2019-11-05T10:39:49-06:00 2018-12-31 420714325 RSM US LLP 52700 Independence Court PO Box 99 Elkhart IN 46515 990 2018-01-01 351974765 Goshen Health Systems Inc GOSH 5745352665 200 High Park Avenue Goshen IN 46526 Ben Bontrager CFO 5745352665 2019-10-16 1 Rebekuh Eley P01247672 5745220410 66.98.98.131 2019-10-16 14:21:07 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 49D5A1596642B6DD837368B1E984A310120BB776 2018 2020-03-31 21:24:44Z Randal Christophel 200 High Park Avenue Goshen IN 46526 66122803 0 X https://goshenhealth.com X 1997 IN To improve the health of our communities by providing innovative, outstanding care and services. 17 16 628 16 -106424 0 23754806 26494682 35638957 36870036 0 0 559416 2758085 59953179 66122803 0 0 0 0 44238560 50336747 0 0 0 17260847 17140509 61499407 67477256 -1546228 -1354453 10856229 12173534 13708975 14821635 -2852746 -2648101 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 61051050 39519839 See Schedule O 61051050 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 0 1 1 1 0 0 1 76 0 1 628 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 17 16 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 0 0 1 1 IN X Ben Bontrager 5745352665 200 High Park Avenue Goshen IN 46526 Randal Christophel President and CEO 1.00 41.00 X X 0 883932 166858 Derald Bontrager Chair 1.00 1.00 X X 0 0 0 Denise Davis Esq Vice Chair 1.00 0.00 X X 0 0 0 Edward Boyts MD Secretary/Treasurer 40.00 0.00 X X 234970 0 53731 James Alvarez 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 0.00 X 0 0 0 George Kim MD Director 1.00 0.00 X 0 0 0 Mark King PhD Director 1.00 0.00 X 0 0 0 John Leavitt Director 1.00 0.00 X 0 0 0 Gretchen Lund Esq Director 1.00 1.00 X 0 0 0 George E Marlow Director 1.00 0.00 X 0 0 0 Alan R Tehan Director 1.00 0.00 X 0 0 0 Gerald A Trolz Director 1.00 0.00 X 0 0 0 Leroy Weaver MD Director 1.00 0.00 X 0 0 0 Betsy Wenz Director 1.00 0.00 X 0 0 0 Candy Yoder Director (until 8/1/18) 1.00 0.00 X 0 0 0 Alan Weldy VP of HR and Compliance 1.00 40.00 X 0 525693 95991 Rob Myers Chief Operating Officer 1.00 40.00 X 0 503615 94643 Ben Bontrager CFO (as of 1/1/18) 1.00 41.00 X 0 217016 63743 Richard Tarske VP of Goshen Physicians 40.00 0.00 X 0 346663 35061 Christopher Owens MD Physician 40.00 0.00 X 752948 0 64505 Abdul Basit MD Physician 40.00 0.00 X 784287 0 56265 Abrar Sayeed MD Physician 40.00 0.00 X 785016 0 59680 Blair MacPhail MD Physician 40.00 0.00 X 751935 0 54307 Michael Hartman MD Physician 40.00 0.00 X 686598 0 44179 Amy Floria CFO (until 12/31/17) 0.00 0.00 X 0 542630 5155 3995754 3019549 794118 81 1 1 0 Michael J Hartman MD PC 500 Arcade Avenue Suite 110 Elkhart IN 46514 Contracted Physician Services 734610 Weatherby Locums Inc PO Box 972633 Dallas TX 753972633 Contracted Staffing 261868 Quest Diagnostics PO Box 12989 Chicago IL 60693 Lab Services 237669 Doiron Michael D dba M&J Cleaning PO Box 345 Goshen IN 465270345 Cleaning Services 151660 Eckert Tony and Amy Complete Cleaning So 66167 Prairie View Drive Goshen IN 46526 Cleaning Services 122316 6 26494682 26494682 Healthcare Services 621110 34901385 34901385 OB/GYN 621300 1837995 1837995 Team Bariatrics 621110 74616 74616 EKG Revenues 621110 56040 56040 36870036 77732 0 77732 77732 77732 Billings 561000 214706 214706 2465647 2572071 -106424 2680353 66122803 39519839 -106424 214706 234970 234970 39123265 36025173 3098092 2488577 2071416 417161 6346843 5525868 820975 2143092 1908767 234325 318501 318501 3507374 3025842 481532 56780 42808 13972 1435115 1190372 244743 2976271 2911854 64417 487293 438935 48358 1100674 994250 106424 536389 513513 22876 Clinical Supplies 5603973 5597055 6918 Repairs & Maintenance 1035309 487397 547912 82830 82830 67477256 61051050 6426206 0 231889 553449 4729551 5106362 79742 208943 910747 962942 13792662 8742821 4374187 5049841 530113 291997 10856229 12173534 13178862 14529638 530113 291997 13708975 14821635 X -2852746 -2648101 -2852746 -2648101 10856229 12173534 X -1354453 1559098 X 0 1 X 1 0 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. Annual operating budgets are submitted by the Hospital to the Goshen Health System board of directors for approval detailing capital expenditures and key investments in hospital operations. 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 13792662 8742821 5049841 5049841 Insurance Claims Liability 291997 291997 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, 2018 and 2017, 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 2015 and prior. X 0 1 0 1 0 0 0 0 0 0 0 Randal Christophel President and CEO 0 587607 0 276089 0 20236 0 133068 0 33790 0 1050790 0 0 Edward Boyts MD Secretary/Treasurer 148380 0 86590 0 0 0 25320 0 28411 0 288701 0 0 0 Alan Weldy VP of HR and Compliance 0 400102 0 117096 0 8495 0 65526 0 30465 0 621684 0 0 Rob Myers Chief Operating Officer 0 390859 0 107440 0 5316 0 65504 0 29139 0 598258 0 0 Ben Bontrager CFO (as of 1/1/18) 0 216260 0 0 0 756 0 43993 0 19750 0 280759 0 0 Richard Tarske VP of Goshen Physicians 0 267061 0 69496 0 10106 0 21708 0 13353 0 381724 0 0 Christopher Owens MD Physician 596379 0 156569 0 0 0 29512 0 34993 0 817453 0 0 0 Abdul Basit MD Physician 749291 0 34996 0 0 0 29309 0 26956 0 840552 0 0 0 Abrar Sayeed MD Physician 696403 0 73228 0 15385 0 29512 0 30168 0 844696 0 0 0 Blair MacPhail MD Physician 732185 0 19750 0 0 0 29512 0 24795 0 806242 0 0 0 Michael Hartman MD Physician 551209 0 135389 0 0 0 29512 0 14667 0 730777 0 0 0 Amy Floria CFO (until 12/31/17) 0 63271 0 108222 0 371137 0 4911 0 244 0 547785 0 0 Part I, Line 1b Goshen Health System reimbursed 2 directors reported on Part VII, Section A for travel expenses of companions. Goshen Health System does not have a specific written policy for the reimbursement of expense for travel for companions, 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. 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 -Indpendent Compensation Consulant -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 follwing individuals participate in the plan: Randal Christophel Alan Weldy Rob Myers Ben Bontrager Amy Floria 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. Building upon our mission and values, Goshen Health will deliver exceptional healthcare to the communities we serve using an integrated model of care and achieving excellence through a commitment to quality, leadership, and innovation. By 2020, we will achieve this vision by focusing on the following strategic priorities: -Lead the region in clinical integration and management of population health. -Deliver high value to our patients, providers, payers and colleagues. -Goshen's oncology and heart & vascular service lines will become the destination of choice in our broader region. -Cultivate a culture for colleagues where personal and professional missions are aligned. -Inspire a spirit of partnership and generosity by engaging our community with opportunities that meet regional health needs. 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 excels at meeting the health care needs of its patients as measured by Press Ganey and NRC Picker, nationally recognized companies that partner with healthcare facilities to measure the level of customer satisfaction and improve their quality of health care delivery. In 2012, Goshen Health physicians ranked above the 90th percentile in overall patient satisfaction. Goshen Health earned the 2013 apex workplace of distinction award from Morehead Associates. The apex award recognizes the industry's top employers, determined by objective data gathered from employee surveys. Our national health care percentile ranking for workforce commitment in 2013 was 69th. Goshen Health has been named one of Indiana's best places to work by the Indiana Chamber of Commerce, and was named to the list of "100 best places to work in healthcare" by Modern Healthcare and Becker's hospital review. 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 2018, the network provided approximately $1,235,820 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 Alan Weldy Rob Myers Ben Bontrager 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 1,559,098. Goshen Health Surgery Center LLC 1605 Winsted Drive Goshen IN 46526 Healthcare IN -1354453 2162352 Goshen Health Systems Inc Goshen Hospital Association Inc 200 High Park Avenue Goshen IN 46526 356001540 Healthcare IN 501(c)(3) Line 3 Goshen Health Systems Inc 1 Goshen Health Foundation Inc 200 High Park Avenue Goshen IN 46526 462565300 Fundraising IN 501(c)(3) Line 12a, I Goshen Health Systems 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 Systems Inc Related 22163 142975 0 0 0.50000 Parkmor Drug Inc 1501 S Main Street Goshen IN 46526 351394980 Pharmacy Sales IN Goshen Health Systems Inc C 1 PILR Inc 200 High Park Avenue Goshen IN 46526 204294750 Development IN Goshen Health Systems Inc C 1 Radiation Oncology Resources Inc 200 High Park Avenue Goshen IN 46526 262008424 Healthcare IN Goshen Health Systems Inc C 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 26494682 FMV Goshen Hospital Association Inc O 3505876 FMV