JEFFERSON COMMUNITY HEALTH CENTER INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- JEFFERSON COMMUNITY HEALTH CENTER INC (EIN 47-0468078)
- Tax period
- 2010-10-01 to 2011-09-30
- Filed
- 2012-06-06
- IRS object ID
- 201221589349300022
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-06-06T13:26:39-05:00 | Timestamp |
| Tax Period End Date | 2011-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470468078 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFERSON COMMUNITY HEALTH CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JEFF | NameControl |
| Phone | 4027293351 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 H STREET PO BOX 277 | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | CHAD JURGENS CFO | Name |
| Title | CFO | Title |
| Phone | 4027293351 | Phone |
| Date Signed | 2012-05-31 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JULIE M GERKEN | Name |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | CHAD JURGENS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 H STREET PO BOX 277 | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 19150431 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.JCHCHEALTHCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1960 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | JCHC IS DEVOTED TO PROVIDING APPROPRIATE QUALITY HEALTH SERVICES IN A CARING ENVIRONMENT. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 215 | TotalNbrEmployees |
| Total Nbr Volunteers | 15 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 526817 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 81501 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 14993388 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 16036870 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 71276 | InvestmentIncomePriorYear |
| Investment Income Current Year | 109898 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 101622 | OtherRevenuePriorYear |
| Other Revenue Current Year | 101832 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 15693103 | TotalRevenuePriorYear |
| Total Revenue Current Year | 16330101 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 7394406 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7607171 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 38127 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7442021 | OtherExpensePriorYear |
| Other Expenses Current Year | 8025900 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 14836427 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15633071 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 856676 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 697030 | RevenuesLessExpensesCY |
| Total Assets BOY | 16259616 | TotalAssetsBOY |
| Total Assets EOY | 16605300 | TotalAssetsEOY |
| Total Liabilities BOY | 2029432 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1732278 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14230184 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 14873022 | NetAssetsOrFundBalancesEOY |
| Mission Description | JCHC IS DEVOTED TO PROVIDING APPROPRIATE QUALITY HEALTH SERVICES IN A CARING ENVIRONMENT. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 12851856 | Expense |
| Revenue | 13817004 | Revenue |
| Description | JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 25 BED ACUTE CARE HOSPITAL. JEFFERSON COMMUNITY HEALTH CENTER ALSO OPERATES A WELLNESS CENTER AND PROVIDES HOME HEALTH SERVICES. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1124590 | Expense |
| Revenue | 2232799 | Revenue |
| Description | JEFFERSON COMMUNITY HEALTH CENTER OPERATES A 39 BED LONG-TERM CARE FACILITY FOR THE RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 13976446 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 6 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 215 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHAD JURGENS | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4027293351 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2200 H STREET PO BOX 277 | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DICK HOPPE | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| DR CRAIG SHUMARD | |||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| LYMON HAMM | |||||||
| SECRETARY/TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| MARY GLENN | |||||||
| MEMBER (01/11 - PRESENT) | 1.00 | X | 0 | 0 | 0 | ||
| PAUL JUDD | |||||||
| MEMBER (09/10 - 12/10) | 1.00 | X | 0 | 0 | 0 | ||
| JULIE KNIGGE | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RYAN PARKER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| TRENA ROGGE | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MIKE STEEL | |||||||
| MEMBER (01/11 - PRESENT) | 1.00 | X | 0 | 0 | 0 | ||
| JACK WESCH | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| CRAIG WHITE | |||||||
| MEMBER (09/10 - 12/10) | 1.00 | X | 0 | 0 | 0 | ||
| WILLIAM WELCH | |||||||
| CEO | 40.00 | X | 150806 | 0 | 19592 | ||
| CHAD JURGENS | |||||||
| CFO | 40.00 | X | 126314 | 0 | 18398 | ||
| GARY MITCHELL | |||||||
| DIRECTOR OF PHARMACY | 40.00 | 122725 | 0 | 15652 | X | ||
| DENNIS RUSSELL | |||||||
| PHARMACIST | 40.00 | 100194 | 0 | 13768 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 500039 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 67410 | TotalOtherCompensation |
| Number Individuals GT100 K | 4 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| FAIRBURY CLINIC PC | |||||
| 825 22ND STREET | FAIRBURY | NE | 68352 | ER COVERAGE | 571740 |
| HUSKER REHAB | |||||
| 4911 N 26TH STREET | LINCOLN | NE | 68521 | THERAPY SERVICES | 434627 |
| SOUTHEAST ANESTHESIA SERVICES | |||||
| 8426 W BIRCH | CLATONIA | NE | 68328 | CRNA SERVICES | 360000 |
| HEALTHCARE MANAGEMENT SYSTEMS | |||||
| 3102 WEST END AVE STE 400 | NASHVILLE | TN | 37203 | HOSPTIAL IT SERVICES | 229943 |
| AUREAUS RADIOLOGY LLC | |||||
| 13609 CALIFORNIA ST | OMAHA | NE | 68103 | CONTRACT LAB SERVICES | 206311 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Government Grants | 8558 | GovernmentGrants |
| All Other Contributions | 72943 | AllOtherContributions |
| Total Contributions | 81501 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID PAYM | 624100 | 8617229 | 8617229 |
| PATIENT SERVICE REVENU | 624100 | 4184679 | 4184679 |
| PHARMACY | 446110 | 1425571 | 1425571 |
| LONG TERM CARE REVENUE | 623000 | 945871 | 945871 |
| LAB | 621500 | 472498 | 472498 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 391022 | TotalRevenueColumn |
| Related Or Exempt Function Income | 391022 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 16036870 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 97013 | TotalRevenueColumn |
| Exclusion | $97,013 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2833215 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2820330 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 12885 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12885 | TotalRevenueColumn |
| Exclusion | $12,885 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 722210 | 88899 | $88,899 | |
| CENTRAL SUPP - EMPLOYE | 624100 | 5907 | 5907 | |
| MEDICAL RECORDS | 561000 | 3606 | 3606 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3420 | TotalRevenueColumn |
| Related Or Exempt Function Income | 3420 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 101832 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 16330101 | TotalRevenueColumn |
| Related Or Exempt Function Income | 16049803 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $198,797 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 315110 | Total |
| Management And General | 315110 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5768987 | Total |
| Program Services | 5215134 | ProgramServices |
| Management And General | 525800 | ManagementAndGeneral |
| Fundraising | 28053 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187134 | Total |
| Program Services | 173495 | ProgramServices |
| Management And General | 12706 | ManagementAndGeneral |
| Fundraising | 933 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 911905 | Total |
| Program Services | 810495 | ProgramServices |
| Management And General | 101360 | ManagementAndGeneral |
| Fundraising | 50 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 424035 | Total |
| Program Services | 369153 | ProgramServices |
| Management And General | 52893 | ManagementAndGeneral |
| Fundraising | 1989 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6180 | Total |
| Management And General | 6180 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42109 | Total |
| Management And General | 42109 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10997 | Total |
| Management And General | 10997 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2133951 | Total |
| Program Services | 2132497 | ProgramServices |
| Management And General | 539 | ManagementAndGeneral |
| Fundraising | 915 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43622 | Total |
| Program Services | 11422 | ProgramServices |
| Management And General | 31557 | ManagementAndGeneral |
| Fundraising | 643 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3671192 | Total |
| Program Services | 3449917 | ProgramServices |
| Management And General | 219022 | ManagementAndGeneral |
| Fundraising | 2253 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 267708 | Total |
| Program Services | 240520 | ProgramServices |
| Management And General | 27188 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27902 | Total |
| Program Services | 18140 | ProgramServices |
| Management And General | 9750 | ManagementAndGeneral |
| Fundraising | 12 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16977 | Total |
| Program Services | 16977 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1110353 | Total |
| Program Services | 997588 | ProgramServices |
| Management And General | 112765 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 109836 | Total |
| Management And General | 109836 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBTS EXPENSE | 504626 | 504626 | ||
| DUES AND SUBSCRIPTIONS | 46391 | 15770 | 30181 | 440 |
| OUTSIDE TRAINING | 28750 | 18245 | 10505 | |
| MISCELLANEOUS | 5306 | 2467 | 2839 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15633071 | Total |
| Program Services | 13976446 | ProgramServices |
| Management And General | 1618498 | ManagementAndGeneral |
| Fundraising | 38127 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 909119 | BOY |
| EOY | 630235 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 472707 | BOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1964127 | BOY |
| EOY | 1952245 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 341630 | BOY |
| EOY | 321110 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 151860 | BOY |
| EOY | 157733 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17327274 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9360708 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8455162 | BOY |
| EOY | 7966566 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1357212 | BOY |
| EOY | 1952896 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2500000 | BOY |
| EOY | 3500000 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90842 | BOY |
| EOY | 106559 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16957 | BOY |
| EOY | 17956 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16259616 | BOY |
| EOY | 16605300 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1204351 | BOY |
| EOY | 1016858 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 781091 | BOY |
| EOY | 611779 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 43990 | BOY |
| EOY | 103641 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2029432 | BOY |
| EOY | 1732278 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14087276 | BOY |
| EOY | 14738677 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 92154 | BOY |
| EOY | 83591 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50754 | BOY |
| EOY | 50754 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14230184 | BOY |
| EOY | 14873022 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16259616 | BOY |
| EOY | 16605300 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 697030 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -54192 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 50754 | BeginningOfYearBalance |
| End Of Year Balance | 50754 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 50754 | Contributions |
| Investment Earnings Or Losses | 250 | InvestmentEarningsOrLosses |
| Grants Or Scholarships | 250 | GrantsOrScholarships |
| End Of Year Balance | 50754 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 0.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13943 | OtherCostOrOtherBasis |
| Book Value | 13943 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11192169 | OtherCostOrOtherBasis |
| Depreciation | 5333084 | Depreciation |
| Book Value | 5859085 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5879543 | OtherCostOrOtherBasis |
| Depreciation | 3945664 | Depreciation |
| Book Value | 1933879 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 241619 | OtherCostOrOtherBasis |
| Depreciation | 81960 | Depreciation |
| Book Value | 159659 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7966566 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | REPURCHASE AGREEMENTS | Description |
| Book Value | 3500000 | BookValue |
| Method Of Valuation | C | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 3500000 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | Description |
| Amount | $103,641 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 103641 | TotalOfAmounts |
| Total Revenue | 16330101 | TotalRevenue |
| Total Expenses | 15633071 | TotalExpenses |
| Excess Or Deficit For Year | 697030 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | -54192 | NetUnrealizedGLOnInvestments |
| Total Adjustments | -54192 | TotalAdjustments |
| Excess Or Deficit Per FS | 642838 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 16264912 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | -54192 | NetUnrealizedGainsInvestments |
| Revenue Not Rptd F990 | -54192 | RevenueNotRptdF990 |
| Revenue Subtotal | 16319104 | RevenueSubtotal |
| Investment Expenses Not Included | 10997 | InvestmentExpensesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 10997 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 16330101 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 15622074 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 15622074 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 10997 | InvestmentExpensesNotIncluded2 |
| Expenses Not Rptd On Fin Stmt | 10997 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 15633071 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE INTENDED USE OF THE HOSPITAL'S ENDOWMENT FUNDS IS TO PROVIDE NURSING SCHOLARSHIPS AND CAPITAL IMPROVEMENTS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | 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, 2011, 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, 2008. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 93326 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 93326 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00620 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 827043 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 754089 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 72954 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00480 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 920369 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 754089 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 166280 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01100 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16089 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 16089 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1700 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1700 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 468964 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 207832 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 261132 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01730 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2609 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2609 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 489362 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 207832 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 281530 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01870 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1409731 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 961921 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 447810 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02970 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $384,424 | BadDebtExpenseAmount |
| Amount Attributable To | 100000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5721625 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5664975 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 56650 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JEFFERSON COMMUNITY HEALTH CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 H STREET | AddressLine1 |
| City | FAIRBURY | City |
| State | NE | State |
| ZIP Code | 68352 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | Return ReferenceReturnReference |
|---|---|
| PART I, LINE 3C: FEDERAL POVERTY GUIDELINES ARE USED TO DETERMINE ELIGIBILITY FOR PROVIDING FREE AND DISCOUNTED CARE TO LOW INCOME INDIVIDUALS. | |
| PART I, LINE 6A: JEFFERSON COMMUNITY HEALTH CENTER PREPARES ITS OWN COMMUNITY BENEFIT REPORT. | |
| PART I, LINE 7: THE HOSPITAL USED THE WORKSHEETS PROVIDED IN THE FORM 990 INSTRUCTIONS. | |
| PART I, LINE 7G: THERE ARE NO COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC INCLUDED ON LINE 7G. | |
| PART I, L7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINCE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $504,626. | |
| PART II: CURRENTLY, THERE ARE NO COMMUNITY BUILDING ACTIVITIES CONDUCTED BY JCHC. | |
| 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" AND "CHARITY CARE":PATIENT ACCOUNTS RECEIVABLE:THE HEALTH CENTER REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS AND OTHERS. THE HEALTH CENTER PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS.CHARITY CARE:THE HEALTH CENTER PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HEALTH CENTER DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE.THE HEALTH CENTER IS DEDICATED TO PROVIDING COMPREHENSIVE HEALTHCARE SERVICES TO ALL SEGMENTS OF SOCIETY, INCLUDING THE AGED AND OTHERWISE ECONOMICALLY DISADVANTAGED. IN ADDITION, THE HEALTH CENTER PROVIDES A VARIETY OF COMMUNITY HEALTH SERVICES AT OR BELOW COST.THE HEALTH CENTER USED THE RATIO OF COST TO CHARGES FROM WORKSHEET 2 OF THE SCHEDULE H INSTRUCTIONS. THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CONSERVATIVELY BASED ON THE BELIEF THAT MANY POTENTIALLY ELIGIBLE PATIENTS DID NOT TAKE THE TIME OR EFFORT TO COMPLETE AN APPLICATION FOR CHARITY CARE. | |
| PART III, LINE 8: THE HOSPITAL CALCULATED THE MEDICARE ALLOWABLE COSTS BY ADDING THE INPATIENT, SWING BED AND OUTPATIENT COSTS AS FOUND ON THE MEDICARE COST REPORT (WORKSHEET D) FOR SEPTEMBER 30, 2011. | |
| PART III, LINE 9B: ONCE IT IS DETERMINED THAT A PATIENT MAY NOT HAVE THE MEANS TO PAY, AN ASSISTANCE APPLICATION SHOULD BE PROVIDED. IN ADDITION, ALL ACCOUNTS THAT OUR SELF-PAY RECEIVABLE VENDOR DID NOT RECEIVE PAYMENT ON AFTER 75 DAYS WILL BE RUN THROUGH A PRESUMPTIVE CHARITY CRITERIA PROCESS. THIS PROCESS ASSISTS IN THE DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY. JCHC STAFF WILL APPLY THE RECOMMENDED PERCENTAGE DISCOUNT TO THE PATIENT'S ACCOUNT. | |
| NOT REQUIRED IN THE CURRENT YEAR. | PART V, SECTION B: |
| PART VI, LINE 2: JCHC ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY JCHC SERVES IN SEVERAL WAYS. JCHC UTILIZES SURVEYS BY PUBLIC HEALTH SOLUTIONS OF THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING COMMUNITY. JCHC VISITS LOCAL COMMUNITY SERVICE ORGANIZATIONS AND SEEKS INPUT ON NEEDS. JCHC CONDUCTED A COMMUNITY PERCEPTION SURVEY IN 2006, WHICH INCLUDES QUESTIONS ON COMMUNITY HEALTH NEEDS. JCHC REVIEWS SURVEYS DONE BY THE STATE AND OTHER ORGANIZATIONS ON THE HEALTH CARE NEEDS FOR RESIDENTS OF JEFFERSON COUNTY AND THE SURROUNDING AREA. | |
| PART VI, LINE 3: JCHC INFORMS AND EDUCATES PATIENTS ABOUT ELIGIBILITY FOR ASSISTANCE ON AN INDIVIDUAL BASIS WHEN QUESTIONS ARISE. THE PATIENT BOOKLET THAT IS HANDED OUT EXPLAINS WHO IN THE BUSINESS OFFICE TO CONTACT IF THE PATIENT HAS QUESTIONS ABOUT THEIR BILL. THE SELF-PAY BILLING VENDOR JCHC USES NOW HAS A SET OF CRITERIA IT ASSESSES TO DETERMINE IF A PATIENT MIGHT BE ELIGIBLE FOR ASSISTANCE PROGRAMS THE PATIENT IS NOT ALREADY UTILIZING, OR IF THEY MIGHT QUALIFY FOR JCHC'S CHARITY CARE. | |
| PART VI, LINE 4: JCHC SERVES JEFFERSON COUNTY AND PARTS OF THAYER, FILLMORE, SALINE AND GAGE COUNTIES, ALL IN NEBRASKA; AND PARTS OF WASHINGTON AND MARSHALL COUNTIES IN KANSAS. THE POPULATION OF THE SERVICE AREA IS ESTIMATED AT ABOUT 18,000. REVENUE FROM MEDICARE PATIENTS IS OVER 50% ON AVERAGE, AND REVENUE FROM MEDICAID CLIENTS IS OVER 10% ON AVERAGE. | |
| PART VI, LINE 6: 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 $261,132. 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 7: JCHC IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM BUT DOES WORK TO BE A LEADER IN PROMOTING THE HEALTH OF THE COMMUNITIES IT SERVES. JCHC PARTNERS WITH MANY OTHER AREA ORGANIZATIONS - PUBLIC HEALTH SOLUTIONS, FARM SAFETY 4 JUST KIDS, NEBRASKA SAFE KIDS, JEFFERSON COUNTY EXTENSION, BLUE VALLEY COMMUNITY ACTION, FAIRBURY CHAMBER OF COMMERCE, FAIRBURY PUBLIC SCHOOLS, FAIRBURY CLINIC, NEBRASKA COMMUNITY BLOOD BANK, RURAL COMPREHENSIVE CARE NETWORK, BLUE RIVER VALLEY NETWORK, HEARTLAND HEALTH ALLIANCE, AND OTHERS. DEPENDING ON THE ACTIVITY, JCHC MAY BE THE LEAD ORGANIZATION, OR AN ORGANIZATION PROVIDING HELP AND ASSISTANCE. | |
| JCHC DOES NOT FILE A COMMUNITY BENEFIT REPORT WITH ANY STATES. | PART VI, LINE 7: |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | WILLIAM WELCH | NamePerson |
| Base Compensation Filing Org | 150806 | BaseCompensationFilingOrg |
| Comp Based On Related Orgs | 0 | CompBasedOnRelatedOrgs |
| Bonus Filing Org | 0 | BonusFilingOrg |
| Bonus Related Orgs | 0 | BonusRelatedOrgs |
| Other Compensation Filing Org | 0 | OtherCompensationFilingOrg |
| Other Compensation Related Orgs | 0 | OtherCompensationRelatedOrgs |
| Deferred Comp Filing Org | 7600 | DeferredCompFilingOrg |
| Deferred Comp Related Orgs | 0 | DeferredCompRelatedOrgs |
| Nontaxable Benefits Filing Org | 11992 | NontaxableBenefitsFilingOrg |
| Nontaxable Benefits Related Orgs | 0 | NontaxableBenefitsRelatedOrgs |
| Total Compensation Filing Org | 170398 | TotalCompensationFilingOrg |
| Total Compensation Related Orgs | 0 | TotalCompensationRelatedOrgs |
| Comp Report Prior990 Filing Org | 0 | CompReportPrior990FilingOrg |
| Comp Report Prior990 Related Orgs | 0 | CompReportPrior990RelatedOrgs |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FAIRBURY CLINIC PC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | DR. CRAIG SHUMARD, BOARD MEMBER, OWNS MORE THAN 5% OF FAIRBURY CLINIC P.C. | Relationship |
| Amount Of Transaction | 571740 | AmountOfTransaction |
| Description Of Transaction | FAIRBURY CLINIC P.C. PROVIDED EMERGENCY ROOM COVERAGE SERVICES TO JEFFERSON COMMUNTIY HEALTH CENTER. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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. | |
| BOARD MEMBERS ARE REQUIRED, BY THE ARTICLES AND BYLAWS, TO REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. A BOARD MEMBER WITH A CONFLICT OF INTEREST IS REQUIRED TO ABSTAIN FROM VOTING ON ANY MOTION REGARDING DISCLOSED CONFLICT OF INTEREST. BOARD MEMBERS ARE WELL ACQUAINTED AND WOULD BE AWARE OF ANY PERSONAL CONFLICTS OF INTEREST. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE HOSPITAL PARTICIPATES IN THE NEBRASKA COMPDATA SALARY SURVEYS FOR ALL POSITIONS. THE CEO SURVEY DATA IS GIVEN TO THE BOARD TO REVIEW AND APPROVE THE CEO SALARY ON AN ANNUAL BASIS. | FORM 990, PART VI, SECTION B, LINE 15A | |
| THE ORGANIZATIONS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED LOSSES ON INVESTMENTS: -54,192. | FORM 990, PART XI, LINE 5: |
| THERE HAVE BEEN NO CHANGES FROM THE PRIOR YEAR. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS SELECTS THE INDEPENDENT ACCOUNTANT AND HAS THE RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE FINANCE COMMITTEE. | FORM 990, PAGE 11, PART XI, LINE 2C: |
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