T J SAMSON COMMUNITY HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- T J SAMSON COMMUNITY HOSPITAL (EIN 61-0461767)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-08-15
- IRS object ID
- 201322279349302592
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-15T13:50:21-07:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 610461767 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | T J SAMSON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | TJSA | NameControl |
| Phone | 2706514114 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 North Race Street | AddressLine1 |
| City | Glasgow | City |
| State | KY | State |
| ZIP Code | 42141 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | WILLIAM KINDRED | Name |
| Title | CEO | Title |
| Phone | 2706514114 | Phone |
| Date Signed | 2013-08-14 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | WILLIAM KINDRED | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 NORTH RACE STREET | AddressLine1 |
| City | GLASGOW | City |
| State | KY | State |
| ZIP Code | 42141 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 130371622 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.TJSAMSON.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1928 | YearFormation |
| State Legal Domicile | KY | StateLegalDomicile |
| Activity Or Mission Description | TJ SAMSON COMMUNITY HOSPITAL WILL PROMOTE AND PROVIDE FOR THE HEALTH AND WELL-BEING OF THOSE THEY SERVE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1116 | TotalNbrEmployees |
| Total Nbr Volunteers | 72 | TotalNbrVolunteers |
| Total Gross UBI | -112594 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -112594 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 5121 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 12139 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 123535448 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 126839720 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 1983301 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2223588 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 980171 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1229311 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 126504041 | TotalRevenuePriorYear |
| Total Revenue Current Year | 130304758 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 60059982 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 59774106 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 64500845 | OtherExpensePriorYear |
| Other Expenses Current Year | 63238364 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 124560827 | TotalExpensesPriorYear |
| Total Expenses Current Year | 123012470 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1943214 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 7292288 | RevenuesLessExpensesCY |
| Total Assets BOY | 156424783 | TotalAssetsBOY |
| Total Assets EOY | 167428479 | TotalAssetsEOY |
| Total Liabilities BOY | 65319178 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 84541597 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 91105605 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 82886882 | NetAssetsOrFundBalancesEOY |
| Mission Description | TJ SAMSON COMMUITY HOSPITAL PROVIDES HEALTHCARE SERVICES TO BARREN AND SURROUNDING COUNTIES IN KENTUCKY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 101673551 | Expense |
| Revenue | 126513699 | Revenue |
| Description | ACUTE HOSPITAL AND EMERGENCY ROOM CARE: PATIENT DAYS 24,710 AND ER VISITS 34,056 | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 101673551 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 1 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 73 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1116 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 1 | LocalChapters |
| Policies Reference Chapters | 1 | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ SAMSON COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 2706514112 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 North Race Street | AddressLine1 |
| City | Glasgow | City |
| State | KY | State |
| ZIP Code | 42141 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| HENRY ROYSE | ||||||||
| CHAIRMAN | 1.3 | X | X | 0 | 0 | 0 | ||
| DAN FOUTCH | ||||||||
| VICE CHAIRMAN | 1.2 | X | X | 0 | 0 | 0 | ||
| BUDDY UNDERWOOD | ||||||||
| SECRETARY | 1.2 | X | X | 0 | 0 | 0 | ||
| FOLLIS CROW III | ||||||||
| TREASURER | 1.2 | X | X | 0 | 0 | 0 | ||
| ELLEN BALE | ||||||||
| DIRECTOR | 1 | X | 0 | 0 | 0 | |||
| KAREN SMALL | ||||||||
| DIRECTOR | 40 | X | 0 | 35629 | 0 | |||
| CHRIS LAWERENCE | ||||||||
| DIRECTOR | 1 | X | 0 | 0 | 0 | |||
| JOEY BOTTS | ||||||||
| DIRECTOR | 1 | X | 0 | 0 | 0 | |||
| BOGDAN MARCOL | ||||||||
| CHIEF OF STAFF | 40 | X | 21057 | 526283 | 0 | |||
| JASON CAMPBELL | ||||||||
| INCOMING CHIEF OF STAFF | 40 | X | 0 | 0 | 0 | |||
| MIKE BRYANT | ||||||||
| DIRECTOR | 1 | X | 0 | 0 | 0 | |||
| WILLIAM KINDRED | ||||||||
| CEO | 40 | X | 318127 | 0 | 0 | X | ||
| ANTHONY SUDDUTH | ||||||||
| CFO/COO | 40 | X | 258623 | 0 | 0 | X | ||
| NEIL THORNBURY | ||||||||
| CHIEF OF PATIENT CARE SERVICES | 40 | 154788 | 0 | 0 | X | |||
| MARGARET BILLINGSLEY | ||||||||
| CHIEF OF NURSING SERVICES | 40 | 157556 | 0 | 0 | X | |||
| JOHN NESBITT | ||||||||
| PHYSICIAN | 40 | 19936 | 499905 | 0 | X | |||
| VENKATA REDDY | ||||||||
| PHYSICIAN | 40 | 28755 | 719121 | 0 | X | |||
| HARIKRISHNAN NAIR | ||||||||
| PHYSICIAN | 40 | 0 | 482159 | 0 | X | |||
| RYAN TURPEN | ||||||||
| PHYSICIAN | 40 | 0 | 189285 | 0 | X | |||
| SUDHEER NAMBIAR | ||||||||
| PHYSICIAN | 40 | 0 | 187391 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 958842 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2639773 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 15 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| APOGEE MEDICAL MANAGEMENT | |||||
| 2525 E CAMELBACK RD SUITE 1100 | PHOENIX | AZ | 85016 | HOSPITALIST | 1286195 |
| SURGICAL SOLUTIONS | |||||
| 702 A BARRETT BLVD | HENDERSON | KY | 42420 | SURGERY | 987642 |
| STENGEL HILL ARCHITECTURE | |||||
| 613 WEST MAIN | LOUISVILLE | KY | 40202 | ARCHITECTURE | 1099147 |
| UNIDINE | |||||
| ONE GATEWAY CENTER SUITE 751 | NEWTON | MA | 02458 | DINING SERVICES | 944992 |
| ALLIANCE CORPORATION | |||||
| PO BOX 1480 | GLASGOW | KY | 42142 | CONSTRUCTION CONTRACTORS | 7517483 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 28 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| All Other Contributions | 12139 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 12139 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| HOSPITAL PROGRAM SERVICE | 622000 | 126513699 | 126513699 | 0 | $0 |
| PARTNERSHIP INCOME | 541900 | 335991 | 331511 | 4480 | $0 |
| OUTSIDE LAB | 621500 | -9970 | 0 | -9970 | $0 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 126839720 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2210250 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $2,210,250 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 156462 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 66864 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 89598 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 89598 | TotalRevenueColumn |
| Related Or Exempt Function Income | 89598 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 13338 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 13338 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 13338 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13338 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue | ExclusionExclusionAmount |
|---|---|---|---|---|---|
| CHILD CARE SERVICES | 624410 | -72296 | 34190 | -106486 | $0 |
| LAUNDRY | 812300 | -618 | 0 | -618 | $0 |
| PRIME ADVANTAGE | 624100 | 11413 | 11413 | 0 | $0 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1201214 | TotalRevenueColumn |
| Related Or Exempt Function Income | 654944 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $546,270 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1139713 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 130304758 | TotalRevenueColumn |
| Related Or Exempt Function Income | 127648693 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | -112594 | UnrelatedBusinessRevenue |
| Exclusion | $2,756,520 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 485512 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 485512 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 45202240 | Total |
| Program Services | 40229994 | ProgramServices |
| Management And General | 4972246 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3322992 | Total |
| Program Services | 2957463 | ProgramServices |
| Management And General | 365529 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7437298 | Total |
| Program Services | 6619195 | ProgramServices |
| Management And General | 818103 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3326064 | Total |
| Program Services | 2960197 | ProgramServices |
| Management And General | 365867 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65530 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 65530 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59034 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 59034 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3556540 | Total |
| Program Services | 3556540 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 428213 | Total |
| Program Services | 428213 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 601323 | Total |
| Program Services | 535177 | ProgramServices |
| Management And General | 66146 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1770118 | Total |
| Program Services | 1575405 | ProgramServices |
| Management And General | 194713 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 546506 | Total |
| Program Services | 486390 | ProgramServices |
| Management And General | 60116 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6599 | Total |
| Management And General | 6599 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 541104 | Total |
| Program Services | 541104 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9700521 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 9700521 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5711475 | Total |
| Program Services | 5711475 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 892780 | Total |
| Program Services | 794574 | ProgramServices |
| Management And General | 98206 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| SUPPLIES | 22086649 | 19657118 | 2429531 | 0 |
| REPAIRS AND MAINTENANCE | 4785178 | 4258808 | 526370 | 0 |
| CONTRACT SERVICES | 7568162 | 6735664 | 832498 | 0 |
| TAXES | 2260472 | 2260472 | 0 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2658160 | Total |
| Program Services | 2365762 | ProgramServices |
| Management And General | 292398 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 123012470 | Total |
| Program Services | 101673551 | ProgramServices |
| Management And General | 21338919 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 368398 | BOY |
| EOY | 580923 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76058264 | BOY |
| EOY | 65338450 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21172436 | BOY |
| EOY | 22851974 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3330 | BOY |
| EOY | 3330 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2289884 | BOY |
| EOY | 2630369 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4101782 | BOY |
| EOY | 8503851 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 148380294 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 91964013 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41938255 | BOY |
| EOY | 56416281 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4230248 | BOY |
| EOY | 2212853 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3270466 | BOY |
| EOY | 3456375 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2991720 | BOY |
| EOY | 5434073 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156424783 | BOY |
| EOY | 167428479 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25540847 | BOY |
| EOY | 46728151 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 39174702 | BOY |
| EOY | 36623261 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 603629 | BOY |
| EOY | 1190185 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65319178 | BOY |
| EOY | 84541597 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91105605 | BOY |
| EOY | 82886882 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91105605 | BOY |
| EOY | 82886882 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 156424783 | BOY |
| EOY | 167428479 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 7292288 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -15511011 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 1 | RalliesDemonstrations |
| Rallies Demonstrations | $7,881 | RalliesDemonstrationsAmount |
| Other Activities | 0 | OtherActivities |
| Total Lobbying Expenditures IIB | 7881 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchC_P2B_S00_L01 | Identifier |
| Return Reference | Schedule C, Part II-B, Line 1 | ReturnReference |
| Explanation | THE HOSPITAL PAYS MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION AS WELL AS THE KENTUCKY HOSPITAL ASSOCIATION OF WHICH SOME OF THE DUES ARE USED FOR LOBBYING PURPOSES. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 2091573 | OtherCostOrOtherBasis |
| Book Value | 2091573 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 54333716 | OtherCostOrOtherBasis |
| Depreciation | 18335807 | Depreciation |
| Book Value | 35997909 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1866304 | OtherCostOrOtherBasis |
| Depreciation | 1367183 | Depreciation |
| Book Value | 499121 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 90088701 | OtherCostOrOtherBasis |
| Depreciation | 72261023 | Depreciation |
| Book Value | 17827678 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 56416281 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY PAYOR SETTLEMENT | $180,770 |
| PROVIDER TAX PAYABLE | $1,009,415 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1190185 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3191964 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1023956 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2154862 | NetCommunityBenefitExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16116937 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 12778778 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3240931 | NetCommunityBenefitExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 19308901 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13802734 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 5395793 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 309000 | NetCommunityBenefitExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 839450 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 839450 | NetCommunityBenefitExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 23690 | NetCommunityBenefitExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expense | 66281 | NetCommunityBenefitExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 839450 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1238421 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 20148351 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 13802734 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6634214 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 515 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 515 | NetCommunityBuildingExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 77611 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 77611 | NetCommunityBuildingExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 2560 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 2560 | NetCommunityBuildingExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7337 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7337 | NetCommunityBuildingExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 26910 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 26910 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 23319 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 23319 | NetCommunityBuildingExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 30900 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 30900 | NetCommunityBuildingExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Building Expense | 169152 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Building Expense | 169152 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $4,819,768 | BadDebtExpenseAmount |
| Amount Attributable To | 1301337 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 29831441 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 36933006 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -7101565 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ SAMSON COMMUNITY HOSPITAL INC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 NORTH RACE STREET | AddressLine1 |
| City | GLASGOW | City |
| State | KY | State |
| ZIP Code | 42141 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ SAMSON COMMUNITY HOSPITAL INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | COST IS CALCULATED BY APPLYING THE TOTAL COST TO CHARGE RATIO |
| SchH_P01_S00_L072f | Schedule H, Part I, Line 7, Column f | N/A |
| SchH_P01_S00_L07g | Schedule H, Part I, Line 7g | N/A |
| SchH_P02_S00_L00 | Schedule H, Part II | THE HOSPITAL PREFORMS BUILDING ACTIVITIES TO IMPROVE RESIDENTS HEALTH. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | 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. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, 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. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | THE HOSPITAL PROVIDES ASSISTANCE TO PATIENTS THAT QUALIFY UNDER THE GUIDELINES. |
| SchH_P06_S00_L02 | Schedule H, 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. |
| SchH_P06_S00_L03 | Schedule H, 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 (DISH), First Source which provides information and education on federal assistance programs, charity and financial aid assistance applications, and payment schedule arrangements. |
| SchH_P06_S00_L04 | Schedule H, 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. |
| SchH_P06_S00_L05 | Schedule H, 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 |
| SchH_P06_S00_L06 | Schedule H, Part VI, Line 6 | Affiliated health care systems T.J. 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 1 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 1 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WILLIAM KINDRED | |||||||||||||
| 264555 | 0 | 53572 | 0 | 0 | 0 | 21643 | 0 | 14335 | 0 | 354105 | 0 | 0 | |
| ANTHONY SUDDUTH | |||||||||||||
| 214453 | 0 | 44170 | 0 | 0 | 0 | 20315 | 0 | 13978 | 0 | 292916 | 0 | 0 | 0 |
| BOGDAN MARCOL | |||||||||||||
| 21057 | 526283 | 0 | 0 | 0 | 0 | 20315 | 0 | 0 | 15584 | 41372 | 541867 | 0 | 0 |
| NEIL THORNBURY | |||||||||||||
| 135962 | 0 | 18826 | 0 | 0 | 0 | 1418 | 0 | 12909 | 0 | 169115 | 0 | 0 | 0 |
| MARGARET BILLINGSLEY | |||||||||||||
| 157556 | 0 | 18826 | 0 | 0 | 0 | 1443 | 0 | 5827 | 0 | 183652 | 0 | 0 | 0 |
| JOHN NESBITT | |||||||||||||
| 19936 | 499905 | 0 | 0 | 0 | 0 | 9800 | 0 | 0 | 14794 | 29736 | 514699 | 0 | 0 |
| VENKATA REDDY | |||||||||||||
| 28755 | 719121 | 0 | 0 | 0 | 0 | 9800 | 0 | 0 | 14614 | 38555 | 733735 | 0 | 0 |
| HARIKRISHNAN NAIR | |||||||||||||
| 0 | 482159 | 0 | 0 | 0 | 0 | 0 | 5077 | 0 | 14901 | 0 | 502137 | 0 | 0 |
| RYAN TURPEN | |||||||||||||
| 0 | 189285 | 0 | 0 | 0 | 0 | 0 | 6154 | 0 | 12071 | 0 | 207510 | 0 | 0 |
| SUDHEER NAMBIAR | |||||||||||||
| 0 | 187391 | 0 | 0 | 0 | 0 | 0 | 3942 | 0 | 15921 | 0 | 207254 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SchJ_P01_S00_L06 | Identifier |
| Return Reference | Schedule J, Part I, Line 6 | ReturnReference |
| Explanation | THE CHEIFS 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. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| CITY OF GLASGOW KENTUCKY | |||||||
| 616001831 | 376844AT3 | 2011-08-24 | 29632455 | FOR CONSTRUCTION | 0 | 0 | 0 |
| CITY OF EDMONTON KY | |||||||
| 616012870 | 2012-04-03 | 7650000 | To refinance 1998 bond issue. | 0 | 0 | 0 | |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Amount Bond DefeasedAmountBondDefeased | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Capitalized InterestCapitalizedInterest | Refunding EscrowRefundingEscrow | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Working Capital ExpendituresWorkingCapitalExpenditures | Capital ExpendituresCapitalExpenditures | Other Spent ProceedsOtherSpentProceeds | Amount UnspentAmountUnspent | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 2212852 | 1940080 | 221767 | 0 | 0 | 0 | 19693045 | 0 | 0 | 2013 | 0 | 0 | 1 | 1 |
| 0 | 0 | 7650000 | 0 | 0 | 0 | 132460 | 0 | 0 | 0 | 7650000 | 0 | 0 | 1 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 1 | ||
| 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 1 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | THE 990 IS REVIEWED BY THE CEO AND CFO BEFORE FILED. |
| F990_P06_S0B_L12c | 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. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | THE HOSPITAL USES AN OUTSIDE AGENCY TO HELP DETERMINE COMPENSATION LEVELS. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | ALL DOCUMENTS ARE AVAILABLE UPON REQUEST FROM THE ORGANIZATION. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | PARTNERSHIP DEDUCTIONS-2 UNREALIZED GAINS ON INVESTMENTS-590,646 CHANGE IN RETIREMENT PLAN-(15,731,035) PARTNERSHIP INCOME PER K-1-(335,991) PARTNERSHIP INVESTMENT INCOME PER K-1-( 1,104) PARTNERSHIP GAIN PER K-1-(4) GIFT SHOP PROFIT-(33,525) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ REGIONAL HEALTH INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 NORTH RACE STREET | AddressLine1 |
| City | GLASGOW | City |
| State | KY | State |
| ZIP Code | 42141 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273988336 | EIN |
| Primary Activities | PARENT ORGANIZATION OF HEALTHCARE FACILITY | PrimaryActivities |
| Legal Domicile State | KY | LegalDomicileState |
| Exempt Code Section | 501c3 | ExemptCodeSection |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 1 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TJ HEALTH PARTNERS LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1301 NORTH RACE STREET | AddressLine1 |
| City | GLASGOW | City |
| State | KY | State |
| ZIP Code | 42141 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 273988456 | EIN |
| Primary Activity | TO PROVIDE DOCTOR SERVICES IN BARREN AND SURROUNDING COUNTIES IN KENTUCKY | PrimaryActivity |
| Legal Domicile State | KY | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| TJ REGIONAL HEALTH INC | ||
| b | 9700520 | CASH AMOUNT DONATED TO TJ REGIONAL HEALTH FROM TJ SAMSON COMMUNITY HOSPITAL. |
| TJ HEALTH PARTNERS LLC | ||
| d | 2510322 | THE AMOUNT IS THE ADDITIONAL AMOUNT FOR THE YEAR THAT TJ HEALTH PARTNER OWES TJ SAMSON FOR SERVICES IN WHICH TJ SAMSON PROVIDED FOR TJ HEALTH PARTNER'S OR AMOUNTS PAID ON BEHALF OF TJ HEALTH PARTNERS. THE TOTAL OF THE DUE FROM TJ HEALTH PARTNERS IS 3,852,796 |
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