2021-08-13T13:05:30-05:00 2020-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2019-10-01 610461767 TJ SAMSON COMMUNITY HOSPITAL TJSA 2706514114 1301 NORTH RACE STREET GLASGOW KY 42141 MEI DENG CFO 2706514114 2021-08-13 1 CARRIE A MERRILL CPA P00832283 3176334705 2021-08-13 2019 2022-09-23 18:48:47Z MEI DENG 1301 NORTH RACE STREET GLASGOW KY 42141 205182381 0 X WWW.TJREGIONALHEALTH.ORG X 1928 KY TJ SAMSON COMMUNITY HOSPITAL WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL-BEING OF THOSE THEY SERVE AND THE HEALTHCARE PROFESSIONALS WHO SERVE THEM. 13 10 1337 4 698 0 15997 17586884 198847200 180648691 1804753 5276528 1059201 1568178 201727151 205080281 6180306 7688877 0 0 87395129 85341098 0 0 0 88016944 87671893 181592379 180701868 20134772 24378413 178709529 230279698 97704561 107869401 81004968 122410297 TJ SAMSON COMMUNITY HOSPITAL WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL-BEING OF THOSE THEY SERVE AND THE HEALTHCARE PROFESSIONALS WHO SERVE THEM. 0 0 166242502 7688877 181821314 TJ SAMSON COMMUNITY HOSPITAL PROVIDES HEALTHCARE SERVICES TO BARREN AND SURROUNDING COUNTIES IN KENTUCKY. ACUTE HOSPITAL AND EMERGENCY ROOM CARE PATIENT DAYS 23,051 AND ER VISITS 23,437 IN FYE 9/30/20. 166242502 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 162 0 1 1337 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 13 10 0 0 0 0 0 0 0 1 1 0 1 1 0 1 1 1 1 1 1 1 0 KY X X MARGIE GENTRY 2706514114 1301 NORTH RACE STREET GLASGOW KY 42141 JOEY ALLEN BOTTS CHAIRMAN 1.00 3.00 X 0 0 0 T RICH ALEXANDER VICE CHAIRMAN 1.00 3.00 X 0 0 0 BRENT BILLINGSLEY TREASURER 1.00 3.00 X 0 0 0 MICHAEL SCOTT YOUNG SECRETARY 1.00 3.00 X 0 0 0 MIKE V BRYANT DIRECTOR 1.00 3.00 X 0 0 0 BUDDY UNDERWOOD DIRECTOR 1.00 3.00 X 0 0 0 KAREN SMALL MD DIRECTOR 1.00 3.00 X 0 0 0 ERVIN SORRELL DIRECTOR 1.00 3.00 X 0 0 0 BO MATTHEWS DIRECTOR 1.00 3.00 X 0 0 0 JOHN P CRADDOCK MD DIRECTOR/VICE CHIEF OF STAFF 40.00 1.00 X 615754 0 35618 ERIC FISHER MD DIRECTOR/CHIEF OF STAFF 40.00 1.00 X 266231 0 32741 HENRY ROYSE DIRECTOR 1.00 3.00 X 13750 0 0 DAN FOUTCH DIRECTOR 1.00 3.00 X 0 0 0 NEIL THORNBURY CHIEF EXECUTIVE DIRECTOR 5.00 40.00 X 0 374617 38780 MEI DENG CHIEF FINANCIAL OFFICER 5.00 40.00 X 0 306288 32973 VENKATA REDDY PHYSICAN 40.00 1.00 X 1046021 0 24984 HARIKRISHNAN NAIR PHYSICAN 40.00 1.00 X 1181989 0 37807 YASHPAL MODI PHYSICAN 40.00 1.00 X 769320 0 32387 ZAKARE SALIFU PHYSICAN 40.00 1.00 X 673863 0 37130 TODD MARION PHYSICAN 40.00 1.00 X 687666 0 36840 5254594 680905 309260 69 0 1 0 HURON CONSULTING SERVICES LLC 3005 MOMENTUM PLACE CHICAGO IL 60689 MANAGEMENT CONSULTING 2975573 CROTHALL HEALTHCARE 1500 LIBERTY RIDGE DR SUITE 210 WAYNE PA 19087 CONTRACTED HOUSEKEEPING 2897475 MORRISON HEALTHCARE P O BOX 102289 ATLANTA GA 30368 CONTRACTED FOOD SERVICES 2611135 SE EMERGENCY PHYSICIANS PO BOX 634850 CINCINNATI OH 45263 ER/URGENT CARE PHYSICIANS 2010420 ANESTHESIOLOGY ASSOCIATES OF GLASGOW PO BOX 1947 GLASGOW KY 42142 ANESTHESIOLOGY SERVICE 1267583 45 17573221 13663 17586884 NET PATIENT REVENUE 900099 177111447 177111447 340B PHARMACY 900099 3537244 3537244 180648691 2563783 2563783 240175 102100 138075 138075 138075 1968665 744080 0 0 1968665 744080 2712745 2712745 CAFETERIA SALES 900099 256782 256782 1173321 1172623 698 1430103 205080281 181821314 698 5671385 X 7688877 7688877 66252755 60952534 5300221 4209586 3872819 336767 10724635 9866664 857971 4154122 3821792 332330 694061 694061 791806 791806 26045957 23962280 2083677 648172 648172 534731 491953 42778 6049442 5565487 483955 4526178 4164084 362094 405456 373020 32436 21965 21965 1894190 1894190 7712480 7712480 1448335 1332468 115867 SUPPLIES 15940837 13455345 2485492 DRUGS 14483962 14483962 REPAIRS AND MAINTENANCE 2312635 2127624 185011 TAXES 2305290 2120867 184423 1856396 1707884 148512 180701868 166242502 14459366 0 1672992 2213710 70846486 130078707 23051099 20216626 688373 2837238 3217436 3669300 4676985 4761381 204512130 151645626 57931233 52866504 4222019 4222019 2959244 3237651 9443662 6176562 178709529 230279698 15932448 17188835 26148759 25551051 947606 439778 54675748 64689737 97704561 107869401 X 81004968 122410297 81004968 122410297 178709529 230279698 X 24378413 1090849 -200001 16136068 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 8940 8940 0 PART II-B, LINE 1: THE HOSPITAL PAYS MEMBERSHIP DUES TO THE KENTUCKY HOSPITAL ASSOCIATION OF WHICH A PORTION OF THE DUES ARE USED FOR LOBBYING PURPOSES. 3106073 3106073 56779684 31932517 24847167 2022830 1898598 124232 141805742 117814511 23991231 797801 797801 52866504 ACCRUED PENSION 42193931 EST DUE TO GOVERNMENT PROGRAMS 22317230 PROVIDER TAX PAYABLE 178576 64689737 1 1 X 1 X 1 X 1 1 1 0 1 1 688615 688615 0.00380 1 47767140 36849032 10918108 0.06040 1 48455755 36849032 11606723 0.06420 223 70069 211030 38896 172134 0.00100 56 1000 36332 36332 0.00020 279 71069 247362 38896 208466 0.00120 280 71069 48703117 36887928 11815189 0.06540 2 1300 35781 35781 0.00020 1 27 644 644 0.00000 3 1327 36425 36425 0.00020 1 7784842 40262415 43152950 -2890535 X 1 1 1 1 TJ SAMSON COMMUNITY HOSPITAL INC 1301 NORTH RACE STREET GLASGOW KY 42141 WWW.TJREGIONALHEALTH.ORG 720185 X X X TJ SAMSON COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 18 1 1 0 1 X HTTPS://WWW.TJREGIONALHEALTH.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT/ X X 1 18 1 HTTPS://WWW.TJREGIONALHEALTH.ORG/ABOUT-US/COMMUNITY-NEEDS-ASSESSMENT/ 0 1 X 100.000000000000 200.000000000000 X X X X 1 1 X X X 1 X SEE PAGE 8 PART V SECTION B LINE 16J X SEE PAGE 8 PART V SECTION B LINE 16J X SEE PAGE 8 PART V SECTION B LINE 16J X X X X 1 X 0 X X X X 1 X 0 0 TJ SAMSON COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 5: COUNTY ASSESSMENT TEAMS FROM THE DIFFERENT COUNTIES THE HOSPITAL SERVES WERE CREATED TO HELP DISTRIBUTE AND COLLECT COMMUNITY-WIDE SURVEYS AND CONDUCT KEY INFORMANT INTERVIEWS. KEY INFORMANT INTERVIEWS WERE BROKEN UP INTO THREE GROUPS: GROUP A-AFFECTED PEOPLE, GROUP B-POLICY-MAKERS, AND GROUP C-PROVIDERS. GROUP A-AFFECTED PEOPLE INCLUDED INDIVIDUALS DIRECTLY RELATED TO ONE OF THE PRIORITY HEALTH ISSUES. GROUP B-POLICY MAKERS INCLUDED INDIVIDUALS WHO MUST MAKE LEADERSHIP DECISIONS THAT AFFECT THE PRIORITY HEALTH ISSUES AND INCLUDED ELECTED OFFICIALS, HUMAN RESOURCE DIRECTORS, SCHOOL SYSTEM SUPERINTENDENTS, AND LOCAL GOVERNMENT OFFICALS. GROUP C-PROVIDERS INCLUDED HEALTH CARE PROVIDERS SUCH AS PHYSICIANS, SCHOOL NURSES, NUTRITIONISTS, AND HEALTH EDUCATORS. TJ SAMSON COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING ORGANIZATIONS: BARREN RIVER DISTRICT HEALTH DEPARTMENT, CAVERNA MEMORIAL HOSPITAL, THE MEDICAL CENTER AT BOWLING GREEN, THE MEDICAL CENTER AT FRANKLIN, THE MEDICAL CENTER AT SCOTTSVILLE, AND THE MONROE COUNTY MEDICAL CENTER. TJ SAMSON COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 7D: SOCIAL MEDIA TJ SAMSON COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 11: T.J. SAMSON COMMUNITY HOSPITAL, IN RESPONSE TO THE ASSESSMENT AND PRIORITY HEALTH ISSUE FINDINGS, HAS USED THE DATA COLLECTED TO IDENTIFY AREAS OF OPPORTUNITY TO BETTER MEET THE HEALTH NEEDS THAT IMPACT THE HOSPITAL'S PATIENT POPULATION. THE COMMUNITY HEALTH NEED ASSESSMENT IN PLACE HAS GUIDED THIS ORGANIZATION IN DECISIONS MADE REGARDING PROGRAM IMPLEMENTATION AND PROMOTION, DISEASE MANAGEMENT, COMMUNITY PARTNERSHIPS, AND HEALTH AND AWARENESS CAMPAIGNS ESTABLISHED OVER THE PAST YEARS. THE PRIORITY HEALTH ISSUES IDENTIFIED FOR TJSCH SERVICES AREAS ARE CARDIOVASCULAR DISEASES, DIABETES, OBESITY, LUNG CANCER, AND DRUG ABUSE & ADDICTION. TJSCH OFFERS AND HOST MANY COMMUNITY FUNCTIONS THROUGHOUT THE YEAR TO PATIENTS IN THE COMMUNITY. THE COMMUNITY HEALTH FAIRS ARE THE LARGEST AND MOST WELL ATTENDED EVENTS THAT ARE OFFERED THROUGHOUT THE YEAR. OBESITY, DIABETES, AND CARDIOVASCULAR DISEASE: WHEN ADDRESSING OBESITY IN OUR COMMUNITIES TJSC HELD AN ANNUAL HEALTH COMMUNITY HEALTH FAIR IN GLASGOW ON JUNE 16TH AND COLUMBIA ON OCTOBER 27TH SERVING OVER 2,500 PATIENTS WITH DIRECT CARE SERVES FOR BOTH EVENTS COMBINED. T.J. HEALTH FAIRS OFFER A WIDE VARIETY OF EARLY DETECTION INFORMATION, EDUCATIONAL BOOTHS, AND PREVENTIVE HEALTH SCREENINGS. PREVENTIVE SCREENINGS INCLUDE: BASIC LAB PANEL, LIPID PANEL, HEIGHT/WEIGHT, BODY FAT ANALYSIS/BODY MASS INDEX, BLOOD PRESSURE AND MORE. T.J. ALSO OFFERED A FREE SPORT PHYSICALS FOR 400 STUDENTS IN GRADES 6 THROUGH 12. T.J. SAMSON COMMUNITY HOSPITAL OFFERED MONTHLY LUNCH AND LEARN EVENTS THAT PROVIDE HEALTH INFORMATION TO STAFF AND THE GENERAL PUBLIC TO OVER 250 PEOPLE CONCERNING CURRENT HEALTH TOPICS FACING THE COMMUNITY. THE PRESENTATIONS SPECIFICALLY FOCUSED ON NUTRITION, PHYSICAL ACTIVITY, AND LIFESTYLE.TJSCH OFFERED COMMUNITY QUARTERLY SCREENINGS THROUGHOUT THE YEAR TO OVER 20 PATIENTS. THE PATIENTS INCLUDE THOSE THAT ARE UNDERINSURANCE OR DO NOT HAVE INSURANCE. THE PREVENTIVE SCREENINGS INCLUDE: GLUCOSE, LIPID PANEL, TOTAL CHOLESTEROL, BONE DENSITY, HEIGHT/WEIGHT, BODY FAT ANALYSIS/BODY MASS INDEX AND BLOOD PRESSURE.TJSCH HOST AN ANNUAL HEART WALK EVENT IN SEPTEMBER IN CONJUNCTION WITH THE AMERICAN HEART ASSOCIATION. TJ HEART WALK TEAMS DONATED OVER $15,000 TO OUR COMMUNITY TO HELP SUPPORT THIS CAUSE. T.J HEALTH PAVILION FACILITATES A WALKING CLUB. THE WALKING CLUB HAS AN INCENTIVE PROGRAM THAT RECOGNIZES MILESTONES FOR EVERY HUNDRED MILES WALKED. THE T.J. HEALTH PAVILION OFFERS A CLIMATE-CONTROLLED SETTING FOR THE PUBLIC OR EMPLOYEES TO UTILIZE THE RESOURCE OF AN INDOOR WALKING TRACK. T.J. SAMSON COMMUNITY HOSPITAL OFFERED MONTHLY BARIATRIC SUPPORT GROUPS AND SEMINARS.DRUG & ALCOHOL ABUSE AND ADDICTION: T.J. SAMSON COMMUNITY HOSPITAL, IN AN EFFORT TO JOIN THE FIGHT AGAINST DRUG AND ALCOHOL ABUSE AND ADDICTION, WILL CONTINUE TO FACILITATE THE GRANTS FOR THE KENTUCKY AGENCY FOR SUBSTANCE ABUSE POLICY (KY-ASAP) PROGRAM. CURRENTLY THE HOSPITAL OVERSEE TWO MULTI- THOUSAND DOLLAR GRANTS THAT TOTAL OVER $80,000 THAT GO IN THE COMMUNITIES TO FUND ACTIVITIES SUCH AS THE PRESCRIPTION DRUG DISPOSALS, NAXOLONE/NARCAN KITS AND TRAININGS FOR FIRST RESPONDERS AND COMMUNITY MEMBERS, SCHOOL ACTIVITIES (RED RIBBON WEEK, AFTER PROM/GRADUATION) AND OTHER SCHOOL EVENTS CENTERED AROUND SUBSTANCE ABUSE.LUNG CANCER: TJSCH OFFERED THREE FREEDOM FROM SMOKING CLASS IN JUNE, OCTOBER, AND JANUARY IN AN EFFORTS TO HELP OVER 20 PARTICIPANTS LIVE HEALTHIER LIFESTYLES AND QUIT USING TOBACCO. TJ SAMSON/KY ASAP OFFER COMMUNITY AND SCHOOL ACTIVITIES THROUGHOUT THE YEAR CENTERED ON PREVENTION AND EDUCATION ON TOBACCO, SECOND HAND SMOKING, AND E-CIGARETTES. T.J. SAMSON COMMUNITY HOSPITAL OFFERED MONTHLY CANCER SUPPORT GROUPS. TJ SAMSON COMMUNITY HOSPITAL INC PART V, SECTION B, LINE 16J: HTTPS://WWW.TJREGIONALHEALTH.ORG/PATIENTS-VISITORS/BILLING-INSURANCE-PRICING/FINANCIAL-ASSISTANCE/ 6 1 - TJ HEALTH PAVILION 310 N L ROGERS WELLS BLVD GLASGOW KY 42141 OUTPATIENT SERVICES 2 - CAVE CITY CLINIC 400 N DIXIE HIGHWAY CAVE CITY KY 42127 PRIMARY CARE 3 - WALMART CLINIC 2345 HAPPY VALLEY ROAD GLASGOW KY 42141 OUTPATIENT SERVICES 4 - EDMONTON CLINIC 1704 W STOCKTON STREET EDMONTON KY 42129 PRIMARY CARE 5 - TOMPKINSVILLE CLINIC 800 N MAIN STREET TOMPKINSVILLE KY 42167 PRIMARY CARE 6 - SLEEP DISORDERS CLININC 1301 N RACE STREET GLASGOW KY 42141 PRIMARY CARE PART I, LINE 3C: TJ SAMSON COMMUNITY HOSPITAL'S FINANCIAL ASSISTANCE POLICY USES THE FOLLOWING ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE IN ADDITION TO THE FPG: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. PART I, LINE 7: TJ SAMSON COMMUNITY HOSPITAL CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS USING THE COST-TO-CHARGE RATIO DERIVED FROM IRS WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART II, COMMUNITY BUILDING ACTIVITIES: TJS'S COMMUNITY BUILDING ACTIVITIES PROMOTE THE HEALTH OF THE COMMUNITY THE ORGANIZATION SERVES BY OFFERING THE FOLLOWING:- BATRIATRIC SUPPORT GROUP- CAMP TJ KIDS- EARLY INTERVENTION GROUPS- HART OF AUTISM SUPPORT GROUP- INSERVICE WITH GLASGOW PEDIATRICS- LUNCH & LEARNS- PAVILION QUARTERLY HEALTH SCREENINGS- SAMSONITE ACTIVITIES- SAMSONITE CHRISTMAS MEAL- SLEEP MASK FITTING- TUITION REIMBURSEMENT PART III, LINE 2: PATIENT ACCOUNTS RECEIVABLE ARE STATED AT NET REALIZABLE VALUE. THE HOSPITAL MAINTAINS ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND FOR ESTIMATED LOSSES RESULTING FROM A PAYOR'S INABILITY TO PAY. MANAGEMENT ESTIMATES THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED ON THEIR ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL AND CURRENT BUSINESS AND ECONOMIC FACTORS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE. PART III, LINE 3: THE HOSPITAL HAS A DETAILED FINANCIAL ASSISTANCE POLICY WHICH STATES THAT TO PARTICIPATE IN CHARITY CARE, CANDIDATES MUST COOPERATE FULLY. IN ADDITION, THE HOSPITAL EDUCATES PATIENTS WITH LIMITED ABILITY TO PAY REGARDING FINANCIAL ASSISTANCE. FOR THIS REASON, THE ORGANIZATION BELIEVES THAT IT ACCURATELY CAPTURES ALL CHARITY CARE DEDUCTIONS PROVIDED ACCORDING TO THE FINANCIAL ASSISTANCE POLICY, AND THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS NEGLIGIBLE. PART III, LINE 4: THE FOOTNOTE EXPLANATION FOR BAD DEBT EXPENSE IS ON PAGE 14 AND 15 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: THE HOSPITAL BELIEVES THAT 100% OF THE SHORTFALL IS COMMUNITY BENEFIT AND IT IS AN UNREIMBURSED COST TO THE HOSPITAL FOR PROVIDING THE GOVERNMENT PROGRAM. PART III, LINE 9B: THE HOSPITAL PROVIDES ASSISTANCE TO PATIENTS THAT QUALIFY UNDER THE GUIDELINES. PART VI, LINE 2: NEEDS ASSESSMENT- TJSCH HAS AN ORGANIZATIONAL COMMITMENT TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITIES THAT WE SERVE. THE HEALTH NEEDS OF OUR COMMUNITY ARE ASSESSED IN A NUMBER OF WAYS. QUARTERLY MARKET SHARE REPORTS ARE UTILIZED TO IDENTIFY INPATIENT AND OUTPATIENT TRENDS AND MIGRATION OF PATIENTS. THIS METHOD IS USED TO IDENTIFY SERVICES THAT ARE CURRENTLY NEEDED OR IN HIGH DEMAND FOR EXPANSION. IN ADDITION, BY STUDYING COMMUNITY HEALTH REPORTING, WE ARE ABLE TO IDENTIFY AREAS THAT NEED TO BE ADDRESSED WITHIN OUR COMMUNITY. CURRENTLY, PLANS ARE DEVELOPED UTILIZING HOSPITAL COMMUNITY HEALTH EDUCATORS TO SCREEN AND EDUCATE THE COMMUNITY AND TARGET THOSE SPECIFIC DEMOGRAPHICS IN NEED. OUR COMMUNITY HEALTH EDUCATORS PARTNER WITH LOCAL BUSINESSES AND INDUSTRIES TO CONDUCT HEALTH EVENTS. SOME EXAMPLES OF SERVICES PROVIDED TO THE COMMUNITY ARE; HEALTH FAIRS, LUNCH AND LEARNS, PROSTATE SCREENINGS, GLUCOSE CHECKS, CPR, CHOLESTEROL TESTS, BLOOD PRESSURE SCREENINGS, BMI CHECK, CANCER SUPPORT, DIABETIC SUPPORT, BEREAVEMENT SUPPORT, CHILD BIRTH CLASSES, AND COMMUNITY SUPPORT GROUPS. TJSCH PROUDLY SPONSORS EVENTS CONDUCTED BY AREA SCHOOL SYSTEMS. OUR VISION IS TO INVEST IN THE YOUTH BY PROVIDING INFORMATION AND EDUCATION AT AN EARLY AGE CAUSING STUDENTS TO BE PROACTIVE ABOUT THEIR HEALTH. EXAMPLES OF EVENTS INCLUDE REALITY FAIR, CAREER FAIRS, AND SCHOOL HEALTH EVENTS. FOR THE LAST SEVEN YEARS, TJSCH HAS JOINED WITH TEACH KENTUCKY (A STATE FUNDED PROGRAM DESIGNED TO HELP KENTUCKY SCHOOL TEACHERS BETTER UNDERSTAND HEALTHCARE RELATED CAREERS). TJSCH INVITES PROGRAM ATTENDEES TO ROUND THROUGHOUT THE FACILITY TO MEET WITH STAFF. WE PROVIDE TEACHERS WITH KNOWLEDGE TO EDUCATE STUDENTS WHO ARE INTERESTED IN HEALTHCARE CAREERS; REALIZING THAT OPPORTUNITIES EXIST OUTSIDE THE CAREERS OF A DOCTOR OR A NURSE. IN 2011, TJSCH ALONG WITH BUSINESS, EDUCATIONAL, COMMUNITY AND OTHER HEALTHCARE LEADERS JOINED ALONGSIDE THE BARREN RIVER DISTRICT HEALTH DEPARTMENT TO FACILITATE AN EVIDENCED-BASED COMMUNITY HEALTH ASSESSMENT PROCESS CALLED MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS). EVIDENCE SUPPORTS THAT THE POOR HEALTH STATUS OF KENTUCKY IMPACTS THE CURRENT/FUTURE WORKFORCE, OUR LOCAL ECONOMY AND OUR QUALITY OF LIFE. THE COALITION WILL WORK TO ADDRESS THE ISSUES AT HAND. THE OUTCOME OF THE COLLABORATION WILL PRODUCE A REGIONAL COMMUNITY HEALTH PLAN THAT WILL INVOLVE COMMITMENTS FROM STAKEHOLDERS. THE HOSPITAL ALSO UTILIZES COMMUNITY MEMBERS TO FORM THE PATIENT ADVISORY COUNCIL TO WORK AS A SOUNDING BOARD FOR NEW AND EXPANDING SERVICES AS WELL AS TO IDENTIFY PATIENT EXPERIENCES THAT NEED IMPROVEMENT. ANNUALLY, T.J. SAMSON COMMUNITY HOSPITAL WORKS THROUGH STRATEGIC PLANNING AND CONSUMER PREFERENCE DATA (AN ONLINE SERVICING TOOL) TO HELP IDENTIFY AND PRIORITIZE SERVICES THAT NEED TO BE IMPROVED OR CREATED IN ORDER TO BETTER MEET THE HEALTH NEEDS OF THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: T.J. SAMSON COMMUNITY HOSPITAL IN AN EFFORT TO PROVIDE SUPERIOR PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE INFORMS EACH PERSON BILLED FOR SERVICES ON THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, AND LOCAL GOVERNMENT. UPON ADMISSION EACH PATIENT IS PROVIDED WITH A PACKET THAT INCLUDES A BROCHURE THAT IS A GUIDE TO THEIR HOSPITAL BILL. THIS GUIDE EDUCATES THAT PATIENT ON INSURANCE BILLING INFORMATION AS WELL AS PAYMENT ARRANGEMENTS OFFERED BY T.J. SAMSON. OPTIONS INCLUDE A DISPROPORTIONATE SHARE HOSPITAL PROGRAM (DSH), FIRST SOURCE WHICH PROVIDES INFORMATION AND EDUCATION ON FEDERAL ASSISTANCE PROGRAMS, CHARITY AND FINANCIAL AID ASSISTANCE APPLICATIONS, AND PAYMENT SCHEDULE ARRANGEMENTS. PART VI, LINE 4: COMMUNITY INFORMATION SERVICE AREA AND DEMOGRAPHICS OVERVIEW: TJSCH'S 196 BEDS ARE LOCATED IN GLASGOW, KENTUCKY, THE COUNTY SEAT OF BARREN COUNTY. BARREN COUNTY IS ONE OF THE MAIN HUBS FOR THE BARREN RIVER AREA DEVELOPMENT DISTRICT (BRADD), WITH DIRECT ACCESS TO INTERSTATE 65, RAILWAY SERVICE AND AN AIRPORT. TJSCH IS CONVENIENTLY SITUATED HALFWAY BETWEEN LOUISVILLE, KENTUCKY AND NASHVILLE, TENNESSEE. THE PRIMARY SERVICE AREA (PSA) INCLUDES BARREN, HART AND METCALFE COUNTIES WITH 71,933 RESIDENTS IN A 1,200 SQUARE MILE AREA. THE SECONDARY SERVICE AREA (SSA) INCLUDES ADAIR, ALLEN, CLINTON, CUMBERLAND, EDMONSON, GREEN, MONROE, RUSSELL, TAYLOR, AND WARREN COUNTIES WITH 266,042 RESIDENTS IN 3,000 SQUARE MILES. IN TOTAL, TJSCH'S THIRTEEN-COUNTY SERVICE AREA OF APPROXIMATELY 4,200 SQUARE MILES EXTENDS BEYOND THE BRADD COUNTIES-PROVIDING HEALTH CARE SERVICES TO OVER 330,000 RESIDENTS.THE PERCENT OF PERSONS IN POVERTY FOR TJSCH'S PRIMARY AND SECONDARY SERVICE AREAS RANGED FROM 16.1%-26.4% WITH 11 OF THE 13 COUNTIES BEING ABOVE THE STATE AVERAGE OF 17.2%. WHEN LOOKING AT THE INCOME PER CAPITA IN THE PAST 12 MONTHS THE AVERAGE MEDIAN INCOME FOR THE TJSCH SERVICES AREAS WAS $19,600, WHICH IS WELL UNDER STATE AVERAGE OF $25,888. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH OUR MISSION: TJSCH WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL BEING OF THOSE WE SERVE. OUR VISION: AS A REGIONAL PROVIDER, TJSCH TAKES PRIDE IN BEING GOOD STEWARDS OF OUR AVAILABLE RESOURCES AND UTILIZING THEM TO ANTICIPATE AND MEET THE HEALTH NEEDS OF THE REGION BY PROMOTING HEALTH IN OUR COMMUNITIES AND DELIVERING QUALITY, APPROPRIATE AND COMPASSIONATE CARE. OUR GOALS: * CLINICAL QUALITY * CUSTOMER SERVICE * QUALITY WORK-LIFE * FINANCIAL PERFORMANCE ORGANIZATIONAL VALUES: * SERVICE * EXCELLENCE * RESOURCES * VALUE * INNOVATION * COMPASSIONATE CARE * ETHICS STATEMENT OF COMMUNITY COMMITMENT: TJSCH IS A NONPROFIT, CHARITABLE CORPORATION OPERATED FOR THE SOLE PURPOSE OF PROMOTING AND PROVIDING FOR THE HEALTH OF THE PEOPLE IN ITS SERVICE AREA. IT DOES SO BY MAKING SURE THAT NECESSARY HOSPITAL AND HEALTH SERVICES, APPROPRIATE FOR THE SIZE OF THE COMMUNITY, ARE AVAILABLE TO ALL ON A COST-EFFECTIVE BASIS, WITHOUT REGARD TO THEIR ABILITY TO PAY. THESE INCLUDE SUCH ESSENTIAL SERVICES SUCH AS A 24-HOUR EMERGENCY ROOM, OBSTETRICS, CRITICAL CARE CAPABILITIES, AND DISASTER PREPAREDNESS. TO BE ABLE TO CONTINUE TO OFFER THESE SERVICES AT A LEVEL OF SAFETY THE COMMUNITY HAS A RIGHT TO EXPECT, THIS ORGANIZATION MUST BE ABLE TO GENERATE SUFFICIENT VOLUME AND SUFFICIENT REVENUE TO SUPPORT THOSE ESSENTIAL SERVICES WHICH, DUE TO INSUFFICIENT REIMBURSEMENT OR HIGH EXPENSES ASSOCIATED WITH THE TYPE OF SERVICE OR PATIENT INVOLVED, CANNOT SUSTAIN THEMSELVES. IT MUST ALSO RELY ON THE SUPPORT OF A HIGH QUALITY STAFF OF PHYSICIANS, NURSES AND OTHER PROFESSIONALS WHO NOT ONLY DELIVER CARE, BUT ALSO MONITOR AND WORK TO IMPROVE THE QUALITY AND EFFECTIVENESS OF THE SERVICES PROVIDED TO THE COMMUNITY. ALL POLICIES AND ACTIONS OF TJSCH SHALL BE IN FURTHERANCE OF IDENTIFYING AND MEETING THE HEALTH NEEDS OF THOSE THAT WE SERVE. WITH DEDICATED STAFF POSITIONED LOCALLY, THE COMMUNITY CAN BE ASSURED ACCESS TO PRIMARY CARE. PHYSICIANS STRATEGICALLY ALIGNED WITH THE RURAL PROVIDER CAN SUCCESSFULLY MANAGE THEIR PRACTICE AND THE HEALTH OF THE LOCAL COMMUNITY. PAST STRATEGIES RECOMMENDED THAT RURAL HOSPITALS AFFILIATE WITH LARGER, URBAN HOSPITALS OR HEALTH SYSTEMS TO INCREASE THE FACILITY'S ACCESS TO CAPITAL, ADVANCED HEALTH CARE AND IMPROVED COMMUNITY HEALTH OPTIONS. TO DIRECTLY INFLUENCE ITS OWN OPERATIONS, THE DEVELOPMENT OF STRONG SPECIALTY CLINICS SHOULD INCREASE ANCILLARY UTILIZATION AND IMPROVE LOCAL CONFIDENCE IN THE HOSPITAL'S ABILITY TO MEET THE LOCAL COMMUNITY'S HEALTH DEMANDS. IN ORDER TO MEET INCREASED DEMAND FOR ANCILLARY SERVICES, RURAL HOSPITALS NEED TO EXPAND AND GROW OUTPATIENT BUSINESS. THIS IS DONE SO BY PURCHASING THE TECHNOLOGY AND LABORATORY EQUIPMENT TO KEEP TESTING IN- HOUSE. BY EXPANDING THE OUTPATIENT SERVICES OFFERED TO THE COMMUNITY AND INVESTING IN THE EQUIPMENT TO PROVIDE THOSE SERVICES, A RURAL HOSPITAL IS ABLE TO TAKE FULL ADVANTAGE OF THE BUSINESS DRIVEN BY THE SPECIALTY CLINICS. MARKETING A SITUATION WHERE YOUR CARE CAN BE MANAGED LOCALLY DRIVES FACILITY CONFIDENCE LOCALLY. THE COMMUNITY WILL BE AWARE OF THE MANY SERVICES AVAILABLE THROUGH THE HOSPITAL, ITS OUTPATIENT CENTERS AND ITS SPECIALTY CLINICS. THE AGING COMMUNITY OPENS THE DOOR TO INCREASED DEMAND FOR SUB-ACUTE HEALTHCARE. HOME HEALTH, SKILLED NURSING, AND REHABILITATION SERVICES PROVIDE AN INPATIENT HOSPITAL WITH A CONTINUUM OF CARE TO SERVE THE COMMUNITY BEYOND THE ACUTE ENVIRONMENT. EVEN IF A RESIDENT NEEDS TO SEEK SPECIALTY CARE OUT OF MARKET, EXTENSIVE SUB-ACUTE SERVICES WILL RETURN THE PATIENT TO THEIR COMMUNITY WHERE THEY ARE COMFORTABLE AND FAMILIAR TO THE SURROUNDINGS. OTHER COMMUNITY HEALTH EFFORTS TJSCH CLINICAL STAFF COMPLETED THE AGENCY FOR HEALTHCARE RESEARCH AND QUALITY (AHRQ) PATIENT SAFETY CULTURE SURVEY ANNUALLY SINCE 2009 DEMONSTRATING IMPROVEMENTS EACH YEAR. OUR NURSING DEPARTMENT HAS HELD MEMBERSHIP WITH THE NATIONAL DATABASE OF NURSING QUALITY INDICATORS (NDNQI) SINCE 2008. WE CURRENTLY SUBMIT NURSING QUALITY INDICATORS FOR PRESSURE ULCERS, PATIENT FALLS, CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTIONS, CATHETER RELATED URINARY TRACT INFECTIONS, AND VENTILATOR ACQUIRED PNEUMONIA. WE ALSO INITIATED PARTICIPATION IN THE RN STAFF SATISFACTION SURVEY THE FALL OF 2010. TJSCH HAS RECEIVED BETTER THAN THE NATIONAL AVERAGE FOR HOSPITAL CONSUMER ASSESSMENT FOR HEALTHCARE PROVIDER SERVICES (HCAHPS) FOR THE PAST THREE REPORTING QUARTERS IN ALL TEN COMPOSITE INDICATORS. TJSCH IS A MEMBER OF PREMIER PURCHASING PARTNERS FOR THE PURPOSE OF GROUP PURCHASING. TJSCH IS VERY INVOLVED IN THE COMMUNITY AND HAS LED THE CHARGE IN BRINGING SEVERAL COALITIONS TOGETHER FOR STATE PROGRAMS. IN FALL 2003, BARREN, HART AND METCALFE COUNTIES RECEIVED AN AWARD OF $175,000 IN FEDERAL FUNDING TO CREATE A COALITION TO STUDY SUBSTANCE ABUSE IN THEIR COUNTIES. THE COALITION NOW ONLY RECEIVES UP TO $20,000 IN STATE FUNDING PER COUNTY SERVED FROM THE KY OFFICE OF DRUG CONTROL POLICY AGENCY FOR SUBSTANCE ABUSE PREVENTION (ASAP) GRANT. TJSCH SERVED AS THE LEAD ENTITY IN FORMING THE COALITION AND PROCURING THE FUNDING TO IDENTIFY AND DEVELOP POLICIES AND TREATMENT OPTIONS FOR INDIVIDUALS IN NEED OF EDUCATION AND TREATMENT FOR SUBSTANCE ABUSE. UPON RECEIPT OF THE FUNDS TJSCH HIRED A BOARD COORDINATOR TO EXECUTE THE STRATEGIC PLAN THAT WAS DEVELOPED DURING THE GRANT APPLICATION PROCESS. TJSCH SERVES AS THE FISCAL AGENT FOR THE DISTRIBUTION AND RECORD KEEPER OF THESE RESOURCES. THE MAIN GOAL OF THE COALITION IS TO PROVIDE COMMUNITY EDUCATION AND SUBSTANCE ABUSE PREVENTION EFFORTS IN THE TRI-COUNTY SERVICE AREA. WE KNOW THE CALL TO TRULY IMPROVE HEALTH STATUS AND QUALITY OF LIFE REGULARLY TAKES US OUTSIDE OF THE HOSPITAL WALLS. AS SUCH, THE HOSPITAL IS AN ACTIVE PARTICIPANT AND SUPPORTER OF ORGANIZATIONS SUCH AS CAMP COURAGEOUS, DISCOVERY ACADEMY, COMMUNITY MEDICAL CARE AND MED SHARE INTERNATIONAL. TJSCH AND ITS ASSOCIATES PROVIDE ASSISTANCE TO SEVERAL COMMUNITY FUNDRAISERS THAT SUPPORT THE SERVICE, EDUCATION AND RESEARCH NEEDS OF HEALTH AND SOCIAL SERVICE RELATED ORGANIZATIONS. IN DONATIONS AND STAFF TIME OUR CONTRIBUTIONS FOR THESE ACTIVITIES EXCEED $167,000 NOT INCLUDING THE PERSONAL CONTRIBUTIONS OF OUR EMPLOYEES TOTALING OVER $30,000. * AMERICAN CANCER SOCIETY-RELAY FOR LIFE * AMERICAN DIABETES ASSOCIATION WALK * AMERICAN HEART ASSOCIATION-HEART WALK AND WEAR RED DAY * BARREN COUNTY SAFE COMMUNITIES * BARREN COUNTY SAFE KIDS * BIG BROTHERS/BIG SISTERS * COALITION FOR DRUG FREE COMMUNITIES * COMMUNITY ACTION ANGEL TREE * CYSTIC FIBROSIS WALK * MARCH OF DIMES WALK AMERICA * SUSAN G. KOMEN * UNITED WAY * YMCA PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM: TJ REGIONAL HEALTH INC. : AS OF JANUARY 1, 2011, TJSCH BECAME A SUBSIDIARY OF A NEWLY FORMED ORGANIZATION, T. J. REGIONAL HEALTH, INC. THIS ORGANIZATION SERVES AS THE PARENT ORGANIZATION AND WAS FORMED TO HELP FACILITATE THE ORGANIZATIONS PLANS TO BECOME MORE REGIONALLY FOCUSED. AT THE SAME TIME A SECOND SUBSIDIARY OF T. J. REGIONAL HEALTH WAS FORMED, T. J. HEALTH PARTNERS, LLC. T. J. HEALTH PARTNERS, LLC, OPERATES PHYSICIAN CLINICS THAT INCLUDE FAMILY MEDICINE, INTERNAL MEDICINE, OB/GYN, ONCOLOGY, PULMONOLOGY, NEPHROLOGY, CARDIOLOGY, UROLOGY, NEUROLOGY, GYNECOLOGY AND PAIN MANAGEMENT. T. J. HEALTH PARTNERS, LLC IS A PHYSICIAN MULTI-SPECIALTY CLINIC THAT OFFERS PATIENTS EASY ACCESS TO CARE. THE COMPREHENSIVE SERVICES ALLOW PATIENTS TO REMAIN IN THE COMMUNITY FOR THEIR HEALTHCARE NEEDS. AS COMMUNITY NEEDS ARE IDENTIFIED, ONGOING EFFORTS WILL BE MADE TO EXPAND THE OFFERINGS. SPECIALTIES RANGE FROM PRIMARY CARE TO INVASIVE/INTERVENTIONAL CARDIOLOGY, UROLOGY, PULMONARY, ONCOLOGY, AND NEUROLOGY. EACH OFFICE IS DESIGNED TO MEET AS MANY OF THE PATIENT'S NEEDS IN THE OFFICE SETTING AS POSSIBLE. T.J. HEALTH PAVILION IS AN OUTPATIENT SERVICE FACILITY OWNED AND OPERATED BY T.J. SAMSON COMMUNITY HOSPITAL AND IS DESIGNED TO MEET THE DEMAND OF RISING OUTPATIENT VOLUMES. THE T.J. HEALTH PAVILION HOUSES THE PHYSICIAN GROUP OF T.J. HEALTH PARTNERS AND THE OUTPATIENT SERVICES OF T.J. SAMSON COMMUNITY HOSPITAL. THE FACILITY ALLOWS THE COMMUNITY ACCESS TO A WIDE ARRAY OF SERVICES AND TECHNOLOGY ALL LOCATED IN ONE CONVENIENT LOCATION. SERVICES AND SPECIALTIES INCLUDE; REHABILITATION, DIALYSIS, URGENT CARE SERVICES, LABORATORY, RADIOLOGY, PRIMARY CARE, ONCOLOGY, UROLOGY, PAIN MANAGEMENT, SURGERY PHYSICIANS, OBSTETRICS AND GYNECOLOGY, CARDIOLOGY, AND NEPHROLOGY. BARREN-METCALFE EMS IS A MEDICAL TRANSPORT SERVICE COMPANY PROVIDING LOCAL MEDICAL TRANSPORTATION IN BARREN AND METCALFE COUNTY. IT OFFERS A FULL RANGE OF MEDICAL TRANSPORTATION SERVICES. THE HOSPITAL HAS TWO REPRESENTATIVES THAT SERVE ON THE AMBULANCE BOARD AND PROVIDES FINANCIAL SUPPORT TO COVER 20% OF THE DEFICIT INCURRED AT MONTH END. TJSCH IS HOME TO THE LOUISVILLE MEDICAL CENTER'S AIR METHODS. AIR METHODS IS A COMPREHENSIVE MEDICAL TRANSPORTATION SYSTEM THAT INCLUDES EMERGENCY HELICOPTER, FIXED-WING (AIRPLANE) AIRCRAFT, AND GROUND MOBILE INTENSIVE CARE VEHICLES. AIR METHODS IS NOT A REPLACEMENT FOR EXISTING GROUND EMERGENCY MEDICAL SERVICES. THE GOAL IS TO COMPLIMENT THE CARE GIVEN BY THE TEAM ON THE GROUND. AIR METHODS IS VERY ACTIVE WITH PUBLIC SAFETY EDUCATION. THIS INCLUDES GOING TO HIGH SCHOOLS TO DISCOURAGE DRINKING AND DRIVING BY PARTICIPATING IN MOCK MOTOR VEHICLE CRASH DEMONSTRATIONS FOR LOCAL SADD CHAPTERS. AIR METHODS ALSO PARTICIPATES IN PROM PROMISE ACTIVITIES AND VICTIM IMPACT PANELS. AIR METHODS FREQUENTLY PROVIDES ASSISTANCE TO LOCAL EMS, FIRE DEPARTMENTS, AND POLICE AGENCIES WITH MOCK MOTOR VEHICLE CRASHES, DISASTER SCENARIOS, AND OTHER TRAINING. TJSCH HAS ON ITS CAMPUS THE UNIVERSITY OF LOUISVILLE FAMILY MEDICINE RESIDENCY PROGRAM. THIS THREE-YEAR PROGRAM TRAINS RESIDENTS TO BECOME FAMILY PRACTITIONERS UNDER THE GUIDANCE OF LOCAL PHYSICIANS. THE RESIDENCY PROGRAM AT TJSCH IS 1 OF ONLY 7 IN KENTUCKY AND TREATS SOME 12,000 PATIENTS ANNUALLY. THE BARREN RIVER REGIONAL CANCER CENTER IS A JOINT VENTURE BETWEEN TJSCH AND THE MEDICAL CENTER. THIS CENTER HAS ALLOWED CANCER SPECIALISTS TO CREATE A CARING AND PERSONAL ENVIRONMENT FOR THOSE PATIENTS WHO REQUIRE RADIATION ONCOLOGY. CANCER TREATMENT IS INDIVIDUALIZED, INNOVATIVE, COMPREHENSIVE, AND DELIVERED WITH CARE AND OPTIMISM. ALL TREATMENT TEAM MEMBERS ARE SPECIALLY CERTIFIED AND STRIVE TO CREATE A RELAXING, COMFORTABLE PLACE IN WHICH TO SEEK TREATMENT. THE CENTER IS STAFFED WITH FULL-TIME ONCOLOGISTS, THERAPISTS AND TECHNICIANS USING THE NEWEST EQUIPMENT TO EFFECTIVELY DIAGNOSE CANCERS AND PLAN THE MOST EFFECTIVE COURSE OF TREATMENT. COMMUNITY MEDICAL CARE, INC. IS A LOCAL CHARITY ASSISTING BARREN COUNTY'S LOW-INCOME SENIORS WITH PRESCRIPTION MEDICATION, PRESCRIPTION GLASSES, AND HEARING AIDS. COMMUNITY MEDICAL CARE ALSO ASSISTS LOW-INCOME, WORKING UNINSURED ADULTS OF BARREN COUNTY BY PROVIDING PRIMARY HEALTH CARE, PRESCRIPTION MEDICATION, EMERGENCY DENTAL, OPTOMETRIC AND HOSPITAL CARE, AND SPECIALIST CONSULTATION. THE PRIMARY HEALTH CARE IS MADE POSSIBLE THROUGH THE RESIDENCY PROGRAM AT T.J. SAMSON COMMUNITY HOSPITAL. 1 TJ REGIONAL HEALTH INC 1301 N RACE STREET GLASGOW KY 42141 273988336 501C3 7588470 TO PROVIDE SUPPORT BOYS & GIRLS CLUB OF GLASGOWBARREN CO 100 CHEATHAM ST GLASGOW KY 42141 454693954 501C3 20000 TO PROVIDE SUPPORT BARREN CO ECONOMIC AUTHORITY PO BOX 1703 GLASGOW KY 42141 611064852 GOV'T ENTITY 25000 TO PROVIDE SUPPORT BARREN COUNTY AREA TECHNOLOGY CENTER 491 TROJAN TRAIL GLASGOW KY 42141 610600439 GOV'T ENTITY 29927 TO PROVIDE SUPPORT BARREN COUNTY EDUCATIONAL FOUNDATION INC 202 W WASHINGTON ST GLASGOW KY 42141 202351623 501C3 5000 TO PROVIDE SUPPORT YMCA 1 YMCA WAY GLASGOW KY 42141 621364505 501C3 10000 TO PROVIDE SUPPORT 6 0 PART I, LINE 2: ALL GRANTS ARE PROVIDED TO PUBLIC CHARITIES FOR GENERAL SUPPORT. TJ SAMSON COMMUNITY HOSPITAL DOES NOT MONITOR THE USE OF THESE FUNDS BY THESE CHARITIES. 0 0 0 0 0 0 0 1 0 JOHN P CRADDOCK MD DIRECTOR/VICE CHIEF OF STAFF 567042 0 47452 0 1260 0 10025 0 25593 0 651372 0 0 0 ERIC FISHER MD DIRECTOR/CHIEF OF STAFF 250526 0 12243 0 3462 0 9546 0 23195 0 298972 0 0 0 NEIL THORNBURY CHIEF EXECUTIVE DIRECTOR 0 342725 0 30632 0 1260 0 24245 0 14535 0 413397 0 0 MEI DENG CHIEF FINANCIAL OFFICER 0 281627 0 23401 0 1260 0 9545 0 23428 0 339261 0 0 VENKATA REDDY PHYSICAN 805610 0 234867 0 5544 0 11200 0 13784 0 1071005 0 0 0 HARIKRISHNAN NAIR PHYSICAN 667579 0 513114 0 1296 0 11100 0 26707 0 1219796 0 0 0 YASHPAL MODI PHYSICAN 456559 0 302005 0 10756 0 9874 0 22513 0 801707 0 0 0 ZAKARE SALIFU PHYSICAN 450046 0 221885 0 1932 0 11200 0 25930 0 710993 0 0 0 TODD MARION PHYSICAN 651633 0 32421 0 3612 0 11200 0 25640 0 724506 0 0 0 PART I, LINE 3 THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. TJ REGIONAL HEALTH, INC., A RELATED ORGANIZATION OF TJ SAMSON COMMUNITY HOSPITAL, INC., USES THE FOLLOWING METHOD TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: - COMPENSATION SURVEY OR STUDY PART I, LINE 7 PHYSICIANS ARE ELGIBLE FOR INCENTIVE COMPENSATION. PHYSICIANS MAY EARN ADDITONAL COMPENSATION THROUGH QUARTERLY PRODUCTIVITY BONUSES THAT ARE BASED ON THE CALCULATED DIFFERENCE OF ACTUAL WRVUS FOR THE QUARTER LESS A WRVU QUARTERLY TARGET. THE OFFICER'S BONUSES ARE CALCULATED BASED ON STANDARD PERFORMANCE METRICS AS MEASURED BY ANNUAL CMS PATIENT SATISFACTION SURVEY RESULTS, ANNUAL EMPLOYEE SATISFACTION AND TURNOVER RESULTS, ANNUAL CMS HOSPITAL QUALITY SCORES IMPROVEMENT, FINANCIAL PERFORMANCE TO GOALS, SERVICE LINE GROWTH AND MARKET SHARE EXPANSION, AND COMMUNITY DEVELOPMENT SUPPORT AND PROGRESS. A CITY OF GLASGOW KENTUCKY 616001831 376844AT3 2011-08-24 30007455 FOR CONSTRUCTION 0 0 0 A 30007455 2212852 1940080 221767 596767 25035989 2013 0 0 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 A 1 FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE CEO AND CFO BEFORE FILED. FORM 990, PART VI, SECTION B, LINE 12C YEARLY THE BOARD REVIEWS THE POLICY AND ENSURES COMPLIANCE BY ALL MEMBERS. EACH MEMBER MUST ANNUALLY DISCLOSE COMPLIANCE. FORM 990, PART VI, SECTION B, LINE 15 THE HOSPITAL USES AN OUTSIDE THIRD PARTY AGENCY TO HELP DETERMINE COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 19 ALL DOCUMENTS ARE MADE AVAILABLE UPON REQUEST FROM THE ORGANIZATION. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 11,492,073. MANAGEMENT AND GENERAL EXPENSES 999,311. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,491,384. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 12,470,207. MANAGEMENT AND GENERAL EXPENSES 1,084,366. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,554,573. FORM 990, PART XI, LINE 9: CHANGE IN FUNDED STATUS OF PENSION -3,000,985. TJ HEALTH PARTNERS INVESTMENT 11,765,127. MEDICAID SETTLEMENTS 9,556,180. ESTATE WRITE OFF -2,184,254. FORM 990, PART XII, LINE 2C, OVERSIGHT OF AUDIT: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM THE PRIOR YEAR. TJ REGIONAL HEALTH INC 1301 NORTH RACE STREET GLASGOW KY 42141 273988336 PARENT ORGANIZATION OF HEALTHCARE FACILITY KY 501(C)(3) LINE 12B, II 0 TJ HEALTH PARTNERS LLC 1301 NORTH RACE STREET GLASGOW KY 42141 273988456 PHYSICIAN CLINICS KY 501(C)(3) LINE 10 TJ REGIONAL HEALTH INC 0 TJ HEALTH COLUMBIA 1301 NORTH RACE STREET GLASGOW KY 42141 810893103 HOSPITAL KY 501(C)(3) LINE 3 TJ REGIONAL HEALTH INC 0 TJ COMMUNITY MISSION FOUNDATION 1301 NORTH RACE STREET GLASGOW KY 42141 472208322 FOUNDATION KY 501(C)(3) LINE 10 TJ REGIONAL HEALTH INC 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0