2014-11-11T14:25:02-06:00 2013-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 2000 INDIANAPOLIS IN 462045108 990 2013-01-01 351974765 GOSHEN HEALTH SYSTEM INC GOSH 5745352665 200 HIGH PARK AVENUE GOSHEN IN 46526 AMY FLORIA CFO 5745332141 2014-11-11 1 SAMANTHA BOKORI P01057347 3174648600 2014-11-07 2013 2015-11-30 17:44:51Z IU HEALTH GOSHEN RANDAL CHRISTOPHEL 200 HIGH PARK AVENUE GOSHEN IN 46526 36176724 0 X WWW.IUHEALTH.ORG/GOSHEN X 1997 IN TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES. 22 17 369 18 -37154 -136984 9661063 11338514 21961335 24085684 -14796 -58746 987759 811272 32595361 36176724 0 0 0 0 23509371 26144027 0 0 0 9251536 10239568 32760907 36383595 -165546 -206871 10280005 7154194 4624962 4875202 5655043 2278992 X THE MISSION OF IU HEALTH GOSHEN IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES, THROUGH EXCEPTIONAL PEOPLE DOING EXCEPTIONAL WORK. 0 0 33227016 24557892 IU HEALTH GOSHEN IS A NON-DENOMINATIONAL NON-FOR-PROFIT ORGANIZATION PROVIDING HEALTH CARE SERVICES FOR THE GENERAL PUBLIC. SEE SCHEDULE O FOR ADDITIONAL DETAIL.THE MISSION OF IU HEALTH GOSHEN IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICE, THROUGH EXCEPTIONAL PEOPLE DOING EXCEPTIONAL WORK. THE SYSTEM'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.BUILDING UPON OUR MISSION AND VALUES, IU HEALTH GOSHEN WILL DELIVER EXCEPTIONAL HEALTHCARE IN AN INTEGRATED MODEL TO THE COMMUNITIES WE SERVE, ACHIEVING PREEMINENCE WITH COMMITMENT TO QUALITY, LEADERSHIP, AND INNOVATION. BY 2015, WE WILL ACHIEVE ALL ELEMENTS OF THIS VISION BY FOCUSING ON THE FOLLOWING KEY AREAS:- LEAD THE REGION WITH OUR CANCER SERVICES.- CREATE AN ENVIRONMENT IN WHICH EACH COLLEAGUE CAN FULFILL HIS OR HER PERSONAL MISSION.- EMPHASIZE THE BENEFITS OF HEALTH AND WELLNESS.- RESPOND STRATEGICALLY TO THE EVOLVING HEALTH NEEDS OF OUR COMMUNITY.- BECOME THE GENESIS FOR CREATING A NEW ECONOMIC BASE IN THE GREATER GOSHEN COMMUNITY.KEY COMPONENTS OF IU HEALTH GOSHEN INCLUDE THE OPERATIONS OF A MULTI-SPECIALTY PHYSICIAN NETWORK OR IU HEALTH GOSHEN PHYSICIANS. THE PHYSICIAN NETWORK EMPLOYS HEALTHCARE PROVIDERS DEDICATED TO MEETING THE HEALTH CARE NEEDS OF AREA RESIDENTS, YOUNG AND OLD. THE NETWORK OF BOTH PRIMARY CARE AND SPECIALTY PROVIDERS ENHANCES THE SYSTEM'S ABILITY TO CARE FOR THE COMMUNITY. IU HEALTH GOSHEN PHYSICIANS REPRESENT THE FOLLOWING CARE AREAS: FAMILY PRACTICE, NEUROLOGY, CARDIOLOGY, ADULT INTERNAL MEDICINE, PEDIATRICS, ORTHOPEDICS, OBSTETRICS AND GYNECOLOGY, BARIATRICS, GASTROENTEROLOGY, INFECTION CONTROL, AND ONCOLOGY.IU HEALTH GOSHEN EXCELS AT MEETING THE HEALTH CARE NEEDS OF ITS PATIENTS AS MEASURED BY PRESS GANEY AND NRC PICKER, NATIONALLY RECOGNIZED COMPANIES THAT PARTNER WITH HEALTHCARE FACILITIES TO MEASURE THE LEVEL OF CUSTOMER SATISFACTION AND IMPROVE THEIR QUALITY OF HEALTH CARE DELIVERY. IN 2012, IU HEALTH GOSHEN PHYSICIANS RANKED ABOVE THE 90TH PERCENTILE IN OVERALL PATIENT SATISFACTION. IU HEALTH GOSHEN CENTER FOR CANCER CARE GOES ABOVE AND BEYOND TRADITIONAL TEAMWORK IN ORDER TO HEAL EVERY PERSON THAT ENTERS OUR DOORS. OUR HOLISTIC, FULLY INTEGRATED CARE MODEL RECENTLY RECEIVED NATIONAL RECOGNITION AS A HOPE AWARD WINNER BY HEMATOLOGY & ONCOLOGY NEWS & ISSUES MAGAZINE. THE NATIONAL PUBLICATION NAMED IU HEALTH GOSHEN CENTER FOR CANCER CARE AS "THE BEST EXAMPLE OF INTEGRATION OF CARE AMONG ENTRIES IN MEDIUM-SIZED COMMUNITY-BASED ONCOLOGY PRACTICES." IU HEALTH GOSHEN CENTER FOR CANCER CARE ALSO HAS BEEN AWARDED THE OUTSTANDING ACHIEVEMENT AWARD BY THE AMERICAN COLLEGE OF SURGEONS' COMMISSION ON CANCER (COC). ONLY SEVEN PERCENT OF APPROVED CANCER PROGRAMS IN THE UNITED STATES EARN THIS DISTINCTION.IU HEALTH GOSHEN EARNED THE 2013 APEX WORKPLACE OF DISTINCTION AWARD FROM MOREHEAD ASSOCIATES. THE APEX AWARD RECOGNIZES THE INDUSTRY'S TOP EMPLOYERS, DETERMINED BY OBJECTIVE DATA GATHERED FROM EMPLOYEE SURVEYS. OUR NATIONAL HEALTH CARE PERCENTILE RANKING FOR WORKFORCE COMMITMENT IN 2013 WAS 69TH. IU HEALTH GOSHEN HAS BEEN NAMED ONE OF INDIANA'S BEST PLACES TO WORK BY THE INDIANA CHAMBER OF COMMERCE, AND WAS NAMED TO THE LIST OF "100 BEST PLACES TO WORK IN HEALTHCARE" BY MODERN HEALTHCARE AND BECKER'S HOSPITAL REVIEW. IU HEALTH GOSHEN PHYSICIANS PROVIDES HEALTH CARE SERVICES TO ALL MEMBERS OF THE COMMUNITIES REGARDLESS OF THEIR ABILITY TO PAY. THE NETWORK 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 PROVIDE FINANCIAL INFORMATION TO ASSESS THEIR FINANCIAL POSITION. IN 2013, THE NETWORK PROVIDED APPROXIMATELY $820,744 OF CHARITY CARE TO PATIENTS. 33227016 1 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 87 0 1 369 1 1 1 0 0 0 0 0 0 0 0 0 X 22 17 1 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 1 1 IN X DIRECTOR OF FINANCE 5745352665 200 HIGH PARK GOSHEN IN 46526 RANDY CHRISTOPHEL PRESIDENT AND CEO 1.00 41.00 X X 0 596505 31823 EDWARD BOYTS MD TREASURER 40.00 0.00 X X 292997 0 28780 RICHARD B HOSTETTER MD SECRETARY 1.00 40.00 X X 561831 0 48810 DELMAR G GOOD PHD DIRECTOR 1.00 0.00 X 0 0 0 GERALD A TROLZ DIRECTOR 1.00 0.00 X 0 0 0 GEORGE MARLOW DIRECTOR 1.00 1.00 X 0 0 0 ALAN R TEHAN DIRECTOR 1.00 0.00 X 0 0 0 STEPHEN FIDLER DIRECTOR 1.00 0.00 X 0 0 0 PARIS BALL-MILLER DIRECTOR 1.00 0.00 X 0 0 0 MICHAEL L KUBACKI DIRECTOR 1.00 0.00 X 0 0 0 DENISE DAVIS ESQ DIRECTOR 1.00 0.00 X 0 0 0 WES HERSCHBERGER VICE CHAIR 1.00 0.00 X X 0 0 0 NEIL PICKETT DIRECTOR - IU HEALTH 1.00 0.00 X 0 0 0 MARK KING PHD CHAIR 1.00 0.00 X X 0 0 0 MARK DICKEN DIRECTOR 1.00 0.00 X 0 0 0 GRETCHEN LUND DIRECTOR 1.00 0.00 X 0 0 0 JAMES ALVAREZ DIRECTOR 1.00 0.00 X 0 0 0 SHERYL EAKINS DIRECTOR 1.00 0.00 X 0 0 0 JOHN LEAVITT DIRECTOR 1.00 1.00 X 0 0 0 DERALD BONTRAGER DIRECTOR 1.00 1.00 X 0 0 0 LINDA BAXLEY DIRECTOR 1.00 1.00 X 0 0 0 DAVID KORONKIEWICZ MD DIRECTOR - PARTIAL YEAR 1.00 40.00 X 393423 0 29323 DANIEL BERGER MD DIRECTOR 40.00 1.00 X 237554 0 18754 AMY FLORIA CFO 1.00 40.00 X 0 478030 46498 RANDALL CAMMENGA MD COO 1.00 40.00 X 0 633410 59353 LARRY ALLEN MD CMO 8.00 32.00 X 0 310126 30476 ALAN WELDY V/P OF HR 1.00 40.00 X 0 585225 54841 MARGARET S FRANGER V/P OF CANCER SERVICES 1.00 40.00 X 0 226876 39580 PAM KARSEN V/P OF NURSING 1.00 40.00 X 0 316118 36555 MARK SMUCKER MD PHYSICIAN 1.00 40.00 X 741037 0 34281 PETER KIM MD PHYSICIAN 1.00 40.00 X 625824 0 28149 GARY CORNETTE DO PHYSICIAN 40.00 0.00 X 627831 0 23084 JAMES DUNNICK MD PHYSICIAN 1.00 40.00 X 615058 0 32461 BINOY OUSEPH MD PHYSICIAN 40.00 0.00 X 560461 0 25315 JAMES DAGUE FORMER OFFICER 0.00 0.00 X 0 700411 0 4656016 3846701 568083 49 1 1 0 GNKL PROPERTIES 1824 DORCHESTER COURT GOSHEN IN 46526 RENT 371420 AJJM LLC 2523 MESSICK DRIVE GOSHEN IN 46526 RENT 174263 LARRY ALLEN MD 13275 N EAST SHORE DRIVE SYRACUSE IN 46567 RENT 150175 QUEST DIAGNOSTICS PO BOX 12989 CHICAGO IL 60693 MEDICAL SERVICES 136072 4 11338514 11338514 HEALTHCARE SERVICES 621110 24038692 24038692 EKG REVENUE 621110 46992 46992 24085684 -58746 -37154 -21592 110239 0 110239 110239 110239 BILLINGS 561000 228825 228825 TEAM BARIATRICS 621110 31440 31440 SPECIALIST X-RAY 621500 24255 24255 416513 416513 701033 36176724 24557892 -37154 317472 1485805 1485805 19635656 18117790 1517866 1164364 1069537 94827 2732238 2354145 378093 1125964 1000891 125073 77464 77464 1516491 1516491 1943932 1867598 76334 288373 225411 62962 729397 563857 165540 480589 480389 200 CLINICAL SUPPLIES 1970086 1968737 1349 0 PURCHASED SERVICES 1609179 874844 734335 0 BAD DEBT EXPENSE 1406538 1406538 0 0 217519 217519 36383595 33227016 3156579 0 2332273 1957361 593638 542974 7339421 5553838 1861775 1785583 5492319 2116267 0 752009 10280005 7154194 4624962 4875202 0 4624962 4875202 X 5655043 2278992 0 0 5655043 2278992 10280005 7154194 X -206871 -43374 -3125806 X 0 1 X 1 0 X X X 0 0 0 GOSHEN HOSPITAL ASSOCIATION INC 356001540 3 1 1 1 11940806 1 11940806 SCHEDULE A, PART I, LINE 11H: GOSHEN HEALTH SYSTEM, INC. HAS FUNDED SOME OF THE OPERATING EXPENSES OF GOSHEN HOSPITAL ASSOCIATION, INC. THE AMOUNT OF FUNDING DURING 2013 WAS $11,940,806. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7339421 5553838 1785583 1785583 SPECTRON LAND, LLC, SPECTRON MRC, LLC, SPECTRON EQUIPMENT, LLC 2116267 F 2116267 INTERCOMPANY RECEIVABLES 752009 752009 1 1 0 0 0 0 0 0 0 RANDY CHRISTOPHEL PRESIDENT AND CEO 0 419461 0 141765 0 35279 0 25315 0 6508 0 628328 0 0 EDWARD BOYTS MD TREASURER 140647 0 152250 0 100 0 20561 0 8219 0 321777 0 0 0 RICHARD B HOSTETTER MD SECRETARY 451001 0 69581 0 41249 0 42302 0 6508 0 610641 0 0 0 DAVID KORONKIEWICZ MD DIRECTOR - PARTIAL YEAR 252754 0 140669 0 0 0 25315 0 4008 0 422746 0 0 0 DANIEL BERGER MD DIRECTOR 162160 0 75394 0 0 0 16419 0 2335 0 256308 0 0 0 AMY FLORIA CFO 0 264300 0 80272 0 133458 0 41704 0 4794 0 524528 0 0 RANDALL CAMMENGA MD COO 0 329590 0 123447 0 180373 0 50742 0 8611 0 692763 0 0 LARRY ALLEN MD CMO 0 261348 0 35640 0 13138 0 27207 0 3269 0 340602 0 0 ALAN WELDY V/P OF HR 0 330460 0 103605 0 151160 0 50833 0 4008 0 640066 0 0 MARGARET S FRANGER V/P OF CANCER SERVICES 0 175666 0 50400 0 810 0 27427 0 12153 0 266456 0 0 PAM KARSEN V/P OF NURSING 0 233767 0 69989 0 12362 0 34682 0 1873 0 352673 0 0 MARK SMUCKER MD PHYSICIAN 691037 0 50000 0 0 0 25315 0 8966 0 775318 0 0 0 PETER KIM MD PHYSICIAN 576160 0 675 0 48989 0 19815 0 8334 0 653973 0 0 0 GARY CORNETTE DO PHYSICIAN 575928 0 51903 0 0 0 19815 0 3269 0 650915 0 0 0 JAMES DUNNICK MD PHYSICIAN 544780 0 20833 0 49445 0 25315 0 7146 0 647519 0 0 0 BINOY OUSEPH MD PHYSICIAN 509417 0 10468 0 40576 0 25315 0 0 0 585776 0 0 0 JAMES DAGUE FORMER OFFICER 0 0 0 125000 0 575411 0 0 0 0 0 700411 0 575411 PART I, LINE 3 GOSHEN HOSPITAL ASSOCIATION, INC., A RELATED TAX-EXEMPT ORGANIZATION OF GOSHEN HEALTH SYSTEM, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4A: AS PER OUR EMPLOYMENT AGREEMENT, UPON A QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM IU HEALTH GOSHEN. JAMES DAGUE $575,411 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 RECEIVED CURRENT YEAR DISTRIBUTIONS OF: AMY FLORIA $102,959 RICHARD B. HOSTETTER $23,749 ALAN WELDY $138,118 RANDALL CAMMENGA, MD $153,915 LARRY ALLEN, MD $6,349 FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF IU HEALTH GOSHEN OR ITS RELATED ORGANIZATIONS, AND SERVE ON OTHER RELATED TAXABLE BOARDS: RANDY CHRISTOPHEL AMY FLORIA ALAN WELDY FORM 990, PART VI, SECTION A, LINE 6 IU HEALTH IS THE SOLE MEMBER OF IU HEALTH GOSHEN. FORM 990, PART VI, SECTION A, LINE 7A IU HEALTH, AS THE SOLE MEMBER OF IU HEALTH GOSHEN, HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF IU HEALTH GOSHEN. FORM 990, PART VI, SECTION A, LINE 7B ITEMS THAT REQUIRE APPROVAL OF IU HEALTH GOSHEN INCLUDE ANY AMENDMENT OF THE OPERATING AGREEMENT, DISSOLUTION OF THE ORGANIZATION OR THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND THE AUDIT COMMITTEE IN OCTOBER 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. THE DISCLOSURES ARE 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 IU HEALTH GOSHEN'S TOP MANAGEMENT OFFICIALS AND OTHER OFFICERS ARE COMPENSATED BY IU HEALTH GOSHEN HOSPITAL, A RELATED TAX-EXEMPT ORGANIZATION. AN INDEPENDENT COMMITTEE APPROVES THE COMPENSATION WHICH IS DETERMINED TO BE REASONABLE BASED UPON INDEPENDENT COMPARABILITY DATA. APPROVAL OF AMOUNTS ARE DOCUMENTED IN THE BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 IU HEALTH GOSHEN WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFER -3,125,806. 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