GOSHEN HEALTH SYSTEM INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- GOSHEN HEALTH SYSTEM INC (EIN 35-1974765)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-15
- IRS object ID
- 201843199349312514
- Schema version
- 2017v2.3
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-15T14:41:33-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 S WACKER DRIVE STE 800 | AddressLine1Txt |
| City | CHICAGO | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 60606 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 351974765 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOSHEN HEALTH SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | GOSH | BusinessNameControlTxt |
| Phone | 5745352665 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46526 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BEN BONTRAGER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5745352665 | PhoneNum |
| Signature | 2018-11-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | ZACK FORTSCH | PreparerPersonNm |
| PTIN | P00052725 | PTIN |
| Phone | 3126343400 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 108.171.131.189 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-11-13 | IPDt |
| IP Tm | 15:24:42 | IPTm |
| IP Timezone | CS | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 7C605E2F418ECD3347EC446B51AB1B1A7CC4F3F2 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 7C605E2F418ECD3347EC446B51AB1B1A7CC4F3F2 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RANDAL CHRISTOPHEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46526 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $59,953,179 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://GOSHENHEALTH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or Mission | TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 18 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 579 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | -$149,876 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$149,876 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $18,949,984 | PYContributionsGrantsAmt |
| CY Contributions Grants | $23,754,806 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,054,969 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,638,957 | CYProgramServiceRevenueAmt |
| PY Investment Income | $0 | PYInvestmentIncomeAmt |
| CY Investment Income | $0 | CYInvestmentIncomeAmt |
| PY Other Revenue | $632,932 | PYOtherRevenueAmt |
| CY Other Revenue | $559,416 | CYOtherRevenueAmt |
| PY Total Revenue | $48,637,885 | PYTotalRevenueAmt |
| CY Total Revenue | $59,953,179 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $36,236,539 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $44,238,560 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,401,346 | PYOtherExpensesAmt |
| CY Other Expenses | $17,260,847 | CYOtherExpensesAmt |
| PY Total Expenses | $48,637,885 | PYTotalExpensesAmt |
| CY Total Expenses | $61,499,407 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $0 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,546,228 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,612,139 | TotalAssetsBOYAmt |
| Total Assets EOY | $10,856,229 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,222,374 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,708,975 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | -$1,610,235 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | -$2,852,746 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $55,261,121 | ExpenseAmt |
| Revenue | $36,154,320 | RevenueAmt |
| Desc | GOSHEN HEALTH IS A NON-DENOMINATIONAL NOT-FOR-PROFIT ORGANIZATION PROVIDING HEALTH CARE SERVICES FOR THE GENERAL PUBLIC. SEE SCHEDULE O FOR ADDITIONAL DETAIL.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 SPECIALITY 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 HEALTHARE 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 ASESS THEIR FINANCIAL POSITION. IN 2017, THE NETWORK PROVIDED APPROXIMATELY $1,005,873 OF CHARITY CARE TO PATIENTS. | Desc |
| Total Program Service Expenses | $55,261,121 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 78 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 579 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 18 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | Yes (1) | LocalChaptersInd |
| Policies Reference Chapters | Yes (1) | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEN BONTRAGER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5745352665 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 HIGH PARK AVENUE | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46526 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (28 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| RANDAL CHRISTOPHEL | |||||||||
| PRESIDENT AND CEO | 1.00 | 41.00 | Yes (X) | Yes (X) | $0 | $855,730 | $171,841 | ||
| DERALD BONTRAGER | |||||||||
| CHAIR | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| DENISE DAVIS ESQ | |||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| RICHARD B HOSTETTER MD | |||||||||
| SECRETARY (UNTIL 2/1/17) | 40.00 | 0.00 | Yes (X) | $535,657 | $0 | $65,655 | |||
| EDWARD BOYTS MD | |||||||||
| SECRETARY/TREASURER | 40.00 | 0.00 | Yes (X) | Yes (X) | $230,862 | $0 | $58,637 | ||
| WES HERSCHBERGER | |||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES ALVAREZ | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| STEPHEN FIDLER | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| DELMAR G GOOD PHD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| MARK KING PHD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| JOHN LEAVITT | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GRETCHEN LUND ESQ | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GEORGE E MARLOW | |||||||||
| DIRECTOR | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| ALAN R TEHAN | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GERALD A TROLZ | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| LEROY WEAVER MD | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| BETSY WENZ | |||||||||
| DIRECTOR | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| GEORGE KIM MD | |||||||||
| DIRECTOR (AS OF 2/1/17) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| CANDY YODER | |||||||||
| DIRECTOR (AS OF 2/1/17) | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| AMY FLORIA | |||||||||
| CHIEF FINANCIAL OFFICER | 1.00 | 41.00 | Yes (X) | $0 | $485,964 | $54,976 | |||
| ALAN WELDY | |||||||||
| VP OF HR AND COMPLIANCE | 1.00 | 40.00 | Yes (X) | $0 | $503,544 | $101,266 | |||
| ROB MYERS | |||||||||
| CHIEF OPERATING OFFICER | 1.00 | 40.00 | Yes (X) | $0 | $459,726 | $104,422 | |||
| RICHARD TARSKE | |||||||||
| VP OF GOSHEN PHYSICIANS | 40.00 | 0.00 | $0 | $325,264 | $38,860 | Yes (X) | |||
| CHRISTOPHER OWENS MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $640,513 | $0 | $70,263 | Yes (X) | |||
| ABDUL BASIT MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $851,791 | $0 | $64,800 | Yes (X) | |||
| SADAT RASHID MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $582,910 | $0 | $65,578 | Yes (X) | |||
| ABRAR SAYEED MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $785,873 | $0 | $65,057 | Yes (X) | |||
| ROSS HEIL MD | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $602,705 | $0 | $67,924 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,230,311 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,630,228 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $929,279 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 72 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MICHAEL J HARTMANMD PC | |||||
| 500 ARCADE AVENUE SUITE 110 | ELKHART | IN | 46514 | CONTRACTED PHYSICIAN SERVICES | $1,362,302 |
| COMPHEALTH ASSOCIATES | |||||
| PO BOX 972651 | DALLAS | TX | 75397 | CONTRACTED STAFFING | $672,099 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 12989 | CHICAGO | IL | 60693 | MEDICAL SUPPLIES | $227,219 |
| NEPHEW PHARMACY | |||||
| WATERFALL DRIVE | NAPPANEE | IN | 46550 | DRUGS | $215,482 |
| BARTON & ASSOCIATES INC | |||||
| PO BOX 417844 | BOSTON | MA | 022417844 | CLEANING SERVICES | $181,208 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $23,754,806 | RelatedOrganizationsAmt |
| Total Contributions | $23,754,806 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HEALTHCARE SERVICES | 621110 | $35,582,293 | $35,582,293 |
| EKG REVENUES | 621110 | $56,664 | $56,664 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,638,957 | TotalProgramServiceRevenueAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,212 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $75,212 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $75,212 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $75,212 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| BILLINGS | 561000 | $193,929 | $193,929 | |
| TEAM BARIATRICS | 621110 | $35,553 | $35,553 | |
| SPECIALIST X-RAY | 621500 | $10,808 | $10,808 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $243,914 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $393,790 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$149,876 | UnrelatedBusinessRevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $484,204 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,953,179 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,154,320 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | -$149,876 | UnrelatedBusinessRevenueAmt |
| Exclusion | $193,929 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $766,519 | TotalAmt |
| Program Services | $766,519 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,084,781 | TotalAmt |
| Program Services | $31,017,144 | ProgramServicesAmt |
| Management And General | $3,067,637 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,186,803 | TotalAmt |
| Program Services | $1,864,904 | ProgramServicesAmt |
| Management And General | $321,899 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,261,585 | TotalAmt |
| Program Services | $4,451,834 | ProgramServicesAmt |
| Management And General | $809,751 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,938,872 | TotalAmt |
| Program Services | $1,713,620 | ProgramServicesAmt |
| Management And General | $225,252 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $501,736 | TotalAmt |
| Program Services | $193,130 | ProgramServicesAmt |
| Management And General | $308,606 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,556,904 | TotalAmt |
| Program Services | $4,175,106 | ProgramServicesAmt |
| Management And General | $381,798 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,327 | TotalAmt |
| Program Services | $64,396 | ProgramServicesAmt |
| Management And General | $11,931 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,642,042 | TotalAmt |
| Program Services | $1,391,228 | ProgramServicesAmt |
| Management And General | $250,814 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,745,394 | TotalAmt |
| Program Services | $2,670,675 | ProgramServicesAmt |
| Management And General | $74,719 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $429,678 | TotalAmt |
| Program Services | $364,807 | ProgramServicesAmt |
| Management And General | $64,871 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,038,398 | TotalAmt |
| Program Services | $946,755 | ProgramServicesAmt |
| Management And General | $91,643 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $432,229 | TotalAmt |
| Program Services | $432,229 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| CLINICAL SUPPLIES | $3,584,010 | $3,581,315 | $2,695 |
| BAD DEBT EXPENSE | $1,154,915 | $1,154,915 | |
| REPAIRS & MAINTENANCE | $1,017,568 | $390,898 | $626,670 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,646 | TotalAmt |
| Program Services | $81,646 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,499,407 | TotalAmt |
| Program Services | $55,261,121 | ProgramServicesAmt |
| Management And General | $6,238,286 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $231,889 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,455,905 | BOYAmt |
| EOY | $4,729,551 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $79,742 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $717,345 | BOYAmt |
| EOY | $910,747 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $12,001,894 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,627,707 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,438,889 | BOYAmt |
| EOY | $4,374,187 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $530,113 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,612,139 | BOYAmt |
| EOY | $10,856,229 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,222,374 | BOYAmt |
| EOY | $13,178,862 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $530,113 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,222,374 | BOYAmt |
| EOY | $13,708,975 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,610,235 | BOYAmt |
| EOY | -$2,852,746 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -$1,610,235 | BOYAmt |
| EOY | -$2,852,746 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,612,139 | BOYAmt |
| EOY | $10,856,229 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,546,228 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$923,026 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $1,226,743 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type3 Func Int | Yes (X) | SupportingOrgType3FuncIntInd |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOSHEN HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 356001540 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $0 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $0 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type3 Sprt Org All Form990SchAType3SprtOrgAllGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timely Provided Documents | Yes (1) | TimelyProvidedDocumentsInd |
| Officers Close Relationship | Yes (1) | OfficersCloseRelationshipInd |
| Supported Org Voice Investment | Yes (1) | SupportedOrgVoiceInvestmentInd |
Form990 Sch A Type3 Func Int Form990SchAType3FuncIntGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Parent Supported Org | Yes (X) | ParentSupportedOrgInd |
| Appoint Elect Majority Officer | Yes (1) | AppointElectMajorityOfficerInd |
| Exercise Direction Policies | Yes (1) | ExerciseDirectionPoliciesInd |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 ASSOCATION, 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. |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,961,208 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,627,707 | DepreciationAmt |
| Book Value | $4,333,501 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,686 | OtherCostOrOtherBasisAmt |
| Book Value | $40,686 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,374,187 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INSURANCE CLAIMS LIABILITY | Desc |
| Amt | $530,113 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $530,113 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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, 2017 AND 2016, 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 2014 AND PRIOR. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Travel For Companions | Yes (X) | TravelForCompanionsInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RANDAL CHRISTOPHEL | ||||||||||||||
| PRESIDENT AND CEO | $0 | $591,722 | $0 | $242,362 | $0 | $21,646 | $0 | $131,413 | $0 | $40,428 | $0 | $1,027,571 | $0 | $0 |
| RICHARD B HOSTETTER MD | ||||||||||||||
| SECRETARY (UNTIL 2/1/17) | $465,461 | $0 | $70,196 | $0 | $0 | $0 | $38,558 | $0 | $27,097 | $0 | $601,312 | $0 | $0 | $0 |
| EDWARD BOYTS MD | ||||||||||||||
| SECRETARY/TREASURER | $145,130 | $0 | $85,732 | $0 | $0 | $0 | $24,815 | $0 | $33,822 | $0 | $289,499 | $0 | $0 | $0 |
| AMY FLORIA | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $0 | $371,147 | $0 | $99,927 | $0 | $14,890 | $0 | $23,285 | $0 | $31,691 | $0 | $540,940 | $0 | $0 |
| ALAN WELDY | ||||||||||||||
| VP OF HR AND COMPLIANCE | $0 | $389,972 | $0 | $103,196 | $0 | $10,376 | $0 | $64,668 | $0 | $36,598 | $0 | $604,810 | $0 | $0 |
| ROB MYERS | ||||||||||||||
| CHIEF OPERATING OFFICER | $0 | $383,619 | $0 | $71,415 | $0 | $4,692 | $0 | $65,539 | $0 | $38,883 | $0 | $564,148 | $0 | $0 |
| RICHARD TARSKE | ||||||||||||||
| VP OF GOSHEN PHYSICIANS | $0 | $258,178 | $0 | $60,750 | $0 | $6,336 | $0 | $22,901 | $0 | $15,959 | $0 | $364,124 | $0 | $0 |
| CHRISTOPHER OWENS MD | ||||||||||||||
| PHYSICIAN | $574,260 | $0 | $42,808 | $0 | $23,445 | $0 | $28,435 | $0 | $41,828 | $0 | $710,776 | $0 | $0 | $0 |
| ABDUL BASIT MD | ||||||||||||||
| PHYSICIAN | $681,483 | $0 | $170,308 | $0 | $0 | $0 | $28,896 | $0 | $35,904 | $0 | $916,591 | $0 | $0 | $0 |
| SADAT RASHID MD | ||||||||||||||
| PHYSICIAN | $569,160 | $0 | $13,750 | $0 | $0 | $0 | $28,896 | $0 | $36,682 | $0 | $648,488 | $0 | $0 | $0 |
| ABRAR SAYEED MD | ||||||||||||||
| PHYSICIAN | $545,434 | $0 | $215,439 | $0 | $25,000 | $0 | $28,896 | $0 | $36,161 | $0 | $850,930 | $0 | $0 | $0 |
| ROSS HEIL MD | ||||||||||||||
| PHYSICIAN | $487,109 | $0 | $88,824 | $0 | $26,772 | $0 | $24,658 | $0 | $43,266 | $0 | $670,629 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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., 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 RICHARD B. HOSTETTER, MD ALAN WELDY ROB MYERS NO NONQUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 AMY FLORIA ALAN WELDY ROB MYERS |
| 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. |
| FORM 990, PART XI, LINE 9: | EQUITY TRANSFER TO GOSHEN HOSPITAL ASSOCIATION, INC. 1,226,743. |
Schedule R IRS990ScheduleR
Id Disregarded Entities IdDisregardedEntitiesGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GOSHEN HEALTH SURGERY CENTER LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1605 WINSTED DRIVE | AddressLine1Txt |
| City | GOSHEN | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46526 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | HEALTHCARE | PrimaryActivitiesTxt |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Total Income | $490,336 | TotalIncomeAmt |
| End Of Year Assets | $1,962,765 | EndOfYearAssetsAmt |
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| GOSHEN HOSPITAL ASSOCIATION INC | ||||||||||
| 200 HIGH PARK AVE | GOSHEN | IN | 46526 | 356001540 | HEALTHCARE | IN | 501(C)(3) | LINE 3 | GHS | Yes (1) |
| GOSHEN HEALTH FOUNDATION INC | ||||||||||
| 200 HIGH PARK AVE | GOSHEN | IN | 46526 | 462565300 | FUNDRAISING | IN | 501(C)(3) | LINE 12A, I | GHS | Yes (1) |
| GOSHEN HOSPITAL WOMEN'S AUXILIARY | ||||||||||
| 200 HIGH PARK AVE | GOSHEN | IN | 46526 | 237017521 | HEALTHCARE | IN | 501(C)(3) | LINE 12D, III-O | GOSHEN HOSPITAL ASSOCIATION | 0 |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| PARKMOR DRUG INC | |||||||||
| 1501 S MAIN ST | GOSHEN | IN | 46526 | 351394980 | PHARMACY SALES | IN | GHS | C | 0 |
| PILR INC | |||||||||
| 200 HIGH PARK AVE | GOSHEN | IN | 46526 | 204294750 | DEVELOPMENT | IN | GHS | C | 0 |
| RADIATION ONCOLOGY RESOURCES INC | |||||||||
| 200 HIGH PARK AVE | GOSHEN | IN | 46526 | 262008424 | HEALTHCARE | IN | GHS | C | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| GOSHEN HOSPITAL ASSOCIATION INC | ||
| C | $23,754,806 | FMV |
| GOSHEN HOSPITAL ASSOCIATION INC | ||
| O | $3,118,008 | FMV |