T J SAMSON COMMUNITY HOSPITAL: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- T J SAMSON COMMUNITY HOSPITAL (EIN 61-0461767)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-15
- IRS object ID
- 201812279349302861
- Schema version
- 2016v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-15T14:48:31-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Blue & Co LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N Meridian St Suite 200 | AddressLine1Txt |
| City | Indianapolis | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610461767 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ Samson Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | TJSA | BusinessNameControlTxt |
| Phone | 2706514114 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 North Race Street | AddressLine1Txt |
| City | Glasgow | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42141 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MEI DENG | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 2706514114 | PhoneNum |
| Signature | 2018-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carrie A Merrill CPA | PreparerPersonNm |
| PTIN | P00832283 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2018-08-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MEI DENG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 North Race Street | AddressLine1Txt |
| City | Glasgow | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42141 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $170,253,776 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.tjsamson.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1928 | FormationYr |
| Legal Domicile State | KY | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 1375 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $9,884 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $2,962 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $62,436 | PYContributionsGrantsAmt |
| CY Contributions Grants | $12,335 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $155,077,481 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $168,024,469 | CYProgramServiceRevenueAmt |
| PY Investment Income | $584,460 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,195,510 | CYInvestmentIncomeAmt |
| PY Other Revenue | $981,572 | PYOtherRevenueAmt |
| CY Other Revenue | $948,617 | CYOtherRevenueAmt |
| PY Total Revenue | $156,705,949 | PYTotalRevenueAmt |
| CY Total Revenue | $170,180,931 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,351,687 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,855,051 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $82,353,338 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $80,368,590 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $74,324,049 | PYOtherExpensesAmt |
| CY Other Expenses | $78,129,567 | CYOtherExpensesAmt |
| PY Total Expenses | $167,029,074 | PYTotalExpensesAmt |
| CY Total Expenses | $164,353,208 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$10,323,125 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,827,723 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $150,473,983 | TotalAssetsBOYAmt |
| Total Assets EOY | $152,076,092 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $103,449,191 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $92,606,128 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $47,024,792 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $59,469,964 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $151,204,952 | ExpenseAmt |
| Grant | $5,855,051 | GrantAmt |
| Revenue | $168,544,237 | RevenueAmt |
| Desc | TJ Samson community hospital provides healthcare services to barren and surrounding counties in kentucky. ACUTE HOSPITAL AND EMERGENCY ROOM CARE PATIENT DAYS 22,586 AND ER VISITS 28,386 in FYE 9/30/17. | Desc |
| Total Program Service Expenses | $151,204,952 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 104 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 1375 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KY | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Margie Gentry | PersonNm |
| Phone | 2706514114 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 North Race Street | AddressLine1Txt |
| City | Glasgow | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42141 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MIKE BRYANT | ||||||||
| CHAIRMAN | 1.00 | 3.00 | Yes (X) | $0 | $0 | $78 | ||
| JOEY BOTTS | ||||||||
| VICE CHAIRMAN | 1.00 | 3.00 | Yes (X) | $14,766 | $0 | $0 | ||
| BUDDY UNDERWOOD | ||||||||
| Secretary | 1.00 | 3.00 | Yes (X) | $0 | $0 | $78 | ||
| HENRY ROYSE | ||||||||
| TREASURER | 1.00 | 3.00 | Yes (X) | $9,614 | $0 | $0 | ||
| DAN FOUTCH | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $9,523 | $0 | $0 | ||
| KAREN SMALL MD | ||||||||
| DIRECTOR | 40.00 | 1.00 | Yes (X) | $45,537 | $0 | $35,836 | ||
| WALTER DAVIS | ||||||||
| EMERITUS STATUS | 1.00 | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| Scott Young | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $78 | ||
| Rich Alexander | ||||||||
| DIRECTOR | 1.00 | 3.00 | Yes (X) | $0 | $0 | $78 | ||
| BRENT BILLINGSLEY | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $26 | ||
| DR JAMES THURMAN | ||||||||
| Director | 1.00 | 3.00 | Yes (X) | $0 | $0 | $26 | ||
| Allison Campbell MD | ||||||||
| DIRECTOR/Chief of Staff | 40.00 | 1.00 | Yes (X) | $244,971 | $0 | $19,437 | ||
| WILLIAM KLAPHEKE MD | ||||||||
| DIRECTOR/VICE Chief of Sta | 40.00 | 1.00 | Yes (X) | $507,176 | $0 | $27,415 | ||
| Bud Wethington | ||||||||
| Chief EXECUTIVE OFFICER | 5.00 | 40.00 | $0 | $460,190 | $22,412 | Yes (X) | ||
| NEIL THORNBURY | ||||||||
| CHIEF OPERATING OFFICER | 5.00 | 40.00 | $0 | $253,665 | $29,076 | Yes (X) | ||
| MEI DENG | ||||||||
| CFO (10/31/16 - 9/30/17) | 5.00 | 40.00 | $0 | $32,550 | $2,141 | Yes (X) | ||
| Harikrishnan Nair | ||||||||
| Physican | 40.00 | 0.00 | $1,151,301 | $0 | $25,608 | Yes (X) | ||
| Venkata Reddy | ||||||||
| Physican | 40.00 | 0.00 | $982,493 | $0 | $21,703 | Yes (X) | ||
| Carlos Kummerfeldt | ||||||||
| Physican | 40.00 | 0.00 | $787,539 | $0 | $21,213 | Yes (X) | ||
| Donald Goodin | ||||||||
| Physican | 40.00 | 0.00 | $670,424 | $0 | $23,084 | Yes (X) | ||
| Michael Marion | ||||||||
| Physican | 40.00 | 0.00 | $621,486 | $0 | $29,481 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $5,044,830 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $746,405 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $257,770 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 60 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SE EMERGENCY PHYSICIANS | |||||
| P O BOX 634850 | Cincinnati | OH | 452634850 | URGENT CARE MD | $1,354,705 |
| COMPHEALTH | |||||
| P O BOX 972651 | DALLAS | TX | 753972651 | HOSPITALISTS | $1,199,421 |
| EMCARE INC | |||||
| 7032 COLLECTIONS CENTER DRIVE | CHIcago | IL | 60693 | ER PHYSICIANS | $842,133 |
| CARDINAL HEALTHPHARMACY | |||||
| 21377 NETWORK PLACE | Chicago | IL | 606731213 | PHARMACY SUPERVISION | $782,111 |
| ASSOCIATED PATHOLOGY | |||||
| P O BOX 402978 | Atlanta | GA | 30384 | Pathology | $557,326 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 21 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $10,000 | RelatedOrganizationsAmt |
| All Other Contributions | $2,335 | AllOtherContributionsAmt |
| Total Contributions | $12,335 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| NET PATIENT REVENUE | 900099 | $168,020,231 | $168,020,231 | |
| OUTSIDE LAB | 621500 | $4,238 | $4,238 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $168,024,469 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,199,641 | TotalRevenueColumnAmt |
| Exclusion | $1,199,641 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $160,731 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $68,714 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $92,017 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $92,017 | TotalRevenueColumnAmt |
| Exclusion | $92,017 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,131 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$4,131 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,131 | TotalRevenueColumnAmt |
| Exclusion | -$4,131 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|---|
| CAFETERIA SALES | 900099 | $326,948 | $326,948 | ||
| Premier Partnership Income | 541900 | $130,174 | $124,528 | $5,646 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $399,478 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $399,478 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $856,600 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $170,180,931 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $168,544,237 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $9,884 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,614,475 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,855,051 | TotalAmt |
| Program Services | $5,855,051 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,406,205 | TotalAmt |
| Program Services | $58,333,709 | ProgramServicesAmt |
| Management And General | $5,072,496 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,857,074 | TotalAmt |
| Program Services | $3,548,508 | ProgramServicesAmt |
| Management And General | $308,566 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,090,000 | TotalAmt |
| Program Services | $8,362,800 | ProgramServicesAmt |
| Management And General | $727,200 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,015,311 | TotalAmt |
| Program Services | $3,694,086 | ProgramServicesAmt |
| Management And General | $321,225 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $562,146 | TotalAmt |
| Management And General | $562,146 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $398,975 | TotalAmt |
| Management And General | $398,975 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,964,756 | TotalAmt |
| Program Services | $17,447,576 | ProgramServicesAmt |
| Management And General | $1,517,180 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $928,380 | TotalAmt |
| Program Services | $928,380 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $717,481 | TotalAmt |
| Program Services | $660,083 | ProgramServicesAmt |
| Management And General | $57,398 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,554,786 | TotalAmt |
| Program Services | $4,190,403 | ProgramServicesAmt |
| Management And General | $364,383 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,355,898 | TotalAmt |
| Program Services | $4,007,426 | ProgramServicesAmt |
| Management And General | $348,472 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $516,548 | TotalAmt |
| Program Services | $475,224 | ProgramServicesAmt |
| Management And General | $41,324 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,222 | TotalAmt |
| Management And General | $25,222 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,892,846 | TotalAmt |
| Program Services | $1,892,846 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,309,451 | TotalAmt |
| Program Services | $9,309,451 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,677,203 | TotalAmt |
| Program Services | $1,543,027 | ProgramServicesAmt |
| Management And General | $134,176 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $15,988,612 | $13,255,461 | $2,733,151 |
| Drugs | $11,532,997 | $11,532,997 | |
| Repairs and Maintenance | $2,526,894 | $2,324,742 | $202,152 |
| Provider taxes | $2,333,637 | $2,146,946 | $186,691 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,843,735 | TotalAmt |
| Program Services | $1,696,236 | ProgramServicesAmt |
| Management And General | $147,499 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,353,208 | TotalAmt |
| Program Services | $151,204,952 | ProgramServicesAmt |
| Management And General | $13,148,256 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $670,383 | BOYAmt |
| EOY | $1,498,109 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,090,425 | BOYAmt |
| EOY | $39,710,745 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,307,304 | BOYAmt |
| EOY | $20,646,084 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $179,412 | BOYAmt |
| EOY | $236,580 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,297,072 | BOYAmt |
| EOY | $3,245,634 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,635,386 | BOYAmt |
| EOY | $3,288,624 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $194,946,707 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $128,813,972 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,536,232 | BOYAmt |
| EOY | $66,132,735 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,212,853 | BOYAmt |
| EOY | $2,212,853 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,260,691 | BOYAmt |
| EOY | $2,403,689 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,284,225 | BOYAmt |
| EOY | $12,701,039 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,473,983 | BOYAmt |
| EOY | $152,076,092 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,480,801 | BOYAmt |
| EOY | $15,668,432 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,015,328 | BOYAmt |
| EOY | $28,252,661 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,953,062 | BOYAmt |
| EOY | $48,685,035 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $103,449,191 | BOYAmt |
| EOY | $92,606,128 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,024,792 | BOYAmt |
| EOY | $59,469,964 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,024,792 | BOYAmt |
| EOY | $59,469,964 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $150,473,983 | BOYAmt |
| EOY | $152,076,092 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,827,723 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$190,361 | NetUnrlzdGainsLossesInvstAmt |
| Investment Expense | -$37,822 | InvestmentExpenseAmt |
| Other Changes In Net Assets | $6,845,632 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $7,765 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,765 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | The hospital pays membership dues to the Kentucky hospital association of which a portion of the dues are used for lobbying purposes. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,091,573 | OtherCostOrOtherBasisAmt |
| Book Value | $3,091,573 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $55,512,918 | OtherCostOrOtherBasisAmt |
| Depreciation | $27,222,824 | DepreciationAmt |
| Book Value | $28,290,094 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,003,195 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,784,048 | DepreciationAmt |
| Book Value | $219,147 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $133,220,927 | OtherCostOrOtherBasisAmt |
| Depreciation | $99,807,100 | DepreciationAmt |
| Book Value | $33,413,827 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,118,094 | OtherCostOrOtherBasisAmt |
| Book Value | $1,118,094 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $66,132,735 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Due from related entity - TJHC | $9,313,765 |
| INVESTMENT IN PREMIER LLP | $2,405,262 |
| Physician Contracts | $365,583 |
| Deposits | $328,130 |
| Other current assets | $288,299 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $12,701,039 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| accrued pension costs | $36,270,146 |
| Due to related entity - TJHP | $11,907,871 |
| Est due to government programs | $327,933 |
| Provider Tax Payable | $179,085 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $48,685,035 | TotalLiabilityAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,590,960 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,416,553 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,174,407 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00710 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $42,413,267 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $35,553,617 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,859,650 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04170 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $45,004,227 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $36,970,170 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,034,057 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04880 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 85 | ActivitiesOrProgramsCnt |
| Persons Served | 12583 | PersonsServedCnt |
| Total Community Benefit Expns | $122,967 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,610 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $100,357 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 85 | ActivitiesOrProgramsCnt |
| Persons Served | 12583 | PersonsServedCnt |
| Total Community Benefit Expns | $122,967 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $22,610 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $100,357 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 85 | ActivitiesOrProgramsCnt |
| Persons Served | 12583 | PersonsServedCnt |
| Total Community Benefit Expns | $45,127,194 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $36,992,780 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,134,414 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04940 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 421 | PersonsServedCnt |
| Total Community Benefit Expns | $3,991 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 421 | PersonsServedCnt |
| Total Community Benefit Expns | $3,991 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,991 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $10,282,835 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $39,972,473 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $42,101,480 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,129,007 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ SAMSON COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 North Race Street | AddressLine1Txt |
| City | Glasgow | CityNm |
| State Abbreviation | KY | StateAbbreviationCd |
| ZIP | 42141 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.tjsamson.org | WebsiteAddressTxt |
| State License | 720185 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ SAMSON COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | https://www.tjsamson.org/about_us/community_needs_assessment.aspx | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.tjsamson.org/about_us/community_needs_assessment.aspx | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.tjsamson.org/charityfinancial_assistance.aspx | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.tjsamson.org/charityfinancial_assistance.aspx | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.tjsamson.org/charityfinancial_assistance.aspx | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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: Do not have adequate resources for mental health and substance abuse. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 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 70,470 residents in a 1,200 square mile area. The secondary service area (SSA) includes Adair, Allen, Clinton, Cumberland, Edmonson, Green, Monroe, Russell and Warren counties with 221,480 residents in 3,000 square miles. In total, TJSCH's twelve-county service area of approximately 4,200 square miles extends beyond the BRADD counties-providing health care services to over 290,000 residents. |
| 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 state funding to create a coalition to study substance abuse in their counties. 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. 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| TJ REGIONAL HEALTH INC | |||||||
| 1301 N RACE STREET | GLASGOW | KY | 42141 | 273988336 | 501c3 | $5,809,751 | TO PROVIDE SUPPORT |
| Boys & Girls Club of GlasgowBarren Co | |||||||
| 301 Bunche Avenue | Glasgow | KY | 42141 | 454693954 | 501c3 | $20,000 | TO PROVIDE SUPPORT |
| AMERICAN HEART ASSOCIATION | |||||||
| 5455 North High Street | Columbus | OH | 43214 | 135613797 | 501c3 | $15,000 | to provide support |
| Barren County Educational Foundation Inc | |||||||
| 202 W Washington St | GlaSGOW | KY | 42141 | 202351623 | 501c3 | $5,000 | 2017 Children's Day Fund |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Allison Campbell MD | ||||||||||||||
| DIRECTOR/Chief of Staff | $244,971 | $0 | $0 | $0 | $0 | $0 | $9,262 | $0 | $10,175 | $0 | $264,408 | $0 | $0 | $0 |
| WILLIAM KLAPHEKE MD | ||||||||||||||
| DIRECTOR/VICE Chief of Sta | $383,671 | $0 | $117,920 | $0 | $5,585 | $0 | $9,250 | $0 | $18,165 | $0 | $534,591 | $0 | $0 | $0 |
| Bud Wethington | ||||||||||||||
| Chief EXECUTIVE OFFICER | $0 | $394,813 | $0 | $50,062 | $0 | $15,315 | $0 | $10,070 | $0 | $12,342 | $0 | $482,602 | $0 | $0 |
| NEIL THORNBURY | ||||||||||||||
| CHIEF OPERATING OFFICER | $0 | $252,807 | $0 | $0 | $0 | $858 | $0 | $18,843 | $0 | $10,233 | $0 | $282,741 | $0 | $0 |
| Harikrishnan Nair | ||||||||||||||
| Physican | $595,971 | $0 | $554,490 | $0 | $840 | $0 | $10,168 | $0 | $15,440 | $0 | $1,176,909 | $0 | $0 | $0 |
| Venkata Reddy | ||||||||||||||
| Physican | $815,376 | $0 | $163,205 | $0 | $3,912 | $0 | $10,600 | $0 | $11,103 | $0 | $1,004,196 | $0 | $0 | $0 |
| Carlos Kummerfeldt | ||||||||||||||
| Physican | $396,267 | $0 | $390,600 | $0 | $672 | $0 | $8,013 | $0 | $13,200 | $0 | $808,752 | $0 | $0 | $0 |
| Donald Goodin | ||||||||||||||
| Physican | $491,726 | $0 | $157,438 | $0 | $21,260 | $0 | $9,523 | $0 | $13,561 | $0 | $693,508 | $0 | $0 | $0 |
| Michael Marion | ||||||||||||||
| Physican | $575,202 | $0 | $44,352 | $0 | $1,932 | $0 | $10,600 | $0 | $18,881 | $0 | $650,967 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | THE ORGANIZATION'S OFFICERS ARE PAID BY A RELATED ORGANIZATION. |
| 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. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| CITY OF GLASGOW KENTUCKY | ||||||||
| A | 616001831 | 376844AT3 | 2011-08-24 | $30,007,455 | For Construction | 0 | 0 | 0 |
| CITY OF EDMONTON KENTUCKY | ||||||||
| B | 616012870 | 2012-04-04 | $7,650,000 | To Refinance 1998 bond issue | 0 | 0 | 0 | |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Capitalized InterestCapitalizedInterestAmt | Refunding EscrowRefundingEscrowAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Other Spent ProceedsOtherSpentProceedsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | $30,007,455 | $2,212,852 | $1,940,080 | $221,767 | $596,767 | $25,035,989 | 2013 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $7,650,000 | $130,000 | 0 | Yes (1) | Yes (1) | Yes (1) | $7,520,000 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | Yes (1) | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 7,497,705. Management and general expenses 651,974. Fundraising expenses 0. Total expenses 8,149,679. Contract Labor: Program service expenses 9,949,871. Management and general expenses 865,206. Fundraising expenses 0. Total expenses 10,815,077. |
| Form 990, Part XI, line 9: | CHANGE IN FUNDED STATUS OF PENSION 6,845,606. Rounding 26. |
| 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. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 0 | TJ REGIONAL HEALTH INC |
| TJ Health Columbia | ||||||||||
| 1301 North Race Street | Glasgow | KY | 42141 | 810893103 | Hospital | KY | 501(c)(3) | Line 3 | 0 | TJ REGIONAL HEALTH INC |
| TJ Community Mission Foundation | ||||||||||
| 1301 North Race Street | Glasgow | KY | 42141 | 472208322 | Foundation | KY | 501(c)(3) | Line 10 | 0 | TJ REGIONAL HEALTH INC |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (1) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |