GOSHEN HOSPITAL ASSOCIATION INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: GOSHEN HOSPITAL ASSOCIATION INC (EIN 35-6001540)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-11-13
IRS object ID: 201713179349307251
Schema version: 2016v3.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-11-13T15:36:32-06:00	ReturnTs
Tax Period End	2016-12-31	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	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	356001540	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOSHEN HOSPITAL ASSOCIATION INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	GOSH	BusinessNameControlTxt
Phone	5743642665	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	AMY FLORIA	PersonNm
Person Title	CFO	PersonTitleTxt
Phone	5743642665	PhoneNum
Signature	2017-11-10	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	WAYNE HARDER	PreparerPersonNm
PTIN	P00294296	PTIN
Phone	3126343400	PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	108.171.131.187	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-11-10	IPDt
IP Tm	11:14:31	IPTm
IP Timezone	CS	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	4B8E1423B9F197D509CCF13AB357181C17C415CB	AtSubmissionCreationDeviceId
At Submission Filing Device Id	DC2E9104D1DF889C19E53CC962CFBFD70076CF54	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2018-03-14 21:41:22Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	GOSHEN HOSPITAL	BusinessNameLine1Txt

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	$235,239,687	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	1946	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	13	VotingMembersGoverningBodyCnt
Voting Members Independent	10	VotingMembersIndependentCnt
Total Employee	1629	TotalEmployeeCnt
Total Volunteers	448	TotalVolunteersCnt
Total Gross UBI	-$48,555	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	-$48,555	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$483,910	PYContributionsGrantsAmt
CY Contributions Grants	$95,964	CYContributionsGrantsAmt
PY Program Service Revenue	$215,474,240	PYProgramServiceRevenueAmt
CY Program Service Revenue	$227,910,843	CYProgramServiceRevenueAmt
PY Investment Income	$4,471,536	PYInvestmentIncomeAmt
CY Investment Income	$947,118	CYInvestmentIncomeAmt
PY Other Revenue	$7,871,173	PYOtherRevenueAmt
CY Other Revenue	$6,285,762	CYOtherRevenueAmt
PY Total Revenue	$228,300,859	PYTotalRevenueAmt
CY Total Revenue	$235,239,687	CYTotalRevenueAmt
PY Grants And Similar Paid	$699,113	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$337,848	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$90,139,382	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$93,482,641	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$107,134,955	PYOtherExpensesAmt
CY Other Expenses	$124,423,883	CYOtherExpensesAmt
PY Total Expenses	$197,973,450	PYTotalExpensesAmt
CY Total Expenses	$218,244,372	CYTotalExpensesAmt
PY Revenues Less Expenses	$30,327,409	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$16,995,315	CYRevenuesLessExpensesAmt
Total Assets BOY	$334,905,201	TotalAssetsBOYAmt
Total Assets EOY	$355,806,978	TotalAssetsEOYAmt
Total Liabilities BOY	$49,391,038	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$60,182,655	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$285,514,163	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$295,624,323	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	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.	MissionDesc
Significant New Program Srvc	0	SignificantNewProgramSrvcInd
Significant Change	0	SignificantChangeInd
Expense	$185,446,390	ExpenseAmt
Grant	$337,848	GrantAmt
Revenue	$232,434,523	RevenueAmt
Desc	GOSHEN HOSPITAL IS A NON-DENOMINATIONAL NOT-FOR-PROFIT ORGANIZATION PROVIDING HEALTH CARE SERVICES FOR THE GENERAL PUBLIC AS WELL AS CHARITY WITHIN THE COMMUNITY. SEE SCHEDULE O FOR ADDITIONAL DETAIL.	Desc
Total Program Service Expenses	$185,446,390	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	Yes (1)	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	0	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	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (1)	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	Yes (1)	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	Yes (1)	DisregardedEntityInd
Related Entity	Yes (1)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (1)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	0	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	160	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	1629	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
Indoor Tanning Services	0	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	13	GoverningBodyVotingMembersCnt
Independent Voting Member	10	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	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	Yes (1)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (1)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
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	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
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	5743642665	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	200 HIGH PARK AVE	AddressLine1Txt
City	GOSHEN	CityNm
State Abbreviation	IN	StateAbbreviationCd
ZIP	46526	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (31 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
GEORGE KIM MD
DIRECTOR	1.00	0.00	Yes (X)	$0	$0	$0
MARTHA SUZIE YEAGER
DIRECTOR	1.00	0.00	Yes (X)	$0	$0	$0
VERNITA TODD
DIRECTOR (UNTIL 1/11/16)	1.00	0.00	Yes (X)	$0	$0	$0
RANDY CRIPE
VICE CHAIR	1.00	0.00	Yes (X)	$0	$0	$0	Yes (X)
BRENDA SROF
TREASURER	1.00	0.00	Yes (X)	$0	$0	$0	Yes (X)
KAREN SMITH
DIRECTOR	1.00	0.00	Yes (X)	$0	$0	$0
LINDA BAXLEY
PAST CHAIR	1.00	0.00	Yes (X)	$0	$0	$0	Yes (X)
SUSAN STIFFNEY RN
DIRECTOR	1.00	0.00	Yes (X)	$0	$0	$0
DANIEL NAFZIGER MD
CHAIR	1.00	40.00	Yes (X)	$0	$162,777	$23,287	Yes (X)
RANDAL CHRISTOPHEL
PRESIDENT AND CEO	40.00	2.00	Yes (X)	$782,686	$0	$179,020	Yes (X)
KAREN PLETCHER
DIRECTOR	1.00	0.00	Yes (X)	$0	$0	$0
LILIANA QUINTERO
DIRECTOR (AS OF 4/26/16)	1.00	0.00	Yes (X)	$0	$0	$0
BONITA SCHROCK
DIRECTOR (AS OF 4/26/16)	1.00	0.00	Yes (X)	$0	$0	$0
JODY NEER MD
DIRECTOR	1.00	0.00	Yes (X)	$0	$455,037	$58,479
MARGARET S FRANGER
VP OF CANCER SERVICES	40.00	1.00		$352,340	$0	$86,059	Yes (X)
RICK TARSKE
VP OF GOSHEN PHYSICIANS	40.00	1.00		$287,968	$0	$58,370	Yes (X)
ALAN WELDY
VP OF HR AND COMPLIANCE	40.00	1.00		$463,283	$0	$93,478	Yes (X)
VLADIMIR RADIVOJEVIC
VP OF SURGICAL SERVICES	40.00	1.00		$218,843	$0	$69,546	Yes (X)
MARK PODGORSKI
VP OF HOSPITAL OPERATIONS	40.00	1.00		$280,602	$0	$71,787	Yes (X)
PAM KARSEN
VP OF NURSING (UNTIL 3/31/16)	40.00	1.00		$151,087	$0	$6,184	Yes (X)
STEVE GARBODEN
VP PLANNING AND MANAGED CARE	40.00	1.00		$282,126	$0	$70,930	Yes (X)
AMY FLORIA
CHIEF FINANCIAL OFFICER	40.00	1.00		$459,952	$0	$101,454	Yes (X)
LARRY ALLEN MD
CHIEF MEDICAL OFFICER	40.00	1.00		$432,411	$0	$87,235	Yes (X)
ROB MYERS
CHIEF OPERATING OFFICER	40.00	1.00		$286,233	$0	$84,480	Yes (X)
JULIE CROSSLEY
CHIEF NURSING OFFICER	40.00	1.00		$163,066	$0	$45,313	Yes (X)
DANIEL BRUETMAN MD
PHYSICIAN	40.00	0.00		$550,509	$0	$82,132		Yes (X)
HUBERT FORNALIK MD
PHYSICIAN	40.00	0.00		$625,459	$0	$29,653		Yes (X)
LEONARD HENRY MD
PHYSICIAN	40.00	0.00		$546,553	$0	$77,931		Yes (X)
EBENEZER KIO MD
PHYSICIAN	40.00	0.00		$572,937	$0	$81,181		Yes (X)
RODERICH SCHWARZ MD
PHYSICIAN	40.00	0.00		$594,699	$0	$71,817		Yes (X)
RANDALL CAMMENGA MD
CHIEF OPERATING OFCR.(UNTIL 8/28/15)	0.00	0.00		$288,871	$0	$0			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$7,339,625	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$617,814	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,378,336	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	52	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (1)	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
DJ CONSTRUCTION CO INC
3414 ELKHART RD	GOSHEN	IN	46526	CONSTRUCTION COMPANY	$3,499,521
FASTAFF LLC
PO BOX 911452	DENVER	CO	802911452	CONTRACTED STAFFING	$2,122,344
MAPLETRONICS COMPUTERS INC
PO BOX 136	GOSHEN	IN	465270136	CONSULTING	$1,348,291
APOGEE MEDICAL MANAGEMENT
15059 N SCOTTSDALE RD STE 600	SCOTTSDALE	AZ	852542685	CONTRACTED STAFFING	$1,305,495
QUEST DIAGNOSTICS
PO BOX 12989	CHICAGO	IL	60693	MEDICAL SERVICES	$1,063,889

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	30	CntrctRcvdGreaterThan100KCnt
Related Organizations	$95,964	RelatedOrganizationsAmt
Total Contributions	$95,964	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

Field	Value	IRS element (for citing)
Desc	PATIENT CARE	Desc
Business	622110	BusinessCd
Total Revenue Column	$227,910,843	TotalRevenueColumnAmt
Related Or Exempt Func Income	$227,910,843	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Total Program Service Revenue	$227,910,843	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$947,118	TotalRevenueColumnAmt
Unrelated Business Revenue	-$48,555	UnrelatedBusinessRevenueAmt
Exclusion	$995,673	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,152,122	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	$1,152,122	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,152,122	TotalRevenueColumnAmt
Exclusion	$1,152,122	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	ExclusionExclusionAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
FOOD SERVICE REVENUE	722514	$609,960	$609,960
FINANCE CHARGES	561000	$306,186		$306,186
OTHER ONCOLOGY REV MIS	621500	$215,960		$215,960

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,001,534	TotalRevenueColumnAmt
Related Or Exempt Func Income	$4,001,534	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$5,133,640	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$235,239,687	TotalRevenueColumnAmt
Related Or Exempt Func Income	$232,434,523	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	-$48,555	UnrelatedBusinessRevenueAmt
Exclusion	$2,757,755	ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$337,848	TotalAmt
Program Services	$337,848	ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$4,323,374	TotalAmt
Program Services	$3,026,362	ProgramServicesAmt
Management And General	$1,297,012	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$65,527,197	TotalAmt
Program Services	$45,402,871	ProgramServicesAmt
Management And General	$20,124,326	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$4,472,912	TotalAmt
Program Services	$2,907,393	ProgramServicesAmt
Management And General	$1,565,519	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$14,427,249	TotalAmt
Program Services	$9,377,712	ProgramServicesAmt
Management And General	$5,049,537	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$4,731,909	TotalAmt
Program Services	$3,075,741	ProgramServicesAmt
Management And General	$1,656,168	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$1,592,868	TotalAmt
Management And General	$1,592,868	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$120,103	TotalAmt
Management And General	$120,103	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$205,000	TotalAmt
Management And General	$205,000	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$19,574,656	TotalAmt
Program Services	$19,574,656	ProgramServicesAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$2,690,181	TotalAmt
Program Services	$2,690,181	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$4,845,295	TotalAmt
Program Services	$4,845,295	ProgramServicesAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$2,039,601	TotalAmt
Program Services	$2,039,601	ProgramServicesAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$2,049,772	TotalAmt
Program Services	$2,049,772	ProgramServicesAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$672,092	TotalAmt
Program Services	$672,092	ProgramServicesAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$1,187,449	TotalAmt
Management And General	$1,187,449	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$19,352,372	TotalAmt
Program Services	$19,352,372	ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$10,881,854	TotalAmt
Program Services	$10,881,854	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$2,114,739	TotalAmt
Program Services	$2,114,739	ProgramServicesAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt
DRUGS & MEDICAL SUPPLIE	$45,372,500	$45,372,500
HOSPITAL ASSESSMENT FEE	$5,130,379	$5,130,379
REPAIRS & MAINTENANCE	$5,016,294	$5,016,294

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,578,728	TotalAmt
Program Services	$1,578,728	ProgramServicesAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$218,244,372	TotalAmt
Program Services	$185,446,390	ProgramServicesAmt
Management And General	$32,797,982	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$14,701,061	BOYAmt
EOY	$1,379,098	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$105,033	BOYAmt
EOY	$0	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$28,697,333	BOYAmt
EOY	$29,794,781	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$5,144,095	BOYAmt
EOY	$5,107,001	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$4,234,630	BOYAmt
EOY	$6,307,843	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$250,094,711	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$138,723,861	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$106,882,213	BOYAmt
EOY	$111,370,850	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$174,017,852	BOYAmt
EOY	$201,069,527	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$1,122,984	BOYAmt
EOY	$777,878	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$334,905,201	BOYAmt
EOY	$355,806,978	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$17,057,640	BOYAmt
EOY	$14,669,119	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$31,267,109	BOYAmt
EOY	$45,348,215	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$1,066,289	BOYAmt
EOY	$165,321	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$49,391,038	BOYAmt
EOY	$60,182,655	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$284,714,852	BOYAmt
EOY	$294,875,832	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$799,311	BOYAmt
EOY	$748,491	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$285,514,163	BOYAmt
EOY	$295,624,323	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$334,905,201	BOYAmt
EOY	$355,806,978	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$16,995,315	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$11,136,727	NetUnrlzdGainsLossesInvstAmt
Prior Period Adjustments	-$1,505	PriorPeriodAdjustmentsAmt
Other Changes In Net Assets	-$18,020,377	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	Yes (1)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (1)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	0	VolunteersInd
Paid Staff Or Management	0	PaidStaffOrManagementInd
Media Advertisements	0	MediaAdvertisementsInd
Mailings Members	0	MailingsMembersInd
Publications Or Broadcast	0	PublicationsOrBroadcastInd
Grants Other Organizations	0	GrantsOtherOrganizationsInd
Direct Contact Legislators	0	DirectContactLegislatorsInd
Rallies Demonstrations	0	RalliesDemonstrationsInd
Other Activities	Yes (1)	OtherActivitiesInd
Other Activities	$5,854	OtherActivitiesAmt
Total Lobbying Expenditures	$5,854	TotalLobbyingExpendituresAmt
Not Described Section501c3	0	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART II-B, LINE 1:	FormAndLineReferenceDesc
Explanation	LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$2,988,795	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$4,027,467	OtherCostOrOtherBasisAmt
Book Value	$7,016,262	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$108,234,673	OtherCostOrOtherBasisAmt
Depreciation	$43,138,431	DepreciationAmt
Book Value	$65,096,242	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	$377,004	InvestmentCostOrOtherBasisAmt
Other Cost Or Other Basis	$113,748	OtherCostOrOtherBasisAmt
Depreciation	$239,876	DepreciationAmt
Book Value	$250,876	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$125,565,293	OtherCostOrOtherBasisAmt
Depreciation	$95,345,554	DepreciationAmt
Book Value	$30,219,739	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$8,787,731	OtherCostOrOtherBasisAmt
Book Value	$8,787,731	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$111,370,850	TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
ASSET RETIREMENT OBLIGATION	$113,138
DEFERRED MALPRACTICE	$45,000
INTEREST RATE SWAP	$7,183

Field	Value	IRS element (for citing)
Total Liability	$165,321	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, 2016 AND 2015, 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 2013 AND PRIOR.	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent200	Yes (X)	Percent200Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent400	Yes (X)	Percent400Ind
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (1)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (1)	ExpensesExceedBudgetInd
Unable To Provide Care	0	UnableToProvideCareInd
Annual Community Bnft Report	Yes (1)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (1)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	7270	PersonsServedCnt
Total Community Benefit Expns	$3,786,611	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,786,611	NetCommunityBenefitExpnsAmt
Total Expense	0.01940	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	8381	PersonsServedCnt
Total Community Benefit Expns	$30,290,763	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$26,601,731	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,689,032	NetCommunityBenefitExpnsAmt
Total Expense	0.01890	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Persons Served	15651	PersonsServedCnt
Total Community Benefit Expns	$34,077,374	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$26,601,731	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$7,475,643	NetCommunityBenefitExpnsAmt
Total Expense	0.03830	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Persons Served	24796	PersonsServedCnt
Total Community Benefit Expns	$1,723,263	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$65,520	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,657,743	NetCommunityBenefitExpnsAmt
Total Expense	0.00850	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Persons Served	738	PersonsServedCnt
Total Community Benefit Expns	$667,184	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$21,547	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$645,637	NetCommunityBenefitExpnsAmt
Total Expense	0.00330	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$18,949,984	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$18,949,984	NetCommunityBenefitExpnsAmt
Total Expense	0.09690	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Persons Served	87	PersonsServedCnt
Total Community Benefit Expns	$762,230	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$762,230	NetCommunityBenefitExpnsAmt
Total Expense	0.00390	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	25621	PersonsServedCnt
Total Community Benefit Expns	$22,102,661	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$87,067	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$22,015,594	NetCommunityBenefitExpnsAmt
Total Expense	0.11260	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	41272	PersonsServedCnt
Total Community Benefit Expns	$56,180,035	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$26,688,798	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$29,491,237	NetCommunityBenefitExpnsAmt
Total Expense	0.15090	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$3,407	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,407	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$372,774	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$372,774	NetCommunityBenefitExpnsAmt
Total Expense	0.00190	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$241	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$241	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$24,915	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$24,915	NetCommunityBenefitExpnsAmt
Total Expense	0.00010	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$401,337	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$401,337	NetCommunityBenefitExpnsAmt
Total Expense	0.00200	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$9,123,085	BadDebtExpenseAmt
Reimbursed By Medicare	$35,072,167	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$55,852,082	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$20,779,915	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOSHEN HOSPITAL ASSOCIATION INC	BusinessNameLine1Txt

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)
Website Address	HTTPS://GOSHENHEALTH.COM	WebsiteAddressTxt
State License	100270430	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
General Medical And Surgical	Yes (X)	GeneralMedicalAndSurgicalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	GOSHEN HOSPITAL ASSOCIATION INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	15	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	HTTPS://GOSHENHEALTH.COM/PROMO-PAGES/COMMUNITY-NEEDS	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	15	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTPS://GOSHENHEALTH.COM/PROMO-PAGES/COMMUNITY-NEEDS	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	200.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	400.000000000000	FPGFamilyIncmLmtDscntCarePct
Residency Criteria	Yes (X)	ResidencyCriteriaInd
Other Criteria	Yes (X)	OtherCriteriaInd
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	HTTPS://GOSHENHEALTH.COM/GOSHENHOSPITAL/MEDIA/FORMS-AND-APPLICATIONS/FINAL-	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	HTTPS://GOSHENHEALTH.COM/PATIENT-TOOLS/PAY-ONLINE	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	HTTPS://GOSHENHEALTH.COM/PATIENT-TOOLS/PAY-ONLINE	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Made Effort Orally Notify	Yes (X)	MadeEffortOrallyNotifyInd
Processed FAP Application	Yes (X)	ProcessedFAPApplicationInd
Made Presumptive Elig Determ	Yes (X)	MadePresumptiveEligDetermInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Look Back Medicare	Yes (X)	LookBackMedicareInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
GOSHEN HOSPITAL ASSOCIATION, INC.	PART V, SECTION B, LINE 5: THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH. THE HEALTH NEEDS OF ELKHART COUNTY WERE IDENTIFIED AND PRIORITIZED THROUGH A SYSTEMATIC DATA INFORMED PROCESS AND WITH THE INPUT OF INDIVIDUALS THROUGHOUT ELKHART COUNTY AND IN THE ELKHART COUNTY HEALTH DEPARTMENT.MORE THAN 23,000 SURVEYS, AVAILABLE IN BOTH ENGLISH AND SPANISH, WERE SENT TO COMMUNITY MEMBERS, INCLUDING THE MINORITY POPULATIONS OF AMISH, HISPANIC AND AFRICAN-AMERICAN. PERSONS RECEIVING THE COMMUNITY SURVEY COULD RESPOND VIA A WEB LINK, THROUGH THE POST, OR BY PHONE (AVAILABLE 24/7)FROM THE LAST WEEK OF MAY 2015 THROUGH THE SECOND WEEK OF JUNE 2015. OVER 600 SURVEYS WERE RETURNED, 599 (93.2%) OF THESE FROM ELKHART COUNTY.BESIDES PROVIDING RESIDENTIAL AND DEMOGRAPHIC INFORMATION, RECIPIENTS WERE ALSO ASKED TO RATE THEIR OWN HEALTH, THE COMMUNITY'S HEALTH, THE TOP HEALTH NEEDS IN THE COMMUNITY, WHETHER OR NOT THERE WERE ENOUGH PROGRAMS TO MEET THESE NEEDS, AND HOW GOSHEN HOSPITAL ASSOCIATION, INC. COULD IMPROVE. ELKHART COUNTY HEALTH DEPARTMENT OFFICIALS WERE ALSO CONSULTED. NO COMMENTS WERE RECEIVED FROM THE PUBLIC REGARDING THE LAST CHNA REPORT AND IMPLEMENTATION PLAN.GOSHEN HOSPITAL ASSOCIATION, INC. CONTRACTED WITH THE BOWEN RESEARCH CENTER, DEPARTMENT OF FAMILY MEDICINE, INDIANA UNIVERSITY SCHOOL OF MEDICINE, TO ANALYZE PRIMARY DATA COLLECTED FROM THE SURVEYS. THE BOWEN CENTER ALSO ANALYZED VARIOUS EXISTING HEALTH, SOCIAL, AND ECONOMIC SECONDARY DATA SETS. FOR CONTEXTUAL COMPARISONS, ELKHART COUNTY DATA WERE COMPARED WITH KOSCIUSKO, LAGRANGE, MARSHALL, NOBLE AND ST. JOSEPH COUNTIES, AS WELL AS THE STATE OF INDIANA.
GOSHEN HOSPITAL ASSOCIATION, INC.	PART V, SECTION B, LINE 11: THE HEALTH NEEDS LISTED BELOW ACCOUNT FOR 96.6% OF THE HEALTH NEEDS IDENTIFIED BY COMMUNITY RESIDENTS AND SUPORTED BY SECONDARY DATA FROM ELKHART COUNTY. -OBESITY/EXERCISE/HEALTHY EATING-ACCESS TO HEALTH SERVICES-TREATMENT OF CHRONIC DISEASES-MENTAL HEALTH/ADDICTION/DEPRESSION-POVERTY-HEALTH LITERACY-TOBACCO USE/SMOKINGGOSHEN HOSPITAL ASSOCIATION, INC. CONSIDERED THE FOLLOWING SOURCES OF INFORMATION IN PRIORITIZING THE HEALTH NEEDS THAT IT WOULD ADDRESS:-COMMUNITY PRECEPTIONS - THESE WERE OBTAINED THROUGH THE COMMUNITY SURVEY-STATISTICAL HEALTH INFORMATION - SECONDARY DATA FOR ELKHART COUNTY WAS COMPARED TO ITS BENCHMARKS-EXPERTISE OF HEALTH LEADERS - THE ELKHART COUNTY HEALTH DEPARTMENT ON THE MOST SIGNIFICANT HEALTH NEEDSAFTER CAREFUL CONSIDERATION, GOSHEN HOSPITAL ASSOCIATION, INC. HAS IDENTIFIED THE FOLLOWING HEALTH NEEDS IN RANK ODER THAT IT IS BEST EQUIPPED TO ADDRESS:-OBESITY-ACCESS TO HEALTH SERVICES-MENTAL HEALTH ISSUES-TREATMENT OF CHRONIC DISEASES - FOCUSING SPECIFICALLY ON DIABETES AND HYPERTENSION, POTENTIALLY CANCER RELATED HEALTH ISSUES-TOBACCO USE/SMOKINGIN ADDITION, GOSHEN HOSPITAL ASSOCIATION, INC. WILL INDIRECTLY ADDRESS POVERTY. GOSHEN HOSPITAL ASSOCATION, INC. IS ALSO AWARE OF AND SENSITIVE TO THE HEALTH-RELATED NEEDS OF ALL MEMBERS OF THE COMMUNITY, AND CONTINUALLY SEEKS INNOVATIVE WAYS FOR PROVIDING IMPROVED ACCESS TO HEALTH SERVICES FOR THOSE IN POVERTY. THROUGH ONGOING PROGRAM DEVELOPMENT AND MONITORING, GOSHEN HOSPITAL ASSOCIATION, INC. WILL CONTINUE EXISTING PROGRAMS FOR ADDRESSING HEALTH LITERACY. HOWEVER, THE EXPERTISE OF GOSHEN HEALTH IS BEST SUITED TO FORMALLY ADDRESS THE FIVE PRIORITY NEEDS NOTED. GOSHEN HOSPITAL ASSOCIATION, INC. DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2016 WITH RESPECT TO ITS PREVIOUSLY CONDUCTED CHNA:HEALTH NEED IDENTIFIED: OBESITYSERVICES WERE PROVIDED BY TEAM BARIATRICS WHICH IS A MULTI-DISCIPLINARY PROGRAM FOR WEIGHT REDUCTION. IT PROVIDES BOTH SURGICAL AND NON-SURGICAL WEIGHT LOSS OPTIONS. PROGRAMS ARE DESIGNED FOR THE PATIENT THROUGH A TEAM APPROACH AND INCLUDES AN ON-SITE FITNESS CENTER, SUPPORT GROUPS, AND COMMUNITY EDUCATION. THE NUMBER OF PERSONS SERVED IS 699.GOSHEN HOSPITAL ASSOCIATION, INC. OFFERED COMMUNITY PROGRAMS FOCUSING ON OBESITY PREVENTION, NUTRITION, WEIGHT MANAGEMENT, RUN THE HALLS AND HEALTHY STEPS TO HEALTHY WEIGHT. THE NUMBER OF PERSONS SERVED IS 480.FITNESS CENTER CLASSES AND SEMINARS AS WELL AS AN ANNUAL GET UP AND GOSHEN EVENT WAS OFFERED TO THE COMMUNITY. THE NUMBER OF PERSONS SERVED IS 13,116.HEALTH NEED IDENTIFIED: ACCESS TO HEALTH SERVICESA TOTAL OF 17 NEW PROVIDERS, PCPS AND SPECIALTY PHYSICIANS WERE UTILIZED BY GOSHEN HOSPITAL ASSOCIATION, INC. TO HELP INCREASE THE ACCESS TO HEALTH SERVICES. THE NUMBER OF PERSONS SERVED IS 3,357.GOSHEN HOSPITAL ASSOCIATION, INC. PARTIPATED IN NURSING CLINICALS AS WELL AS PROVIDED VARIOUS TYPE OF EDUCATION TO MEDICAL STUDENTS AND OTHER HEALTH PROFESSIONS. THE NUMBER OF PERSONS SERVED IS 733.LOW OR NO-COST COMMUNITY SCREENING EVENTS WERE HOSTED IN THE COMMUNITY. THE NUMBER OF PERSONS SERVED IS 2,465. COMMUNITY FLU SHOT CLINICS WERE OFFERED TO THE COMMUNITY. THE NUMBER OF PERSON SERVED IS 146.GOSHEN HOSPITAL ASSOCIATION, INC. PROVIDES FREE ASSISTANCE TO COMMUNITY MEMBERS WHO HAVE A NON-EMERGENCY, HEALTH RELATED QUESTION THROUGH NURSE ON CALL SERVICES. THE NUMBER OF PERSONS SERVED IS 11,952.HEALTH NEED IDENTIFIED: MENTAL HEALTH ACCESS AND COORDINATIONGOSHEN HOSPITAL ASSOCIATION, INC. COORDINATED A TELEMENTAL HEALTH PROJECT IN WHICH PATIENTS COULD INTERACT WITH A MENTAL HEALTH PROFESSIONAL THROUGH VIDEO CONFERENCING. THE NUMBER OF PERSONS SERVED IS 40.SCREENINGS WERE CONDUCTED FOR DEPRESSION, DISTRESS AND MENTAL HEALTH. THE NUMBER OF PERSONS SERVED IS 66,691.GROUP THERAPY WAS OFFERED BY THE CENTER FOR CANCER CARE. THE NUMBER OF PERSONS SERVED IS 31.HEALTH NEED IDENTIFIED: TREATMENT OF CHRONIC CONDITIONSQUALITY MEASURES REGARDING DIABETES, HEART FAILURE, DEPRESSION AND OTHER AREAS DETERMINED BY PAYORS ARE MONITORED AND USED TO EVALUATE PROCESSES AND WORKFLOWS TO IMPROVE THE QUALITY OF CARE PROVIDED TO PATIENTS. THE NUMBER OF PERSONS SERVED IS 36,634.DIABETES EDUCATION, SUPPORT GROUPS, ACTION PLANS AND SEMINARS WERE PROVIDED BY GOSHEN HOSPITAL ASSOCIATION, INC. THE NUMBER OF PERSONS SERVED IS 2,069.SERVICES LIKE COPD ACTION PLANNING AND OUTREACH TELEPHONE CALLS WERE ALSO CONDUCTED. THE NUMBER OF PERSONS SERVED IS 61.AMBULATORY NURSE CARE COORDINATION WAS GIVEN TO HIGH RISK ACO PATIENTS. THE NUMBER OF PERSONS SERVED IS 1,390.GOSHEN HOSPITAL ASSOCIATION, INC. COORDINATED SERVICES WITH HEALTH COACHES, HOME HEALTH CARE AND HOSPICE. THE NUMBER OF PERSONS SERVED IS 232.A CHRONIC-DISEASE SUPPORT GROUP AS WELL AS CANCER SUPPORT AND COORDINATED WAS PROVIDED. THE NUMBER OF PERSONS SERVED IS 878,HEALTH NEED IDENTIFIED: TOBACCO USE/SMOKING CESSATIONGOSHEN HOSPITAL ASSOCIATION, INC. PROVIDED TOBACCO EDUCATION AND SUPPORT GROUPS. THE NUMBER OF PERSONS SERVED IS 9,690.
GOSHEN HOSPITAL ASSOCIATION, INC.	PART V, SECTION B, LINE 13H: FAMILY SIZE IS ANOTHER FACTOR IN DETERMINING DISCOUNTS GRANTED TO PATIENTS.

Field	Value	IRS element (for citing)
Facility	5	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
1 - GOSHEN HOSPITAL
200 HIGH PARK AVE	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
4 - INDIANA LAKES MANAGED CARE
2018 SOUTH MAIN STREET	GOSHEN	IN	46526	HEALTH CARE MANAGEMENT
5 - NEW PARIS MEDICAL CLINIC
200 HIGH PARK AVE	GOSHEN	IN	46526	CLINIC

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 7:	GOSHEN HOSPITAL ASSOCIATION, INC. CALCULATED THE COST OF FINANCIAL ASSISTANCE AND MEANS-TESTED GOVERNMENT PROGRAMS, USING THE COST-TO-CHARGE RATIO DERIVED FROM SCHEDULE H, WORKSHEET 2, 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 I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 22,773,553.
PART II, COMMUNITY BUILDING ACTIVITIES:	GOSHEN HOSPITAL ASSOCIATION, INC. PROMOTED THE HEALTH OF ITS COMMUNITY BY SUPPORTING VARIOUS LOCAL ORGANIZATIONS THAT ENGAGE IN COMMUNITY BUILDING ACTIVITIES.
PART III, LINE 2:	GOSHEN HOSPITAL ASSOCATION, INC.'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 ASSOCIATION, INC. 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 ASSOCIATION, INC.:THE PROVISION FOR UNCOLLECTED PATIENT ACCOUNTS, FOR ALL PAYORS, IS RECOGNIZED WHEN SERVICES ARE PROVIDED BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CHANGES AND TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY, MANAGEMENT ASSESSES 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 ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION OF UNCOLLECTED PATIENT ACCOUNTS AN THE ALLOWANCE FOR UNCOLLECTED ACCOUNTS. IN ADDITION, GOSHEN HOSPITAL FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST DUE PATIENT BALANCES WITH COLLECTION AGENCIES. PATIENT ACCOUNTS THAT ARE UNCOLLECTED, INCLUDING THOSE PLACED WITH COLLECTION AGENCIES, ARE INITIALLY CHARGED AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IN ACCORDANCE WITH COLLECITON POLICIES OF GOSHEN HOSPITAL AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OHERWISE MEET FINANCIAL ASSISTANCE POLICIES OF GOSHEN HOSPITAL.
PART III, LINE 8:	ACTUAL MONTH TO DATE AND YEAR TO DATE REVENUES, CONTRACTUALS, REVENUE AND ACCOUNTS RECEIVABLE RELATED RATIOS, AND REVENUE RELATED STATISTICS (DAYS, DISCHARGES, ETC.) ARE COMPARED TO BUDGET AND PRIOR YEAR AMOUNTS ON A MONTHLY BASIS BY THE CFO OF GOSHEN HOSPITAL'S DIRECTORS AND FINANCIAL REPRESENTATIVES. ADDITIONALLY, ACTUAL CONTRACTUAL ALLOWANCE AS A PERCENTAGE OF GROSS ACCOUNTS RECEIVABLE AND CONTRACTUAL PROVISION AS A PERCENTAGE OF GROSS PATIENT CHARGES COMPARED TO BUDGETED AND PRIOR YEAR AMOUNTS ARE MONTIORED. 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. DISCHAGES, DAYS, ETC.) AND ON CURRENT REIMBURSEMENT RATES. THE MODEL ANALYZES PATIENT RECEIVABLES AND CONTRACTUAL ALLOWANCE BY PAYOR AND BY PATIENT STATUS. THE MODEL ESTIMATES THE COLLECTABILITY OF PATIENT ACCOUNTS BASED ON HISTORICAL COLLECTION RATES. FINANCE COLLEAGUES ALSO UPDATE THE MODEL TO ACCOUNT FOR CHANGES IN REIMBURSEMENT RULES. AFTER THE MODEL IS PREPARED, IT IS REVIEWED BY THE CHIEF FINANCIAL OFFICER FOR APPROPRIATENESS AND REASONABLENESS.CONTRACTUAL ALLOWANCE CALCULATIONS ARE RECONCILED TO THE GENERAL LEDGER ON A MONTHLY BASIS. ONCE THE CALCULATION IS PREPARED, THE FINANCE DEPARTMENT ADJUSTS THE GENERAL LEDGER ACCOUNTS.
PART III, LINE 9B:	FINANCIAL ASSISTANCE IS GRANTED TO THOSE PATIENTS UNABLE TO PAY ALL OR A PORTION OF THEIR BILL AND WHO ARE UNABLE TO QUALIFY FOR ASSISTANCE THROUGH FEDERAL AND STATE GOVERNMENT ASSISTANCE PROGRAMS. IF AFTER INSURANCE REIMBURSEMENT ADDITIONAL ASSISTANCE IS NEEDED, ALL PATIENTS MAY OBTAIN FINANCIAL ASSISTANCE IF THE INCOME CRITERIA ARE MET. ALL FINANCIAL ASSISTANCE APPLICATIONS ARE BASED ON POLICY GUIDELINES. UNINSURED PATIENTS ARE REQUIRED TO PROVIDE DOCUMENTATION AND AN APPLICATION. WHEN APPROVED, THE ADJUSTMENT IS APPLIED TO THE PATIENT'S ACCOUNT. FOR PATIENTS WHO DO NOT QUALIFY FOR CHARITY CARE OF FINANCIAL ASSISTANCE, PAYMENT PLANS AND LUMP SUM SETTLEMENTS ARE AVAILABLE. GOSHEN HOSPITAL ASSOCIATION, INC. 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 ASSOCIATION, INC. IS DEDICTATED TO MEETING THE SPECIFIC HEALTH CARE NEEDS OF OUR COMMUNITY. THE HOSPITAL HAS 123 PATIENT BEDS AND OVER 137 PHYSICIANS ON ITS MEDICAL STAFF IN NEARLY 25 SPECIALTIES. THESE PHYSICIANS, TOGETHER WITH OTHER DEDICATED PROFESSIONALS, PROVIDE A WIDE RANGE OF SERVICES INCLUDING THE FOLLOWING: ACUTE MEDICAL & SURGICAL, EMERGENCY, HOME HEALTH, RADIOLOGY, LABORATORY, CANCER CARE, BARIATRICS, WOMEN'S HEALTH, PAIN MANAGEMENT, SLEEP STUDIES, REHABILITATION, PATIENT AND COMMUNITY HEALTH EDUCATION AND PROFESSIONAL EDUCATION. THE CENTER FOR CANCER CARE IS A LEADER IN INNOVATIVE CANCER TREATMENT. WE WERE AMONG THE FIRST TO ADOPT A COMPREHENSIVE, MULTIDISCIPLINARY APPROACH TO CANCER TREATMENT. WE OFFER HOLISTIC PROGRAMS FOR STRENGTHENING MINDS AS WELL AS BODIES, PLACE A PREMIUM ON FAMILY INVOLVEMENT AND SPIRITUAL NEEDS, AND ENCOURAGE PATIENTS TO PLAY A DECISION-MAKING ROLE IN TREATMENT SELECTION. THE CENTER FOR CANCER CARE HAS SPECIALLY TRAINED SURGICAL ONCOLOGISTS, A BREAST SURGEON, MEDICAL ONCOLOGISTS, A RADIATION ONCOLOGIST, NATUROPATHIC PRACTITIONERS AND HIGHLY DISTINGUISHED MAGNET DESIGNATED NURSES.GOSHEN HOSPITAL ASSOCIATION, INC. IMPROVES THE HEALTH AND WELL-BEING OF ITS COMMUNITIES BY PROVIDING COMMUNITY WELLNESS AND EDUCATION PROGRAMS. THROUGH LOCAL PARTNERSHIPS, THE HOSPITAL IDENTIFIES HEALTH ISSUES AND CREATES PROGRAMS TO ENSURE OUR COMMUNITY IS THE HEALTHIEST PLACE TO LIVE, WORK AND RAISE A FAMILY. THE FIRST OF THESE PROGRAMS COVER CPR, EMS, DIABETES, CHILDBIRTH, FITNESS, NUTRITION, COMMUNITY EDUCATION AND HEALTH SCREENINGS AND ELKHART COUNTY CHILDHOOD OBESITY INITIATIVE. THE CPR CLASS IS FOR ANYONE - PROFESSIONALS OR PRIVATE CITIZENS - WHO WANT TO KNOW HOW TO PERFORM LIFE-SAVING CARDIOPULMONARY RESUSCITATION; FIRST AID CLASSES ARE ALSO OFFERED. EMS TRAINING IS AVAILABLE FOR PERSONS INTERESTED IN BECOMING EMERGENCY MEDICAL TECHNICIANS OR FIREFIGHTERS. THE DIABETES EDUCATION HELPS PEOPLE DELAY THE ONSET AND SLOW THE PROGRESSION OF COMPLICATIONS FROM THIS DISEASE. IT INCLUDES SEMINARS, SUPPORT GROUPS, CONSULTATIONS AND SCREENINGS. CHILDBIRTH EDUCATION PREPARES EXPECTANT MOTHERS AND THEIR FAMILIES DURING THIS SIGNIFICANT TIME IN THEIR LIFE. CLASSES REVIEW MANY ASPECTS OF CHILDBIRTH INCLUDING LABOR REHEARSAL, CESAREAN DELIVERIES, SINGLE-TEEN ISSUES, BREAST FEEDING AND A CLASS JUST FOR SIBLINGS.IN ADDITION TO VARIOUS COMMUNITY WELLNESS AND EDUCATION PROGRAMS, GOSHEN HOSPITAL ASSOCATION, INC. PROVIDES A FULL-SERVICES RESOURCE FOR COMPEHENSIVE HEALTH INFORMATION AND ASSISTANCE. NURSE ON CALL (NOC) IS FULL-SERVICE, MULTI-LINGUAL HEALTH INFORMATION, REFERRAL AND NURSE TRIAGE TELEPHONE SERVICE AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. NOC IS STAFFED BY SPECIALLY TRAINED, KNOWLEDGEABLE AND EXPERIENCED REGISTERED NURSES. THIS FREE SERVICE PROVIDES MEDICAL GUIDANCE WHEN SICK OR INJURED, INFORMATION ON PHYSICIANS IN THE AREA, REFERRALS TO COMMUNITY RESOURCES AND REGISTRATION FOR CLASSES AND EVENTS.
PART VI, LINE 3:	UNINSURED PATIENTS ARE SCREENED DURING THE PRE-REGISTRATION PROCESS FOR ELIGIBILITY IN THE HEALTHY INDIANA PLAN AND OFFER ANY OTHER KNOWN SOURCES OF FINANCIAL ASSISTANCE. ALL REGISTRATION LOCATIONS HAVE FINANCIAL ASISSTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE AND WILL HAVE INFORMATION ON THE CRITERIA AND PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE. APPLICATONS ARE ALSO PROVIDED TO ANY PATIENTS WITH A BALANCE DUE WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE. COUNSELORS ARE AVAILABLE TO PATIENTS TO AID IN THE APPLICATION PROCESS INCLUDING THE COLLECTION OF INFORMATION TO COMPLETE THE APPLICATION. PAYMENT OPTIONS AND INFORMATION ON FINANCIAL ASSISTANCE IS AVAILABLE ON THE HOSPITAL'S WEBSITE. PATIENTS MAY DOWNLOAD A PRELIMINARY APPLICATION, AND THE PATIENT AGREEMENT ASSOCIATED WITH FINANCIAL ASSISTANCE 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 2016 CENSUS, THE POPULATION OF ELKHART COUNTY IS 203,781. THE MEDIAN INCOME FOR A HOUSEHOLD IS ELKHART COUNTY BASED ON THE 2016 CENSUS IS $47,913. APPROXIMATELY 12.4% OF FAMILIES AND 16.1% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 23.7% OF THOSE UNDER THE AGE 18 AND 6.1% OF THOSE AGE 65 AND OVER. THE RACIAL MAKEUP OF THE COUNTY WAS ABOUT 75.5% WHITE, 6.2% AFRICAN AMERICAN, AND 15.5% HISPANIC OR LATINO. THE REMAINING 2.8% OF THE POPULATION IS A MAKEUP OF ALL OTHER RACES.
PART VI, LINE 5:	ALL OF THE HOPSITAL'S GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA. A MAJORITY OF THE BOARD MEMBERS ARE INDEPENDENT OF THE ORGANIZATION. THE GOVERNING BODY APPROVES MEDICAL STAFF PRIVELEGES AS INDICATED IN THE ORGANIZATION'S CREDENTIALING AND PRIVELEGING 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 IU HEALTH WITH THE HOSPITAL'S ANNUAL OPERATING BUDGET AND KEY STRATEGIC OBJECTIVES. IN ADDITION, THE HOSPITAL MANAGEMENT PROVIDES GOSHEN HOSPITAL ASSOCIATION, INC. WITH VARIOUS KEY METRICS INVOLVING PATIENT SATISFACTION, PATIENT QUALITY AND COLLEAGUE SATISFACTION. GOSHEN HOSPITAL ASSOCIATION, INC. REVIEWS THE DATA TO ENSURE KEY INITIATIVES ARE FOCUSED TOWARDS THE PROMOTING AND MEETING THE HEALTHCARE NEEDS OF THE COMMUNITIES. IN ADDITION, THE HOSPITAL COLLABORATES WITH IU HEALTH TO PROVIDE NECESSARY NURSING EDUCATION AND PHYSICIAN RECRUITMENT TO ASSIST IN MEETING THE HEALTH NEEDS OF THE COMMUNITY.
PART VI, LINE 7, REPORTS FILED WITH STATES	IN

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (1)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (25 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt	Address Line2USAddress/AddressLine2Txt
THE HORIZON EDUCATIONAL ALLIANCE
124 E WASHINGTON STREET	GOSHEN	IN	46528	460803293	501(C)(3)	$30,000	OPERATING SUPPORT
CENTER FOR HEALING AND HOPE
423 E JEFFERSON STREET	GOSHEN	IN	46528	020560511	501(C)(3)	$21,800	OPERATING SUPPORT
UNITED CANCER SERVICES ELKHART COUNTY
23971 US HIGHWAY 33	ELKHART	IN	46530	351091429	501(C)(3)	$20,125	OPERATING SUPPORT
BOYS & GIRLS CLUBS ELKHART COUNTY
102 WEST LINCOLN SUITE 240	GOSHEN	IN	46526	351033735	501(C)(3)	$20,000	OPERATING SUPPORT
COUNCIL ON AGING OF ELKHART COUNTY INC
230 E JACKSON BLVD	ELKHART	IN	46516	510178910	501(C)(3)	$20,000	OPERATING SUPPORT
MAPLE CITY HEALTH CARE CENTER
213 MIDDLEBURY STREET	GOSHEN	IN	46528	351749398	501(C)(3)	$20,000	OPERATING SUPPORT
OAKLAWN PSYCHIATRIC CENTER
330 LAKEVIEW DRIVE	GOSHEN	IN	46527	351070041	501(C)(3)	$16,000	OPERATING SUPPORT
CARE FOUNDATION INC
64468 MEADOW RIDGE DRIVE	GOSHEN	IN	46526	352111562	501(C)(3)	$15,000	OPERATING SUPPORT
NORTHERN INDIANA HISPANIC HEALTH COALITION
444 N NAPPANEE STREET	ELKHART	IN	46514	320039221	501(C)(3)	$15,000	OPERATING SUPPORT
BASHOR HOME OF THE UMC INC
62226 COUNTY ROAD 15	GOSHEN	IN	46526	350933555	501(C)(3)	$13,465	OPERATING SUPPORT
BETHEL COLLEGE
1001 BETHEL CIRCLE	MISHAWAKA	IN	46545	350935587	501(C)(3)	$10,000	OPERATING SUPPORT
ELKHART COUNTY CLUBHOUSE
114 S 5TH STREET	GOSHEN	IN	46528	271151738	501(C)(3)	$10,000	OPERATING SUPPORT
GOSHEN COLLEGE
1700 S MAIN STREET	GOSHEN	IN	46526	352158366	501(C)(3)	$10,000	OPERATING SUPPORT
GOSHEN COMMUNITY SCHOOLS
613 PURL STREET	GOSHEN	IN	46526	351099157	STATE OF INDIANA	$10,000	OPERATING SUPPORT
FAMILY CHRISTIAN DEVELOPMENT CENTER
151 S LOCKE STREET	NAPPANEE	IN	46550	351979463	501(C)(3)	$8,000	OPERATING SUPPORT
LACASA INC
202 N COTTAGE AVE	GOSHEN	IN	46528	351554538	501(C)(3)	$7,300	OPERATING SUPPORT
ADEC
19670 IN-20	BRISTOL	IN	46507	351060633	501(C)(3)	$7,000	OPERATING SUPPORT
CHILD AND PARENT SERVICES
100 W HIVELY AVENUE	ELKHART	IN	46517	350888765	501(C)(3)	$6,000	OPERATING SUPPORT
CHURCH COMMUNITY SERVICES
907 OAKLAND AVENUE	ELKHART	IN	46516	351155054	501(C)(3)	$5,200	OPERATING SUPPORT
BIG BROTHERS BIG SISTERS OF ELKHART COUNTY
2606 PEDDLERS VILLAGE ROAD SUITE	GOSHEN	IN	46526	351272588	501(C)(3)	$5,000	OPERATING SUPPORT	205
COMMUNITY DENTAL CLINIC INC
7750 W 200 SOUTH	TOPEKA	IN	46571	352068053	501(C)(3)	$5,000	OPERATING SUPPORT
GOSHEN INTERFAITH HOSPITALITY NETWORK
105 S 3RD STREET	GOSHEN	IN	46526	351969470	501(C)(3)	$5,000	OPERATING SUPPORT
GREENCROFT COMMUNITIES FOUNDATION INC
PO BOX 819	GOSHEN	IN	46527	237126990	501(C)(3)	$5,000	OPERATING SUPPORT
MDC GOLDENROD
1514 COLLEGE AVENUE	GOSHEN	IN	46526	311205424	501(C)(3)	$5,000	OPERATING SUPPORT
THE WINDOW INC
223 S MAIN STREET	GOSHEN	IN	46526	351427937	501(C)(3)	$5,000	OPERATING SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	24	Total501c3OrgCnt
Total Other Org	1	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 2:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Club Dues Or Fees	Yes (X)	ClubDuesOrFeesInd
Written Policy Ref T And E Expnss	Yes (1)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (1)	SubstantiationRequiredInd
Compensation Committee	Yes (X)	CompensationCommitteeInd
Independent Consultant	Yes (X)	IndependentConsultantInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
Severance Payment	Yes (1)	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	Yes (1)	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (20 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
DANIEL NAFZIGER MD
CHAIR	$0	$63,867	$0	$53,795	$0	$45,115	$0	$14,977	$0	$8,310	$0	$186,064	$0	$0
RANDAL CHRISTOPHEL
PRESIDENT AND CEO	$553,260	$0	$213,735	$0	$15,691	$0	$145,805	$0	$33,215	$0	$961,706	$0	$0	$0
JODY NEER MD
DIRECTOR	$0	$408,116	$0	$29,750	$0	$17,171	$0	$23,881	$0	$34,598	$0	$513,516	$0	$0
MARGARET S FRANGER
VP OF CANCER SERVICES	$291,842	$0	$59,202	$0	$1,296	$0	$58,643	$0	$27,416	$0	$438,399	$0	$0	$0
RICK TARSKE
VP OF GOSHEN PHYSICIANS	$228,658	$0	$39,684	$0	$19,626	$0	$45,879	$0	$12,491	$0	$346,338	$0	$0	$0
ALAN WELDY
VP OF HR AND COMPLIANCE	$370,155	$0	$83,108	$0	$10,020	$0	$63,071	$0	$30,407	$0	$556,761	$0	$0	$0
VLADIMIR RADIVOJEVIC
VP OF SURGICAL SERVICES	$179,981	$0	$37,417	$0	$1,445	$0	$37,936	$0	$31,610	$0	$288,389	$0	$0	$0
MARK PODGORSKI
VP OF HOSPITAL OPERATIONS	$230,158	$0	$45,031	$0	$5,413	$0	$49,788	$0	$21,999	$0	$352,389	$0	$0	$0
PAM KARSEN
VP OF NURSING (UNTIL 3/31/16)	$86,629	$0	$62,225	$0	$2,233	$0	$2,878	$0	$3,306	$0	$157,271	$0	$0	$0
STEVE GARBODEN
VP PLANNING AND MANAGED CARE	$231,072	$0	$45,510	$0	$5,544	$0	$44,428	$0	$26,502	$0	$353,056	$0	$0	$0
AMY FLORIA
CHIEF FINANCIAL OFFICER	$369,430	$0	$76,471	$0	$14,051	$0	$78,920	$0	$22,534	$0	$561,406	$0	$0	$0
LARRY ALLEN MD
CHIEF MEDICAL OFFICER	$363,664	$0	$60,479	$0	$8,268	$0	$59,040	$0	$28,195	$0	$519,646	$0	$0	$0
ROB MYERS
CHIEF OPERATING OFFICER	$281,711	$0	$765	$0	$3,757	$0	$57,278	$0	$27,202	$0	$370,713	$0	$0	$0
JULIE CROSSLEY
CHIEF NURSING OFFICER	$161,673	$0	$500	$0	$893	$0	$27,672	$0	$17,641	$0	$208,379	$0	$0	$0
DANIEL BRUETMAN MD
PHYSICIAN	$493,075	$0	$57,434	$0	$0	$0	$46,805	$0	$35,327	$0	$632,641	$0	$0	$0
HUBERT FORNALIK MD
PHYSICIAN	$559,042	$0	$66,417	$0	$0	$0	$28,805	$0	$848	$0	$655,112	$0	$0	$0
LEONARD HENRY MD
PHYSICIAN	$455,835	$0	$64,504	$0	$26,214	$0	$46,805	$0	$31,126	$0	$624,484	$0	$0	$0
EBENEZER KIO MD
PHYSICIAN	$530,357	$0	$42,580	$0	$0	$0	$46,805	$0	$34,376	$0	$654,118	$0	$0	$0
RODERICH SCHWARZ MD
PHYSICIAN	$534,447	$0	$60,252	$0	$0	$0	$44,687	$0	$27,130	$0	$666,516	$0	$0	$0
RANDALL CAMMENGA MD
CHIEF OPERATING OFCR.(UNTIL 8/28/15)	$0	$0	$0	$0	$288,871	$0	$0	$0	$0	$0	$288,871	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART I, LINE 1A

TAX INDEMNIFICATION AND GROSS-UP PAYMENTS GOSHEN HOSPITAL ASSOCIATION GROSSED UP THE TAXABLE VALUE OF AUTOMOBILES FOR 3 OF THE OFFICERS LISTED IN FORM 990, PART VII AND INCLUDED THE AMOUNT IN THE EMPLOYEES' W-2 AS ADDITIONAL COMPENSATION. HEALTH OR SOCIAL CLUB DUES GOSHEN HOSPITAL ASSOCIATION PAID FOR COUNTRY CLUB DUES FOR 4 OF THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES LISTED IN FORM 990, PART VII. ALL REIMBURSEMENTS ARE CONSIDERED TAXABLE INCOME TO THE EMPLOYEES.

PART I, LINES 4A-B

AS PER OUR EMPLOYMENT AGREEMENT, UPON QUALIFYING TERMINATION DEFINED AS AN INVOLUNTARY SEPARATION FROM SERVICE OTHER THAN FOR CAUSE, THE EMPLOYEE IS ENTITLED TO SEVERANCE PAY BASED UPON YEARS OF SERVICE. THE TERMS AND CONDITIONS TO RECIEVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM GOSHEN HOSPITAL ASSOCIATION. THE FOLLOWING INDIVIDUALS RECIEVED SEVERANCE PAYMENTS IN 2016 THAT WERE TREATED AS TAXABLE AND INCLUDED IN SCHEDULE J, PART II, COLUMN (B)(III): RANDALL CAMMENGA $272,149 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 INDIVDUALS PARTICIPATE IN THE PLAN: RANDAL CHRISTOPHEL LARRY ALLEN AMY FLORIA MARK PODGORSKI ALAN WELDY ROB MYERS JULIE CROSSLEY MARGARET FRANGE VLADIMIR RADIVOJEVIC RICHARD TARSKE THE FOLLOWING INDIVIDUALS RECIEVED NONQUALIFIED PLAN PAYMENTS IN 2016 THAT ARE INCLUDED AS TAXABLE INCOME IN SCHEDULE J, PART II, COLUMN (B)(III): RICHARD TARSKE - 13,290

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

Field	Value	IRS element (for citing)
Person	JODY NEER MD	PersonNm
Relationship With Org	TRUSTEE	RelationshipWithOrgTxt
Loan Purpose	MISCELLANEOUS	LoanPurposeTxt
Loan From Organization	Yes (X)	LoanFromOrganizationInd
Original Principal	$75,000	OriginalPrincipalAmt
Balance Due	$55,000	BalanceDueAmt
Default	0	DefaultInd
Board Or Committee Approval	Yes (1)	BoardOrCommitteeApprovalInd
Written Agreement	Yes (1)	WrittenAgreementInd

Field	Value	IRS element (for citing)
Total Balance Due	$55,000	TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART III, LINE 4A	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. BUILDING UPON OUR MISSION AND VALUES, GOSHEN HOSPITAL 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 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. 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 123 PATIENT BEDS AND OVER 137 PHYSICIANS ON ITS MEDICAL STAFF IN NEARLY 25 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. GOSHEN HOSPITAL HAS CONSISTENTLY MET NATIONAL QUALITY STANDARDS. THE HOSPITAL COMPOSITE SCORES FOR PUBLICLY REPORTED QUALITY MEASURES IN THE AREAS OF ACUTE MYOCARDIAL INFARTCTION, PNEUMONIA, HEART FAILURE, SURGICAL CARE IMPROVEMENT PROJECT, AND HOSPITAL OUTPATIENT EXCEEDED 95% IN 2013. IN ADDITION, HEALTHCARE EXCEL (QUALITY IMPROVEMENT ORGANIZATION FOR INDIANA) REPORTED THAT THE HOSPITAL WAS ABOVE OUR PEER GROUP AND OVERALL STATE PERFORMANCE IN 17 OUT OF 19 AREAS OF OUR PUBLICLY REPORTED MEASURES FOR CY 2013. THE AMERICAN NURSES CREDENTIALING CENTER'S (ANCC) MAGNET RECOGNITION PROGRAM FOR EXCELLENCE IN NURSING SERVICES HAS DESIGNATED GOSHEN HOSPITAL AS A MAGNET HOSPITAL. DESIGNATED HOSPITALS HAVE SUCCESSFULLY CREATED A WORK ENVIRONMENT THAT NURSES FIND BOTH PERSONALLY AND PROFESSIONALLY REWARDING, ADVANCING THE PRACTICE OF NURSING AND IMPROVING PATIENT OUTCOMES. RESEARCH SHOWS THAT MAGNET HOSPITALS ARE MORE EFFECTIVE AT ATTRACTING AND KEEPING QUALITY NURSES. GOSHEN HOSPITAL IS AMONG AN ELITE GROUP OF ONLY 7% OF HOSPITALS IN THE NATION TO BE RE-DESIGNATED AS A MAGNET FACILITY AND THE ONLY FACILITY IN THE REGION. THE GOSHEN CENTER FOR CANCER CARE IS ACCREDITED BY THE COMMISSION ON CANCER OF THE AMERICAN COLLEGE OF SURGEONS (COC). RECEIVING CARE AT A COC-APPROVED CENTER FOR CANCER CARE ASSURES THAT PATIENTS WILL HAVE ACCESS TO: -QUALITY CARE CLOSE TO HOME. -COMPREHENSIVE CARE OFFERING A RANGE OF STATE-OF-THE ART SERVICES AND EQUIPMENT. -A MULTIDISCIPLINARY TEAM APPROACH TO COORDINATE THE BEST TREATMENT OPTIONS AVAILABLE TO CANCER PATIENTS. -PARTICIPATION IN CANCER CLINICAL TRIALS, EDUCATION AND SUPPORT. -LIFELONG PATIENT FOLLOW-UP THROUGH A CANCER REGISTRY THAT COLLECTS DATA ON TYPE AND STAGE OF CANCERS AND TREATMENT RESULTS. -ONGOING MONITORING AND IMPROVEMENT IN CARE. THE CENTER FOR CANCER CARE IS A LEADER IN INNOVATIVE CANCER TREATMENT. WE WERE AMONG THE FIRST TO ADOPT A COMPREHENSIVE, MULTIDISCIPLINARY APPROACH TO CANCER TREATMENT. WE OFFER HOLISTIC PROGRAMS FOR STRENGTHENING MINDS AS WELL AS BODIES, PLACE A PREMIUM ON FAMILY INVOLVEMENT AND SPIRITUAL NEEDS, AND ENCOURAGE PATIENTS TO PLAY A DECISION-MAKING ROLE IN TREATMENT SELECTION. THE CENTER FOR CANCER CARE HAS SPECIFICALLY TRAINED SURGICAL ONCOLOGISTS, A BREAST SURGEON, 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 FIREFIGHTERS. THE DIABETES EDUCATION HELPS PEOPLE DELAY THE ONSET AND SLOW THE PROGRESSION OF COMPLICATIONS FROM THIS DISEASE. IT INCLUDES SEMINARS, SUPPORT GROUPS, CONSULTATIONS AND SCREENINGS. CHILDBIRTH EDUCATION PREPARES EXPECTANT MOTHERS AND THEIR FAMILIES DURING THIS SIGNIFICANT TIME IN THEIR LIFE. CLASSES REVIEW MANY ASPECTS OF CHILDBIRTH INCLUDING LABOR REHEARSAL, CESAREAN DELIVERIES, SINGLE-TEEN ISSUES, BREAST FEEDING AND A CLASS JUST FOR SIBLINGS. IN ADDITION TO VARIOUS COMMUNITY WELLNESS AND EDUCATION PROGRAMS, GOSHEN HOSPITAL PROVIDES A FULL-SERVICE RESOURCE FOR COMPREHENSIVE HEALTH INFORMATION AND ASSISTANCE. NURSE ON CALL (NOC) IS A FULL-SERVICE, MULTI-LINGUAL HEALTH INFORMATION, REFERRAL AND NURSE TRIAGE TELEPHONE SERVICE AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK. NOC IS STAFFED BY SPECIALLY TRAINED, KNOWLEDGEABLE AND EXPERIENCED REGISTRED NURSES. THIS FREE SERVICE PROVIDES MEDICAL GUIDANCE WHEN SICK OR INJURED, INFORMATION FOR PHYSICIANS IN THE AREA, REFERRALS TO COMMUNITY RESOURCES AND REGISTRATION FOR CLASSES AND EVENTS. THE GOSHEN HEALTH COMMUNITY BENEFIT FUND IS ONE EXAMPLE OF HOW GOSHEN HEALTH RE-INVESTS MONEY INTO THE COMMUNITIES WE SERVE. 2016 MARKS THE 18TH ANNIVERSARY OF THE HEALTH SYSTEM'S COMMITMENT. 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 $5.4 MILLION IN GRANTS TO COMMUNITY ORGANIZATIONS AND PROJECTS THAT MEET THE HEALTH NEEDS OF OUR COMMUNITY. IN 2016, THE COMMUNITY BENEFIT FUND GRANT COMMITTEE AWARDED $361,150 TO 39 DIFFERENT ORGANIZATIONS IN GOSHEN AND SURROUNDING COMMUNITIES. ALSO, $24,590 IN MATCHING GIFTS WAS DISTRIBUTED TO THE 2015 GRANT RECIPIENTS. ADDITIONALLY, FUNDS WERE DESIGNATED TO HELP CREATE THE NEW SITE FOR MAPLE CITY HEALTH CARE CENTER AS WELL AS TO FUND PILOT PROGRAMS LOCALLY IN TELEHEALTH. EVERY YEAR THE BOARD OF DIRECTORS OF GOSHEN HEALTH DESIGNATES A PERCENTAGE OF THE PREVIOUS YEAR'S OPERATIONAL BUDGET FOR THE HOSPITAL'S COMMUNITY BENEFIT FUND, THROUGH WHICH GRANTS ARE AWARDED EACH SPRING. GOSHEN HOSPITAL PROVIDES HEALTH CARE SERVICES TO ALL MEMBERS OF THE COMMUNITIES REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFERS 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 STAT 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 2016, THE HOSPITAL EXTENDED CHARITY CARE TO 7,270 ACCOUNTS TOTALING $6.8 MILLION. GOSHEN HOSPITAL ALSO PARTNERS WITH A LOCAL INSTITUTION TO PROVIDE FLEXIBLE AND AFFORDABLE FINANCING SOLUTION FOR A PATIENT'S MEDICAL CARE. GOSHEN HEALTH RECEIVED THE BEACON AWARD FOR EXCELLENCE FROM THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES. THIS IS THE SECOND TIME GOSHEN HEALTH HAS WON THE AWARD AND IS ONLY ONE OF TWO IN THE STATE TO BE A RECIPIENT. GOSHEN IS THE ONLY HOSPITAL IN THE REGION TO HAVE RECEIVED THIS, AND SECOND IN INDIANA TO HAVE ACHIEVED THE HIGHEST STATUS, GOLD. GOSHEN HOSPITAL HAS BEEN NAMED AN ACCREDITED HEART FAILURE INSTITUTE BY THE NATIONAL HEALTHCARE ADDREDITATION COLLOQUIUM. THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC) HAS AWARDED THREE-YEAR, FULL ACCREDITATION TO GOSHEN HEALTH RETREAT WOMEN'S HEALTH CENTER.
PART III, LINE 4A CONTINUED	PRESS GANEY HAS AWARDED GOSHEN HEALTH WITH 7 SUMMIT AWARDS. THE FOLLOWING ACHIEVEMENTS WERE AWARDED IN 2014: NCDR ACTION REGISTRY GWTG PLATINUM PERFORMANCE ACHIEVEMENT AWARD; THE CENTER OF DISTINCTION AWARD AND THE ROBERT A. WARRINER III, M.D., CENTER OF EXCELLENCE AWARD WAS GIVEN TO GOSHEN HEALTH WOUND CENTER BY HEALOGICS, INC.; GOSHEN HOSPITAL RECEIVED ACCREDITATION FROM THE INTERSOCIETAL ACCREDITATION COMMISSION (IAC) FOR FOUR TESTING AREAS; 2014 PRESS GANEY GUARDIAN OF EXCELLENCE AWARD WINNER FOR GOSHEN HEALTH BY REACHNG THE 95TH PERCENTILE FOR EACH REPORTING PERIOD FOR THE AWARD YEAR FOR EMPLOYEE ENGAGEMENT; OUTSTANDING ACHIEVEMENT AWARD FROM THE COMMION ON CANCER (COC) OF THE AMERCIAN COLLEGE OF SURGEONS (ACOS). IN ADDITION, GOSHEN HEALTH HAS RECEIVED THE H&V PLATINUM PERFORMANCE ACHIEVEMENT AWARD (NCDR) IN 2015 AND 2016, MAKING IT THE FOURTH YEAR IN A ROW TO RECEIVE THIS ACHIEVEMENT. THE ORGANIZATION ALSO RECEIVED THE WHO-BABY-FRIENDLY DESIGNATION AND WAS REPORTED IN THE US NEWS TOP 5 HOSPITALS IN INDIANA IN 2015.
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, AND ALAN WELDY.
FORM 990, PART VI, SECTION A, LINE 6	GOSHEN HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF GOSHEN HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7A	GOSHEN HEALTH SYSTEM, INC. AS THE SOLE MEMBER OF GOSHEN HOSPITAL HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF THE HOSPITAL.
FORM 990, PART VI, SECTION A, LINE 7B	ITEMS THAT REQUIRE APPROVAL OF GOSHEN HEALTH INCLUDE ANY AMMENDMENT OF THE OPERATING AGREEMENT, DISSOLUTION OF THE ORGANIZATION OR THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINE 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.
FORM 990, PART XI, LINE 9:	INTEREST RATE SWAP -44,780. EQUITY TRANSFER -17,975,597.

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (2 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Total IncomeTotalIncomeAmt	End Of Year AssetsEndOfYearAssetsAmt	Direct Controlling NADirectControllingNACd
INDIANA LAKES MANAGED CARE ORG LLC
200 HIGH PARK AVENUE	GOSHEN	IN	46526	351946663	HEALTHCARE	IN	$54,067	$227,283	N/A
INDIANA LAKES ACCOUNTABLE CARE ORG LLC
200 HIGH PARK AVENUE	GOSHEN	IN	46526	455450141	HEALTHCARE	IN	$238,764	$25,274	N/A

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (46 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	Direct Controlling NADirectControllingNACd
CLARIAN TRANSPLANT INSTITUTE INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	134350599	HEALTHCARE	IN	501(C)(3)	LINE 9	IUH	0
GOSHEN HEALTH SYSTEM INC
200 HIGH PARK AVE	GOSHEN	IN	46526	351974765	HEALTHCARE	IN	501(C)(3)	LINE 12C, III-FI	IUH	0
HEALTHLINC INCORPORATED
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	263571507	HEALTHCARE	IN	501(C)(3)	LINE 9	IHB	0
INDIANA HEALTH INFO EXCHANGE INC
846 N SENATE AVE	INDIANAPOLIS	IN	46202	364550324	HEALTHCARE	IN	501(C)(3)	LINE 12A, I		0	N/A
INDIANA RADIOLOGY PARTNERS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	201017034	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
INDIANA UNIVERSITY HEALTH INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351955872	HEALTHCARE	IN	501(C)(3)	LINE 3		0	N/A
IU HEALTH ARNETT FOUNDATION INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	356079797	FUNDRAISING	IN	501(C)(3)	LINE 12A, I	IUHA	0
IU HEALTH ARNETT INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	263162145	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH BALL MEMORIAL HOSPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	350867958	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH BALL MEMORIAL PHYSICIANS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	ID	46204	351925641	HEALTHCARE	IN	501(C)(3)	LINE 9	IUHBMH	0
IU HEALTH BEDFORD INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	237042323	HEALTHCARE	IN		LINE 3	IUH	0
IU HEALTH BLACKFORD HOSPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	010646166	HEALTHCARE	IN	501(C)(3)	LINE 3	IUHBMH	0
IU HEALTH BLOOMINGTON INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351720796	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH BMH FOUNDATION INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	311111784	FUNDRAISING	IN	501(C)(3)	LINE 12A, I	IUHBMH	0
IU HEALTH CARE ASSOCIATES INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351747218	HEALTHCARE	IN	501(C)(3)	LINE 9	IUH	0
IU HEALTH GOSHEN FOUNDATION INC
200 HIGH PARK AVE	GOSHEN	IN	46526	462565300	FUNDRAISING	IN	501(C)(3)	LINE 7	GHS	0
IU HEALTH LAPORTE HOSPITAL INC
PO BOX 250	LAPORTE	IN	46352	351125434	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH LAPORTE PHYSICIANS INC
PO BOX 250	LAPORTE	IN	46352	311070868	HEALTHCARE	IN	501(C)(3)	LINE 3	IUHLH	0
IU HEALTH MORGAN INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	273533027	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH NORTH HOSPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351932442	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH PAOLI HOSP FOUNDATION INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	310992486	FUNDRAISING	IN	501(C)(3)	LINE 9	IUHP	0
IU HEALTH PAOLI INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	352090919	HEALTHCARE	IN	501(C)(3)	LINE 3	IUHB	0
IU HEALTH PLANS NFP INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	463803873	INSURANCE	IN	501(C)(4)		IUH	0
IU HEALTH TIPTON HOSPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	262772226	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH WEST HOSPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351814660	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU HEALTH WHITE MEM HOSP FNDTN INC
PO BOX 952	MONTICELLO	IN	47960	351671806	FUNDRAISING	IN	501(C)(3)	LINE 12C, III-FI	IUHWMH	0
IU HEALTH WHITE MEMORIAL HOSPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	273532963	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
IU MEDICAL GROUP FOUNDATION INC
340 W 10TH ST NO FS5100	INDIANAPOLIS	IN	46202	201093251	FUNDRAISING	IN	501(C)(3)	LINE 12B, II		0	N/A
LAPORTE HOSPITAL FOUNDATION INC
PO BOX 250	LAPORTE	IN	46352	310952775	FUNDRAISING	IN	501(C)(3)	LINE 12A, I		0	N/A
MDWISE MARKETPLACE INC
1200 MADISON AVE	INDIANAPOLIS	IN	46225	465270582	INSURANCE	IN	501(C)(4)		IUH	0
MDWISE NETWORK INC
1200 MADISON AVE	INDIANAPOLIS	IN	46225	472619552	INSURANCE	IN	501(C)(4)		IUH	0
METHODIST HEALTH FOUNDATION INC
1800 N CAPITAL AVE	INDIANAPOLIS	IN	46202	356043086	FUNDRAISING	IN	501(C)(3)	LINE 12A, I	IUH	0
METHODIST HEALTH GROUP INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	350876390	HEALTHCARE	IN	501(C)(3)	LINE 12C, III-FI		0	N/A
METHODIST MEDICAL GROUP INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351945384	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
METHODIST OCCUP HEALTH CENTERS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351844176	HEALTHCARE	IN	501(C)(3)	LINE 3	IUH	0
METHODIST RESEARCH INSTITUTE INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	352023710	HEALTHCARE	IN	501(C)(3)	LINE 12A, I	IUH	0
MH HEALTHCARE INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351766531	HEALTHCARE	IN	501(C)(3)	LINE 3	MMG	0
MORGAN CO MEM HOSP FOUNDATION INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	352035162	FUNDRAISING	IN	501(C)(3)	LINE 12B, II	IUHMH	0
MORGAN CO MEM HOSP GUILD INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	310886844	FUNDRAISING	IN	501(C)(3)	LINE 12C, III-FI	IUHMH	0
MORGAN HEALTH SERVICES INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351968564	HEALTHCARE	IN	501(C)(3)	LINE 3	IUHMH	0
REHABILITATION HOSPITAL OF INDIANA INC
4141 SHORE DR	INDIANAPOLIS	IN	46254	351786005	HEALTHCARE	IN	501(C)(3)	LINE 3	MHH	0
RHI FOUNDATION INC
4141 SHORE DR	INDIANAPOLIS	IN	46254	351932349	FUNDRAISING	IN	501(C)(3)	LINE 12B, II	RHI	0
THE CHEER GUILD OF RILEY HOS FOR CHILD
705 RILEY HOSPITAL DR	INDIANAPOLIS	IN	46202	356018517	FUNDRAISING	IN	501(C)(3)	LINE 12C, III-FI		0	N/A
TIPTON CO HEALTH CARE FOUNDATION INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	311231905	FUNDRAISING	IN	501(C)(3)	LINE 12A, I	IUHTH	0
UNIVERSITY FAMILY PHYSICIANS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	237427350	HEALTHCARE	IN	501(C)(3)	LINE 9	IUHCA	0
GOSHEN HOSPITAL WOMENS AUXILIARY
200 HIGH PARK AVE	GOSHEN	IN	46526	237017521	HEALTHCARE	IN	501(C)(3)	LINE 12D, III-O		0	N/A

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (23 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Disproportionate AllocationsDisproportionateAllocationsInd	General Or Managing PartnerGeneralOrManagingPartnerInd
BALL OUTPATIENT SURGERY CENTER LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	270275794	HEALTHCARE	IN	0	0
BELTWAY SURGERY CENTERS LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	352072586	HEALTHCARE	IN	0	0
BLOOMINGTON ENDOSCOPY CENTER LLC
PO BOX 550	BLOOMINGTON	IN	47402	352117943	HEALTHCARE	IN	0	0
BOSC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	454147343	HEALTHCARE	IN	0	0
BSC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	452314634	HEALTHCARE	IN	0	0
CHV FUND I LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	262523206	VENTURE CAPITAL	IN	0	0
CHV FUND II MANAGEMENT LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	371717823	VENTURE CAPITAL	IN	0	0
CHV FUND II LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	800902337	VENTURE CAPITAL	IN	0	0
CHV FUND MANAGEMENT LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	262523151	VENTURE CAPITAL	IN	0	0
CLARIAN HEALTH NETWORK LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	352055030	HEALTHCARE	IN	0	0
EAGLE HIGHLANDS SURGERY CENTER LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	352259204	HEALTHCARE	IN	0	0
EHSC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	454147879	HEALTHCARE	IN	0	0
EWASC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	473087761	HEALTHCARE	IN	0	0
HEALTH VENTURE MANAGEMENT LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	205740218	MANAGEMENT	IN	0	0
IEC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	454148032	HEALTHCARE	IN	0	0
INDIANA ENDOSCOPY CENTERS LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	208398421	HEALTHCARE	IN	0	0
IU HEALTH EWA SURGERY CENTER LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	473102482	HEALTHCARE	IN	0	0
IU HEALTH SAXONY SURGERY CENTER LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	275271091	HEALTHCARE	IN	0	0
ROC SURGERY LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	271497960	HEALTHCARE	IN	0	0
ROCS HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	454148369	HEALTHCARE	IN	0	0
SENATE STREET SURGERY CENTER LLC
569 BROOKWOOD VILLAGE STE 901	BIRMINGHAM	AL	35209	421709357	HEALTHCARE	IN	0	0
SSC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	464472887	HEALTHCARE	IN	0	0
SSSC HOLDINGS LLC
950 N MERIDIAN STSTE 800	INDIANAPOLIS	IN	46204	454148167	HEALTHCARE	IN	0	0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (22 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Controlled OrganizationControlledOrganizationInd	Address Line1ForeignAddress/AddressLine1Txt	Province Or StateForeignAddress/ProvinceOrStateNm	CountryForeignAddress/CountryCd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct
BMH MEDICAL PAVILION ASSOCIATION INC
2525 W UNIVERSITY AVE	MUNCIE	IN	47303	351858408	CONDO MANAGEMENT	IN	0
CARDINAL HEALTH VENTURES INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	351611424	MANAGEMENT	IN	0
CHV CAPITAL INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	260752507	VENTURE CAPITAL	IN	0
IU HEALTH 457(B) PLAN
1100 N MARKET ST	WILMINGTON	DE	19890	476948347	INVESTMENTS	IN	0
IU HEALTH ACO INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	454421020	HEALTHCARE	IN	0
IU HEALTH BOARD DESIGNATED TRUST
400 HOWARD ST	SAN FRANCISCO	CA	94105	306309021	INVESTMENTS	IN	0
IU HEALTH NTGI S&P500 FUND CF
PO BOX 804358	CHICAGO	IL	60680	306298263	INVESTMENTS	IN	0
IU HEALTH PLANS HOLDING COMPANY INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	463794815	INSURANCE	IN	0
IU HELATH PLANS NFP INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	463803873	INSURANCE	IN	0
IU HEALTH PLANS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	262127080	HMO	IN	0
IU HEALTH RISK PURCHASING GROUP INC
151 MEETING ST STE 301	CHARLESTON	SC	29401	260202446	INSURANCE	IN	0
IU HEALTH RISK RETENTION GROUP INC
151 MEETING ST STE 301	CHARLESTON	SC	29401	201107674	INSURANCE	SC	0
IU HEALTH SOUTHERN IN PHYSICIANS INC
PO BOX 1149	BLOOMINGTON	IN	47402	351913875	HEALTHCARE	IN	0
IUH ASSURANCE SPC LTD
				980395429	INSURANCE		0	PO BOX 69 94 SOLARIS AVE	GRAND CAYMAN	CJ	CJ
OCC-HEALTH REVENUE SYSTEMS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	203308057	WORK COMP PPO	IN	0
PARKMOR DRUG INC AND SUBSIDIARIES
1501 S MAIN ST	GOSHEN	IN	46526	131394980	PHARMACY SALES	IN	Yes (1)					GHS	$465,688	$3,979,020	1.00000
PROTEUO FUND LP
				981075227	INVESTMENTS		0	PO BOX 31106 89 NEXUS WAY	GRAND CAYMAN	CJ	CJ
RADIATION ONCOLOGY RESOURCES INC
200 HIGH PARK AVE	GOSHEN	IN	46526	262008424	HEALTHCARE	IN	0					GHS			1.00000
SCANS INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	453080392	HEALTHCARE	IN	0
UNIV HLTH (SHANGHAI) MGT CON CO LTD
					MANAGEMENT		0	88 CENTURY AVE	SHANGHAI	CH	CH
UNIVERSITY HELATH MANAGEMENT INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	272891143	MANAGEMENT	IN	0
UNIVERSITY HEALTH MGMT (CHINA) INC
950 N MERIDIAN ST STE 800	INDIANAPOLIS	IN	46204	273891311	MANAGEMENT	IN	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	Yes (1)	TransferToOtherOrgInd
Transfer From Other Org	0	TransferFromOtherOrgInd