GOSHEN HOSPITAL ASSOCIATION INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- GOSHEN HOSPITAL ASSOCIATION INC (EIN 35-6001540)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201133199349304978
- Schema version
- 2010v3.4
- 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 B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T12:11:19-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DELOITTE TAX LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 MONUMENT CIRCLE SUITE 2000 | AddressLine1 |
| City | INDIANAPOLIS | City |
| State | IN | State |
| ZIP Code | 462045108 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 356001540 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOSHEN HOSPITAL ASSOCIATION INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | GOSH | NameControl |
| Phone | 5745352665 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 46526 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | AMY FLORIA | Name |
| Title | CFO | Title |
| Phone | 5745352665 | Phone |
| Date Signed | 2011-11-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SHAWNA M JIMENEZ | Name |
| Phone | 3174648600 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | IU HEALTH GOSHEN HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES DAGUE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2024 S MAIN ST | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 46526 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 190297429 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.GOSHENHEALTH.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | IN | StateLegalDomicile |
| Activity Or Mission Description | TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1357 | TotalNbrEmployees |
| Total Nbr Volunteers | 332 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 831884 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 175927 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 168187524 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 184695165 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -4006460 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1380192 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1834479 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4046145 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 166847427 | TotalRevenuePriorYear |
| Total Revenue Current Year | 190297429 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 169000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 203000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 67504438 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 70200359 | 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 | 93013190 | OtherExpensePriorYear |
| Other Expenses Current Year | 104312949 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 160686628 | TotalExpensesPriorYear |
| Total Expenses Current Year | 174716308 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6160799 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 15581121 | RevenuesLessExpensesCY |
| Total Assets BOY | 176858376 | TotalAssetsBOY |
| Total Assets EOY | 196983221 | TotalAssetsEOY |
| Total Liabilities BOY | 64550691 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 66823409 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 112307685 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 130159812 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF IU HEALTH GOSHEN HOSPITAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES, THROUGH EXCEPTIONAL PEOPLE DOING EXCEPTIONAL WORK. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 147686776 | Expense |
| Grants | 203000 | Grants |
| Revenue | 186979682 | Revenue |
| Description | GOSHEN HOSPITAL ASSOCIATION, INC. IS A NON-DENOMINATIONAL NON-FOR-PROFIT ORGANIZATION PROVIDING HEALTH CARE SERVICES FOR THE GENERAL PUBLIC AS WELL AS CHARITY WITHIN THE COMMUNITY. - SEE SCHEDULE O FOR ADDITIONAL DETAILTHE MISSION OF IU HEALTH 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.BUILDING UPON OUR HERITAGE AND VALUES, IU HEALTH GOSHEN HOSPITAL 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:- PROVIDING HIGH-QUALITY CARE WITH COMPASSION, VALUE AND STATE-OF-THE-ART TECHNOLOGY;- CREATING AN ENVIRONMENT THAT FOSTERS THE HIGHEST LEVEL OF ENTHUSIASM, COMMITMENT, COLLABORATION AND SATISFACTION;- STRATEGICALLY RESPONDING TO OUR DIVERSE COMMUNITY'S CHANGING HEALTHCARE NEEDS, WITH INCREASING EMPHASIS ON WELLNESS; AND- HELPING OUR COMMUNITIES TO BE THE "BEST PLACES" TO LIVE AND WORK.AS A COMMUNITY HOSPITAL, IU HEALTH GOSHEN HOSPITAL IS DEDICATED TO MEETING THE SPECIFIC HEALTH CARE NEEDS OF OUR COMMUNITIES. AS A COMMUNITY LEADER, THE HOSPITAL IS COMMITTED TO PROVIDE CARE IN AN INNOVATIVE AND DYNAMIC ENVIRONMENT. THE HOSPITAL HAS 123 PATIENT BEDS AND OVER 145 PHYSICIANS ON ITS MEDICAL STAFF IN NEARLY 22 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.IU HEALTH GOSHEN HOSPITAL HAS CONSISTENTLY MET NATIONAL QUALITY STANDARDS. THE HOSPITAL COMPOSITE SCORES FOR PUBLICLY REPORTED QUALITY MEASURES IN THE AREAS OF ACUTE MYOCARDIAL INFARCTION, PNEUMONIA, HEART FAILURE, SURGICAL CARE IMPROVEMENT PROJECT, AND HOSPITAL OUTPATIENT EXCEED 95% IN 2010. IN ADDITION, HEALTHCARE EXCEL (QUALITY IMPROVEMENT ORGANIZATION FOR INDIANA) REPORTED THAT THE HOSPITAL WAS ABOVE OUR PEER GROUP AND OVERALL STATE PERFORMANCE IN ALL AREAS OF OUR PUBLICLY REPORTED MEASURES FOR THE 4 QUARTERS ENDING MARCH 31, 2011.THE AMERICAN NURSES CREDENTIALING CENTER'S (ANCC) MAGNET RECOGNITION PROGRAM FOR EXCELLENCE IN NURSING SERVICES HAS DESIGNATED IU HEALTH GOSHEN HOSPITAL AS A MAGNET HOSPITAL. 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. IU HEALTH GOSHEN HOSPITAL IS AMONG AN ELITE GROUP OF ONLY 2% OF HOSPITALS IN THE NATION TO BE RE-DESIGNATED AS A MAGNET FACILITY AND THE ONLY FACILITY IN THE REGION.THE GOSHEN CENTER FOR CANCER CARE IS ACCREDITED BY THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS (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 SPECIALLY TRAINED SURGICAL ONCOLOGISTS, A BREAST SURGEON, MEDICAL ONCOLOGIST, A RADIATION ONCOLOGIST, NATUROPATHIC PRACTITIONERS AND HIGHLY DISTINGUISHED MAGNET DESIGNATED NURSES.IU HEALTH 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 AND 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 FIREFIGHTERS. 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. CLASSES REVIEW MANY ASPECTS OF CHILDBIRTH INCLUDING LABOR REHEARSAL, CESAREAN DELIVERIES, SINGLE-TEEN ISSUES, BREAST FEEDING AND A CLASS JUST FOR SIBLINGS. IN ADDITION TO VARIOUS COMMUNITY WELLNESS AND EDUCATION PROGRAMS, IU HEALTH GOSHEN HOSPITAL PROVIDES A FULL-SERVICE RESOURCE FOR COMPREHENSIVE HEALTH INFORMATION AND ASSISTANCE. NURSE ON CALL (NOC) IS FULL-SERVICE, MULTI-LINGUAL HEALTH INFORMATION, REFERRAL AND NURSE TRIAGE TELEPHONE SERVICE AVAILABLE 24 HOURS A DAY, 7 DAYS WEEK. NOC IS STAFFED BY SPECIALLY TRAINED, KNOWLEDGEABLE AND EXPERIENCED REGISTERED NURSES. THIS FREE SERVICE PROVIDES MEDICAL GUIDANCE WHEN SICK OR INJURED, INFORMATION ON PHYSICIANS IN THE AREA, REFERRALS TO COMMUNITY RESOURCES AND REGISTRATION FOR CLASSES AND EVENTS. ANNUALLY, IU HEALTH GOSHEN HOSPITAL MAKES CONTRIBUTIONS TO WELL-DESERVING ORGANIZATIONS FROM GOSHEN AND THE SURROUNDING COMMUNITIES. THE HOSPITAL SUPPORTS AREA NON-PROFIT AGENCIES THAT SHARES ITS MISSION, VISION AND VALUES THROUGH THE COMMUNITY BENEFIT FUND. THE PROGRAM IS AN EFFORT TO FURTHER THE IMPACT THESE ORGANIZATIONS CAN MAKE AND INCREASE THE NUMBER OF BENEFICIAL PROGRAMS AVAILABLE TO THE COMMUNITY. IN 2010, THE HOSPITAL PROVIDED OVER $203,000 TO 49 ORGANIZATIONS. SINCE ITS INCEPTION IN 1998, THE COMMUNITY BENEFIT FUND HAS GIVEN OVER $1.4 MILLION IN GRANT MONEY. IU HEALTH 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. IN 2010, THE HOSPITAL EXTENDED CHARITY CARE TO OVER 1,286 PATIENTS TOTALING $5.9 MILLION. IU HEALTH GOSHEN HOSPITAL ALSO PARTNERS WITH A LOCAL FINANCIAL INSTITUTION TO PROVIDE A FLEXIBLE AND AFFORDABLE FINANCING SOLUTION FOR A PATIENT'S MEDICAL CARE. | Description |
| Total Program Service Expense | 147686776 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| 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 | 1 | 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 | 0 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| 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 | 1 | 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 | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 103 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1357 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| 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 |
| States Where Copy Of Return Is Filed | IN | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DIRECTOR OF FINANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5745352665 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 46526 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| JAMES DAGUE | |||||||
| PRESIDENT & CEO | 40.00 | X | X | 688361 | 0 | 4928 | |
| LINDA BAXLEY | |||||||
| SECRETARY/TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| JESSE BERGER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RAO BETINA MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DERALD BONTRAGER | |||||||
| VICE CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| EDWARD BOYTS MD | |||||||
| DIRECTOR | 1.00 | X | 0 | 227209 | 7393 | ||
| DANIEL BRUETMAN MD | |||||||
| MEDICAL STAFF PRESIDENT | 1.00 | X | 0 | 509412 | 9819 | ||
| RANDY CRIPE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KEVIN DEARY | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| CHRISTOPHER GRAFF | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DAVID KORONKIEWICZ DO | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DON OGLE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JACKIE PARK | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KAREN PLETCHER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| MARTHA SUZIE YEAGER | |||||||
| CHAIRMAN | 1.00 | X | 0 | 0 | 0 | ||
| AMY FLORIA | |||||||
| CFO | 40.00 | X | 297250 | 0 | 5058 | ||
| RANDY CHRISTOPHEL | |||||||
| EVP & COO | 40.00 | X | 427249 | 0 | 6551 | ||
| ALAN WELDY | |||||||
| V/P LEGAL | 40.00 | X | 355387 | 0 | 3311 | ||
| POOPALASINGHAM POOVENDRAN | |||||||
| PHYSICIAN | 40.00 | 557214 | 0 | 9706 | X | ||
| RANDALL CAMMENGA | |||||||
| PHYSICIAN | 40.00 | 364255 | 0 | 7662 | X | ||
| JOSEPH GAGLIARDI | |||||||
| SENIOR VICE PRESIDENT | 40.00 | 346564 | 0 | 2471 | X | ||
| MIN YAN | |||||||
| PHYSICIAN | 40.00 | 332728 | 0 | 2538 | X | ||
| MARIA GARCIA | |||||||
| PHYSICIAN | 40.00 | 297548 | 0 | 1040 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3666556 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 736621 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 60477 | TotalOtherCompensation |
| Number Individuals GT100 K | 32 | 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 |
|---|---|---|---|---|---|
| GERIG SURGICAL | |||||
| 303 SOUTH MAIN STREET | MISHAWAKA | IN | 46544 | ON CALL SERVICES | 1097782 |
| VARIAN MEDICAL SYSTEMS | |||||
| 70140 NETWORK PLACE | CHICAGO | IL | 406731701 | MAINTENANCE CONTRACTS | 513612 |
| GLOBAL PHYSICS SOLUTIONS | |||||
| PO BOX 809153 | CHICAGO | IL | 606809153 | PHYSICS SERVICES | 428403 |
| MICHIANA LINEN SERVICES | |||||
| 600 EAST BOULEVARD | ELKHART | IN | 46514 | LAUNDRY SERVICES | 313670 |
| ELKHART GENERAL HOSPITAL | |||||
| PO BOX 1329 | ELKHART | IN | 46515 | LAUNDRY SERVICES | 220162 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| Government Grants | 16700 | GovernmentGrants |
| All Other Contributions | 159227 | AllOtherContributions |
| Total Contributions | 175927 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT CARE | Description |
| Business Code | 621110 | BusinessCode |
| Total Revenue Column | 184695165 | TotalRevenueColumn |
| Related Or Exempt Function Income | 184695165 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 184695165 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1380192 | TotalRevenueColumn |
| Exclusion | $1,380,192 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 812454 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 812454 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 812454 | TotalRevenueColumn |
| Exclusion | $812,454 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| FOOD SERVICE REVENUE | 721000 | 949174 | $949,174 | |
| OTHER ONCOLOGY REV MIS | 621500 | 226037 | 226037 | |
| FINANCE CHARGES | 561000 | 194861 | 194861 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1863619 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1863619 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 3233691 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 190297429 | TotalRevenueColumn |
| Related Or Exempt Function Income | 186979682 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $3,141,820 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 203000 | Total |
| Program Services | 203000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1768247 | Total |
| Management And General | 1768247 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52198297 | Total |
| Program Services | 35078254 | ProgramServices |
| Management And General | 17120043 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2704850 | Total |
| Program Services | 1758153 | ProgramServices |
| Management And General | 946697 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9878396 | Total |
| Program Services | 6420957 | ProgramServices |
| Management And General | 3457439 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3650569 | Total |
| Program Services | 2372870 | ProgramServices |
| Management And General | 1277699 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51821 | Total |
| Management And General | 51821 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 191239 | Total |
| Management And General | 191239 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 53257 | Total |
| Program Services | 53257 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13767379 | Total |
| Program Services | 13767379 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3226835 | Total |
| Program Services | 3226835 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2723219 | Total |
| Program Services | 2723219 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 859355 | Total |
| Program Services | 859355 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1722374 | Total |
| Program Services | 1722374 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 683221 | Total |
| Program Services | 683221 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2216347 | Total |
| Management And General | 2216347 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7036926 | Total |
| Program Services | 7036926 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10022573 | Total |
| Program Services | 10022573 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1304457 | Total |
| Program Services | 1304457 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| DRUGS AND MEDICAL SUPPL | 35708600 | 35708600 | 0 | 0 |
| BAD DEBT | 17552818 | 17552818 | 0 | 0 |
| REPAIRS & MAINTENANCE | 4384235 | 4384235 | 0 | 0 |
| DUES & SUBSCRIPTIONS | 299035 | 299035 | 0 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2509258 | Total |
| Program Services | 2509258 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 174716308 | Total |
| Program Services | 147686776 | ProgramServices |
| Management And General | 27029532 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7372491 | BOY |
| EOY | 6293820 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9844800 | BOY |
| EOY | 16068380 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24506410 | BOY |
| EOY | 25361491 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -86357 | BOY |
| EOY | 523731 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4040433 | BOY |
| EOY | 5275839 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1677762 | BOY |
| EOY | 2730703 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 182113219 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 88094427 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93533230 | BOY |
| EOY | 94018792 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 35198195 | BOY |
| EOY | 45879836 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 213366 | BOY |
| EOY | 110922 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 558046 | BOY |
| EOY | 719707 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 176858376 | BOY |
| EOY | 196983221 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15206079 | BOY |
| EOY | 18463427 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47734007 | BOY |
| EOY | 46386972 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1610605 | BOY |
| EOY | 1973010 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 64550691 | BOY |
| EOY | 66823409 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 111965931 | BOY |
| EOY | 129697959 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 341754 | BOY |
| EOY | 461853 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 112307685 | BOY |
| EOY | 130159812 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 176858376 | BOY |
| EOY | 196983221 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 15581121 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 2271006 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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 B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6872683 | OtherCostOrOtherBasis |
| Book Value | 6872683 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 84393259 | OtherCostOrOtherBasis |
| Depreciation | 24741253 | Depreciation |
| Book Value | 59652006 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 490753 | OtherCostOrOtherBasis |
| Depreciation | 134617 | Depreciation |
| Book Value | 356136 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 86858833 | OtherCostOrOtherBasis |
| Depreciation | 63218557 | Depreciation |
| Book Value | 23640276 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3497691 | OtherCostOrOtherBasis |
| Book Value | 3497691 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 94018792 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| BOARD DESIGNATED FUNDS | 44703865 | F |
| CANCER CENTER INVESTMENT | 1175971 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 45879836 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ASSET RETIREMENT OBLIGATION | $225,857 |
| DEFERRED COMPENSATION | $664,217 |
| DEFERRED MEDICAL MALPRACTICE | $270,482 |
| INTEREST RATE SWAP | $812,454 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1973010 | TotalOfAmounts |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| 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 | 2421842 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2421842 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01390 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14774478 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 14774478 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08460 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 17196320 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 17196320 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09850 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 448638 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 448638 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 105951 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 105951 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 223264 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 223264 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00130 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 246035 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 246035 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1023888 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1023888 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00590 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18220208 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 18220208 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10440 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 8525 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 8525 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 11811 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 11811 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 57411 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 57411 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 15460 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 15460 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 362 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 362 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Other Other
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3993 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3993 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 97562 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 97562 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $7,214,208 | BadDebtExpenseAmount |
| Amount Attributable To | 605587 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 32166519 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 38907271 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -6740752 | 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 | 5 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (5 entries)
| Facility NumberFacilityNumber | Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Licensed HospitalLicensedHospital | General Medical And SurgicalGeneralMedicalAndSurgical | Er24 HoursEr24Hours |
|---|---|---|---|---|---|---|---|
| IU HEALTH GOSHEN HOSPITAL | |||||||
| 1 | 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | X | X | X |
| IU HEALTH GOSHEN | |||||||
| 2 | 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | X | ||
| NEW PARIS MEDICAL CLINIC | |||||||
| 3 | 2018 SOUTH MAIN STREET | GOSHEN | IN | 46526 | X | ||
| INDIANA LAKES MANAGED CARE | |||||||
| 4 | 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | X | ||
| THE RETREAT WOMEN'S HEALTH CENTER | |||||||
| 5 | 1135 PROFESSIONAL DRIVE | GOSHEN | IN | 46526 | X | ||
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: A COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES, WAS USED TO DETERMINE COSTS FOR LINES A THROUGH C REPORTED IN THE TABLE. | ||
| PART III, LINE 4: A DETAILED COLLECTION POLICY IS FOLLOWED. BAD DEBT COSTS ARE BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED COLLECTIONS TAKING INTO CONSIDERATION BUSINESS AND ECONOMIC CONDITIONS. THESE ALLOWANCES ARE PERIODICALLY REVIEWED FOR ACCURACY AND IF ANY FURTHER ACTIONS ARE REQUIRED. THE FOLLOWING NARRATIVE ADDRESSES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WHICH IS INCLUDED IN THE FOOTNOTES IN THE FINANCIAL STATEMENTS FOR IU HEALTH: THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTIONINDICATORS. PERIODICALLY, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON ESTIMATED COLLECTIONS BY PAYOR CATEGORY AND AGING. THE RESULTS OF THESE ESTIMATES ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN ADDITION, THE SYSTEM HAS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. | ||
| PART III, LINE 8: ACTUAL MONTH TO DATE AND YEAR TO DATE REVENUES, CONTRACTUALS, REVENUE AND ACCOUNTS RECEIVABLE RELATED RATIOS, AND REVENUE RELATED STATISTICS (DAYS, DISCHARGES, ETC.) ARE COMPARED TO BUDGET AND PRIOR YEAR AMOUNTS ON A MONTHLY BASIS BY CFO OF IU HEALTH GOSHEN HOSPITAL DEPARTMENT HEADS AND FINANCIAL REPRESENTATIVES. ADDITIONALLY, ACTUAL CONTRACTUAL ALLOWANCE AS A PERCENTAGE OF GROSS ACCOUNTS RECEIVABLE AND CONTRACTUAL PROVISION AS A PERCENTAGE OF GROSS PATIENT CHARGES COMPARED TO BUDGETED AND PRIOR YEAR AMOUNTS ARE MONITORED. 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 A MINIMUM OF THREE TIMES THROUGHOUT THE YEAR 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 CHIEF FINANCIAL OFFICER 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 CHARITY CARE OF FINANCIAL ASSISTANCE, PAYMENT PLANS AND LUMP SUM SETTLEMENTS ARE AVAILABLE. IU HEALTH 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, IU HEALTH GOSHEN HOSPITAL IS DEDICATED TO MEETING THE SPECIFIC HEALTH CARE NEEDS OF OUR COMMUNITY. THE HOSPITAL HAS 123 PATIENT BEDS AND OVER 145 PHYSICIANS ON ITS MEDICAL STAFF IN NEARLY 22 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 SPECIALLY TRAINED SURGICAL ONCOLOGISTS, A BREAST SURGEON, MEDICAL ONCOLOGISTS, A RADIATION ONCOLOGIST, NATUROPATHIC PRACTITIONERS AND HIGHLY DISTINGUISHED MAGNET DESIGNATED NURSES.IU HEALTH 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 AND 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 FIREFIGHTERS. 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. CLASSES REVIEW MANY ASPECTS OF CHILDBIRTH INCLUDING LABOR REHEARSAL, CESAREAN DELIVERIES, SINGLE-TEEN ISSUES, BREAST FEEDING AND A CLASS JUST FOR SIBLINGS. IN ADDITION TO VARIOUS COMMUNITY WELLNESS AND EDUCATION PROGRAMS, IU HEALTH GOSHEN HOSPITAL PROVIDES A FULL-SERVICE RESOURCE FOR COMPREHENSIVE HEALTH INFORMATION AND ASSISTANCE. NURSE ON CALL (NOC) IS FULL-SERVICE, MULTI-LINGUAL HEALTH INFORMATION, REFERRAL AND NURSE TRIAGE TELEPHONE SERVICE AVAILABLE 24 HOURS A DAY, 7 DAYS WEEK. NOC IS STAFFED BY SPECIALLY TRAINED, KNOWLEDGEABLE AND EXPERIENCED REGISTERED NURSES. THIS FREE SERVICE PROVIDES MEDICAL GUIDANCE WHEN SICK OR INJURED, INFORMATION ON PHYSICIANS IN THE AREA, REFERRALS TO COMMUNITY RESOURCES AND REGISTRATION FOR CLASSES AND EVENTS. | ||
| PART VI, LINE 3: UNINSURED PATIENTS ARE SCREENED DURING THE PRE-REGISTRATION PROCESS FOR ELIGIBILITY IN THE HEALTHY INDIANA PLAN AND FOR 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 FROM THE WEBSITE. THIS INFORMATION IS AVAILABLE IN ENGLISH AND SPANISH. | ||
| PART VI, LINE 4: GOSHEN HOSPITAL ASSOCIATION, INC. SERVES THE NORTHERN INDIANA AREA IN ELKHART COUNTY. ACCORDING TO THE 2010 CENSUS, THE POPULATION OF ELKHART COUNTY IS 197,559. THE MEDIAN INCOME FOR A HOUSEHOLD IN ELKHART COUNTY BASED ON THE 2010 CENSUS IS $43,531 AND THE MEDIAN INCOME FOR A FAMILY IS $54,549. APPROXIMATELY 9.6% OF FAMILIES AND 12.95% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 21.8% OF THOSE UNDER THE AGE 18 AND 6.5% OF THOSE AGE 65 AND OVER. THE RACIAL MAKEUP OF THE COUNTY WAS ABOUT 82.9% WHITE, 5.7% AFRICAN AMERICAN, AND 11.4% OTHER RACES. 14.1% OF THE POPULATION IS HISPANIC OR LATINO OR ANY RACE. | ||
| PART VI, LINE 6: ALL OF THE HOSPITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. 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 7: HOSPITAL MANAGEMENT PROVIDES IU HEALTH WITH THE HOSPITAL'S ANNUAL OPERATING BUDGET AND KEY STRATEGIC OBJECTIVES. IN ADDITION, THE HOSPITAL MANAGEMENT PROVIDES IU HEALTH WITH VARIOUS KEY METRICS INVOLVING PATIENT SATISFACTION, PATIENT QUALITY AND COLLEAGUE SATISFACTION. IU HEALTH 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 IU HEALTH TO PROVIDE NECESSARY NURSING EDUCATION AND PHYSICIAN RECRUITMENT TO ASSIST IN MEETING THE HEALTH NEEDS OF THE COMMUNITY. | ||
| IN | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (13 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| BASHOR CHILDREN'S HOME | |||||||
| PO BOX 843 | GOSHEN | IN | 46257 | 350933555 | 501(C)(3) | 10000 | MEDICAL/DENTAL BENEFITS |
| BOYS AND GIRLS CLUB OF GREATER GOSHEN INC | |||||||
| PO BOX 614 | GOSHEN | IN | 46257 | 351033735 | 501(C)(3) | 10000 | GIRLS IN FOCUS INITIATIVE |
| CAPS - CHILD AND PARENT SERVICES | |||||||
| 1000 WEST HIVELY AVENUE | ELKHART | IN | 46517 | 350888765 | 501(C)(3) | 5000 | HEALTHY FAMILIES PROGRAM |
| ELKHART COUNTY AMERICAN RED CROSS | |||||||
| 721 RIVERVIEW AVENUE | ELKHART | IN | 46516 | 350909968 | 501(C)(3) | 10000 | BASIC AID TRAINING COURSE EXPENSES |
| FAMILY CHRISTIAN DEVELOPMENT CENTER | |||||||
| PO BOX 227 | NAPPANEE | IN | 46550 | 351979463 | 501(C)(3) | 5000 | MEDICINE ASSISTANCE PROGRAM |
| FAMILY SERVICES OF ELKHART COUNTY INC IFIT | |||||||
| 101 E HIVELY AVENUE | ELKHART | IN | 46517 | 350868079 | 501(C)(3) | 5000 | ELKHART COUNTY WOMEN'S SHELTER COUNSELING SERVICES |
| GOSHEN COLLEGE DEPARTMENT OF NURSING | |||||||
| 1700 SOUTH MAIN STREET | GOSHEN | IN | 46526 | 352158366 | 501(C)(3) | 10000 | NURSING SCHOLARSHIPS |
| HISPANICLATINO HEALTH COALITION OF ELKHART CO | |||||||
| 323 STOCKER COURT | ELKHART | IN | 46516 | 320039221 | 501(C)(3) | 10000 | ANNUAL HEALTH FAIR |
| INDIANA UNIVERSITY SCHOOL OF MEDICINE - SOUTH BEND | |||||||
| 1234 N NOTRE DAME AVENUE | SOUTH BEND | IN | 46617 | 356018940 | 501(C)(3) | 10000 | CLINICAL TRAINING AND MEDICAL EDUCATION PROGRAMS |
| LACASA INC | |||||||
| 202 N COTTAGE AVENUE | GOSHEN | IN | 46528 | 351554538 | 501(C)(3) | 5000 | HOME OWNERSHIP CENTER |
| MAPLE CITY HEALTH CARE CENTER | |||||||
| 213 MIDDLEBURY | GOSHEN | IN | 46528 | 351749398 | 501(C)(3) | 20000 | HEALTH CARE COST ASSISTANCE |
| THE PARENT SOURCE | |||||||
| 2600 OAKLAND AVENUE | ELKHART | IN | 46517 | 351070041 | 501(C)(3) | 10000 | INCREASING ACCESS PROGRAM |
| UNITED CANCER SERVICES OF ELKHART COUNTY INC | |||||||
| 23971 US HWY 33 | ELKHART | IN | 46517 | 351091429 | 501(C)(3) | 10000 | JOURNEY THROUGH TREATMENT PROGRAM |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 13 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | OTHER INFORMATION: | Identifier |
| Return Reference | PART IV: | ReturnReference |
| Explanation | THE ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. CONSISTS OF REQUIRING THE COMPLETIONG OF A FOLLOW-UP REPORT FORM WITH THE SUBSEQUENT GRANT FUND APPLICATIONS. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Payments | X | IdemnificationGrossUpPayments |
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | 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 | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (11 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 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES DAGUE | |||||||||||||
| 465821 | 0 | 187598 | 0 | 34942 | 0 | 0 | 0 | 4928 | 0 | 693289 | 0 | 0 | 0 |
| EDWARD BOYTS MD | |||||||||||||
| 0 | 141472 | 0 | 85737 | 0 | 0 | 0 | 0 | 0 | 7393 | 0 | 234602 | 0 | 0 |
| DANIEL BRUETMAN MD | |||||||||||||
| 0 | 384294 | 0 | 81542 | 0 | 43576 | 0 | 0 | 0 | 9819 | 0 | 519231 | 0 | 0 |
| AMY FLORIA | |||||||||||||
| 194909 | 0 | 64270 | 0 | 38071 | 0 | 0 | 0 | 5058 | 0 | 302308 | 0 | 0 | 0 |
| RANDY CHRISTOPHEL | |||||||||||||
| 288142 | 0 | 98360 | 0 | 40747 | 0 | 0 | 0 | 6551 | 0 | 433800 | 0 | 0 | 0 |
| ALAN WELDY | |||||||||||||
| 245582 | 0 | 73991 | 0 | 35814 | 0 | 0 | 0 | 3311 | 0 | 358698 | 0 | 0 | 0 |
| POOPALASINGHAM POOVENDRAN | |||||||||||||
| 464080 | 0 | 34692 | 0 | 58442 | 0 | 0 | 0 | 9706 | 0 | 566920 | 0 | 0 | 0 |
| RANDALL CAMMENGA | |||||||||||||
| 257813 | 0 | 83077 | 0 | 23365 | 0 | 0 | 0 | 7662 | 0 | 371917 | 0 | 0 | 0 |
| JOSEPH GAGLIARDI | |||||||||||||
| 252525 | 0 | 75962 | 0 | 18077 | 0 | 0 | 0 | 2471 | 0 | 349035 | 0 | 0 | 0 |
| MIN YAN | |||||||||||||
| 297205 | 0 | 0 | 0 | 35523 | 0 | 0 | 0 | 2538 | 0 | 335266 | 0 | 0 | 0 |
| MARIA GARCIA | |||||||||||||
| 261674 | 0 | 0 | 0 | 35874 | 0 | 0 | 0 | 1040 | 0 | 298588 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 1A | TAX INDEMNIFICATION AND GROSS-UP PAYMENTS GOSHEN HOSPITAL ASSOCIATION, INC. GROSSED UP THE TAXABLE VALUE OF AUTOMOBILES FOR 4 OF THE OFFICERS LISTED IN FORM 990, PART VII AND INCLUDED THE AMOUNT IN THE EMPLOYEES' W-2 AS ADDITIONAL COMPENSATION. HEALTH OR SOCIAL CLUB DUES GOSHEN HOSPITAL ASSOCIATION, INC. PAID FOR COUNTRY CLUB DUES FOR 5 OF THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES LISTED IN FORM 990, PART VII. ALL REIMBURSEMENTS ARE CONSIDERED TAXABLE INCOME TO THE EMPLOYEES. |
| PART I, LINE 4B | THE FOLLOWING INDIVIDUALS RECEIVED CONTRIBUTIONS TO A NON-QUALIFIED DEFERRED COMPENSATION PLAN: RANDY CHRISTOPHEL - 25,188 JAMES DAGUE - 87,639 AMY FLORIA - 17,331 ALAN WELDY - 20,867 RANDALL CAMMENGA - 22,315 JOSEPH GAGLIARDI - 20,942 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRESS GANEY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SEE PART V | Relationship |
| Amount Of Transaction | 181252 | AmountOfTransaction |
| Description Of Transaction | SEE PART V | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: | Identifier |
| Explanation | (A) NAME OF PERSON: PRESS GANEY(B) RELATIONSHIP BETWEEN INTERESTED PERSON AND ORGANIZATION:LINDA BAXLEY IS A DIRECTOR OF GOSHEN HOSPITAL AND EMPLOYEE OF PRESS GANEY(C) AMOUNT OF TRANSACTION: $ 181,252(D) DESCRIPTION OF TRANSACTION: CONDUCTING PATIENT SATISFACTION SURVEY(E) SHARING OF ORGANIZATION REVENUES? = NO | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF GOSHEN HEALTH SYSTEM OR ITS RELATED ORGANIZATIONS, AND SERVE ON OTHER RELATED GOSHEN HEALTH SYSTEM BOARDS: JAMES DAGUE EDWARD BOYTS DANEL BRUETMAN KEVIN DEARY AMY FLORIA RANDY CHRISTOPHEL ALAN WELDY | |
| FORM 990, PART VI, SECTION A, LINE 6 | GOSHEN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF GOSHEN HOSPITAL ASSOCIATION, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7A | GOSHEN HEALTH SYSTEM, INC., AS THE SOLE MEMBER OF GOSHEN HOSPITAL ASSOCIATION, INC. HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE HOSPITAL. | |
| FORM 990, PART VI, SECTION A, LINE 7B | ITEMS THAT REQUIRE APPROVAL OF GOSHEN HEALTH SYSTEM, INC. 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 | THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS IN OCTOBER FOR REVIEW AND QUESTIONS BEFORE THE RETURN IS FILED WITH THE IRS. | |
| 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 12C | |
| 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 B, LINE 15 | |
| GOSHEN HOSPITAL ASSOCIATION, INC. WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. | FORM 990, PART VI, SECTION C, LINE 19 | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 3,383,860. EQUITY TRANSFERS -1,084,541. INTEREST RATE SWAP -148,410. RELEASE OF UNSPENT GRANT FUNDS 120,099. ROUNDING -2. TOTAL TO FORM 990, PART XI, LINE 5: 2,271,006. | FORM 990, PART XI, LINE 5: |
| THE FINANCIAL STATEMENTS OF GOSHEN HOSPITAL ASSOCIATION, INC. WERE AUDITED ON A CONSOLIDATED BASIS. THE AUDIT COMMITTEE HAS BEEN DELEGATED AUTHORITY TO OVERSEE THE AUDIT OF THE FINANCIAL STATEMENTS. | FORM 990, PART XII, LINE 2A-2D: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Total IncomeTotalIncome | EOY AssetsEOYAssets | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| NAPPANEE CLINIC LLC | |||||||||
| 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | 201068334 | HEALTH CARE | IN | 0 | 0 | GOSHEN HEALTH SYSTEM INC |
| NEW PARIS CLINIC LLC | |||||||||
| 2018 SOUTH MAIN STREET | GOSHEN | IN | 46526 | 352075244 | HEALTH CARE | IN | 22738 | 367921 | GOSHEN HEALTH SYSTEM INC |
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOSHEN HEALTH SYSTEM INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 46526 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351974765 | EIN |
| Primary Activities | HEALTH CARE | PrimaryActivities |
| Legal Domicile State | IN | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 0 | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | INDIANA LAKES MANAGED CARE ORGANIZATION LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1 |
| City | GOSHEN | City |
| State | IN | State |
| ZIP Code | 46526 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351946663 | EIN |
| Primary Activity | HEALTH CARE | PrimaryActivity |
| Legal Domicile State | IN | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOSHEN HEALTH SYSTEM INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -8527 | ShareOfTotalIncome |
| Share Of EOY Assets | 292708 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 0 | GeneralOrManagingPartner |
| Percentage Ownership | 0.57400 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PARKMOR DRUG INC | |||||||||||
| 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | 351394980 | HEALTH CARE | IN | GOSHEN HEALTH SYSTEM INC | C | 381192 | 2667009 | 1.00000 |
| PARKPLAZA DRUG INC | |||||||||||
| 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | 351837804 | HEALTH CARE | IN | GOSHEN HEALTH SYSTEM INC | C | 1.00000 | ||
| CONTINUING CARE PHARMACY INC | |||||||||||
| 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | 351980157 | HEALTH CARE | IN | GOSHEN HEALTH SYSTEM INC | C | 1.00000 | ||
| RADIATION ONCOLOGY RESOURCES INC | |||||||||||
| 200 HIGH PARK AVENUE | GOSHEN | IN | 46526 | 262008424 | HEALTH CARE | IN | GOSHEN HEALTH SYSTEM INC | C | -253362 | 616271 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | 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 | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | 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 | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| GOSHEN HEALTH SYSTEM INC | ||
| Q | 7036926 | FMV |
| GOSHEN HEALTH SYSTEM INC | ||
| N | 9749969 | FMV |
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