2022-10-27T07:06:53-05:00 2021-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2021-01-01 356001540 Goshen Hospital Association Inc GOSH 5743642665 200 High Park Avenue Goshen IN 46526 Lisa M Wine CFO 5743642665 2022-10-19 1 Lisa Wine 356001540 Rebekuh Eley P01247672 3126343400 2022-10-19 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Goshen Hospital Randal Christophel 200 High Park Avenue Goshen IN 46526 281725266 0 X https://goshenhealth.com X 1946 IN To improve the health of our communities by providing innovative, outstanding care and services. 12 9 1879 227 39934 0 16773624 2237312 239044458 252833700 12668964 14983069 8724343 8291131 277211389 278345212 25829846 23203799 0 0 107723723 108103120 0 0 0 128710172 142359150 262263741 273666069 14947648 4679143 540424850 566570613 139430343 141588273 400994507 424982340 X The mission of Goshen Hospital is to improve the health of our communities by providing innovative, outstanding care and service, through exceptional people doing exceptional work. 0 0 253782083 23203799 259350410 See Schedule O 253782083 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 106 0 1 1879 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 9 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X Lisa M Wine 5743642665 200 High Park Avenue Goshen IN 46526 Randal Christophel President and CEO 40.00 2.00 X X 959009 0 166347 Jody Neer MD Director 1.00 40.00 X 0 483130 53804 Andrew Vorhis NP Director 1.00 40.00 X 0 157626 28962 Bonita Schrock Chair 1.00 0.00 X X 0 0 0 Susan Stiffney RN Secretary/Treasurer 1.00 0.00 X X 0 0 0 Harshil Bhatt MD Director 1.00 0.00 X 0 0 0 Randy Cripe Director 1.00 0.00 X 0 0 0 Bruce Hughes MD Director 1.00 1.00 X 0 0 0 Karen Pletcher Director 1.00 0.00 X 0 0 0 Liliana Quintero Director 1.00 0.00 X 0 0 0 Karen Smith Director 1.00 0.00 X 0 0 0 Jewel Yoder Director 1.00 0.00 X 0 0 0 Rob Myers Chief Operating Officer 40.00 1.00 X 543676 0 86115 Ben Bontrager CFO until 12/2021 40.00 2.00 X 460615 0 29499 Chris Hutfless Chief Legal HR & Compliance Officer 40.00 1.00 X 397410 0 72365 Daniel Nafziger MD Chief Medical Officer 40.00 0.00 X 514055 0 78038 Margaret S Franger VP of Population Health & Bus Devlp. 40.00 0.00 X 384366 0 77275 Mark Podgorski VP of Hospital Operations 40.00 0.00 X 359038 0 76174 Julie Crossley Chief Nursing Officer 40.00 0.00 X 330143 0 65205 Beau McNeff until 102021 VP of Goshen Physicians/Cancer Srvs 20.00 20.00 X 363082 0 35434 Ebenezer Kio MD Physician 40.00 0.00 X 0 738017 48475 Houman Vaghefi MD Physician 40.00 0.00 X 0 687606 47588 Leonard Henry MD Physician 40.00 0.00 X 0 646447 46108 Bolanle Adepoju MD Physician 40.00 0.00 X 0 497428 49777 Urs Von Holzen MD Physician 40.00 0.00 X 0 619116 53683 4311394 3829370 1014849 95 0 1 0 Hagerman Inc 510 W Washington Blvd Ft Wayne IN 46802 Construction 23157683 Quest Diagnostics PO Box 775460 Chicago IL 60677 Medical Services 3374139 DJ Construction Co Inc 3414 Elkhart Road Goshen IN 46526 Construction 3124482 AYA Healthcare Inc 5930 Cornerstone Crt W Suite 300 San Diago CA 92121 Contracted Staffing 2967490 Fastaff LLC 5700 S Quebec St Suite 300 Greenwood Village CO 80111 Contracted Staffing 2598064 56 90864 2146448 2237312 Patient Care 622110 252833700 252833700 252833700 5827655 39934 5787721 1545931 0 1545931 1545931 1545931 12316620 218848 3380054 0 8936566 218848 9155414 9155414 Food Service Revenue 722514 224313 224313 Other Oncology Rev Misc 621500 37099 37099 Finance Charges 900099 4177 4177 6479611 6479611 6745200 278345212 259350410 39934 16717556 X 23203799 23203799 4311393 844198 3467195 77734210 69183447 8550763 5084882 4525545 559337 15418908 13722828 1696080 5553727 4942817 610910 2925675 2925675 367494 367494 290000 290000 10095 10095 549243 549243 27721906 27721906 2703464 2703464 3301913 3301913 465297 465297 2388674 2388674 443526 443526 857194 857194 12983163 12983163 2356077 2356077 Drugs & Medical Supplie 58743581 58743581 Hospital Assessment Fee 11500308 11500308 Repairs & Maintenance 10503951 10503951 Bad Debt Expense 1376013 1376013 2871576 2871576 273666069 253782083 19883986 0 10387899 11776343 28512016 13851162 32777356 34014022 7055481 7766020 14744882 15755023 331181573 148868362 153690356 182313211 286961017 292930927 6295843 8163905 540424850 566570613 27616537 39813799 74566658 74186506 11762398 7849209 25484750 19738759 139430343 141588273 X 400994507 424982340 400994507 424982340 540424850 566570613 X 4679143 19749659 -440969 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10095 10095 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to the American Hospital Association and the Indiana Hospital Association that are specifically allocable to lobbying. 4848692 4848513 9697205 124148658 51263148 72885510 158142 36948 122345 72745 137423802 97482869 39940933 59716818 59716818 182313211 Deferred Malpractice 216000 Claims Liability 1141262 Lease Liability 6471930 Medicare Advance Payments 11609567 Due to Third-Party Payor 300000 19738759 X Part X, Line 2: The Internal Revenue Service has determined that Goshen Health and certain affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code. Certain subsidiaries of Goshen Health are taxable entities, the tax expense and liabilities of which are not material to the consolidated financial statements. Goshen Health and its tax-exempt affiliated entities each file a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the tax-exempt status of each entity, the continued tax-exempt status of bonds, the nature, characterization and taxability of joint venture income, and various positions relating to potential sources of unrelated business taxable income (reported on Form 990T). As of December 31, 2021 and 2020, there are no unrecognized tax benefits resulting from uncertain tax positions. Forms 990 and 990T filed by Goshen Health and its tax-exempt affiliated entities are subject to examination by the Internal Revenue Service up to three years from the extended due date of each return. Forms 990 and 990T filed by Goshen Health and its tax-exempt affiliated entities are no longer subject to examination for tax year 2018 and prior. 1 1 X 1 X 1 X 1 1 1 0 1 1 4400 2729657 0 2729657 0.01000 9863 45730647 31869993 13860654 0.05060 14263 48460304 31869993 16590311 0.06060 25937 24370320 8535 24361785 0.08900 851 1486662 10221 1476441 0.00540 19 19203 0 19203 0.00010 26807 25876185 18756 25857429 0.09450 41070 74336489 31888749 42447740 0.15510 0 56571 0 56571 0.00020 56571 56571 0.00020 1 6350133 41253133 50040780 -8787647 X 1 1 1 1 Goshen Hospital Association Inc 200 High Park Avenue Goshen IN 46526 https://goshenhealth.com License #XXX-XX-XXXX X X X N/A Goshen Hospital Association Inc 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V, Page 8 X 1 21 1 See Part V, Page 8 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X https://goshenhealth.com/patient-information/estimates-financial-assistance X https://goshenhealth.com/patient-information/estimates-financial-assistance X https://goshenhealth.com/patient-information/estimates-financial-assistance X X X X X X 1 X 0 X X X X 1 X 0 0 Goshen Hospital Association, Inc. Part V, Section B, Line 5: In 2021, Goshen Hospital completed an evaluation of the communities' healthcare needs as required by the Patient Protection and Affordable Care Act. The Community Advisory Council met over multiple months and received input from community representatives, including those with special knowledge or expertise in public health. This process continues Goshen Hospital's long-standing practice of regularly identifying and addressing health needs within the community.In an effort to further identify health needs for the 2021 Community Health Needs Assessment (CHNA), additional data was collected from other sources. These sources include Latino and non-Latino parents and guardians, community leaders, focus groups, key informants from business, not-for-profit organizations, service organizations, healthcare workers, mental health workers, and vulnerable or medically underserved populations. Goshen Hospital Association, Inc. Part V, Section B, Line 11: Health needs were identified after an extensive analysis of primary and secondary data. Working with community stakeholders in the Community Advisory Council, this data was analyzed to identify and prioritize health needs in Goshen Hospital communities. The committee identified 29 health needs and prioritized the top 7 accordingly. Prioritized Health Needs1. Mental health2. Diabetes treatment and prevention3. Poverty4. Obesity/Weight management5. Lack of access to health care6. Substance abuse/Addictions7. Heath educationGoshen Hospital will begin reporting on the results of the 2021 CHNA Action Plan in 2022. The following results from the 2019-2021 Action Plan was based on the 2018 CHNA.Health needs were identified after an extensive analysis of primary and secondary data that included surveys, focus groups and key informants. Working with community stakeholders in the Community Action Council, this data was analyzed to identify and prioritize health needs in Goshen Hospital communities. The committee identified 13 needs and ranked accordingly. Prioritized Health Need1. Mental health2. Obesity3. Substance abuse: alcohol, drugs, addiction4. Diabetes5. Mental health providers6. Tobacco use/smoking7. Poverty8. Nutrition9. Physical fitness10. Physicians: primary care and other11. Insurance coverage12. Family support13. Health educationGoshen Hospital reviewed the prioritized list and evaluated based on the following questions:-How much control or influence do we have over each particular category? Can we make a material change in 2-3 years?-Are some of these categories related in a way that we can address more than one with our efforts?-Do we have key community partners we can collaborate with in these efforts?This evaluation process collapsed the original priorities list to the 7 below. Condensed Categories1. Mental Health and Mental Health Provider Access2. Obesity/Nutrition/Physical Fitness3. Substance Abuse4. Diabetes5. Tobacco/Smoking6. PCP Access/Availability7. Insurance CoverageTo accomplish meaningful and measurable change, the decision was made to target interrelated health conditions and behaviors, including obesity, nutrition, health education, physical fitness, and diabetes. Resources may be refocused to best address the needs of the community as they change over time. Goshen Hospital took the following actions in 2021 with respect to the Community Health Needs Assessment conducted in 2018.PRIORITY AREA: Obesity/Physical Fitness/Nutrition/Health EducationGOAL: Reduce the rate of obesity in Goshen Hospital service areas through internal and external programs.LONG TERM INDICATORS OF IMPACT1. Slow or halt the accelerating rate of adult obesity within the community Baseline Values - Elkhart County: 32.8%, 11.2% increase over 4 years2. Reduce the percentage of adults reporting physical inactivity within the community Baseline Values - 25.9% reporting physical inactivity in Elkhart County in 2013 and 26.4% from 2014-20183. Increase engagement in health education related to nutrition, physical fitness, and obesity within the community.STRATEGY #1: Lead a community coalition focused on improving and expanding broad access obesity initiatives with outcomes measures. This group will focus on high risk populations and cultural minorities, leveraging community assets and advancing the role of social determinants of health in programming.2021 ActivityThe COVID-19 pandemic continued to impact Goshen Hospital outreach efforts in 2021. Most activities were still required to remain virtual or significantly modified during the year to comply with public health guidelines. Toward the end of the year, restrictions began to ease and were allowed to implement more traditional methods of outreach.593 total outreach efforts addressing obesity/diabetes were implemented in 2021. Goshen Hospital continued to build partnerships and adjust programming to meet the health education needs of the community. A total of 107 partnership collaborations occurred in 2021. Noteworthy partnerships included: Purdue Extension, Minority Health, Hispanic Latino Health Coalition, Elkhart County Health Department, Elkhart County Food Council, local parks departments, local school systems, Goshen Farmers Market, Elkhart Educational Foundation, Boys and Girls Club, Middlebury Day Camp, Goshen College, Goshen Public Library and the Elkhart County Fairgrounds. New or enhanced noteworthy efforts included; Best in Snow, Active Trac, SFW Challenge, Kahoot Trivia Challenges, Head 2 Toe on the Go, and the Great Lakes Great Apple Crunch event. These programs served a total of 18,231 participants in 2021. STRATEGY #2: Establish a consistent, evidence based pathway for obese patients within the Accountable Care Organization2021 ActivityBMI tracking continued as an indicator throughout our medical homes. Patients with a BMI over 35 are connected with our PAM assessment system for activation. This provides patients with a curriculum to help them move forward on a continuum of success. Progress is recorded as patients show improvement. In 2021, 76 patients completed the PAM assessment.STRATEGY #3: Establish an evidence-based pathway for overweight or obese pediatric patients while considering social determinants of health.2021 ActivityWhile this has a natural connection to the first strategy, the focus of this strategy is the health needs of children. In 2021, Goshen Hospital developed a tiered approach for intervention and started building a community resource document to serve providers during interventions. SUMMARYIn 2021, Goshen Hospital addressed prioritized health needs by: - Informing 25,406 participants through community health education events - Serving 531 individuals with community based clinical services - Expanding access to care by educating 851 doctors, nurses, and other health professional students - Partnering with 19 other organizations across the community in support of their health-building initiatives Goshen Hospital Association, Inc. Part V, Section B, Line 13h: Family size is another factor in determining discounts granted to patients. Goshen Hospital Association, Inc. Part V, Section B, Line 7, CHNA Policy Website:https://goshenhealth.com/health-library/community-health-needsGoshen Hospital Association, Inc.Part V, Section B, Line 10, Implementation Strategy Website:https://goshenhealth.com/health-library/community-health-needs 5 1 - Goshen Hospital 200 High Park Avenue Goshen IN 46526 Clinic 2 - The Retreat Women's Health Center 1135 Professional Drive Goshen IN 46526 Clinic 3 - Indiana Lakes Accountable Care 2018 South Main Street Goshen IN 46526 ACO: Ambulatory Care Coordination 4 - Indiana Lakes Managed Care 2018 South Main Street Goshen IN 46526 Health Care Management 5 - New Paris Medical Clinic 200 High Park Avenue Goshen IN 46526 Clinic Part I, Line 6a: Goshen Hospital Association, Inc. reports community benefit information as part of the Goshen Health, Inc. annual community benefit report (EIN: 35-1955872). Part I, Line 7: Goshen Hospital calculated the cost of financial assistance and means-tested government programs, using the cost-to-charge ratio derived from Schedule H, Worksheet 2, and ratio of patient care cost-to-charges. Other benefits amounts reported on line 7 were calculated using costs charged directly to the individual programs via the financial accounting system. An indirect cost allocation factor for shared services is also calculated and included in applicable programs listed in other benefits. Part II, Community Building Activities: Goshen Hospital promoted the health of the community by supporting various local organizations that engage in community building activities. Part III, Line 2: Goshen Hospital's analysis and assessment of the allowance for doubtful accounts and related bad debt expense uses a receipts "look-back" method utilizing historical payment data on accounts, including contractual adjustments for payer discounts, as well as patient payments, such as co-pays and deductibles, to establish anticipated collectability rates for accounts receivable within each payer category. Part III, Line 3: Goshen Hospital estimated the possible amount of charity care within bad debt expense by reviewing accounts that were internally coded as having been provided a financial assistance application, but that was not completed by the patient or guarantor, in which the account was subsequently written off to bad debt. Part III, Line 4: The following narrative addresses the allowance for doubtful accounts which is included in the footnotes in the financial statements for Goshen Hospital.In 2018 and prior years, the provision for uncollected patient accounts was recognized when services were provided based upon management's assessment of historical and expected net collections, taking into consideration business and economic conditions, changes and trends in health care coverage, and other collection indicators. Periodically, management assessed the adequacy of the allowance for uncollectible accounts based upon accounts receivable payor composition and aging, the significance of individual payors to outstanding accounts receivable balances, and historical write-off experience by payor category, as adjusted for collection indicators. The results of this review were then used to make any modifications to the provision of uncollectible accounts and the allowance for uncollectible accounts. In addition, Goshen Hospital followed established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, were initially charged against the allowance for uncollectible accounts in accordance with collection policies of Goshen Hospital and, in certain cases, were reclassified to charity care if deemed to otherwise meet financial assistance policies of Goshen Hospital.In 2019, Goshen Hospital adopted ASU 2014-09 requiring an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised good or services to customers. The effect of adopting ASU 2014-09 is considered immaterial as revenue recognition under the new standard is not materially different compared to Goshen Hospital's current practice. The primary effect is certain amounts previously reported as provision for uncollectible accounts are now considered implicit price concessions reported as a reduction of patient service revenue. The remaining provision for uncollectible accounts is reported as an operating expense under the new revenue recognition standard rather than as a reduction of patient service revenue. Part III, Line 8: Actual month and year to date revenue, contractuals, accounts receivable balances, ratios and statistics are compared to prior years on a monthly basis. Variances are reviewed and analyzed by finance representatives, hospital directors and the CFO. Additionally, actual contractual allowance as a percentage of gross accounts receivable and contractual provision as a percentage of gross patient charges are compared to prior years. This is done as part of the hospital's monthly close process. Explanations to variances (or non-variances when expected) are researched and provided by the appropriate personnel and reviewed with management of the hospital. The finance department also considers these key performance indicators when developing their estimates of contractual allowances to ensure recorded amounts appear reasonable based on actual data available.Financial representatives prepare and update the contractual allowance model as a basis for all third party payors based on actual statistics (e.g. discharges, days, etc.) and on current reimbursement rates. The model analyzes patient receivables and contractual allowance by payor and by patient status. The model estimates the collectability of patient accounts based on historical collection rates. Finance colleagues also update the model to account for changes in reimbursement rules. After the model is prepared, it is reviewed by the CFO for appropriateness and reasonableness.Contractual allowance calculations are reconciled to the general ledger on a monthly basis. Once the calculation is prepared, the finance department adjusts the general ledger accounts. Part III, Line 9b: Financial assistance is granted to those patients unable to pay all or a portion of their bill and who are unable to qualify for assistance through federal and state government assistance programs. If after insurance reimbursement additional assistance is needed, all patients may obtain financial assistance if the income criteria are met. All financial assistance applications are based on policy guidelines. Uninsured patients are required to provide documentation and an application. When approved, the adjustment is applied to the patient's account. For patients who do not qualify for financial assistance, payment plans and lump sum settlements are available. Goshen Hospital also partners with a local financing institution to provide a flexible and affording financing solution. Part VI, Line 2: As a community hospital, Goshen Hospital is dedicated to meeting the specific health care needs of our community. The hospital has 122 patient beds and over 275 physicians on its medical staff in 30 specialties. These physicians, together with other dedicated professionals, provide a wide range of services including the following: acute medical & surgical, emergency, home health, radiology, laboratory, cancer care, bariatrics, women's health, pain management, sleep studies, rehabilitation, patient and community health education and professional education.The Center for Cancer Care is a leader in innovative cancer treatment. We were among the first to adopt a comprehensive, multidisciplinary approach to cancer treatment. We offer holistic programs for strengthening minds as well as bodies, place a premium on family involvement and spiritual needs, and encourage patients to play a decision-making role in treatment selection. The Center for Cancer Care has specifically trained surgical oncologists, breast surgeons, medical oncologist, radiation oncologist, naturopathic practitioners and highly distinguished magnet designated nurses.Goshen Hospital improves the health and well-being of its communities by providing community wellness and education programs. Through local partnerships, the hospital identifies health issues and creates programs to ensure our community is the healthiest place to live, work and raise a family. The first of these programs cover CPR, EMS, diabetes, childbirth, fitness, nutrition, community education and health screenings the Elkhart County childhood obesity initiative. The CPR class is for anyone - professionals or private citizens - who want to know how to perform life-saving cardiopulmonary resuscitation; first aid classes are also offered. EMS training is available for persons interested in becoming emergency medical technicians or paramedics. The diabetes education helps people delay the onset and slow the progression of complications from this disease. It includes seminars, support groups, consultations and screenings. Childbirth education prepares expectant mothers and their families during this significant time in their life. Part VI, Line 3: Uninsured patients are screened during the pre-registration process for eligibility in the Healthy Indiana Plan and offer any other known sources of financial assistance. All registration locations have financial assistance forms available for self-pay patients to complete and will have information on the criteria and process for applying for financial assistance. Applications are also provided to any patients with a balance due who may qualify for financial assistance. Counselors are available to patients to aid in the application process including the collection of information to complete the application. Payment options and information on financial assistance is available on the hospital's website. Patients may download a preliminary application, and the patient agreement associated with financial assistance form the website, this information is available in English and Spanish. Part VI, Line 4: Goshen Hospital serves the northern Indiana area in Elkhart County. According to the 2021 census, the population of Elkhart County is 206,921. The median income for a household in Elkhart County is $58,509. Approximately 9.8% of the population were below the poverty line. The racial makeup of the county was about 73.2% White, 6.2% African-American, and 17.6% Hispanic or Latino. The remaining 3.0% of the population is a makeup of all other races. Part VI, Line 5: All of the Hospital's governing body is comprised of persons who reside in the organization's primary or secondary service areas. A majority of the board members are independent of the organization. The governing body approves medical staff privileges as indicated in the organization's credentialing and privileging policies and as recommended by the medical executive committee of the hospital. The hospital's governing body approves the annual operating budget for the hospital and the expenditure of capital funds above certain dollar amounts. The governing body also participates in strategic planning initiatives to determine goals objectives focused on patient care for the community. Part VI, Line 6: Hospital management provides Goshen Health with the hospital's annual operating budget and key strategic objectives. In addition, the hospital management provides Goshen Hospital with various key metrics involving patient satisfaction, patient quality and colleague satisfaction. Goshen Hospital reviews the data to ensure key initiatives are focused towards the promoting and meeting the healthcare needs of the communities. In addition, the hospital collaborates with Goshen Health to provide necessary nursing education and physician recruitment to assist in meeting the health needs of the community. Part VI, Line 7, Reports Filed With States IN 1 Goshen Health System Inc 200 High Park Avenue Goshen IN 46526 351974765 501(c)(3) 22970147 0 FMV Operating Support Goshen Health Foundation Inc 200 High Park Avenue Goshen IN 46526 462565300 501(c)(3) 233652 0 FMV Operating Support 2 0 Part I, Line 2: The Organization's Procedures for monitoring the use of grant funds in the U.S. consists of requiring the completion of a follow-up report form with subsequent grant fund applications. X 0 1 X X X X 0 1 0 0 0 0 0 1 0 Randal Christophel President and CEO 636738 0 301945 0 20326 0 134772 0 31575 0 1125356 0 0 0 Ebenezer Kio MD Physician 0 625829 0 112188 0 0 0 22148 0 26327 0 786492 0 0 Houman Vaghefi MD Physician 0 578468 0 90602 0 18536 0 18277 0 29311 0 735194 0 0 Leonard Henry MD Physician 0 524191 0 122256 0 0 0 19228 0 26880 0 692555 0 0 Urs Von Holzen MD Physician 0 450132 0 158984 0 10000 0 22790 0 30893 0 672799 0 0 Rob Myers Chief Operating Officer 415456 0 118158 0 10062 0 66196 0 19919 0 629791 0 0 0 Daniel Nafziger MD Chief Medical Officer 407401 0 101110 0 5544 0 61647 0 16391 0 592093 0 0 0 Bolanle Adepoju MD Physician 0 452375 0 36303 0 8750 0 23246 0 26531 0 547205 0 0 Jody Neer MD Director 0 409448 0 73682 0 0 0 22318 0 31486 0 536934 0 0 Ben Bontrager CFO until 12/2021 360963 0 98812 0 840 0 11600 0 17899 0 490114 0 0 0 Chris Hutfless Chief Legal HR & Compliance Officer 353325 0 35308 0 8777 0 58946 0 13419 0 469775 0 0 0 Margaret S Franger VP of Population Health & Bus Devlp. 344953 0 37291 0 2122 0 58651 0 18624 0 461641 0 0 0 Mark Podgorski VP of Hospital Operations 260821 0 68120 0 30097 0 46694 0 29480 0 435212 0 0 0 Beau McNeff until 102021 VP of Goshen Physicians/Cancer Srvs 244046 0 118266 0 770 0 11600 0 23834 0 398516 0 0 0 Julie Crossley Chief Nursing Officer 261681 0 65199 0 3263 0 42273 0 22932 0 395348 0 0 0 Andrew Vorhis NP Director 0 98444 0 59182 0 0 0 11250 0 17712 0 186588 0 0 Part I, Line 1a Goshen Hospital grossed up the taxable value of an automobile for 1 of the officers listed on Form 990, Part VII and included the amount in the employees' W-2 as additional compensation. Part I, Line 1b Goshen Hospital does not have a specific written policy for the use of automobiles, but does gross up the taxable value of automobiles to include in the employees' W-2 as additional compensation. Part I, Line 4b Eligible executives participate in various non-qualified deferred compensation plans organized under code Section 457(f). The exact purpose of each plan varies, but they include: compensation limitation make-up plans, voluntary deferral plans, deferral of a portion of incentive bonus type plans, etc. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals participate in the plan: Randal Christophel Rob Myers Daniel Nafziger, MD Ben Bontrager Chris Hutfless Margaret S. Franger Mark Podgorski Beau McNeff Julie Crossley No non-qualified plan payments were made during the year to any listed persons in Part VII. A Indiana Finance Authority - 2019A 351602316 45471ATA0 2019-07-31 50630944 Campus improvement project 0 0 0 B Indiana Finance Authority - 2019B 351602316 45471ATA0 2019-07-31 25360000 Campus improvement project 0 0 0 A 50630944 628854 50002090 2022 0 0 0 1 B 25360000 359751 7953965 17046284 2022 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 1 0 0 0 0 A 1 B 1 Form 990, Part III, Line 4a, Program Service Description: The mission of Goshen Hospital is to improve the health of our communities by providing innovative, outstanding care and service, through exceptional people doing exceptional work. The hospital's values include: -Compassion - and commitment to service with empathy. -Accountability - with integrity and action. -Respect - through treating others as you wish to be treated. -Excellence - in all we do. The organization created the current three-year strategic plan during 2019 to run from 1/1/2020 through 12/31/2022. The current strategic priorities for 2023 are as follows: 1. Access & Consumerism: Provide more access to convenient health services than any competitor in order to grow and secure our market position. 2. Provider Network: Attract and retain the highest-quality providers through a variety of alignment mechanisms. 3. Service Complement: Selectively grow and deepen our service offerings to meet the evolving needs of our community. 4. Value-Based Care: Build new and leverage our existing population health management capabilities as we prepare for value-based care to become increasingly prevalent. As a community hospital, Goshen Hospital is dedicated to meeting the specific health care needs of our communities. As a community leader, the hospital is committed to providing care in an innovating and dynamic environment. The hospital has 122 patient beds and over 275 physicians on its medical staff in 30 specialties. These physicians, together with other dedicated professionals, provide a wide range of services including the following: acute medical & surgical, emergency, home health, radiology, laboratory, cancer care, bariatrics, women's health, pain management, sleep studies, rehabilitation, patient and community health education and professional education. The American Nurses Credentialing Center's (ANCC) magnet recognition program for excellence in nursing services has designated Goshen Hospital as a magnet hospital since 2004. Designated hospitals have successfully created a work environment that nurses find both personally and professionally rewarding, advancing the practice of nursing and improving patient outcomes. Research shows that magnet hospitals are more effective at attracting and keeping quality nurses. Goshen Hospital is among an elite group of hospitals in the nation to be re-designated as a magnet facility. The Goshen Center for Cancer Care is accredited by the Commission on Cancer (COC). Receiving care at a COC-approved center for cancer care assures that patients will have access to: -quality care close to home. -comprehensive care offering a range of state-of-the art services and equipment. -a multidisciplinary team approach to coordinate the best treatment options available to cancer patients. -participation in cancer clinical trials, education and support. -lifelong patient follow-up through a cancer registry that collects data on type and stage of cancers and treatment results. -ongoing monitoring and improvement in care. The Center for Cancer Care is a leader in innovative cancer treatment. We were among the first to adopt a comprehensive, multidisciplinary approach to cancer treatment. We offer holistic programs for strengthening minds as well as bodies, place a premium on family involvement and spiritual needs, and encourage patients to play a decision-making role in treatment selection. The Center for Cancer Care has specifically trained surgical oncologists, breast surgeons, medical oncologist, radiation oncologist, naturopathic practitioners and highly distinguished magnet designated nurses. Goshen Hospital improves the health and well-being of its communities by providing community wellness and education programs. Through local partnerships, the hospital identifies health issues and creates programs to ensure our community is the healthiest place to live, work and raise a family. The first of these programs cover CPR, EMS, diabetes, childbirth, fitness, nutrition, community education and health screenings the Elkhart County childhood obesity initiative. The CPR class is for anyone - professionals or private citizens - who want to know how to perform life-saving cardiopulmonary resuscitation; first aid classes are also offered. EMS training is available for persons interested in becoming emergency medical technicians or paramedics. The diabetes education helps people delay the onset and slow the progression of complications from this disease. It includes seminars, support groups, consultations and screenings. Childbirth education prepares expectant mothers and their families during this significant time in their life. The Goshen Health Community Benefit Fund is one example of how Goshen Health re-invests money into the communities we serve. Any nonprofit organization with a mission consistent with that of Goshen Health and works toward meeting the needs of the community are encouraged to apply. Since its inception in 1998, the Community Benefit Grant Committee of Goshen Health's Board of Directors has awarded more than $6 million in grants to community organizations and projects that meet the health needs of our community. Goshen Hospital provides health care services to all members of the communities regardless of their ability to pay. The hospital offers financial assistance to those patients unable to pay all or a portion of their bill and who are unable to qualify for assistance through federal and state government assistance programs. Patients are asked to complete a financial aid application to determine their eligibility for financial assistance. The hospital provides the assistance of a financial advocate to help patients complete this application and to investigate other forms of available assistance including enrollment in marketplace plans. In 2021, the hospital extended charity care to 4,400 accounts totaling $7.9 million. Goshen Hospital also partners with a financial institution to provide flexible and affordable financing solutions for a patient's medical care. Goshen Hospital first received the beacon award for excellence from the American Association of Critical Care Nurses in 2010. This is a three-year accreditation and 2019 marks the fourth time Goshen has won the award and the third time Goshen has achieved the highest status, gold. The National Accreditation Program for Breast Centers (NAPBC) has awarded multiple three-year, full accreditation to Goshen Health Retreat Women's Health Center beginning in 2010. Press Ganey has awarded Goshen Health with 7 summit awards. In addition, Goshen Health has received the H&V Platinum Performance Achievement Award (NCDR) and the WHO baby-friendly designation. Form 990, Part VI, Section A, line 2 The following officers, board members, and key employees are employees of Goshen Hospital or its related organizations, and serve on other related taxable boards: Randal Christophel, Chris Hutfless, Rob Myers, Ben Bontrager, Mark Podgorski, and Beau McNeff. Form 990, Part VI, Section A, line 6 The sole member of Goshen Hospital Association, Inc. is Goshen Health System, Inc. an Indiana not-for-profit corporation that serves as the corporate parent of the health system. Form 990, Part VI, Section A, line 7a Goshen Health System, Inc., a section 501(c)(3) exempt organization and the parent of the exempt healthcare system, is the sole corporate member of the filing organization. Directors shall be appointed as provided in the Bylaws by the member to a term as designated at the time of appointment. Form 990, Part VI, Section B, line 11b A full copy of the Form 990 is provided to the board of directors and the audit committee in November for review and questions before the return is filed with the IRS. Form 990, Part VI, Section B, line 12c Each board member completes an annual disclosure of known or potential conflicts. Each disclosure is reviewed by the VP-legal. Additionally when agenda items are discussed at meetings it is asked if there are any known or potential conflicts of interest, and conflicted parties must recuse themselves. Form 990, Part VI, Section B, line 15 An independent committee approves the compensation which is determined to be reasonable based upon independent comparability data provided by an independent consultant. Approval of amounts are documented in the minutes. Form 990, Part VI, Section C, line 19 Goshen Hospital will provide any documents open to public inspection upon request for the same period of disclosure as set forth in IRC Section 6104(d). Form 990, Part IX, line 11g Outside Purchased Services: Program service expenses 16,038,596. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,038,596. Temp Staffing: Program service expenses 8,484,511. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,484,511. Outside Purchased Anesthesia: Program service expenses 2,100,471. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,100,471. Goshen Marketing: CRM: Program service expenses 360,488. Management and general expenses 0. Fundraising expenses 0. Total expenses 360,488. Collection Services: Program service expenses 274,001. Management and general expenses 0. Fundraising expenses 0. Total expenses 274,001. Snow Removal: Program service expenses 137,990. Management and general expenses 0. Fundraising expenses 0. Total expenses 137,990. Trash Removal: Program service expenses 113,758. Management and general expenses 0. Fundraising expenses 0. Total expenses 113,758. Medical Professional Fees: Program service expenses 111,801. Management and general expenses 0. Fundraising expenses 0. Total expenses 111,801. Outside Purchased Grounds: Program service expenses 100,290. Management and general expenses 0. Fundraising expenses 0. Total expenses 100,290. Form 990, Part XI, line 9: Equity Transfer -440,969. Indiana Lakes Managed Care Org LLC 200 High Park Avenue Goshen IN 46526 351946663 Healthcare IN 248829 125826 Goshen Hospital Association Inc Indiana Lakes Accountable Care Org LLC 200 High Park Avenue Goshen IN 46526 455450141 Healthcare IN 2811980 3051319 Goshen Hospital Association Inc Goshen Health System Inc 200 High Park Avenue Goshen IN 46526 351974765 Healthcare IN 501(c)(3) Line 12c, III-FI N/A 0 Goshen Health Foundation Inc 200 High Park Avenue Goshen IN 46526 462565300 Fundraising IN 501(c)(3) Line 7 Goshen Health System Inc 1 Goshen Hospital Women's Auxiliary Inc 200 High Park Avenue Goshen IN 46526 237017521 Healthcare IN 501(c)(3) Line 12d, III-O N/A 0 New Paris Clinic LLC 2018 S Main Street Goshen IN 46526 352075244 Commerical Rentals IN Goshen Health System Inc n/a 0 0 Parkmor Drug Inc 1501 S Main Street Goshen IN 46526 351394980 Pharmacy Sales IN Goshen Health System Inc C 1 PILR Inc 200 High Park Avenue Goshen IN 46526 204294750 Development IN Goshen Health System Inc C 1 Radiation Oncology Resources Inc 200 High Park Avenue Goshen IN 46526 262008424 Healthcare IN Goshen Health System Inc C 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 Goshen Health Foundation Inc C 90864 FMV Goshen Health Foundation Inc R 233652 FMV Goshen Health Foundation Inc D 100000 FMV