2022-10-27T07:04:54-05:00 2021-12-31 420714325 RSM US LLP 30 South Wacker Dr Suite 3300 Chicago IL 606063392 990 2021-01-01 351974765 Goshen Health System Inc GOSH 5745352665 200 High Park Avenue Goshen IN 46526 Lisa M Wine CFO 5745352665 2022-10-19 1 Lisa Wine XXX-XX-XXXX Rebekuh Eley P01247672 3126343400 2022-10-19 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Randal Christophel 200 High Park Avenue Goshen IN 46526 73798205 0 X https://goshenhealth.com X 1997 IN To improve the health of our communities by providing innovative, outstanding care and services. 17 15 630 15 28417 0 26285997 23349147 39740040 47552701 0 0 2819740 2896357 68845777 73798205 0 0 0 0 49971622 51048293 0 0 0 18223766 20956041 68195388 72004334 650389 1793871 13380075 14747546 17741688 18114070 -4361613 -3366524 X The mission of Goshen Health is to improve the health of our communities by providing innovative, outstanding care and services, through exceptional people doing exceptional work. 0 0 65086896 0 50144303 See Schedule O 65086896 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 61 0 1 630 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 17 15 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 0 0 1 1 IN X Lisa M Wine 5745352665 200 High Park Avenue Goshen IN 46526 Randal Christophel President and CEO 1.00 41.00 X X 0 959009 166347 Edward Boyts MD Secretary/Treasurer 40.00 0.00 X X 273162 0 45240 Leroy Weaver MD Chair 1.00 0.00 X X 0 0 0 John Leavitt Vice Chair 1.00 1.00 X X 0 0 0 Denise Davis Esq Director 1.00 0.00 X 0 0 0 James Alvarez Director 1.00 0.00 X 0 0 0 Marlene Betances Director 1.00 0.00 X 0 0 0 Dennis Blyly Director 1.00 0.00 X 0 0 0 Derald Bontrager Director 1.00 1.00 X 0 0 0 Stephen Fidler Director 1.00 0.00 X 0 0 0 Delmar G Good PhD Director 1.00 0.00 X 0 0 0 Wes Herschberger Director 1.00 1.00 X 0 0 0 Bruce Hughes MD Director 1.00 1.00 X 0 0 0 Mark King PhD Director 1.00 0.00 X 0 0 0 Alan R Tehan Director 1.00 0.00 X 0 0 0 Lane Reed MD Director 1.00 0.00 X 0 0 0 Amy Sink Director 1.00 1.00 X 0 0 0 Betsy Wenz Director until 04/21 1.00 0.00 X 0 0 0 Rob Myers Chief Operating Officer 1.00 40.00 X 0 543676 86115 Ben Bontrager Chief Financial Officer until 12/21 1.00 41.00 X 0 460615 29499 Chris Hutfless Chief Legal HR & Compliance Officer 1.00 40.00 X 0 397410 72365 Beau McNeff until 102021 VP of Goshen Physicians/Cancer Srvs 20.00 20.00 X 0 363082 35434 Christopher Owens MD Physician 40.00 0.00 X 853339 0 51397 Blair MacPhail MD Physician 40.00 0.00 X 833741 0 43600 Arjuna Cuddeback MD Physician 40.00 0.00 X 809943 0 33118 Michael Hartman MD Physician 40.00 0.00 X 814751 0 52033 Farid Jalinous MD Physician 40.00 0.00 X 809644 0 49009 Richard Tarske Former VP of Goshen Physicians 0.00 0.00 X 0 153850 0 4394580 2877642 664157 89 1 1 0 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Contracted Staffing 488734 Doiron Michael D dba M&J Cleaning PO Box 345 Goshen IN 46527 Cleaning Services 206925 2 22970147 379000 23349147 Healthcare Services 621110 44988710 44988710 OB/GYN 621300 2518031 2518031 EKG Revenues 621110 45960 45960 47552701 72174 0 72174 72174 72174 Billings 561000 276338 276338 2547845 2519428 28417 2824183 73798205 50144303 28417 276338 273162 273162 41392774 37676214 3716560 1947798 1740713 207085 5221102 4281128 939974 2213457 1973433 240024 267823 600 267223 1500 1500 3103959 2665586 438373 11460 7699 3761 1399378 1146689 252689 3283479 3196902 86577 304473 276544 27929 1109897 1009662 100235 575797 575797 Clinical Supplies 9047252 9039766 7486 Repairs & Maintenance 1234561 605039 629522 Bad Debt Expense 531955 531955 84507 84507 72004334 65086896 6917438 0 202984 304302 3391290 4278603 200111 231416 788688 795611 16655932 11783819 4646457 4872113 4150545 4265501 13380075 14747546 13077060 13846833 4664628 4267237 17741688 18114070 X -4361613 -3366524 -4361613 -3366524 13380075 14747546 X 1793871 -798782 X 0 1 X 1 1 1 X X 1 Goshen Hospital Association Inc 356001540 3 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 X 1 1 Part IV, Section D, Line 3: Goshen Health System, Inc. is organized to operate for the benefit of, to perform functions of, and to carry out the purposes of Goshen Hospital Association, Inc. (the "Hospital"). Goshen Health System, Inc. as the parent and supporting organization of an integrated health care delivery system, manages and directs the Hospital's delivery of health care services, provides long-range and strategic planning, and upholds financial controls. Goshen Health System, Inc.'s board of directors is composed of at least two board members from the Hospital board of directors. In addition, overlap exists of offices held by key colleagues of Goshen Health System, Inc. and the Hospital. This shared leadership ensures there is a close and continuous working relationship with a set of common strategic goals and objectives between the organizations. Part IV, Section E, Line 3a: Goshen Health System, Inc., has the power to elect a majority of the officers and directors of Goshen Hospital Association, Inc. Part IV, Section E, Line 3b: Goshen Health System, Inc. is organized to operate exclusively for the benefit of, to perform the functions of, and to carry out the purposes of Goshen Hospital Association, Inc. ("the Hospital"). Goshen Health System, Inc. as the parent and supporting organization of an integrated health care delivery system, manages and directs the Hospital's delivery of health care services, including providing long-range and strategic planning, financial control, and programs and policies that cause the Hospital to function as an integrated health care delivery system. Goshen Health System, Inc. is responsible for the approval of the Hospital budget, strategic planning, resource allocation, and community benefit activities. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 16050483 11783819 4266664 605449 605449 4872113 Receivable From Insurance Recovery 548096 Right-of-Use Assets 3717405 4265501 Insurance Claims Liability 548096 Lease Liability 3719141 4267237 X Part X, Line 2: The Internal Revenue Service has determined that Goshen Health and certain affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code. Certain subsidiaries of Goshen Health are taxable entities, the tax expense and liabilities of which are not material to the consolidated financial statements. Goshen Health and its tax-exempt affiliated entities each file a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the tax-exempt status of each entity, the continued tax-exempt status of bonds, the nature, characterization and taxability of joint venture income, and various positions relating to potential sources of unrelated business taxable income (reported on Form 990T). As of December 31, 2021 and 2020, there are no unrecognized tax benefits resulting from uncertain tax positions. Forms 990 and 990T filed by Goshen Health and its tax-exempt affiliated entities are subject to examination by the Internal Revenue Service up to three years from the extended due date of each return. Forms 990 and 990T filed by Goshen Health and its tax-exempt affiliated entities are no longer subject to examination for tax year 2018 and prior. X 0 1 0 1 0 0 0 0 0 0 0 Randal Christophel President and CEO 0 636738 0 301945 0 20326 0 134772 0 31575 0 1125356 0 0 Christopher Owens MD Physician 620529 0 232810 0 0 0 22899 0 28498 0 904736 0 0 0 Blair MacPhail MD Physician 762720 0 71021 0 0 0 23246 0 20354 0 877341 0 0 0 Michael Hartman MD Physician 785501 0 29250 0 0 0 23246 0 28787 0 866784 0 0 0 Farid Jalinous MD Physician 757261 0 52383 0 0 0 23246 0 25763 0 858653 0 0 0 Arjuna Cuddeback MD Physician 622066 0 187877 0 0 0 23246 0 9872 0 843061 0 0 0 Rob Myers Chief Operating Officer 0 415456 0 118158 0 10062 0 66196 0 19919 0 629791 0 0 Ben Bontrager Chief Financial Officer until 12/21 0 360963 0 98812 0 840 0 11600 0 17899 0 490114 0 0 Chris Hutfless Chief Legal HR & Compliance Officer 0 353325 0 35308 0 8777 0 58946 0 13419 0 469775 0 0 Beau McNeff until 102021 VP of Goshen Physicians/Cancer Srvs 0 244046 0 118266 0 770 0 11600 0 23834 0 398516 0 0 Edward Boyts MD Secretary/Treasurer 146260 0 126902 0 0 0 22814 0 22426 0 318402 0 0 0 Richard Tarske Former VP of Goshen Physicians 0 0 0 153850 0 0 0 0 0 0 0 153850 0 0 Part I, Line 1a Goshen Health System grossed up the taxable value of an automobile for 1 of the officers listed on Form 990, Part VII and included the amount in the employees' W-2 as additional compensation. Part I, Line 1b Goshen Health System does not have a specific written policy for the use of automobiles, but does gross up the taxable value of automobiles to include in the employees' W-2 as additional compensation. Part I, Line 3 Goshen Hospital Association, Inc., a related tax-exempt organization of Goshen Health System, Inc., who establishes the compensation of the organization's top management official using the following methods: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - Approval by the Board or Compensation Committee 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 Ben Bontrager Chris Hutfless Beau McNeff No nonqualified plan payments were made during the year to any listed persons in Part VII. Form 990, Part III, Line 4a, Description of Program Service: Goshen Health is a non-denominational not-for-profit organization providing health care services for the general public. The mission of Goshen Health is to improve the health of our communities by providing innovative, outstanding care and service, through exceptional people doing exceptional work. The System's values include: Compassion - and commitment to service with empathy. Accountability - with integrity and action. Respect - through treating others as you wish to be treated. Excellence - in all we do. The organization created the current three-year strategic plan during 2019 to run from 1/1/2020 through 12/31/2022. The current strategic priorities for 2023 are as follows: 1. Access & Consumerism: Provide more access to convenient health services than any competitor in order to grow and secure our market position. 2. Provider Network: Attract and retain the highest-quality providers through a variety of alignment mechanisms. 3. Service Complement: Selectively grow and deepen our service offerings to meet the evolving needs of our community. 4. Value-Based Care: Build new and leverage our existing population health management capabilities as we prepare for value-based care to become increasingly prevalent. Key components of Goshen Health include the operations of a multi-specialty physician network of Goshen Health physicians. The physician network employs healthcare providers dedicated to meeting the health care needs of area residents, young and old. The network of both primary care and specialty providers enhances the system's ability to care for the community. Goshen Health physicians represent the following care areas: family practice, neurology, cardiology, adult internal medicine, pediatrics, orthopedics, obstetrics and gynecology, bariatrics, gastroenterology, infection control, oncology, and urgent care. Goshen Health physicians provide health care services to all members of the communities regardless of their ability to pay. The network offers financial assistance to those patients unable to pay all or a portion of their bill and who are unable to qualify for assistance through federal and state government assistance programs. Patients are asked to provide financial information to assess their financial position. In 2021, the network provided approximately $769,764 of charity care to patients. 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 Rob Myers Ben Bontrager Beau McNeff Chris Hutfless 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 Goshen Health's top management officials and other officers are compensated by Goshen Hospital, a related tax-exempt organization. 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 Health 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 XI, line 9: Equity Transfer -798,782. Goshen Health Surgery Center LLC 1605 Winsted Drive Goshen IN 46526 Healthcare IN 5235700 1868268 Goshen Health System Inc Goshen Hospital Association Inc 200 High Park Avenue Goshen IN 46526 356001540 Healthcare IN 501(c)(3) Line 3 Goshen Health System Inc 1 Goshen Health Foundation Inc 200 High Park Avenue Goshen IN 46526 462565300 Fundraising IN 501(c)(3) Line 7 Goshen Health System Inc 1 Goshen Hospital Women's Auxiliary 200 High Park Avenue Goshen IN 46526 237017521 Healthcare IN 501(c)(3) Line 12d, III-O N/A 0 New Paris Clinic LLC 2018 S Main Street Goshen IN 46526 352075244 Commerical Rentals IN Goshen Health System Inc Related 29407 127209 0 0 0.50000 Parkmor Drug Inc 1501 S Main Street Goshen IN 46526 351394980 Pharmacy Sales IN Goshen Health System Inc C 3079565 5339680 1.00000 1 PILR Inc 200 High Park Avenue Goshen IN 46526 204294750 Development IN Goshen Health System Inc C 1.00000 1 Radiation Oncology Resources Inc 200 High Park Avenue Goshen IN 46526 262008424 Healthcare IN Goshen Health System Inc C 1.00000 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 Goshen Hospital Association Inc C 22970147 FMV Goshen Hospital Association Inc O 3396460 FMV