEFFERSON COMMUNITY HEALTH CENTER SUPPORTS THE ANNUAL WALK TO END ALZHEIMER'S BY PROVIDING STAFF TIME AND POSTAGE TO SEND OUT SPONSORSHIP LETTERS AND NEWS RELEASES PROMOTING THE EVENT, STAFF TIME TO ASSIST IN PLANNING THE EVENT, AND STAFF TIME THE DAY OF THE EVENT. A TOTAL OF 35 WALKERS PARTICIPATED AND THE EVENT RAISED $4,800 FOR THE ALZHEIMER'S ASSOCIATION. ESTIMATED POSTAGE: $22. ESTIMATED STAFF TIME: $240.SAFE KIDS CHAPTER -JEFFERSON COMMUNITY HEALTH CENTER IS A MEMBER OF THE SAFE KIDS COALITION. THREE JCHC STAFF MEMBERS PARTICIPATE IN THE ORGANIZATION. THEY ARE JOINED BY A VARIETY OF OUTSIDE AGENCIES IN THE COMMUNITY WHO BELIEVE STRONGLY IN CHILDHOOD SAFETY. IN ADDITION TO SAFETY SEAT CHECK UP EVENTS, OTHER SAFETY PROMOTIONS WERE OFFERED. ESTIMATED STAFF TIME: $1,200. PART I, LINE 7 (CONTINUED): BLOOD DRIVE SUPPORT - JCHC ASSISTS NEBRASKA COMMUNITY BLOOD BANK BY SCHEDULING APPOINTMENTS FOR SIX BLOOD DRIVES EACH YEAR. THE BLOOD PRODUCTS ULTIMATELY HELP OUR COMMUNITY, AS NEBRASKA COMMUNITY BLOOD BANK IS JCHC'S SUPPLIER OF BLOOD AND BLOOD PRODUCTS. ESTIMATED STAFF TIME: $100.SAFETY DAY FOR KIDS. JCHC WAS ONE OF THE CO-SPONSORS FOR THE ANNUAL SAFETY DAY FOR KIDS IN JEFFERSON COUNTY. A TOTAL OF 98 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. PART II, COMMUNITY BUILDING ACTIVITIES: JEFFERSON COMMUNITY HEALTH CENTER IS ACTIVE IN LOCAL ECONOMIC DEVELOPMENT ACTIVITIES. JCHC IS A MEMBER OF THE FAIRBURY CHAMBER OF COMMERCE. JCHC SEEKS OPPORTUNITIES TO OFFER TOURS, HEALTH CARE INFORMATION ON COMMUNITY WEBSITES, ETC. IN ADDITION TO THESE DIRECT PROGRAMS AND SERVICES, THE EMPLOYEES OF JEFFERSON COMMUNITY HEALTH CENTER SERVE THEIR COMMUNITY IN MANY WAYS INCLUDING SERVING IN THEIR CHURCHES AS GIRL AND BOY SCOUT LEADERS, AS 4-H LEADERS, AS LEADERS IN CIVIC ORGANIZATIONS, AS YOUTH GROUP LEADERS, AS CITY GOVERNMENT MEMBERS, ON COMMUNITY DEVELOPMENT BOARDS, FOR EMERGENCY RESPONSE ORGANIZATIONS AND OTHERS. JCHC STAFF MEMBERS ARE A RESOURCE AS COMMUNITY ROLE MODELS.JCHC IS PROUD OF ITS CONTRIBUTIONS TO THE CITIZENS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. THE CITIZENS OF THIS AREA ALSO HIGHLY REGARD JCHC'S CONTRIBUTIONS TO THE COMMUNITY.THE GOAL OF THE JCHC BOARD OF DIRECTORS, ADMINISTRATION AND STAFF IS TO EXPAND THAT PARTNERSHIP WITH AREA RESIDENTS AND FIND MORE WAYS TO SERVE AS A RESOURCE FOR HEALTH AND WELLNESS INFORMATION. PART III, LINE 2: 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. PART III, LINE 3: 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 AMOUNT REPORTED ON LINE 3 WAS DETERMINED USING PAST EXPERIENCE BY THE EXECUTIVE STAFF OF JEFFERSON COMMUNITY HEALTH CENTER. PART III, LINE 4: 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," "NET PATIENT SERVICE REVENUE" 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.NET PATIENT SERVICE REVENUE:THE HEALTH CENTER HAS AGREEMENTS WITH THIRD-PARTY PAYORS THAT PROVIDE FOR PAYMENTS TO THE HEALTH CENTER AT AMOUNTS DIFFERENT FROM ITS ESTABLISHED RATES. PAYMENT ARRANGEMENTS INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS AS FINAL SETTLEMENTS ARE DETERMINED.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. 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, 2014. NO SHORTFALL IS TREATED AS COMMUNITY BENEFIT. PART III, LINE 9B: ONCE IT IS DETERMINED THAT A PATIENT MAY NOT HAVE THE MEANS TO PAY, AN ASSISTANCE APPLICATION IS PROVIDED. IN ADDITION, ALL ACCOUNTS THAT OUR SELF-PAY RECEIVABLE VENDOR DID NOT RECEIVE PAYMENT ON AFTER 75 DAYS WILL BE RUN THROUGH A PRESUMPTIVE CHARITY CRITERIA PROCESS. THIS PROCESS ASSISTS IN THE DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY. JCHC STAFF WILL APPLY THE RECOMMENDED PERCENTAGE DISCOUNT TO THE PATIENT'S ACCOUNT. PART VI, LINE 2: JCHC ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY JCHC SERVES IN SEVERAL WAYS. JCHC UTILIZES SURVEYS BY PUBLIC HEALTH SOLUTIONS OF THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING COMMUNITY. JCHC VISITS LOCAL COMMUNITY SERVICE ORGANIZATIONS AND SEEKS INPUT ON NEEDS. JCHC CONDUCTED A COMMUNITY PERCEPTION SURVEY IN 2006, WHICH INCLUDES QUESTIONS ON COMMUNITY HEALTH NEEDS. JCHC REVIEWS SURVEYS DONE BY THE STATE AND OTHER ORGANIZATIONS ON THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. PART VI, LINE 3: JCHC INFORMS AND EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE ON AN INDIVIDUAL BASIS WHEN QUESTIONS ARISE. THE PATIENT BOOKLET PROVIDES BUSINESS OFFICE CONTACT INFORMATION FOR PATIENT QUESTIONS ABOUT THEIR BILL. THE SELF-PAY BILLING VENDOR ENGAGED BY JCHC HAS A SET OF CRITERIA IT USES TO ASSESS WHETHER A PATIENT IS ELIGIBLE FOR ASSISTANCE PROGRAMS, OR IF THEY QUALIFY FOR JCHC'S CHARITY CARE PROGRAM. PART VI, LINE 4: JCHC SERVES JEFFERSON COUNTY AND PARTS OF THAYER, FILLMORE, SALINE AND GAGE COUNTIES, ALL IN NEBRASKA; AND PARTS OF WASHINGTON AND MARSHALL COUNTIES IN KANSAS. THE POPULATION OF THE SERVICE AREA IS ESTIMATED AT ABOUT 18,000. REVENUE FROM MEDICARE PATIENTS AVERAGES APPROXIMATELY 50%, AND REVENUE FROM MEDICAID CLIENTS AVERAGES APPROXIMATELY 10%. PART VI, LINE 5: JCHC OPERATES IN JEFFERSON COUNTY WITH A COMMUNITY BOARD AND OPEN MEDICAL STAFF. ALL SURPLUS FUNDS ARE REINVESTED BACK INTO THE FACILITY THROUGH BUILDING CONSTRUCTION, EQUIPMENT PURCHASES, OR COMMUNITY PROGRAMS PROVIDED. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING A COMMUNITY WELLNESS CENTER AT A REASONABLE RATE AND OFFERING SCHOLARSHIPS FOR THE COMMUNITY'S YOUTH WHO HAVE FINANCIAL NEED. THE NET COMMUNITY BENEFIT REPORTED IN PART I RELATING TO THE WELLNESS CENTER WAS $237,000. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY PROMOTING COMMUNITY-WIDE PROGRAMS SUCH AS LIVE HEALTHY NEBRASKA AND STEP-2-IT (PROGRAMS WHICH ENCOURAGE INCREASING ACTIVITY AND LOSING WEIGHT.) JCHC IS ALSO INVOLVED IN CAR SAFETY SEAT CHECKS, PROGRESSIVE AG SAFETY DAY, AND WORKING WITH BLUE VALLEY COMMUNITY ACTION TO OFFER IMMUNIZATIONS TO AREA CHILDREN. JCHC PROMOTES THE HEALTH OF THE COMMUNITY BY OFFERING PROGRAMS, TOURS, SPEAKERS, AND EDUCATION, INCLUDING SUPPORT GROUPS, EDUCATIONAL PROGRAMS AND PROGRAMS FOR LOCAL ORGANIZATIONS. PART VI, LINE 6: JCHC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM BUT DOES WORK TO BE A LEADER IN PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. JCHC PARTNERS WITH MANY OTHER AREA ORGANIZATIONS, INCLUDING PUBLIC HEALTH SOLUTIONS, FARM SAFETY 4 JUST KIDS, NEBRASKA SAFE KIDS, JEFFERSON COUNTY EXTENSION, BLUE VALLEY COMMUNITY ACTION, FAIRBURY CHAMBER OF COMMERCE, FAIRBURY PUBLIC SCHOOLS, FAIRBURY CLINIC, NEBRASKA COMMUNITY BLOOD BANK, RURAL COMPREHENSIVE CARE NETWORK, BLUE RIVER VALLEY NETWORK, HEARTLAND HEALTH ALLIANCE, AND OTHERS. DEPENDING ON THE ACTIVITY, JCHC MAY BE THE LEAD ORGANIZATION, OR AN ORGANIZATION PROVIDING HELP AND ASSISTANCE. PART VI, LINE 7: JCHC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATES. X 0 0 X X X X 0 0 0 0 0 0 0 0 0 CHAD JURGENS CEO 143674 0 0 0 38 0 7390 0 14678 0 165780 0 0 0 GARY MITCHELL DIRECTOR OF PHARMACY 142656 0 0 0 25 0 7383 0 13442 0 163506 0 0 0 BILL WELCH FORMER CEO 112822 0 0 0 22 0 5711 0 9047 0 127602 0 0 0 PART I, LINE 1A JCHC PROVIDES DISCOUNTED OR FREE WELLNESS CENTER MEMBERSHIPS TO ITS EMPLOYEES AND PHYSICIANS. A HOSPITAL AUTHORITY NO 1 OF JEFFERSON COUNTY NE 611683496 2012-12-18 5800000 CONSTRUCTION AND RENOVATION OF FACILITIES 0 0 0 A 4005373 50001 3995372 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 1 A 1 PART II, COLUMN A, LINE 3: THE TOTAL PROCEEDS DO NOT AGREE TO THE ISSUE PRICE IN PART I, COLUMN (E) AS THIS DEBT WAS ISSUED ON A DRAW-DOWN BASIS AND THE TOTAL PRINCIPAL AVAILABLE HAS NOT YET BEEN DRAWN. FAIRBURY CLINIC PC DR. CRAIG SHUMARD, BOARD MEMBER, OWNS MORE THAN 5% OF FAIRBURY CLINIC P.C. 601115 FAIRBURY CLINIC P.C. PROVIDED EMERGENCY ROOM COVERAGE SERVICES TO JEFFERSON COMMUNITY HEALTH CENTER. 0 MARY HOPPE EMPLOYEE OF THE HOSPITAL AND SPOUSE OF DICK HOPPE, CHAIRMAN OF THE BOARD 85596 EMPLOYEE'S W-2 WAGES 0 STACY SHUMARD EMPLOYEE OF THE HOSPITAL AND SPOUSE OF DR. CRAIG SHUMARD, BOARD MEMBER 42153 EMPLOYEE'S W-2 WAGES 0 CAROL BLOBAUM EMPLOYEE OF THE HOSPITAL AND SPOUSE OF BRIAN BLOBAUM, BOARD MEMBER 72957 EMPLOYEE'S W-2 WAGES 0 JANET STEELE EMPLOYEE OF THE HOSPITAL AND SPOUSE OF MIKE STEELE, BOARD MEMBER 35541 EMPLOYEE'S W-2 WAGES 0 JACQUELINE WESCH EMPLOYEE OF THE HOSPITAL AND SPOUSE OF JACK WESCH, BOARD MEMBER 30275 EMPLOYEE'S W-2 WAGES 0 FAIRBURY CLINIC PC DR. TED TUCKER, BOARD MEMBER, OWNS MORE THAN 5% OF FAIRBURY CLINIC P.C. 601115 FAIRBURY CLINIC P.C. PROVIDED EMERGENCY ROOM COVERAGE SERVICES TO JEFFERSON COMMUNITY HEALTH CENTER. 0 FORM 990, PART VI, SECTION A, LINE 6 JEFFERSON COMMUNITY HEALTH CENTER HAS MEMBERS. ANY PERSON, CORPORATION OR OTHER ENTITY MAY BECOME A LIFETIME MEMBER IF A CONTRIBUTION OF $100 OR MORE IS MADE TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A VACANCIES, OCCURRING ON THE BOARD BY EXPIRATION, SHALL BE FILLED THROUGH ELECTION BY THE MEMBERS AT THE ANNUAL MEETING OF THE MEMBERS. THE BOARD DEVELOPMENT COMMITTEE SHALL SUBMIT A SLATE OF PROSPECTIVE CANDIDATES TO THE BOARD OF DIRECTORS AT THEIR MEETING PRIOR TO THE ANNUAL MEETING WHICH WILL THEN BE PRESENTED AT THE ANNUAL MEETING FOR CONSIDERATION FOR ELECTION TO THE BOARD. IN ADDITION, MEMBERS OF THE CORPORATION MAY MAKE NOMINATIONS FROM THE FLOOR. FORM 990, PART VI, SECTION A, LINE 7B EACH MEMBER SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO THE VOTE OF THE MEMBERS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED AT THE REGULAR BOARD MEETING PRIOR TO SUBMISSION TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE REQUIRED, BY THE ARTICLES AND BYLAWS, TO REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. A BOARD MEMBER WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING ON ANY MOTION FOR WHICH HE HAS A CONFLICT OF INTEREST. BOARD MEMBERS ARE WELL ACQUAINTED WITH EACH OTHER AND WOULD BE AWARE OF ANY PERSONAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL PARTICIPATES IN THE NEBRASKA COMPDATA SALARY SURVEYS FOR ALL POSITIONS. THE CEO SURVEY DATA IS GIVEN TO THE BOARD TO REVIEW, AND THE BOARD APPROVES THE CEO'S SALARY ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,636,657. MANAGEMENT AND GENERAL EXPENSES 148,254. FUNDRAISING EXPENSES 481. TOTAL EXPENSES 1,785,392. FEES FOR SERVICE: PROGRAM SERVICE EXPENSES 44,167. MANAGEMENT AND GENERAL EXPENSES 2,110. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 46,277. MAINTENANCE CONTRACTS: PROGRAM SERVICE EXPENSES 43,372. MANAGEMENT AND GENERAL EXPENSES 6,730. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,102. 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.