2018-08-15T14:48:31-05:00 2017-09-30 351178661 Blue & Co LLC 500 N Meridian St Suite 200 Indianapolis IN 46204 990 2016-10-01 610461767 TJ Samson Community Hospital TJSA 2706514114 1301 North Race Street Glasgow KY 42141 MEI DENG CFO 2706514114 2018-08-15 1 Carrie A Merrill CPA P00832283 3176334705 2018-08-15 2016 2022-09-23 18:48:47Z MEI DENG 1301 North Race Street Glasgow KY 42141 170253776 0 X www.tjsamson.org X 1928 KY TJ SAMSON COMMUNITY HOSPITAL WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL-BEING OF THOSE THEY SERVE and the healthcare professionals who serve them. 13 9 1375 9 9884 2962 62436 12335 155077481 168024469 584460 1195510 981572 948617 156705949 170180931 10351687 5855051 0 0 82353338 80368590 0 0 0 74324049 78129567 167029074 164353208 -10323125 5827723 150473983 152076092 103449191 92606128 47024792 59469964 TJ SAMSON COMMUNITY HOSPITAL WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL-BEING OF THOSE THEY SERVE and the healthcare professionals who serve them. 0 0 151204952 5855051 168544237 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. 151204952 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 104 0 1 1375 1 1 1 0 0 0 0 1 1 0 0 0 0 X 13 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 KY X X Margie Gentry 2706514114 1301 North Race Street Glasgow KY 42141 MIKE BRYANT CHAIRMAN 1.00 3.00 X 0 0 78 JOEY BOTTS VICE CHAIRMAN 1.00 3.00 X 14766 0 0 BUDDY UNDERWOOD Secretary 1.00 3.00 X 0 0 78 HENRY ROYSE TREASURER 1.00 3.00 X 9614 0 0 DAN FOUTCH DIRECTOR 1.00 3.00 X 9523 0 0 KAREN SMALL MD DIRECTOR 40.00 1.00 X 45537 0 35836 WALTER DAVIS EMERITUS STATUS 1.00 3.00 X 0 0 0 Scott Young Director 1.00 3.00 X 0 0 78 Rich Alexander DIRECTOR 1.00 3.00 X 0 0 78 BRENT BILLINGSLEY Director 1.00 3.00 X 0 0 26 DR JAMES THURMAN Director 1.00 3.00 X 0 0 26 Allison Campbell MD DIRECTOR/Chief of Staff 40.00 1.00 X 244971 0 19437 WILLIAM KLAPHEKE MD DIRECTOR/VICE Chief of Sta 40.00 1.00 X 507176 0 27415 Bud Wethington Chief EXECUTIVE OFFICER 5.00 40.00 X 0 460190 22412 NEIL THORNBURY CHIEF OPERATING OFFICER 5.00 40.00 X 0 253665 29076 MEI DENG CFO (10/31/16 - 9/30/17) 5.00 40.00 X 0 32550 2141 Harikrishnan Nair Physican 40.00 0.00 X 1151301 0 25608 Venkata Reddy Physican 40.00 0.00 X 982493 0 21703 Carlos Kummerfeldt Physican 40.00 0.00 X 787539 0 21213 Donald Goodin Physican 40.00 0.00 X 670424 0 23084 Michael Marion Physican 40.00 0.00 X 621486 0 29481 5044830 746405 257770 60 0 1 0 SE EMERGENCY PHYSICIANS P O BOX 634850 Cincinnati OH 452634850 URGENT CARE MD 1354705 COMPHEALTH P O BOX 972651 DALLAS TX 753972651 HOSPITALISTS 1199421 EMCARE INC 7032 COLLECTIONS CENTER DRIVE CHIcago IL 60693 ER PHYSICIANS 842133 CARDINAL HEALTHPHARMACY 21377 NETWORK PLACE Chicago IL 606731213 PHARMACY SUPERVISION 782111 ASSOCIATED PATHOLOGY P O BOX 402978 Atlanta GA 30384 Pathology 557326 21 10000 2335 12335 NET PATIENT REVENUE 900099 168020231 168020231 OUTSIDE LAB 621500 4238 4238 168024469 1199641 1199641 160731 68714 92017 92017 92017 4131 -4131 -4131 -4131 CAFETERIA SALES 900099 326948 326948 Premier Partnership Income 541900 130174 124528 5646 399478 399478 856600 170180931 168544237 9884 1614475 X 5855051 5855051 63406205 58333709 5072496 3857074 3548508 308566 9090000 8362800 727200 4015311 3694086 321225 562146 562146 398975 398975 18964756 17447576 1517180 928380 928380 717481 660083 57398 4554786 4190403 364383 4355898 4007426 348472 516548 475224 41324 25222 25222 1892846 1892846 9309451 9309451 1677203 1543027 134176 SUPPLIES 15988612 13255461 2733151 Drugs 11532997 11532997 Repairs and Maintenance 2526894 2324742 202152 Provider taxes 2333637 2146946 186691 1843735 1696236 147499 164353208 151204952 13148256 0 670383 1498109 33090425 39710745 20307304 20646084 179412 236580 3297072 3245634 2635386 3288624 194946707 128813972 72536232 66132735 2212853 2212853 2260691 2403689 13284225 12701039 150473983 152076092 18480801 15668432 30015328 28252661 54953062 48685035 103449191 92606128 X 47024792 59469964 47024792 59469964 150473983 152076092 X 5827723 -190361 -37822 6845632 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7765 7765 0 Part II-B, Line 1: The hospital pays membership dues to the Kentucky hospital association of which a portion of the dues are used for lobbying purposes. 3091573 3091573 55512918 27222824 28290094 2003195 1784048 219147 133220927 99807100 33413827 1118094 1118094 66132735 Due from related entity - TJHC 9313765 INVESTMENT IN PREMIER LLP 2405262 Physician Contracts 365583 Deposits 328130 Other current assets 288299 12701039 accrued pension costs 36270146 Due to related entity - TJHP 11907871 Est due to government programs 327933 Provider Tax Payable 179085 48685035 1 1 1 X 1 X 1 1 1 0 1 1 2590960 1416553 1174407 0.00710 42413267 35553617 6859650 0.04170 45004227 36970170 8034057 0.04880 85 12583 122967 22610 100357 0.00060 85 12583 122967 22610 100357 0.00060 85 12583 45127194 36992780 8134414 0.04940 5 421 3991 3991 0.00000 5 421 3991 3991 0.00000 1 10282835 39972473 42101480 -2129007 X 1 1 1 1 TJ SAMSON COMMUNITY HOSPITAL INC 1301 North Race Street Glasgow KY 42141 www.tjsamson.org 720185 X X X TJ SAMSON COMMUNITY HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 1 0 1 X https://www.tjsamson.org/about_us/community_needs_assessment.aspx X X 1 15 1 https://www.tjsamson.org/about_us/community_needs_assessment.aspx 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X https://www.tjsamson.org/charityfinancial_assistance.aspx X https://www.tjsamson.org/charityfinancial_assistance.aspx X https://www.tjsamson.org/charityfinancial_assistance.aspx X X X X 1 1 X X X X 1 X 0 0 TJ SAMSON COMMUNITY HOSPITAL INC Part V, Section B, Line 5: County assessment teams from the different counties the hospital serves were created to help distribute and collect community-wide surveys and conduct key informant interviews. Key informant interviews were broken up into three groups: Group A-Affected people, Group B-Policy-Makers, and Group C-providers. Group A-Affected people included individuals directly related to one of the priority health issues. Group B-Policy Makers included individuals who must make leadership decisions that affect the priority health issues and included elected officials, human resource directors, school system superintendents, and local government officals. Group C-Providers included health care providers such as physicians, school nurses, nutritionists, and health educators. TJ SAMSON COMMUNITY HOSPITAL INC Part V, Section B, Line 6a: The CHNA was conducted with the following organizations: Barren River District Health Department, Caverna Memorial Hospital, The medical center at bowling green, the medical center at franklin, the medical center at scottsville, and the monroe county medical center. TJ SAMSON COMMUNITY HOSPITAL INC Part V, Section B, Line 7d: social media TJ SAMSON COMMUNITY HOSPITAL INC Part V, Section B, Line 11: Do not have adequate resources for mental health and substance abuse. 6 1 - TJ HEALTH PAVILION 310 N L Rogers Wells BLvd Glasgow KY 42141 outpatient services 2 - CAVE CITY CLINIC 400 N DIXIE HIGHWAY CAVE CITY KY 42127 PRIMARY CARE 3 - walmart CLINIC 2345 HAPPY VALLEY ROAD GLASGOW KY 42141 OUTPATIENT SERVICES 4 - Edmonton Clinic 1704 W Stockton Street Edmonton KY 42129 pRIMARY CARE 5 - Tompkinsville Clinic 800 N Main Street Tompkinsville KY 42167 pRIMARY CARE 6 - Sleep Disorders Clininc 1301 N Race Street Glasgow KY 42141 prIMARY CARE Part 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. 1 TJ REGIONAL HEALTH INC 1301 N RACE STREET GLASGOW KY 42141 273988336 501c3 5809751 TO PROVIDE SUPPORT Boys & Girls Club of GlasgowBarren Co 301 Bunche Avenue Glasgow KY 42141 454693954 501c3 20000 TO PROVIDE SUPPORT AMERICAN HEART ASSOCIATION 5455 North High Street Columbus OH 43214 135613797 501c3 15000 to provide support Barren County Educational Foundation Inc 202 W Washington St GlaSGOW KY 42141 202351623 501c3 5000 2017 Children's Day Fund 4 0 Part I, Line 2: All grants are provided to public charities for general support. TJ Samson COmmunity Hospital does not monitor the use of these funds by these charities. 0 0 0 0 0 0 0 1 0 Allison Campbell MD DIRECTOR/Chief of Staff 244971 0 0 0 0 0 9262 0 10175 0 264408 0 0 0 WILLIAM KLAPHEKE MD DIRECTOR/VICE Chief of Sta 383671 0 117920 0 5585 0 9250 0 18165 0 534591 0 0 0 Bud Wethington Chief EXECUTIVE OFFICER 0 394813 0 50062 0 15315 0 10070 0 12342 0 482602 0 0 NEIL THORNBURY CHIEF OPERATING OFFICER 0 252807 0 0 0 858 0 18843 0 10233 0 282741 0 0 Harikrishnan Nair Physican 595971 0 554490 0 840 0 10168 0 15440 0 1176909 0 0 0 Venkata Reddy Physican 815376 0 163205 0 3912 0 10600 0 11103 0 1004196 0 0 0 Carlos Kummerfeldt Physican 396267 0 390600 0 672 0 8013 0 13200 0 808752 0 0 0 Donald Goodin Physican 491726 0 157438 0 21260 0 9523 0 13561 0 693508 0 0 0 Michael Marion Physican 575202 0 44352 0 1932 0 10600 0 18881 0 650967 0 0 0 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. A CITY OF GLASGOW KENTUCKY 616001831 376844AT3 2011-08-24 30007455 For Construction 0 0 0 B CITY OF EDMONTON KENTUCKY 616012870 2012-04-04 7650000 To Refinance 1998 bond issue 0 0 0 A 30007455 2212852 1940080 221767 596767 25035989 2013 0 0 1 1 B 7650000 130000 7520000 0 1 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 1 0 0 0 0 A 1 B 1 Form 990, Part VI, Section B, line 11b THE 990 IS REVIEWED BY THE CEO AND CFO BEFORE FILED. Form 990, Part VI, Section B, line 12c Yearly the board reviews the policy and ensures compliance by all members. Each member must annually disclose compliance. Form 990, Part VI, Section B, line 15 THE HOSPITAL USES An OUTSIDE THIRD PARTY AGENCY TO HELP DETERMINE COMPENSATION LEVELS. Form 990, Part VI, Section C, line 19 ALL DOCUMENTS ARE MADE AVAILABLE UPON REQUEST FROM THE ORGANIZATION. Form 990, Part IX, line 11g Purchased Services: Program service expenses 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. TJ REGIONAL HEALTH INC 1301 North Race Street Glasgow KY 42141 273988336 Parent organization of healthcare facility KY 501(c)(3) Line 12b, II 0 TJ HEALTH PARTNERS LLC 1301 NORTH RACE STREET GLASGOW KY 42141 273988456 PHYSICIAN CLINICS KY 501(c)(3) Line 10 TJ REGIONAL HEALTH INC 0 TJ Health Columbia 1301 North Race Street Glasgow KY 42141 810893103 Hospital KY 501(c)(3) Line 3 TJ REGIONAL HEALTH INC 0 TJ Community Mission Foundation 1301 North Race Street Glasgow KY 42141 472208322 Foundation KY 501(c)(3) Line 10 TJ REGIONAL HEALTH INC 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 1 0 0 0 0