2024-07-26T07:23:24-05:00 2023-09-30 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2022-10-01 273988336 TJ REGIONAL HEALTH INC TJRE 2706514444 1301 NORTH RACE STREET GLASGOW KY 42141 MEI DENG CFO 2706514444 2024-07-24 1 0 EMILIE M KNIERIEM CPA P01330194 3176334705 2024-07-24 2022 2024-08-08 14:25:15Z MEI DENG 1301 NORTH RACE STREET GLASGOW KY 42141 11228596 0 X N/A X 2010 KY TO PROMOTE AND PROVIDE FOR THE WELL-BEING OF THOSE WE SERVE. 12 10 42 10 0 0 11565427 11186996 0 0 0 0 41092 41600 11606519 11228596 25264 88256 0 0 4996512 5362501 0 0 0 6636391 6378029 11658167 11828786 -51648 -600190 448837 453570 626561 1196301 -177724 -742731 TO PROMOTE AND PROVIDE FOR THE WELL-BEING OF THOSE WE SERVE. TJ REGIONAL HEALTH, INC. SERVES AS A SUPPORTING ORGANIZATION FOR TJ SAMSON COMMUNITY HOSPITAL. 0 0 8200941 88256 TO SUPPORT TJ SAMSON COMMUNITY HOSPITAL, INC., TJ HEALTH PARTNERS LLC AND TJ HEALTH COLUMBIA IN PROVIDING HEALTHCARE TO BARREN AND ADAIR COUNTIES AND THEIR SURROUNDING COUNTIES IN KENTUCKY. 8200941 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 38 0 1 42 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 KY X MARGIE GENTRY 2706514114 1301 NORTH RACE STREET GLASGOW KY 42141 T RICH ALEXANDER CHAIRMAN 2.00 2.00 X X 0 0 0 BRENT BILLINGSLEY VICE CHAIRMAN 2.00 2.00 X X 0 0 0 MICHAEL SCOTT YOUNG SECRETARY 2.00 2.00 X X 0 0 0 ERVIN SORRELL TREASURER 1.00 2.00 X X 0 0 0 JOEY ALLEN BOTTS DIRECTOR 2.00 2.00 X 0 0 0 BO MATTHEWS DIRECTOR 1.00 2.00 X 0 0 0 DAN FOUTCH DIRECTOR 2.00 2.00 X 0 0 0 HENRY ROYSE DIRECTOR 2.00 3.00 X 0 14997 0 KYLE KISER MD DIRECTOR/VICE CHIEF OF STAFF 1.00 41.00 X 0 0 0 MICHAEL SARIDAKIS MD DIRECTOR/CHIEF OF STAFF 1.00 41.00 X 0 481176 37187 AMY NORRIS CASSADY DIRECTOR 1.00 2.00 X 0 0 0 CORNELIUS FAULKNER DIRECTOR 1.00 2.00 X 0 0 0 NEIL THORNBURY CHIEF EXECUTIVE OFFICER 40.00 11.00 X 524340 0 58990 MEI DENG CHIEF FINANCIAL OFFICER 40.00 11.00 X 345720 0 32832 JAMES H LEE EVP - SUPPORT SERVICES 40.00 X 179994 0 15979 LADONNA G RODGERS EVP - HUMAN RESOURCES 40.00 X 202106 0 45990 JENNIFER M CERWINSKE EVP - PRACTICE MANAGEMENT 40.00 X 186476 0 39262 BRANDON DICKEY CNO 40.00 X 291086 0 34424 JODIE M HOLGATE EVP PATIENT CARE SERVICES 40.00 X 170082 0 43624 JOHN CRADDOCK FORMER VICE CHIEF OF STAFF 1.00 41.00 X 0 644323 67196 ERIC FISHER FORMER CHIEF OF STAFF 1.00 41.00 X 0 352121 34232 1899804 1492617 409716 11 1 1 0 BLUE & CO LLC 2650 EASTPOINT PARKWAY LOUISVILLE KY 40223 ACCOUNTING SERVICES 547978 FENEX CONSULTING LLC 223 PINNACLE SHORES DRIVE LAMPE MO 65681 CONSULTING SERVICES 500000 ENGLISH LUCAS PRIEST OWSLEY 1101 COLLEGE ST BOWLING GREEN KY 42101 LEGAL SERVICES 232643 3 11186996 11186996 REV SHARE COMMERCE BANK 900099 41600 41600 41600 11228596 0 0 41600 X 88256 88256 895893 698797 197096 3399787 2651834 747953 130489 101781 28708 676919 527997 148922 259413 202342 57071 427155 427155 683011 683011 1496116 1276935 219181 925442 370177 555265 227004 158151 68853 221757 199581 22176 71341 44945 26396 33244 13298 19946 15057 6023 9034 1748 699 1049 1803249 1622924 180325 DUES AND SUBSCRIPTIONS 250583 100233 150350 FOOD 61580 43106 18474 MEDICAL SUPPLIES AND DR 40445 40445 REPAIRS AND MAINTENANCE 14318 11025 3293 105979 42392 63587 11828786 8200941 3627845 0 7887 7887 118472 65475 132 132 50816 108761 486033 486033 0 0 269751 269751 1779 1564 448837 453570 626561 1196301 626561 1196301 X -177724 -742731 -177724 -742731 448837 453570 -600190 35183 0 X X 0 1 X 1 0 X X X 2 TJ SAMSON COMMUNITY HOSPITAL 610461767 3 0 7570279 0 TJ HEALTH COLUMBIA 810893103 3 0 542406 0 2 8112685 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 PART IV, SECTION D, LINE 3: THE CORPORATION IS ORGANIZED AND AT ALL TIMES SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF TJ SAMSON COMMUNITY HOSPITAL AND TJ HEALTH COLUMBIA. THE CORPORATION SHALL BE OPERATED, SUPERVISED, AND/OR CONTROLLED BY OR IN CONNECTION WITH THE HOSPITALS. THE CORPORATION SHALL BE RESPONSIVE TO THE NEEDS OR DEMANDS OF, AND SHALL BE AN INTEGRAL PART OF OR MAINTAIN A SIGNIFICANT INVOLVEMENT IN, THE OPERATIONS OF THE HOSPITALS. THE ORGANIZATIONS SHARE A MAJORITY OF THE SAME BOARD MEMBERS. PART IV, SECTION E, LINE 3A: THE CORPORATION IS ORGANIZED AND AT ALL TIMES SHALL BE OPERATED EXCLUSIVELY FOR THE BENEFIT OF, TO PERFORM THE FUNCTIONS OF, OR TO CARRY OUT THE PURPOSES OF TJ SAMSON COMMUNITY HOSPITAL AND TJ HEALTH COLUMBIA. THE CORPORATION SHALL BE OPERATED, SUPERVISED, AND/OR CONTROLLED BY OR IN CONNECTION WITH THE HOSPITALS. THE CORPORATION SHALL BE RESPONSIVE TO THE NEEDS OR DEMANDS OF, AND SHALL BE AN INTEGRAL PART OF OR MAINTAIN A SIGNIFICANT INVOLVEMENT IN, THE OPERATIONS OF THE HOSPITALS. THE ORGANIZATIONS SHARE A MAJORITY OF THE SAME BOARD MEMBERS. PART IV, SECTION E, LINE 3B: THE CORPORATION SHALL BE RESPONSIVE TO THE NEEDS OR DEMANDS OF, AND SHALL BE AN INTEGRAL PART OF OR MAINTAIN A SIGNIFICANT INVOLVEMENT IN, THE OPERATIONS OF THE HOSPITALS. THE ORGANIZATIONS SHARE A MAJORITY OF THE SAME BOARD MEMBERS. PART IV, SECTION A, LINE 1: THESE ENTITIES ARE NOT SPECIFICALLY LISTED IN THE ORGANIZING DOCUMENTS BUT ARE REFERENCED. THE ARTICLES STATE THE CORPORATION IS ORGANIZED: (I) TO OWN AND OPERATE HOSPITAL FACILITIES, NURSING HOMES, PHYSICIAN ORGANIZATIONS, AMBULATROY FACILITIES, CLINICS AND ORGANIZATIONS FOR THE PROVISION OF HEALTHCARE ITEMS, GOODS AND SERVICES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 486033 486033 0 0 X PART X, LINE 2: TJ SAMSON COMMUNITY HOSPITAL (TJS), TJ HEALTH COLUMBIA (TJHC), AND TJ REGIONAL HEALTH (TJR) ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. AS SUCH, TJS, TJHC, AND TJR ARE GENERALLY EXEMPT FROM INCOME TAXES. HOWEVER, THEY ARE REQUIRED TO FILE FEDERAL FORM 990 RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX WHICH IS AN INFORMATIONAL RETURN ONLY. TJ HEALTH PARTNERS (TJHP) IS AN LLC, AND IS TREATED AS A PARTNERSHIP FOR INCOME TAX PURPOSES. THE LLC'S NET EARNINGS OR LOSSES ARE ALLOCATED TO ITS SOLE OWNER (TJR) AND INCLUDED IN THE OWNER'S INCOME TAX RETURN. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS REFLECTED IN THE FINANCIAL STATEMENTS. ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF SEPTEMBER 30, 2023, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. 0 ADAIR COUNTY BOARD OF EDUCATION 491 TROJAN TRAIL GLASGOW KY 42141 616001263 ADAIR COUNTY 29947 0 SUPPORT TO THE BOARD OF EDUCATION BARREN COUNTY ECONOMIC AUTHORITY PO BOX 1703 GLASGOW KY 42142 611064852 BARREN COUNTY 18750 0 PROGRAM SUPPORT BARREN COUNTY ATC 1204 GREENSBURG ST COLUMBIA KY 42728 610600439 BARREN COUNTY 39434 0 PROGRAM SUPPORT 3 X X X X 0 0 0 0 0 0 0 1 0 JOHN CRADDOCK FORMER VICE CHIEF OF STAFF 0 510089 0 131926 0 2308 0 12200 0 54996 0 711519 0 0 NEIL THORNBURY CHIEF EXECUTIVE OFFICER 483882 0 40458 0 0 0 34739 0 24251 0 583330 0 0 0 MICHAEL SARIDAKIS MD DIRECTOR/CHIEF OF STAFF 0 408876 0 64800 0 7500 0 12200 0 24987 0 518363 0 0 ERIC FISHER FORMER CHIEF OF STAFF 0 352121 0 0 0 0 0 9245 0 24987 0 386353 0 0 MEI DENG CHIEF FINANCIAL OFFICER 327720 0 18000 0 0 0 12200 0 20632 0 378552 0 0 0 BRANDON DICKEY CNO 272032 0 19054 0 0 0 9423 0 25001 0 325510 0 0 0 LADONNA G RODGERS EVP - HUMAN RESOURCES 188106 0 14000 0 0 0 25649 0 20341 0 248096 0 0 0 JENNIFER M CERWINSKE EVP - PRACTICE MANAGEMENT 174476 0 12000 0 0 0 14632 0 24630 0 225738 0 0 0 JODIE M HOLGATE EVP PATIENT CARE SERVICES 160082 0 10000 0 0 0 19078 0 24546 0 213706 0 0 0 JAMES H LEE EVP - SUPPORT SERVICES 167994 0 12000 0 0 0 6514 0 9465 0 195973 0 0 0 PART I, LINE 7 PHYSICIANS ARE ELIGIBLE FOR INCENTIVE COMPENSATION. PHYSICIANS MAY EARN ADDITONAL COMPENSATION THROUGH QUARTERLY PRODUCTIVITY BONUSES THAT ARE BASED ON THE CALCULATED DIFFERENCE OF ACTUAL WRVUS FOR THE QUARTER LESS A WRVU QUARTERLY TARGET. THE OFFICER'S BONUSES ARE CALCULATED BASED ON STANDARD PERFORMANCE METRICS AS MEASURED BY ANNUAL CMS PATIENT SATISFACTION SURVEY RESULTS, ANNUAL EMPLOYEE SATISFACTION AND TURNOVER RESULTS, ANNUAL CMS HOSPITAL QUALITY SCORES IMPROVEMENT, FINANCIAL PERFORMANCE TO GOALS, SERVICE LINE GROWTH AND MARKET SHARE EXPANSION, AND COMMUNITY DEVELOPMENT SUPPORT AND PROGRESS. FORM 990, PART VI, SECTION B, LINE 11B THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S CEO, CFO, AND OFFICERS OF THE BOARD (CHAIRMAN, VICE CHAIRMAN, FINANCE COMMITTEE). FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS ARE REQUIRED TO FULLY DISCLOSE ANY CONFLICT OF INTEREST ANNUALLY. IN THE EVENT OF A CONFLICT, THE BOARD MEMBER SHALL OBSTAIN FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: TJ REGIONAL USES AN INDEPENDENT THIRD PARTY TO HELP ESTABLISH WAGES FOR THE CEO. COMPARABILITY DATA USED INCLUDED IHA COMPENSATION SURVEYS, AND 990S OF OTHER HOSPITALS SIMILAR IN SIZE. THIS PROCESS IS REVIEWED AND APPROVED BY THE EXECUTIVE BOARD ON AN ANNUAL BASIS. LINE 15B: TJ REGIONAL USES AN INDEPENDENT THIRD PARTY TO HELP ESTABLISH WAGES FOR THE CFO. COMPARABILITY DATA USED INCLUDED IHA COMPENSATION SURVEYS, AND 990S OF OTHER HOSPITALS SIMILAR IN SIZE. THIS PROCESS IS REVIEWED AND APPROVED BY THE EXECUTIVE BOARD ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION C, LINE 19 COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE PROVIDED TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 824,897. MANAGEMENT AND GENERAL EXPENSES 168,955. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 993,852. CONTRACT LABOR : PROGRAM SERVICE EXPENSES 452,038. MANAGEMENT AND GENERAL EXPENSES 50,226. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 502,264. FORM 990, PART XI, LINE 9, CHANGES IN NET ASSETS: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR. TJ SAMSON COMMUNITY HOSPITAL 1301 NORTH RACE STREET GLASGOW KY 42141 610461767 HOSPITAL KY 501(C)3 LINE 3 TJ REGIONAL HEALTH INC 1 TJ HEALTH COLUMBIA 1301 NORTH RACE STREET GLASGOW KY 42141 810893103 HOSPITAL KY 501(C)3 LINE 3 TJ REGIONAL HEALTH INC 1 TJ COMMUNITY MISSION FOUNDATION 1301 NORTH RACE STREET GLASGOW KY 42141 472208322 FOUNDATION KY 501(C)3 LINE 10 TJ REGIONAL HEALTH INC 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 TJ SAMSON COMMUNITY HOSPITAL C 10951545 CASH TJ HEALTH COLUMBIA C 235451 CASH