2023-11-07T16:51:12-06:00 2022-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2022-01-01 356001540 Goshen Hospital Association Inc GOSH 5743642665 200 High Park Avenue Goshen IN 46526 Lisa M Wine CFO 5743642665 2023-11-02 1 Lisa Wine 356001540 1 Rebekuh Eley P01247672 3126343400 2023-11-02 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Goshen Hospital Randal Christophel 200 High Park Avenue Goshen IN 46526 314357052 0 X https://goshenhealth.com X 1946 IN To improve the health of our communities by providing innovative, outstanding care and services. 12 8 1894 184 70125 0 2237312 167919 252833700 249619281 14983069 46233307 8291131 8768584 278345212 304789091 23203799 28527836 0 0 108103120 116806956 0 0 0 142359150 165337524 273666069 310672316 4679143 -5883225 566570613 467057367 141588273 139652427 424982340 327404940 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 291735248 28527836 256476253 See Schedule O 291735248 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 1 125 0 1 1894 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 8 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 946559 0 158933 Bolanle Adepoju MD Director and Physician (as of 5/22) 41.00 0.00 X 0 565351 37262 Jody Neer MD Director 1.00 40.00 X 0 474884 37045 Andrew Vorhis NP Director 1.00 40.00 X 0 165934 27058 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 (until 5/22) 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 Lisa Wine as of 12022 Chief Financial Officer 40.00 2.00 X 362426 0 71137 Rob Myers Chief Operating Officer 40.00 1.00 X 590354 0 81155 Chris Hutfless Chief Legal HR & Compliance Officer 40.00 1.00 X 471298 0 63805 Daniel Nafziger MD Chief Medical Officer 40.00 0.00 X 539399 0 76107 Margaret S Franger VP of Population Health & Bus Devlp. 40.00 0.00 X 488307 0 65038 Mark Podgorski VP of Hospital Operations 40.00 0.00 X 412983 0 65462 Julie Crossley Chief Nursing Officer 40.00 0.00 X 352674 0 54666 Ebenezer Kio MD Physician 40.00 0.00 X 0 721021 34929 Houman Vaghefi MD Physician 40.00 0.00 X 0 729167 36096 Irina Sparks MD Physician 40.00 0.00 X 0 553505 40802 Urs Von Holzen MD Physician 40.00 0.00 X 0 667036 42237 Leonard Henry Physician 40.00 0.00 X 0 470563 29071 Ben Bontrager Former CFO 0.00 0.00 X 103245 0 0 4267245 4347461 920803 172 1 1 0 Hagerman Inc 510 W Washington Blvd Ft Wayne IN 46802 Construction 7252991 Fastaff LLC 5700 S Quebec St Suite 300 Greenwood Village CO 80111 Contracted Staffing 4968999 Quest Diagnostics PO Box 775460 Chicago IL 60677 Medical Services 4214202 AYA Healthcare Inc 5930 Cornerstone Crt W Suite 300 San Diago CA 92121 Contracted Staffing 3267063 Triage LLC PO Box 773328 Chicago IL 60677 Contracted Staffing 2539612 65 167919 167919 Patient Care 622110 249619281 249619281 249619281 5583609 70125 5513484 1681425 0 1681425 1681425 1681425 50165073 52586 9567961 0 40597112 52586 40649698 40649698 Food Service Revenue 722514 219615 219615 Other Oncology Rev Misc 621500 45583 45583 Finance Charges 900099 10572 10572 6811389 6811389 7087159 304789091 256476253 70125 48074794 X 28527836 28527836 4164000 1254499 2909501 86938067 80385297 6552770 3824524 3427292 397232 15700300 14069596 1630704 6180065 5538176 641889 3541845 3541845 174466 174466 265789 265789 546116 546116 40912264 40912264 2851658 2851658 3884195 3884195 520801 520801 2868171 2868171 649899 649899 2276756 2276756 14109481 14109481 2755005 2755005 Drugs & Medical Supplie 58756112 58756112 Repairs & Maintenance 13473882 13473882 Hospital Assessment 12856037 12856037 Bad Debt Expense 1284239 1284239 3610808 3610808 310672316 291735248 18937068 0 11776343 322427 13851162 4800267 34014022 28286396 7766020 7926721 15755023 16453751 350762678 160740492 182313211 190022186 292930927 210304410 8163905 8941209 566570613 467057367 39813799 39629391 74186506 73806354 0 11528599 7849209 5835222 19738759 8852861 141588273 139652427 X 424982340 327404940 424982340 327404940 566570613 467057367 X -5883225 -90624365 -1069810 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 10430 10430 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. 4922978 5535262 10458240 174956062 55629351 119326711 158142 36948 128670 66420 145537758 104982471 40555287 19615528 19615528 190022186 Deferred Malpractice 219000 Claims Liability 1264516 Lease Liability 7069345 Due to Third-Party Payor 300000 8852861 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, 2022 and 2021, 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 2019 and prior. 1 1 X 1 X 1 X 1 1 1 0 1 1 3912 2786784 0 2786784 0.00900 10617 52695057 32711647 19983410 0.06430 14529 55481841 32711647 22770194 0.07330 17 27654 29745023 8965 29736058 0.09570 4 779 2557067 8289 2548778 0.00820 8 19 307833 0 307833 0.00100 29 28452 32609923 17254 32592669 0.10490 29 42981 88091764 32728901 55362863 0.17820 1 0 79888 0 79888 0.00030 1 79888 79888 0.00030 1 7211746 41356195 55417232 -14061037 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.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 took the following actions in 2022 with respect to the Community Health Needs Assessment conducted in 2021.Mental HealthStrategy #1: Integrate mental health service access in support of primary care physicians within Indiana Lakes. This work will relate directly to Oaklawn's access redesign, which intends to enhance outpatient services integration and support for all communities we serve. Based on the initial outcomes of this platform, Goshen Health will support expansion by Oaklawn with additional resources or implementation of alternative strategies.2022 Activity: Due to a delay in project financing on Oaklawn's behalf, this project is currently on hold. Goshen Health has dedicated resources to support the project when funding becomes available. The Patient Center Medical Home Committee of Indiana Lakes Accountable Care Organization coordinated with Oaklawn to communicate changes regarding the access center to community primary care physicians late in 2022 and continues to work collaboratively to support community mental health access. Strategy #2: Investigate mental health intervention support for inpatient care for pilot studies. Telehealth platforms will be reviewed, and one will be selected and implemented to track and evaluate progress regarding our inpatient mental health needs. 2022 Activity: While there is still a need, the demand for crisis inpatient mental health support has decreased significantly post-COVID. Goshen Health has implemented two strategies in this area. The first strategy is that we increased the availability of our social workers to better serve patients in the hospital and emergency department. The second strategy is that we provide monthly financial support to Oaklawn in exchange for enhanced social service support for our emergency department. Strategy #3: Goshen Health will align the focus of our community education and outreach efforts to specifically engage community members and organizations in mental health awareness, education, and prevention tactics in measurable ways. Our efforts to seamlessly engage community partners in successful outreach programs is well demonstrated in obesity/nutrition over the last three years. Our intent is to take that model forward into mental health programming with our school and community partners. 2022 Activity: In partnership with the Goshen Theater, Goshen Health hosted a Youth Mental Health Event which consisted of a showing of the movie "Inside Out". Community organizations provided information and activities on youth mental health and a station where youth could create their own mental health self-care kits. 526 individuals attended this event. As part of this effort, we also created and implemented a Brain Break Challenge geared for 2nd and 3rd grade students. 1,372 students representing six local schools participated.We attempted to pilot a community Mental Health Matters education series in partnership with North Webster Community Center. The pilot did not generate good participation, so we plan to pivot this fall and partner with local libraries.In Partnership with Oaklawn at St. John's Church, Goshen Health hosted a webinar and live watch party in Spanish on the impact of COVID on Mental Health. 75 individuals attended this event.Get Fit Get Healthy created a mental health training program (Mental Health First Aid) that was then launched to their program partners.Obesity/Weight management and Heath educationStrategy #1: Continue engagement with coalitions throughout our service areas that target obesity/nutrition. Directly support efforts that impact high risk populations, cultural minorities, and children by leveraging community assets and advancing impactful programming choices.2022 Activity: 852 total outreach efforts engaging with 36,607 individuals occurred in 2022. This was completed in collaboration with 144 community partners. Some of these events included Run the Halls, Summer Health Lunch Bunch, Emoji Puzzle Challenge, Cultivate Food Rescue, and Summer Camp Health Series. Strategy #2: Pursue grants for partnership expansion and deeper community reach. 2022 Activity: Grant proposals for several projects were written and submitted in 2022. In July and August of 2022, Goshen Health was awarded two grants:Indiana Department of Health Issues and Challenges grant was awarded to fund mobile container gardening units, weekend backpack meals, and activity signs at local parks. The process for finalizing the contract with the IDOH was delayed, so actual work on the grant activities did not start until December 2022. In December, we began the process of interviewing, hiring, and training a contract Coordinator to oversee these grant projects in 2023 and 2024.City of Goshen grant was awarded to fund summer weekend backpacks meals in the City of Goshen starting in the summer of 2023. Lack of Access to Health Care Strategy #1: Establish a pilot program to send community workers into the homes of community members following an acute care visit. This program is designed to send a community health worker directly into the home to assess social determinants of health (SDOH) and identify gaps that can be closed. Those gaps are then reported to a coordinating team member who connects the patient to services that are available in the community on their behalf. Interventions may include but not limited to transportation support, Medicaid enrollment support, homesite risk, and food insecurity. This pilot will initially target a defined subset of acute care visits and be limited to $50,000. We will work with a partner, Firefly Health, to provide community health workers for the pilot. Upon pilot completion and evaluation, we intend to seek grants to support this going forward.2022 Activity: Planning work on this project has started. We have identified community partners for the project and established baseline expectations for how the project will operate. We are currently awaiting funding.Strategy #2: Primary care providers are uniquely positioned to both identify and flag SDOH within their patient care panels. However, they need additional support when these needs are outside of routine medical care. Goshen Health will expand coordination services for patients with SDOH needs. This expansion plan will take a scaled approach and be implemented through the Indiana Lakes Accountable Care Organization. This intervention may be internally developed or integrated with community partners. 2022 Activity: Due to the launch of new software within multiple EMR systems, we are focusing on establishing and utilizing the SDOH tools embedded in software for reporting in 2024. Our social workers in the Ambulatory Care Coordination (ACC) department currently address SDOH on an ongoing basis with high risk, high need patients, but we anticipate that the new software tools will enable us to assist these patients further. We currently support 1.5 FTE social workers in the ACO that continues to carry a significant panel of patients where they address SDOH gaps. Our acute care hospital setting has also established an SDOH work group recently to set milestones for 2023 and 2024. 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 105 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 financialassistance 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 balancedue 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 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 on 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) 28123226 0 FMV Operating Support Goshen Health Foundation Inc 200 High Park Avenue Goshen IN 46526 462565300 501(c)(3) 386302 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 X 0 1 X X X X 0 1 0 0 0 0 0 1 0 Randal Christophel President and CEO 646632 0 274219 0 25708 0 127048 0 31885 0 1105492 0 0 0 Houman Vaghefi MD Physician 0 604689 0 117326 0 7152 0 5995 0 30101 0 765263 0 0 Ebenezer Kio MD Physician 0 647895 0 73126 0 0 0 9373 0 25556 0 755950 0 0 Urs Von Holzen MD Physician 0 453816 0 203220 0 10000 0 11520 0 30717 0 709273 0 0 Rob Myers Chief Operating Officer 426866 0 103724 0 59764 0 56440 0 24715 0 671509 0 0 0 Daniel Nafziger MD Chief Medical Officer 429983 0 103872 0 5544 0 53290 0 22817 0 615506 0 0 0 Bolanle Adepoju MD Director and Physician (as of 5/22) 0 466107 0 45206 0 54038 0 12200 0 25062 0 602613 0 0 Irina Sparks MD Physician 0 504337 0 49168 0 0 0 12200 0 28602 0 594307 0 0 Margaret S Franger VP of Population Health & Bus Devlp. 370570 0 91032 0 26705 0 46936 0 18102 0 553345 0 0 0 Chris Hutfless Chief Legal HR & Compliance Officer 374194 0 87506 0 9598 0 48661 0 15144 0 535103 0 0 0 Jody Neer MD Director 0 433828 0 16056 0 25000 0 11289 0 25756 0 511929 0 0 Leonard Henry Physician 0 372693 0 97870 0 0 0 9064 0 20007 0 499634 0 0 Mark Podgorski VP of Hospital Operations 275285 0 90930 0 46768 0 35910 0 29552 0 478445 0 0 0 Lisa Wine as of 12022 Chief Financial Officer 361271 0 0 0 1155 0 49773 0 21364 0 433563 0 0 0 Julie Crossley Chief Nursing Officer 267861 0 61583 0 23230 0 33201 0 21465 0 407340 0 0 0 Andrew Vorhis NP Director 0 165934 0 0 0 0 0 6869 0 20189 0 192992 0 0 Ben Bontrager Former CFO 21777 0 81468 0 0 0 0 0 0 0 103245 0 0 0 Part I, Line 1a Goshen Hospital reimbursed 4 directors and 2 officers reported on Form 990, Part VII for travel expenses of companions. For 1 of the officers listed on Form 990, Part VII, Goshen Hospital added the taxable value of an automobile as additional compensation to the employees' W-2. Part I, Line 1b Goshen Hospital does not have a specific written policy for the reimbursement of expense for companion travel, but does require all expenses to be substantiated in accordance with an accountable plan. These reimbursements of expenses were regarded as a bona fide business expense and were not treated as taxable to the individuals. Goshen Hospital does not have a specific written policy for the use of automobiles, but does add the taxable value of the automobile to 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 Lisa Wine Chris Hutfless Margaret S. Franger Mark Podgorski 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 21721732 3278517 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 2022 to run from 1/1/2023 through 12/31/2025. The current strategic priorities are as follows: 1. Growth of Key Service Lines 2. Timely and Efficient Access to Services 3. Recruitment and Retention of Colleagues and Providers 4. Clinical Quality 5. Partnerships with Insurers and Employers 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 105 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 2022, the hospital extended charity care to 3,912 accounts totaling $7.7 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 marked 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, and Lisa Wine. 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 21,452,765. Management and general expenses 0. Fundraising expenses 0. Total expenses 21,452,765. Temp Staffing: Program service expenses 16,694,096. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,694,096. Outside Purchased Anesthesia: Program service expenses 1,661,722. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,661,722. Goshen Marketing: CRM: Program service expenses 342,409. Management and general expenses 0. Fundraising expenses 0. Total expenses 342,409. Collection Services: Program service expenses 297,543. Management and general expenses 0. Fundraising expenses 0. Total expenses 297,543. Snow Removal: Program service expenses 218,806. Management and general expenses 0. Fundraising expenses 0. Total expenses 218,806. Trash Removal: Program service expenses 151,753. Management and general expenses 0. Fundraising expenses 0. Total expenses 151,753. Medical Professional Fees: Program service expenses 93,170. Management and general expenses 0. Fundraising expenses 0. Total expenses 93,170. Form 990, Part XI, line 9: Equity Transfer -1,069,810. 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