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TRIGG COUNTY HOSPITAL INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
TRIGG COUNTY HOSPITAL INC (EIN 61-0471581)
Tax period
2014-05-01 to 2015-04-30
Filed
2016-03-15
IRS object ID
201610759349300231
Schema version
2014v6.0
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 ReturnHeader

FieldValueIRS element (for citing)
Return2016-03-15T12:27:07-05:00ReturnTs
Tax Period End2015-04-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1360 E 8TH AVE STE 201 PO BOX 1196AddressLine1Txt
CityBOWLING GREENCityNm
State AbbreviationKYStateAbbreviationCd
ZIP421021196ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-05-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN610471581EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TRIGG COUNTY HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% CHRISTOPHER WALKLEYInCareOfNm
Business Name ControlTRIGBusinessNameControlTxt
Phone2705223215PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1254 MAIN STAddressLine1Txt
CityCADIZCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42211ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonJOHN SUMNERPersonNm
Person TitleCEOPersonTitleTxt
Phone2705223215PhoneNum
Signature2016-03-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKIM SCIFRESPreparerPersonNm
PTINP01316095PTIN
Phone2707810111PhoneNum
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerJOHN SUMNER CEOPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1254 MAIN STREETAddressLine1Txt
CityCADIZCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42211ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$15,798,848GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.TRIGGHOSPITAL.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1952FormationYr
Legal Domicile StateKYLegalDomicileStateCd
Activity Or MissionTO PROVIDE QUALITY HEALTHCARE SERVICES IN a caring and cost-effective manner. WE PLEDGE TO MEET STANDARDS OF EXCELLENCE WHILE CONTINUOUSLY IMPROVING THE VALUE OF OUR SERVICE.ActivityOrMissionDesc
Voting Members Governing Body12VotingMembersGoverningBodyCnt
Voting Members Independent12VotingMembersIndependentCnt
Total Employee219TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$627,686PYContributionsGrantsAmt
CY Contributions Grants$653,754CYContributionsGrantsAmt
PY Program Service Revenue$14,856,659PYProgramServiceRevenueAmt
CY Program Service Revenue$14,967,984CYProgramServiceRevenueAmt
PY Investment Income$4,176PYInvestmentIncomeAmt
CY Investment Income$7,654CYInvestmentIncomeAmt
PY Other Revenue$76,392PYOtherRevenueAmt
CY Other Revenue$162,426CYOtherRevenueAmt
PY Total Revenue$15,564,913PYTotalRevenueAmt
CY Total Revenue$15,791,818CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,541,846PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,619,059CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,871,952PYOtherExpensesAmt
CY Other Expenses$6,957,366CYOtherExpensesAmt
PY Total Expenses$15,413,798PYTotalExpensesAmt
CY Total Expenses$15,576,425CYTotalExpensesAmt
PY Revenues Less Expenses$151,115PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$215,393CYRevenuesLessExpensesAmt
Total Assets BOY$9,363,159TotalAssetsBOYAmt
Total Assets EOY$13,140,337TotalAssetsEOYAmt
Total Liabilities BOY$6,676,357TotalLiabilitiesBOYAmt
Total Liabilities EOY$10,238,142TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,686,802NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$2,902,195NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE QUALITY HEALTHCARE SERVICES IN A CARING AND COST-EFFECTIVE MANNER. IN ACHIEVING OUR MISSION, WE PLEDGE TO MEET STANDARDS OF EXCELLENCE WHILE CONTINUOUSLY IMPROVING THE VALUE OF OUR SERVICE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$14,083,219ExpenseAmt
Revenue$14,973,993RevenueAmt
DescOur mission is to provide quality healthcare services in a caring and cost-effective manner. In achieving our mission, we pledge to meet standards of excellence while continuously improving the value of our service. The Hospital provides inpatient, outpatient, and emergency care services to patients in the Trigg County, Kentucky area.Desc
Total Program Service Expenses$14,083,219TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document36IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee219EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members12GoverningBodyVotingMembersCnt
Independent Voting Member12IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldKYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCHRISTOPHER WALKLEYPersonNm
Phone2705223215PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1254 MAIN STREETAddressLine1Txt
CityCADIZCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42211ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
BOB NOEL
BOARD MEMBER1.00.0Yes (X)$0$0$0
CHRISTY OLIPHANT
BOARD MEMBER1.00.0Yes (X)$0$0$0
CLARA BETH HYDE
BOARD MEMBER1.00.0Yes (X)$0$0$0
GEORGE RADFORD
SECRETARY/TREASURER1.00.0Yes (X)$0$0$0Yes (X)
JESSE THOMAS
VICE CHAIRMAN1.00.0Yes (X)$0$0$0Yes (X)
JOE NICHOLS
BOARD MEMBER1.00.0Yes (X)$0$0$0
MALLORY LAWRENCE
BOARD MEMBER1.00.0Yes (X)$0$0$0
MELISSA HALE
BOARD MEMBER1.00.0Yes (X)$0$0$0
MICHAEL GROSS DMD
CHAIRMAN1.00.0Yes (X)$0$0$0Yes (X)
MIKE WRIGHT
BOARD MEMBER1.00.0Yes (X)$0$0$0
STEPHANIE PERRY
BOARD MEMBER1.00.0Yes (X)$0$0$0
WILLIAM ALEXANDER MD
BOARD MEMBER1.00.0Yes (X)$0$0$0
ALISA COLEMAN
PART-YEAR CEO40.00.0$212,278$0$5,504Yes (X)
DAVID SHORE
PART-YEAR CEO40.00.0$0$0$0Yes (X)
DIANA PHILLIPS
CFO40.00.0$90,789$0$2,823Yes (X)
DAVID RUTLAND
DIRECTOR OF PHARMACY40.00.0$135,676$0$4,317Yes (X)
HOLLY MCCORMICK
NURSE PRACTITIONER40.00.0$123,881$0$3,421Yes (X)
KAREN MIRACLE
DIRECTOR OF REHAB40.00.0$101,192$0$3,076Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$663,816TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$19,141TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BLUEGRASS PHYSICIANS
PO BOX 674579DETROITMI48267ER PHYSICIANS$1,459,592
DIAMOND HELATHCARE CORPORATION
PO BOX 85050RICHMONDVA23285BEHAVIORAL HEALTH$387,470
CPSI
6600 WALL STMOBILEAL36695BILLING/EHR SUPPORT$349,148
COMPHEALTH
PO Box 972651DALLASTX75397HEALTHCARE STAFFING$249,811
SYSTEMS SOLUTIONS
115 CARLISLE COURTPADUCAHKY42001IT EUQIPMENT SUPPORT$199,657
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K7CntrctRcvdGreaterThan100KCnt
Government Grants$601,900GovernmentGrantsAmt
All Other Contributions$51,854AllOtherContributionsAmt
Total Contributions$653,754TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net Patient Service Revenue621110$14,312,030$14,312,030
340B Program Revenue621110$348,219$348,219
EHR INCENTIVE900099$307,735$307,735
FieldValueIRS element (for citing)
Total Program Service Revenue$14,967,984TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,654TotalRevenueColumnAmt
Exclusion$7,654ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$33,943RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$7,030RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$26,913RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$26,913TotalRevenueColumnAmt
Exclusion$26,913ExclusionAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
Life Line900099$6,009$6,009
Cafeteria900099$40,561$40,561
All Other Misc Revenue900099$88,943$88,943
FieldValueIRS element (for citing)
Other Revenue Total$135,513OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$15,791,818TotalRevenueColumnAmt
Related Or Exempt Func Income$14,973,993RelatedOrExemptFuncIncomeAmt
Exclusion$164,071ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$335,247TotalAmt
Management And General$335,247ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,487,963TotalAmt
Program Services$6,327,807ProgramServicesAmt
Management And General$160,156ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$100,176TotalAmt
Program Services$92,903ProgramServicesAmt
Management And General$7,273ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,195,642TotalAmt
Program Services$1,108,832ProgramServicesAmt
Management And General$86,810ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$500,031TotalAmt
Program Services$463,726ProgramServicesAmt
Management And General$36,305ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$214,159TotalAmt
Management And General$214,159ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$6,243TotalAmt
Management And General$6,243ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$2,299TotalAmt
Program Services$2,299ProgramServicesAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,865,592TotalAmt
Program Services$2,806,712ProgramServicesAmt
Management And General$58,880ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$49,157TotalAmt
Program Services$49,157ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$566,205TotalAmt
Program Services$548,008ProgramServicesAmt
Management And General$18,197ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$287,249TotalAmt
Program Services$287,249ProgramServicesAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$302,690TotalAmt
Program Services$290,817ProgramServicesAmt
Management And General$11,873ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$71,315TotalAmt
Program Services$17,612ProgramServicesAmt
Management And General$53,703ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$142,108TotalAmt
Program Services$142,108ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$804,831TotalAmt
Program Services$804,831ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$228,639TotalAmt
Management And General$228,639ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical Supplies$674,362$668,325$6,037
Accounting Collections$188,364$188,364
Maintenance & Repair$167,395$167,395
Provider Tax$131,599$131,599

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$255,159TotalAmt
Program Services$173,839ProgramServicesAmt
Management And General$81,320ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$15,576,425TotalAmt
Program Services$14,083,219ProgramServicesAmt
Management And General$1,493,206ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$397,606BOYAmt
EOY$199,494EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$141,776BOYAmt
EOY$129,580EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,322,693BOYAmt
EOY$2,672,970EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$2,122BOYAmt
EOY$2,150EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$125,547BOYAmt
EOY$143,018EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$197,750BOYAmt
EOY$135,674EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,176,151LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$7,318,700LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$5,990,176BOYAmt
EOY$9,857,451EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$185,489BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$9,363,159BOYAmt
EOY$13,140,337EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,708,597BOYAmt
EOY$2,685,293EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$10,715BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$3,488,736BOYAmt
EOY$8,105,967EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$468,309BOYAmt
EOY-$553,118EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,676,357BOYAmt
EOY$10,238,142EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$5,402,489BOYAmt
EOY$5,083,955EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$2,715,687BOYAmt
EOY-$2,181,760EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,686,802BOYAmt
EOY$2,902,195EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,363,159BOYAmt
EOY$13,140,337EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$215,393ReconcilationRevenueExpnssAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedfalseFSAuditedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Organization Belongs Afflt GrpYes (X)OrganizationBelongsAffltGrpInd
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$2,299OtherActivitiesAmt
Total Lobbying Expenditures$2,299TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind
Form4720 Filed4912 TaxfalseForm4720Filed4912TaxInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCH. C, PART II-B, LINE IFormAndLineReferenceDesc
ExplanationLOBBY EXPENSES -------------- A PORTION OF THE ORGANIZATION'S KHA & AHA DUES ARE USED FOR LOBBYING ACTIVITIES.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp
CY Minus3 Yr Endwmt FundCYMinus3YrEndwmtFundGrp
CY Minus4 Yr Endwmt FundCYMinus4YrEndwmtFundGrp

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$66,000OtherCostOrOtherBasisAmt
Book Value$66,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,028,645OtherCostOrOtherBasisAmt
Depreciation$2,508,733DepreciationAmt
Book Value$3,519,912BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,081,506OtherCostOrOtherBasisAmt
Depreciation$4,809,967DepreciationAmt
Book Value$6,271,539BookValueAmt
FieldValueIRS element (for citing)
Other Land BuildingsOtherLandBuildingsGrp
Total Book Value Land Buildings$9,857,451TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO THIRD PARTY PAYERSDesc
Amt-$553,118Amt
FieldValueIRS element (for citing)
Total Liability-$553,118TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other100DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$602,846TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$222,837DirectOffsettingRevenueAmt
Net Community Benefit Expns$380,009NetCommunityBenefitExpnsAmt
Total Expense0.02460TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,060,519TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,883,133DirectOffsettingRevenueAmt
Net Community Benefit Expns$177,387NetCommunityBenefitExpnsAmt
Total Expense0.01150TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,663,365TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,105,970DirectOffsettingRevenueAmt
Net Community Benefit Expns$557,396NetCommunityBenefitExpnsAmt
Total Expense0.03610TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$40,992TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$40,992NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$40,992TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$40,992NetCommunityBenefitExpnsAmt
Total Expense0.00270TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,704,357TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,105,970DirectOffsettingRevenueAmt
Net Community Benefit Expns$598,388NetCommunityBenefitExpnsAmt
Total Expense0.03880TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs7ActivitiesOrProgramsCnt
Total Community Benefit Expns$6,662TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,662NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs7ActivitiesOrProgramsCnt
Total Community Benefit Expns$6,662TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$6,662NetCommunityBenefitExpnsAmt
Total Expense0.00040TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,006,461BadDebtExpenseAmt
Reimbursed By Medicare$5,523,376ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$5,534,695CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$11,319MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TRIGG COUNTY HOSPITAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1254 MAIN STREETAddressLine1Txt
CityCADIZCityNm
State AbbreviationKYStateAbbreviationCd
ZIP42211ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1TRIGG COUNTY HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://TRIGGHOSPITAL.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt13ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLHTTP://TRIGGHOSPITAL.ORGStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care100FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LILNE 5CHNA COMMUNITY INPUT -------------------- TRIGG COUNTY SENT A CHNA SURVEY OUT TO THE LOCAL POPULATION FOR ANY RESIDENT TO COMPLETE. 135 RESPONSES TO THIS SURVEY WERE RECEIVED FROM AREA RESIDENTS. IN ADDITION, CONSULTATION WITH 34 LOCAL EXPERTS OCCURRED VIA AN INTERNET BASED SURVEY DURING A PERIOD BEGINNING JANUARY 20, 2013 AND ENDING JANUARY 31, 2013. INFORMATION RELATED TO THE EXPERTS' INPUT IS INCLUDED IN THE CHNA AT http://www.trigghospital.org/docs/Trigg_County_Hospital_Community_Health_N eeds_Assessment_(not_marked_as_draft).pdf?sub=Community+Health+Needs+Asses sment
PART V, LINE 11CHNA NEEDS ADDRESSED -------------------- TRIGG COUNTY IDENTIFIED THE NEEDS OF THE COMMUNITY AS EITHER LOW PRIORITY OR HIGH PRIORITY AND DETERMINED THAT THE BEST USE OF TRIGG COUNTY HOSPITAL'S RESOURCES IS TO FOCUS ON RESOLVING OR IMPROVING HIGHER PRIORITY NEEDS RATHER THAN ATTEMPTING TO RESPOND TO EVERYTHING WITH SMALL, PERHAPS INEFFECTIVE, EFFORTS.
PART V, LINE 10IMPLEMENTATION STRATEGY ----------------------- THE IMPLEMENTATION STRATEGY IS AVAILABLE AT http://www.trigghospital.org/docs/Trigg_County_Hospital_Community_Health_N eeds_Assessment_(not_marked_as_draft).pdf?sub=Community+Health+Needs+Asses sment

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7COST OF CHARITY CARE -------------------- COST OF CHARITY CARE WAS CALCULATED WTIH A COST TO CHARGE RATIO USING WORKSHEET 2. COST OF MEDICAID WAS CALCULATED WITH A COST TO CHARGE RATIO USING WORKSHEET 2.
PART III, LINE 8COSTING ------- TRIGG COUNTY HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED FROM MEDICARE AT 101% OF COST RELATED TO CARING FOR MEDICARE PATIENTS. MEDICARE REVENUES AND COSTS REPORTED ON LINES 5 AND 6 ARE BASED ON THE MEDICARE COST REPORT.
PART III, LINE 9BDEBT COLLECTION --------------- THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE OR FINANCIAL ASSISTANCE.
PART VI, LINE 2NEEDS ASSESSMENT ---------------- TRIGG COUNTY HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WHICH WAS ADOPTED BY THE BOARD OF DIRECTORS ON APRIL 29, 2013. TRIGG COUNTY HOSPITAL IS ALWAYS WILLING AND AVAILABLE TO MEET THE NEEDS OF THE COMMUNITY AS THEY ARISE. ADDITIONALLY, TRIGG COUNTY HOSPITAL ASSISTS OTHER AGENCIES, AS NEEDED, TO MEET THE HEALTH AND WELFARE NEEDS OF THE COMMUNITY.
PART VI, LINE 3PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ----------------------------------------------- UNINSURED AND UNDERINSURED PATIENTS ARE PROVIDED WITH INFORMATION ABOUT THE CHARITY CARE PROGRAM. TRIGG COUNTY HOSPITAL CONTRACTS WITH DISABILITY MEDICAL CONSULTANTS (DMC) TO CONTACT EACH OF THESE IDENTIFIED PATIENTS AND PROVIDE THEM WITH INFORMATION ON HOW TO GET QUALIFIED FOR MEDICAID OR HOW TO ENROLL IN INSURANCE PROGRAMS AVAILABLE THROUGH THE AFFORDABLE CARE ACT.
PART VI, LINE 4COMMUNITY INFORMATION --------------------- TRIGG COUNTY, KENTUCKY IS A RURAL COMMUNITY WITH A POPULATION ESTIMATED AT 14,293. TRIGG COUNTY IS LOCATED IN WESTERN KENTUCKY JOINING THE LAND BETWEEN THE LAKES INCLUDING LAKE BARKLEY AND KENTUCKY LAKE. DUE TO OUR LOCATION, TRIGG COUNTY IS A GREAT RETIREMENT COMMUNITY AND AS SUCH APPEALS TO MANY PEOPLE ACROSS THE COUNTRY. APPROXIMATELY 20.5% OF TRIGG COUNTIANS ARE AGE 65 AND OLDER. TRIGG COUNTY HAS BEEN DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA) AND A MEDICALLY UNDERSERVED AREA/POPULATION (MUA/P). THE 2012 MEDIAN HOUSEHOLD INCOME IS RIGHT AT THE AVERAGE FOR KENTUCKIANS (APPROXIMATELY $40K); HOWEVER, WELL BELOW THE AVERAGE FOR THE UNITED STATES AT APPROXIMATELY $50K. TRIGG COUNTY'S ESTIMATED PREMATURE DEATH (LIFE LOST PRIOR TO AGE 75) IS 35% HIGHER THAN THE UNITED STATES AVERAGE AND 10% HIGHER THAN THE STATE AVERAGE, POTENTIALLY ATTRIBUTABLE TO A HIGHER NUMBER OF LUNG/BRONCHUS AND COLORECTAL CANCERS. FINALLY, APPROXIMATELY 18% OF TRIGG COUNTIANS HEALTH INSURANCE IS COVERED THROUGH KENTUCKY MEDICAID AND APPROXIMATELY 21% ARE UNINSURED.
PART VI, LINE 5PROMOTION OF COMMUNITY HEALTH ----------------------------- TRIGG COUNTY HOSPITAL'S DEDICATED STAFF VOLUNTEER FOR NUMEROUS CAUSES PROMOTING HEALTH AND WELFARE FOR TRIGG COUNTIANS INCLUDING: RELAY FOR LIFE, BREAST IMAGING LUNCH & LEARN, HEART HEALTH LUNCH & LEARN, BREAST IMAGING PRESENTATIONS, KIDS HEALTH FAIR, BREAST CANCER AWARENESS EVENTS, OSTEOPOROSIS SCREENINGS, BACK TO SCHOOL SCREENINGS AND BEHAVIORAL HEALTH TRANSPORTATION. ADDITIONALLY, HOSPITAL STAFF ARE INVOLVED IN SUMMER HEALTH CAMP, COMMUNITY READER DAYS, CHILDREN'S CHRISTMAS TREE DECORATING, TEACHERS BACK TO SCHOOL BREAKFAST, MEET & GREET TEACHERS & PARENTS NIGHT, COMMUNITY EDUCATION ADVISORY COUNCIL, BETA NU AND THE TRIGG COUNTY CHAMBER OF COMMERCE. TRIGG COUNTY HOSPITAL'S BOARD OF DIRECTORS IS COMPRISED OF COMMUNITY VOLUNTEERS WHO ARE COMMITTED TO THE HEALTH AND WELFARE OF THE COMMUNITY AND DEDICATED TO ENSURING THE VIABILITY OF THE HOSPITAL FOR YEARS TO COME. THE BOARD EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY DEPARTMENT THAT IS STAFFED 24 HOURS A DAY/7 DAYS A WEEK AND SERVES EVERYONE REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL RESEARCHES AND COMPLETES NUMEROUS GRANT APPLICATIONS APPLICABLE TO PROMOTING THE HEALTH OF OUR COMMUNITY.
PART V, LINE 22AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS ------------------------------------------- PATIENTS QUALIFYING FOR DSH HAVE THEIR STAY WRITTEN OFF. THOSE THAT DO NOT ARE CHARGED FOR THE CARE AND HAVE THE OPTION TO SET UP A PAYMENT PLAN IF NEEDED.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

FieldValueIRS element (for citing)
PersonALISA COLEMANPersonNm
TitlePART-YEAR CEOTitleTxt
Base Compensation Filing Org$176,070BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs$0CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization$36,208BonusFilingOrganizationAmount
Bonus Related Organizations$0BonusRelatedOrganizationsAmt
Other Compensation Filing Org$0OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs$0OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org$5,504DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs$0DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org$0NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs$0NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org$217,782TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs$0TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org$0CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs$0CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BREVIEW OF FORM 990 ------------------ A COPY OF THE FORM 990 WAS NOT PROVIDED TO THE BOARD BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12CMONITORING OF THE CONFLICT OF INTEREST POLICY --------------------------------------------- THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY. ALL EMPLOYEES, STAFF, OFFICERS AND BOARD MEMBERS ARE COVERED BY THIS POLICY. EACH YEAR, THE BOARD MEMBERS ARE ASKED TO SIGN A CONFLICT OF INTEREST STATEMENT. THE HOSPITAL HAS POLICIES AND PROCEDURES IN PLACE THAT WILL BE FOLLOWED SHOULD A CONFLICT OF INTEREST ARISE. A RECORD OF THE PROCEEDINGS WHERE CONFLICTS ARE ADDRESSED IS KEPT ON FILE ONCE REVIEWED.
FORM 990, PART VI, SECTION C, LINE 19MAKING DOCUMENTS AVAILABLE TO THE PUBLIC ---------------------------------------- A LEGAL AD IS PUBLISHED ANNUALLY TO ADVISE OF THE AVAILABILITY OF AUDITED FINANCIAL STATEMENTS AT THE HOSPITAL.
FORM 990, PART VI, SECTION B, LINE 15A & 15BPROCESS FOR DETERMINING COMPENSATION ------------------------------------ BOARD OF DIRECTORS REVIEWS THE CEO COMPENSATION ANNUALLY. THE LAST REVIEW OF THE CEO'S COMPENSATION WAS APRIL 2015.
FROM 990, PART VII, LINE 1PART YEAR CEO ------------- ALISA COLEMAN WAS PART-YEAR CEO UP UNTIL 1/30/2015. DAVID SHORE TOOK OVER AS INTERIM CEO ON 2/2/2015.
FORM 990 PART IX LINE 11GDESCRIPTION:MEDICAL PURCHASED SERVICES TOTAL FEES:2539973
FORM 990 PART IX LINE 11GDESCRIPTION:ADMIN PURCHASED SERVICES TOTAL FEES:266739
FORM 990 PART IX LINE 11GDESCRIPTION:ADMIN PURCHASED SERVICES TOTAL FEES:58880

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
TRIGG COUNTY HOSPITAL FOUNDATION INC
254 MAIN STREETCADIZKY42211061805018EDUCATIONKY501(c)(3)7NAfalse
TRIGG COUNTY PUBLIC HOSPITAL CORPORATION
PO BOX 672CADIZKY42211611336530GOV UNITKY501(a)N/ANAfalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd