T J SAMSON COMMUNITY HOSPITAL: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
T J SAMSON COMMUNITY HOSPITAL (EIN 61-0461767)
Tax period
2013-10-01 to 2014-09-30
Filed
2015-08-17
IRS object ID
201542299349303599
Schema version
2013v4.0
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)
Return2015-08-17T14:58:05-05:00ReturnTs
Tax Period End2014-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351178661PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1ONE AMERICAN SQUARE 2200AddressLine1
CityINDIANAPOLISCity
StateINState
ZIP Code46282ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN610461767EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TJ SAMSON COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlTJSABusinessNameControlTxt
Phone2706514114PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 NORTH RACE STREETAddressLine1
CityGLASGOWCity
StateKYState
ZIP Code42141ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonBUD WETHINGTONPersonNm
Person TitleCEOPersonTitleTxt
Phone2706514114PhoneNum
Signature2015-08-17SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonCARRIE A MERRILL CPAPreparerPersonNm
PTINP00832283PTIN
Phone3176334705PhoneNum
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-04-25 22:37:26ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerBUD WETHINGTONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 NORTH RACE STREETAddressLine1
CityGLASGOWCity
StateKYState
ZIP Code42141ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$134,581,168GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.TJSAMSON.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1928FormationYr
Legal Domicile StateKYLegalDomicileStateCd
Activity Or MissionTJ SAMSON COMMUNITY HOSPITAL WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL-BEING OF THOSE THEY SERVE.ActivityOrMissionDesc
Voting Members Governing Body10VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee1248TotalEmployeeCnt
Total Volunteers55TotalVolunteersCnt
Total Gross UBI$43,769TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$4,034NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$17,934PYContributionsGrantsAmt
CY Contributions Grants$33,681CYContributionsGrantsAmt
PY Program Service Revenue$125,509,517PYProgramServiceRevenueAmt
CY Program Service Revenue$132,949,226CYProgramServiceRevenueAmt
PY Investment Income$2,094,648PYInvestmentIncomeAmt
CY Investment Income$834,244CYInvestmentIncomeAmt
PY Other Revenue$1,612,964PYOtherRevenueAmt
CY Other Revenue$727,995CYOtherRevenueAmt
PY Total Revenue$129,235,063PYTotalRevenueAmt
CY Total Revenue$134,545,146CYTotalRevenueAmt
PY Grants And Similar Paid$15,307,628PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$15,648,651CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$61,597,682PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$60,306,256CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$55,362,968PYOtherExpensesAmt
CY Other Expenses$62,878,592CYOtherExpensesAmt
PY Total Expenses$132,268,278PYTotalExpensesAmt
CY Total Expenses$138,833,499CYTotalExpensesAmt
PY Revenues Less Expenses-$3,033,215PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$4,288,353CYRevenuesLessExpensesAmt
Total Assets BOY$170,522,635TotalAssetsBOYAmt
Total Assets EOY$170,035,634TotalAssetsEOYAmt
Total Liabilities BOY$76,588,796TotalLiabilitiesBOYAmt
Total Liabilities EOY$81,991,933TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$93,933,839NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$88,043,701NetAssetsOrFundBalancesEOYAmt
MissionTJ SAMSON COMMUNITY HOSPITAL PROVIDES HEALTHCARE SERVICES TO BARREN AND SURROUNDING COUNTIES IN KENTUCKY.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$127,379,735ExpenseAmt
Grant$15,648,651GrantAmt
Revenue$133,651,897RevenueAmt
DescTJ SAMSON COMMUNITY HOSPITAL PROVIDES HEALTHCARE SERVICES TO BARREN AND SURROUNDING COUNTIES IN KENTUCKY. ACUTE HOSPITAL AND EMERGENCY ROOM CARE PATIENT DAYS 23,963 AND ER VISITS 29,992 IN FYE 9/30/14.Desc
Total Program Service Expenses$127,379,735TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt BondsYes (1)TaxExemptBondsInd
Invest Tax Exempt Bonds0InvestTaxExemptBondsInd
Escrow Account0EscrowAccountInd
On Behalf Of Issuer0OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document100IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee1248EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (1)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (1)Form990TFiledInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members10GoverningBodyVotingMembersCnt
Independent Voting Member5IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local ChaptersYes (1)LocalChaptersInd
Policies Reference ChaptersYes (1)PoliciesReferenceChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSTEPHEN FISCHERPersonNm
Phone2706514112PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 NORTH RACE STREETAddressLine1
CityGLASGOWCity
StateKYState
ZIP Code42141ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtKey EmployeeKeyEmployeeIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
HENRY ROYSE
CHAIRMAN (12/1 - 9/30)2.002.00Yes (X)Yes (X)$0$0$13,137
DAN FOUTCH
CHAIRMAN (12/1 - 9/30)2.002.00Yes (X)Yes (X)$0$0$78
MIKE BRYANT
VICE CHAIRMAN2.002.00Yes (X)Yes (X)$0$0$78
BUDDY UNDERWOOD
SECRETARY2.002.00Yes (X)Yes (X)$0$0$78
JOEY BOTTS
TREASURER2.002.00Yes (X)Yes (X)$0$0$13,966
ELLEN BALE
DIRECTOR1.001.00Yes (X)$0$0$78
KAREN SMALL MD
DIRECTOR1.0040.00Yes (X)$0$281,748$28,385
CHRIS LAWRENCE
DIRECTOR1.001.00Yes (X)$0$0$78
FOLLIS CROW
DIRECTOR1.001.00Yes (X)$0$0$862
JASON CAMPBELL MD
DIRECTOR / CHIEF OF STAFF1.001.00Yes (X)$0$105,271$7,060
TODD MARION MD
DIRECTOR / VICE CHIEF OF1.001.00Yes (X)$0$906,833$33,773
WALTER DAVIS
EMERITUS STATUS1.001.00Yes (X)$0$0$427
WILLIAM KINDRED
CHIEF EXECUTIVE OFFICER5.0040.00Yes (X)$0$317,338$48,424
STEVE FISCHER
CHIEF FINANCIAL OFFICER (8/13-9/30)5.0040.00Yes (X)$0$84,699$493
ANTHONY SUDDUTH
CHIEF FINANCIAL OFFICER (10/1-8/13/14)5.0040.00Yes (X)$0$324,376$36,254
NEIL THORNBURY
CHIEF OPERATING OFFICER40.001.00Yes (X)$0$259,679$46,135
MARGARET BILLINGSLEY
CHIEF OF NURSING SERVICES40.001.00$172,474$0$27,590Yes (X)
KEVIN ADAMS
DIRECTOR OF PHARMACY40.000.00$142,771$0$30,454Yes (X)
KENNETH JOHNSON
PHARMACIST40.000.00$142,899$0$29,101Yes (X)
LEE ELLIS
PHARMACIST40.000.00$123,436$0$30,597Yes (X)
MARY ANDERSON
DIRECTOR OF CASE MANAGEMENT40.000.00$111,447$0$45,602Yes (X)
DENISE BILLINGSLEY
NURSE PRACTIONER40.000.00$126,858$0$17,270Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$819,885TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$2,279,944TotReportableCompRltdOrgAmt
Total Other Compensation$409,920TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K20IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
SE EMERGENCY PHYSICIANS
PO BOX 634850CINCINNATIOH45263URGENT CARE$1,210,468
ALLIANCE CORPORATION
PO BOX 1480GLASGOWKY42141CONSTRUCTION$930,448
SURGICAL SOLUTIONS
702 A BARRETT BLVDHENDERSONKY42420SURGERY$879,952
ASSOCIATED PATHOLOGY
SUITE 350 3 MARYLAND FARMSBRENTWOODTN37244PATHOLOGY$561,145
UNIDINE
ONE GATEWAY CENTER SUITE 751NEWTONMA02458DINING SERVICES$528,438
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K25CntrctRcvdGreaterThan100KCnt
All Other Contributions$33,681AllOtherContributionsAmt
Total Contributions$33,681TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
NET PATIENT REVENUE900099$132,948,148$132,948,148
OUTSIDE LAB621500$1,078$1,078
FieldValueIRS element (for citing)
Total Program Service Revenue$132,949,226TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$815,799TotalRevenueColumnAmt
Exclusion$815,799ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$122,991RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$36,022RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$86,969RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$86,969TotalRevenueColumnAmt
Related Or Exempt Func Income$86,969RelatedOrExemptFuncIncomeAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$18,445OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$18,445OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,445TotalRevenueColumnAmt
Related Or Exempt Func Income$18,445RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PREMIER PARTNERSHIP INCOME541900$156,901$162,826-$5,925
CHILD CARE SERVICES624410$41,941$41,941
LAUNDRY812300$6,675$6,675

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$435,509TotalRevenueColumnAmt
Related Or Exempt Func Income$435,509RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$641,026OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$134,545,146TotalRevenueColumnAmt
Related Or Exempt Func Income$133,651,897RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$43,769UnrelatedBusinessRevenueAmt
Exclusion$815,799ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$15,648,651TotalAmt
Program Services$15,648,651ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$1,073,867TotalAmt
Management And General$1,073,867ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$44,546,368TotalAmt
Program Services$39,646,268ProgramServicesAmt
Management And General$4,900,100ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$3,400,026TotalAmt
Program Services$3,026,023ProgramServicesAmt
Management And General$374,003ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$8,152,200TotalAmt
Program Services$7,255,458ProgramServicesAmt
Management And General$896,742ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$3,133,795TotalAmt
Program Services$2,789,078ProgramServicesAmt
Management And General$344,717ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$45,017TotalAmt
Management And General$45,017ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$80,157TotalAmt
Management And General$80,157ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$13,748,333TotalAmt
Program Services$13,748,333ProgramServicesAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$619,557TotalAmt
Program Services$619,557ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,046,067TotalAmt
Program Services$930,999ProgramServicesAmt
Management And General$115,068ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$4,600,131TotalAmt
Program Services$4,094,117ProgramServicesAmt
Management And General$506,014ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$363,352TotalAmt
Program Services$323,383ProgramServicesAmt
Management And General$39,969ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$1,998TotalAmt
Management And General$1,998ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$1,978,928TotalAmt
Program Services$1,978,928ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$8,973,911TotalAmt
Program Services$8,973,911ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$57,483TotalAmt
Program Services$51,160ProgramServicesAmt
Management And General$6,323ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES$16,096,263$14,325,674$1,770,589
DRUGS$5,950,208$5,295,685$654,523
REPAIRS AND MAINTENANCE$5,553,746$4,942,833$610,913
PROVIDER TAX & OTHER TA$2,848,692$2,848,692

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$914,749TotalAmt
Program Services$880,985ProgramServicesAmt
Management And General$33,764ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$138,833,499TotalAmt
Program Services$127,379,735ProgramServicesAmt
Management And General$11,453,764ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$736,339BOYAmt
EOY$761,459EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$31,159,975BOYAmt
EOY$31,295,576EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$24,514,643BOYAmt
EOY$29,831,706EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$78,558BOYAmt
EOY$59,852EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$3,096,937BOYAmt
EOY$3,115,906EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,296,989BOYAmt
EOY$1,298,110EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$187,706,658LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$106,981,601LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$86,614,493BOYAmt
EOY$80,725,057EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$2,212,853BOYAmt
EOY$2,212,853EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$2,676,434BOYAmt
EOY$2,750,667EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$18,135,414BOYAmt
EOY$17,984,448EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$170,522,635BOYAmt
EOY$170,035,634EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$15,434,834BOYAmt
EOY$18,236,461EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$35,018,070BOYAmt
EOY$33,489,674EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$26,135,892BOYAmt
EOY$30,265,798EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$76,588,796BOYAmt
EOY$81,991,933EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$93,933,839BOYAmt
EOY$88,043,701EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$93,933,839BOYAmt
EOY$88,043,701EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$170,522,635BOYAmt
EOY$170,035,634EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$4,288,353ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$826,496NetUnrlzdGainsLossesInvstAmt
Investment Expense-$43,939InvestmentExpenseAmt
Other Changes In Net Assets-$2,384,342OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

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)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other Organizations0GrantsOtherOrganizationsInd
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other ActivitiesYes (1)OtherActivitiesInd
Other Activities$8,477OtherActivitiesAmt
Total Lobbying Expenditures$8,477TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART II-B, LINE 1:FormAndLineReferenceDesc
ExplanationTHE 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

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,091,573OtherCostOrOtherBasisAmt
Book Value$3,091,573BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$54,416,199OtherCostOrOtherBasisAmt
Depreciation$21,759,392DepreciationAmt
Book Value$32,656,807BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,974,258OtherCostOrOtherBasisAmt
Depreciation$1,554,659DepreciationAmt
Book Value$419,599BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$126,923,681OtherCostOrOtherBasisAmt
Depreciation$83,667,550DepreciationAmt
Book Value$43,256,131BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,300,947OtherCostOrOtherBasisAmt
Book Value$1,300,947BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$80,725,057TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
OTHER CURRENT ASSETS$92,302
DEPOSITS$6,579,212
PHYSICIAN CONTRACTS$1,085,061
DUE FROM SUBSIDIARY$3,610,976
INVESTMENTS IN PREMIER LLP$4,246,761
ESTIMATED DUE FROM GOVERNMENT PROGR$2,370,136
FieldValueIRS element (for citing)
Total Book Value Other Assets$17,984,448TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
PROVIDER TAX PAYABLE$177,819
ESTIMATED DUE TO GOVERNMENT PROGRAM$525,444
ACCRUED PENSION COSTS$28,920,800
WESTLAKE REG HOSP SECURITY DEP$58,750
CAPITAL LEASES FIRST AMERICAN$582,985
FieldValueIRS element (for citing)
Total Liability$30,265,798TotalLiabilityAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent200 DYes (X)Percent200DInd
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (1)ExpensesExceedBudgetInd
Unable To Provide Care0UnableToProvideCareInd
Annual Community Bnft ReportYes (1)AnnualCommunityBnftReportInd
Report Publically AvailableYes (1)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$959,613TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$959,613NetCommunityBenefitExpnsAmt
Total Expense0.00690TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$32,233,139TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,221,129DirectOffsettingRevenueAmt
Net Community Benefit Expns$12,012,010NetCommunityBenefitExpnsAmt
Total Expense0.08650TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$33,192,752TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,221,129DirectOffsettingRevenueAmt
Net Community Benefit Expns$12,971,623NetCommunityBenefitExpnsAmt
Total Expense0.09340TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Persons Served13914PersonsServedCnt
Total Community Benefit Expns$123,761TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$123,761NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$727,745TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$530,856DirectOffsettingRevenueAmt
Net Community Benefit Expns$196,889NetCommunityBenefitExpnsAmt
Total Expense0.00140TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Persons Served13914PersonsServedCnt
Total Community Benefit Expns$851,506TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$530,856DirectOffsettingRevenueAmt
Net Community Benefit Expns$320,650NetCommunityBenefitExpnsAmt
Total Expense0.00230TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Persons Served13914PersonsServedCnt
Total Community Benefit Expns$34,044,258TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$20,751,985DirectOffsettingRevenueAmt
Net Community Benefit Expns$13,292,273NetCommunityBenefitExpnsAmt
Total Expense0.09570TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$6,640,365BadDebtExpenseAmt
Reimbursed By Medicare$27,690,344ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$35,714,652CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$8,024,308MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1TJ SAMSON COMMUNITY HOSPITAL INCBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line11301 NORTH RACE STREETAddressLine1
CityGLASGOWCity
StateKYState
ZIP Code42141ZIPCode
FieldValueIRS element (for citing)
Website AddressWWW.TJSAMSON.ORGWebsiteAddressTxt
State License720185StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1TJ SAMSON COMMUNITY HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
CHNA ConductedYes (1)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 Conducted12CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsYes (1)CHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Include Operational PlanYes (X)IncludeOperationalPlanInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
All Needs Addressed0AllNeedsAddressedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (1)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care100.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (1)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care200.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (1)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
Asset LevelYes (X)AssetLevelInd
Medical IndigencyYes (X)MedicalIndigencyInd
Insurance StatusYes (X)InsuranceStatusInd
Uninsured DiscountYes (X)UninsuredDiscountInd
Medicaid MedicareYes (X)MedicaidMedicareInd
State RegulationYes (X)StateRegulationInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
Available On RequestYes (X)AvailableOnRequestInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Collection ActivitiesYes (1)CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Lowest Negotiated RatesYes (X)LowestNegotiatedRatesInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
TJ SAMSON COMMUNITY HOSPITAL INCPART V, SECTION B, LINE 3: 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 INCPART V, SECTION B, LINE 4: 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 INCPART V, SECTION B, LINE 5D: SOCIAL MEDIA
TJ SAMSON COMMUNITY HOSPITAL INCPART V, SECTION B, LINE 7: DO NOT HAVE ADEQUATE RESOURCES FOR MENTAL HEALTH AND SUBSTANCE ABUSE.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
TJ HEALTH PAVILION
310 N L ROGERS WELLS BLVDGLASGOWKY42141OUTPATIENT SERVICES
CAVE CITY CLINIC
400 N DIXIE HIGHWAYCAVE CITYKY42127PRIMARY CARE
GLASGOW CLINIC
2345 HAPPY VALLEY ROADGLASGOWKY42141OUTPATIENT SERVICES
GREENSBURG CLINIC
603 COLUMBIANA AVEGREENSBURGKY42743PRIMARY CARE

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7:COST IS CALCULATED BY APPLYING THE TOTAL COST TO CHARGE RATIO
PART I, LN 7 COL(F):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 CONDUCTED BY IOWA DEPARTMENT OF PUBLIC HEALTH, 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 NEEDS. A DEDICATED LOCATION IN THE COMMUNITY HAS BEEN DESIGNATED TO HOUSE THE EDUCATORS. IT WAS DETERMINED THAT A SEPARATE LOCATION AWAY FROM THE HOSPITAL WAS APPEALING TO OUR CONSUMERS AND ALLOWED THE COMMUNITY EDUCATORS PLENTY OF SPACE TO PROVIDE SERVICES. 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, PROSTATE SCREENINGS, GLUCOSE CHECKS, CPR, CHOLESTEROL TESTS, BLOOD PRESSURE SCREENINGS, BMI CHECK, CANCER SUPPORT, DIABETIC SUPPORT, BEREAVEMENT SUPPORT, CHILD BIRTH CLASSES, CHILD SAFETY SEAT TRAINING, 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 SPORTS BOWLS, 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 IN ALL AREAS. WE PROVIDE TEACHERS WITH KNOWLEDGE TO EDUCATED 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 OVER OF THE NEXT FEW YEARS 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 AND MHA-PRIME 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 SUCH AS HIGHWAY SAFETY (NOW SAFE COMMUNITIES), KY INJURY AND PREVENTION RESEARCH (FUNDING PROVIDED AS A PASS-THROUGH GRANT FROM CDC TO THE UNIVERSITY OF KENTUCKY) WHICH HAVE ALL BEEN FINANCIALLY SUPPORTED BY GRANTS THAT TJ HAS HELPED PROCURE. 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 $64,000 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 * HEALTH EDUCATION THEATRE * COALITION FOR DRUG FREE COMMUNITIES * COMMUNITY ACTION ANGEL TREE * COMMUNITY OF PROMISE * CYSTIC FIBROSIS WALK * HIGHLAND GAMES * 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, 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

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtPurpose Of GrantPurposeOfGrantTxt
TJ REGIONAL HEALTH INC
1301 N RACE STREETGLASGOWKY42141273988336501C3$15,615,826TO PROVIDE SUPPORT
BOYS & GIRLS CLUB OF GLASGOWBARREN CO
301 BUNCHE AVENUEGLASGOWKY42141454693954501C3$20,000TO PROVIDE SUPPORT
FieldValueIRS element (for citing)
Total501c3 Org2Total501c3OrgCnt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationALL 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

FieldValueIRS element (for citing)
Independent ConsultantYes (X)IndependentConsultantInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
KAREN SMALL MD
DIRECTOR$0$281,748$0$0$0$0$0$10,200$0$18,185$0$310,133$0$0
TODD MARION MD
DIRECTOR / VICE CHIEF OF$0$587,190$0$319,643$0$0$0$10,200$0$23,573$0$940,606$0$0
WILLIAM KINDRED
CHIEF EXECUTIVE OFFICER$0$295,288$0$22,050$0$0$0$31,294$0$17,130$0$365,762$0$0
ANTHONY SUDDUTH
CHIEF FINANCIAL OFFICER (10/1-8/13/1$0$277,501$0$46,875$0$0$0$26,194$0$10,060$0$360,630$0$0
NEIL THORNBURY
CHIEF OPERATING OFFICER$0$242,377$0$17,302$0$0$0$29,474$0$16,661$0$305,814$0$0
MARGARET BILLINGSLEY
CHIEF OF NURSING SERVICES$155,813$0$16,661$0$0$0$21,604$0$5,986$0$200,064$0$0$0
KEVIN ADAMS
DIRECTOR OF PHARMACY$142,771$0$0$0$0$0$15,264$0$15,190$0$173,225$0$0$0
KENNETH JOHNSON
PHARMACIST$142,899$0$0$0$0$0$18,221$0$10,880$0$172,000$0$0$0
LEE ELLIS
PHARMACIST$123,436$0$0$0$0$0$15,776$0$14,821$0$154,033$0$0$0
MARY ANDERSON
DIRECTOR OF CASE MANAGEMENT$111,447$0$0$0$0$0$11,915$0$14,904$18,783$138,266$18,783$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 6FormAndLineReferenceDesc
ExplanationTHE CHIEFS OF THE HOSPITAL RECEIVE BONUSES IN WHICH PARTS ARE CALCULATED BASED ON THE NET EARNINGS OF TJ SAMSON COMMUNITY HOSPITAL AND TJ HEALTH PARTNERS LLC.ExplanationTxt

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)

Bond ReferenceBondReferenceCdBond Issuer EINBondIssuerEINCUSIPCUSIPNumBond IssuedBondIssuedDtIssue PriceIssuePriceAmtPurposePurposeDescDefeasedDefeasedIndOn Behalf Of IssuerOnBehalfOfIssuerIndPool FinancingPoolFinancingInd
CITY OF GLASGOW KENTUCKY
A616001831376844AT32011-08-24$30,007,455FOR CONSTRUCTION000
CITY OF EDMONTON KENTUCKY
B6160128702012-04-04$7,650,000TO REFINANCE 1998 BOND ISSUE000

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)

Bond ReferenceBondReferenceCdTotal ProceedsTotalProceedsAmtIn Reserve FundInReserveFundAmtCapitalized InterestCapitalizedInterestAmtRefunding EscrowRefundingEscrowAmtIssuance Costs From ProceedsIssuanceCostsFromProceedsAmtCapital ExpendituresCapitalExpendituresAmtSubstantial CompletionSubstantialCompletionYrCurrent RefundingCurrentRefundingIndAdvance RefundingAdvanceRefundingIndFinal Allocation MadeFinalAllocationMadeIndAdequate Books And Rec MaintAdequateBooksAndRecMaintIndOther Spent ProceedsOtherSpentProceedsAmt
A$30,007,455$2,212,852$1,940,080$221,767$596,767$25,035,989201300Yes (1)Yes (1)
B$7,650,000$130,0000Yes (1)Yes (1)Yes (1)$7,520,000

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)

Bond ReferenceBondReferenceCdOwning Bond Financed PropertyOwningBondFinancedPropertyIndAny Lease ArrangementsAnyLeaseArrangementsIndMgmt Contract Bond Fincd PropMgmtContractBondFincdPropIndAny Research AgreementsAnyResearchAgreementsIndPrivate Bus Use By OthersPrivateBusUseByOthersPctPrivate Bus Concerning UBIPrivateBusConcerningUBIPctTotal Private Business UseTotalPrivateBusinessUsePctBond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestIndChange In Use Bond Financed PropChangeInUseBondFinancedPropIndProcs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd
A00000.000000.000000.00000000
B00000.000000.000000.00000000

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)

Bond ReferenceBondReferenceCdForm8038 T FiledForm8038TFiledIndRebate Not Due YetRebateNotDueYetIndException To RebateExceptionToRebateIndNo Rebate DueNoRebateDueIndVariable Rate IssueVariableRateIssueIndHedge Identified In Bks And RecHedgeIdentifiedInBksAndRecIndGross Proceeds Invested In GICGrossProceedsInvestedInGICIndGross Proceeds InvestedGrossProceedsInvestedIndWritten Proc To Monitor ReqsWrittenProcToMonitorReqsInd
A0000Yes (1)0000
B0000Yes (1)0000

Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)

Bond ReferenceBondReferenceCdProcedures Corrective ActionProceduresCorrectiveActionInd
AYes (1)
BYes (1)

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11THE 990 IS REVIEWED BY THE CEO AND CFO BEFORE FILED.
FORM 990, PART VI, SECTION B, LINE 12CYEARLY THE BOARD REVIEWS THE POLICY AND ENSURES COMPLIANCE BY ALL MEMBERS. EACH MEMBER MUST ANNUALLY DISCLOSE COMPLIANCE.
FORM 990, PART VI, SECTION B, LINE 15THE HOSPITAL USES AN OUTSIDE THIRD PARTY AGENCY TO HELP DETERMINE COMPENSATION LEVELS
FORM 990, PART VI, SECTION C, LINE 19ALL DOCUMENTS ARE MADE AVAILABLE UPON REQUEST FROM THE ORGANIZATION.
FORM 990, PART XI, LINE 9:CHANGE IN FUNDED STATUS OF PENSION -7,844,000. PENSION CURTAILMENT 5,459,658.
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 (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationInd
TJ REGIONAL HEALTH INC
1301 NORTH RACE STREETGLASGOWKY42141273988336PARENT ORGANIZATION OF HEALTHCARE FACILITYKY501(C)(3)LINE 11B, II0
TJ HEALTH PARTNERS LLC
1301 NORTH RACE STREETGLASGOWKY42141273988456PHYSICIAN CLINICSKY501(C)(3)LINE 90
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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