2016-11-15T13:50:31-06:00 2015-12-31 861065772 DELOITTE TAX LLP 111 MONUMENT CIRCLE SUITE 4200 INDIANAPOLIS IN 462045108 990 2015-01-01 356001540 GOSHEN HOSPITAL ASSOCIATION INC GOSH 5743642665 200 HIGH PARK AVENUE GOSHEN IN 46526 AMY FLORIA CFO 5743642665 2016-11-15 1 SHAWNA M JIMENEZ P01222873 3174648600 2015 2017-02-10 21:41:12Z IU HEALTH GOSHEN HOSPITAL AMY FLORIA 200 HIGH PARK AVENUE GOSHEN IN 46526 228300859 0 X WWW.IUHEALTH.ORG/GOSHEN X 1946 IN TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES. 12 9 1553 370 -38560 -38560 972913 483910 214342899 215474240 6361131 4471536 6869727 7871173 228546670 228300859 269870 699113 0 0 80717595 90139382 0 0 0 110933350 107134955 191920815 197973450 36625855 30327409 318785001 334905201 53785347 49391038 264999654 285514163 X THE MISSION OF IU HEALTH GOSHEN HOSPITAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITIES BY PROVIDING INNOVATIVE, OUTSTANDING CARE AND SERVICES, THROUGH EXCEPTIONAL PEOPLE DOING EXCEPTIONAL WORK. 0 0 163531710 699113 222249945 IU HEALTH 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.THE MISSION OF IU HEALTH 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, IU HEALTH 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, IU HEALTH 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 INNOVATIVE 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.IU HEALTH GOSHEN HOSPITAL HAS CONSISTENTLY MET NATIONAL QUALITY STANDARDS. THE HOSPITAL COMPOSITE SCORES FOR PUBLICLY REPORTED QUALITY MEASURES IN THE AREAS OF ACUTE MYOCARDIAL INFARCTION, PNEUMONIA, HEART FAILURE, SURGICAL CARE IMPROVEMENT PROJECT, AND HOSPITAL OUTPATIENT EXCEED 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 IU HEALTH 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. IU HEALTH 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 SPECIALLY TRAINED SURGICAL ONCOLOGISTS, A BREAST SURGEON, MEDICAL ONCOLOGIST, A RADIATION ONCOLOGIST, NATUROPATHIC PRACTITIONERS AND HIGHLY DISTINGUISHED MAGNET DESIGNATED NURSES.IU HEALTH 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 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, IU HEALTH 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 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. THE IU HEALTH GOSHEN COMMUNITY BENEFIT FUND IS ONE EXAMPLE OF HOW IU HEALTH GOSHEN 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 IU HEALTH GOSHEN AND WORKS TOWARD MEETING THE NEEDS OF THE COMMUNITY ARE ENCOURAGED TO APPLY. SINCE ITS INCEPTION IN 1998, THE CHARITABLE GIVING COMMITTEE OF THE BOARD OF DIRECTORS HAS AWARDED MORE THAN $4.25 MILLION IN GRANTS TO COMMUNITY ORGANIZATIONS AND PROJECTS THAT MEET THE HEALTH NEEDS OF OUR COMMUNITY. IN 2015, THE COMMUNITY BENEFIT FUND GRANT COMMITTEE AWARDED $300,600 TO MORE THAN 58 DIFFERENT ORGANIZATIONS IN GOSHEN AND SURROUNDING COMMUNITIES. ALSO, $19,343 IN MATCHING GIFTS WAS DISTRIBUTED TO THE 2014 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 IU HEALTH GOSHEN DESIGNATES A PERCENTAGE OF THE PREVIOUS YEAR'S OPERATIONAL BUDGET FOR THE HOSPITAL'S COMMUNITY BENEFIT FUND, THROUGH WHICH GRANTS ARE AWARDED EACH SPRING.IU HEALTH GOSHEN HOSPITAL PROVIDES HEALTH CARE SERVICES TO ALL MEMBERS OF THE COMMUNITIES REGARDLESS OF THEIR ABILITY TO PAY. THE HOSPITAL OFFERS FINANCIAL ASSISTANCE TO THOSE PATIENTS UNABLE TO PAY ALL OR A PORTION OF THEIR BILL AND WHO ARE UNABLE TO QUALIFY FOR ASSISTANCE THROUGH FEDERAL AND STATE GOVERNMENT ASSISTANCE PROGRAMS. PATIENTS ARE ASKED TO COMPLETE A FINANCIAL AID APPLICATION TO DETERMINE THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. THE HOSPITAL PROVIDES THE ASSISTANCE OF A FINANCIAL ADVOCATE TO HELP PATIENTS COMPLETE THIS APPLICATION AND TO INVESTIGATE OTHER FORMS OF AVAILABLE ASSISTANCE INCLUDING ENROLLMENT IN MARKETPLACE PLANS. IN 2015, THE HOSPITAL EXTENDED CHARITY CARE TO 7,848 ACCOUNTS TOTALING $8.9 MILLION. IU HEALTH GOSHEN HOSPITAL ALSO PARTNERS WITH A LOCAL FINANCIAL INSTITUTION TO PROVIDE A FLEXIBLE AND AFFORDABLE FINANCING SOLUTION FOR A PATIENT'S MEDICAL CARE.IU HEALTH GOSHEN RECEIVED THE BEACON AWARD FOR EXCELLENCE FROM THE AMERICAN ASSOCIATION OF CRITICAL CARE NURSES. THIS IS THE SECOND TIME IU HEALTH GOSHEN HAS WON THE AWARD AND IS ONLY ONE OF TWO IN THE STATE TO BE A RECIPIENT.IU HEALTH GOSHEN HOSPITAL HAS BEEN NAMED AN ACCREDITED HEART FAILURE INSTITUTE BY THE NATIONAL HEALTHCARE ACCREDITATION COLLOQUIUM.THE NATIONAL ACCREDITATION PROGRAM FOR BREAST CENTERS (NAPBC) HAS AWARDED THREE-YEAR, FULL ACCREDITATION TO IU HEALTH GOSHEN RETREAT WOMEN'S HEALTH CENTER.PRESS GANEY HAS AWARDED IU HEALTH GOSHEN WITH 7 SUMMIT AWARDS.THE FOLLOWING ACHIEVEMENTS W 163531710 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 152 0 1 1553 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 IN X DIRECTOR OF FINANCE 5743642665 200 HIGH PARK AVE GOSHEN IN 46526 GEORGE KIM MD DIRECTOR 1.00 0.00 X 0 0 0 MARTHA SUZIE YEAGER DIRECTOR 1.00 0.00 X 0 0 0 VERNITA TODD DIRECTOR 1.00 0.00 X 0 0 0 RANDY CRIPE TREASURER 1.00 0.00 X X 0 0 0 BRENDA SROF DIRECTOR 1.00 0.00 X 0 0 0 KAREN SMITH DIRECTOR 1.00 0.00 X 0 0 0 KAREN PLETCHER DIRECTOR 1.00 0.00 X 0 0 0 LINDA BAXLEY CHAIR 1.00 0.00 X X 0 0 0 SUSAN STIFFNEY RN DIRECTOR 1.00 0.00 X 0 0 0 JODY NEER MD DIRECTOR 1.00 40.00 X 0 402256 31732 DANIEL NAFZIGER MD VICE CHAIR 1.00 40.00 X X 0 152724 13461 RANDAL CHRISTOPHEL PRESIDENT AND CEO 40.00 2.00 X X 733020 0 123565 MARGARET S FRANGER VP OF CANCER SERVICES 40.00 1.00 X 292140 0 47260 RICK TARSKE VP OF GOSHEN PHYSICIANS 40.00 1.00 X 186008 0 30345 ALAN WELDY VP OF HR AND COMPLIANCE 40.00 1.00 X 456271 0 54704 VLADIMIR RADIVOJEVIC VP OF SURGICAL SERVICES 40.00 1.00 X 211480 0 37128 MARK PODGORSKI VP OF HOSPITAL OPERATIONS 40.00 1.00 X 276565 0 43373 PAM KARSEN VP OF NURSING 40.00 1.00 X 328138 0 23538 STEVE GARBODEN VP PLANNING AND MANAGED CARE 40.00 1.00 X 256680 0 30005 AMY FLORIA CFO 40.00 1.00 X 409953 0 49311 RANDALL CAMMENGA MD COO 40.00 1.00 X 620599 0 17174 LARRY ALLEN MD CMO 40.00 1.00 X 377752 0 51381 JOHN LOWDEN SENIOR MEDICAL PHYSICIST 40.00 0.00 X 207864 0 22136 VICTORIA OWENS ASSOCIATE PATHOLOGIST 40.00 0.00 X 242105 0 24924 XI ZEE WANG ASSOCIATE PATHOLOGIST 40.00 0.00 X 284474 0 26706 MIN YAN CHIEF PATHOLOGIST 40.00 0.00 X 387244 0 27092 POOPALASINGHAM POOVENDRAN MD PHYSICIAN 40.00 0.00 X 523556 0 33280 5793849 554980 687115 33 0 1 0 GERIG SURGICAL ASSOCIATES PC 2006 SOUTH MAIN ST GOSHEN IN 46526 ON CALL SERVICES 1077049 PERA MEDIA STRATEGIES 10512 REDMOND RD AUSTIN TX 78739 MARKETING CONSULTING/ADVERTISING 1060382 ADVISORY BOARD PO BOX 79461 BALTIMORE MD 212790461 CONSULTING SERVICES 957134 VARIAN MEDICAL SYSTEMS 70140 NETWORK PLACE CHICAGO IL 606731701 MEDICAL SOFTWARE/EQUIPMENT 852049 ERNST & YOUNG PNC BANK 3712 SOLUTIONS CENTER CHICAGO IL 606773007 AUDITING SERVICES 559322 13 483910 483910 PATIENT CARE 622110 215474240 215474240 215474240 4471536 -38560 4510096 215297 0 215297 215297 215297 FOOD SERVICE REVENUE 722514 880171 880171 FINANCE CHARGES 561000 257622 257622 OTHER ONCOLOGY REV MIS 621500 187985 187985 6330098 6330098 7655876 228300859 222249945 -38560 5605564 699113 699113 4683177 4683177 60700797 42499584 18201213 3791457 2464447 1327010 16656254 10826566 5829688 4307697 2800004 1507693 1550282 1550282 121705 121705 5577 5577 1966344 1966344 3012505 3012505 4008740 4008740 1732832 1732832 396555 396555 473971 473971 1215395 1215395 14161089 14161089 10510368 10510368 1814754 1814754 DRUGS & MED. SUPPLIES 39237986 39237986 0 0 REPAIRS & MAINTENANCE 6784923 6784923 0 0 HOSPITAL ASSESSMENT FEE 3915231 3915231 0 0 UTILITIES 1681213 1681213 0 0 14545485 14545485 197973450 163531710 34441740 0 13010170 14701061 104939 105033 27404884 28697333 2349390 4829951 5144095 3082000 4234630 236243435 129361222 103386767 106882213 163184513 174017852 1432387 1122984 318785001 334905201 19754005 17057640 32709995 31267109 1321347 1066289 53785347 49391038 X 263946742 284714852 1052912 799311 264999654 285514163 318785001 334905201 X 30327409 -8515630 -730651 -566619 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5577 5577 0 PART II-B, LINE 1: LOBBYING EXPENSES REPRESENT THE PORTION OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION THAT IS SPECIFICALLY ALLOCABLE TO LOBBYING. 2988795 3884037 6872832 99626893 39906898 59719995 377005 113748 222334 268419 117574089 89231990 28342099 11678868 11678868 106882213 BOARD DESIGNATED FUNDS 168669726 F CANCER CENTER INVESTMENT 1858055 F LONG TERM INVESTMENTS 3490071 F 174017852 ASSET RETIREMENT OBLIGATION 121103 DEFERRED COMPENSATION 469869 DEFERRED MALPRACTICE 223379 INTEREST RATE SWAP 251938 1066289 1 1 X 1 X 1 X 1 1 1 0 1 1 7848 4089295 4089295 0.02070 7791 24781951 24053003 728948 0.00370 15639 28871246 24053003 4818243 0.02440 33051 834978 66692 768286 0.00390 379 689102 4547 684555 0.00350 32 848206 848206 0.00430 33462 2372286 71239 2301047 0.01170 49101 31243532 24124242 7119290 0.03610 20000 20000 0.00010 510923 510923 0.00260 35795 35795 0.00020 566718 566718 0.00290 1 7955604 1131889 38319512 47991711 -9672199 X 1 1 1 1 IU HEALTH GOSHEN HOSPITAL 200 HIGH PARK AVENUE GOSHEN IN 46526 WWW.IUHEALTH.ORG/GOSHEN 100270430 X X X IU HEALTH GOSHEN HOSPITAL 1 0 0 1 X X X X X X X X X 15 1 0 0 1 X HTTPS://GOSHENHEALTH.COM/PROMO-PAGES/COMMUNITY-NEEDS X 1 15 1 HTTPS://GOSHENHEALTH.COM/PROMO-PAGES/COMMUNITY-NEEDS 0 0 1 X 200.000000000000 400.000000000000 X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X 1 X 0 X X X X 1 X 0 0 IU HEALTH GOSHEN HOSPITAL 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 IU HEALTH GOSHEN HOSPITAL 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.IU HEALTH GOSHEN HOSPITAL 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. IU HEALTH GOSHEN HOSPITAL PART V, SECTION B, LINE 11: THE HEALTH NEEDS LISTED BELOW ACCOUNT FOR 96.6% OF THE HEALTH NEEDS IDENTIFIED BY COMMUNITY RESIDENTS AND SUPPORTED 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/SMOKINGIU HEALTH GOSHEN HOSPITAL CONSIDERED THE FOLLOWING SOURCES OF INFORMATION IN PRIORITIZING THE HEALTH NEEDS THAT IT WOULD ADDRESS: - COMMUNITY PERCEPTIONS - 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, IU HEALTH GOSHEN HAS IDENTIFIED THE FOLLOWING HEALTH NEEDS IN RANK ORDER 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- TOBACCOS USE/SMOKINGNO ACTIONS WERE TAKEN DURING TAX YEAR 2015 TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH IU HEALTH GOSHEN HOSPITAL'S MOST RECENTLY CONDUCTED CHNA. THE SECOND CHNA WAS CONDUCTED AND ADOPTED AT THE END OF TAX YEAR 2015; THEREFORE, THESE HEALTH NEEDS WILL BE ADDRESSED OVER THE NEXT 3 YEARS. THE HOSPITAL DOES NOT INTEND TO ADDRESS ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT. THE HEALTH NEEDS SPECIFICALLY NOT ADDRESSED BY THE HOSPITAL IN ITS PLAN ARE POVERTY, HEALTH LITERACY, AND INJURY/SAFETY. THE HOSPITAL DID NOT TAKE ACTION TO ADDRESS THESE NEEDS AS IT HAS LIMITED FINANCIAL AND OTHER RESOURCES, AND WITH THE COMMUNITY'S INPUT USED ITS RESOURCES TO ADDRESS THE TOP FIVE PRIORITIES.IU HEALTH GOSHEN HOSPITAL DID TAKE THE FOLLOWING ACTIONS DURING TAX YEAR 2015 WITH RESPECT TO ITS PREVIOUSLY CONDUCTED CHNA:HEALTH NEED IDENTIFIED: OBESITY PREVENTION- HELD MONTHLY FITNESS CLASSES (ZUMBA/BOOTCAMPS/EXERCISE CLASSES, WALKING CLUBS). THE NUMBER OF PARTICIPANTS FOR 2015 IS 937.- PROVIDED OBESITY PREVENTION, NUTRITION, AND WEIGHT MANAGEMENT PROGRAMS (HEALTHY STEPS PROGRAM, PREVENTION EDUCATION, NUTRITION EDUCATION CLASSES, STUDENT ATHLETE CONFERENCE, NUTRITION NEWSLETTERS, COOKING PRESENTATIONS). THE NUMBER OF PARTICIPANTS FOR 2015 IS 4,949.- PROVIDED SUPPORT GROUP NUTRITION AND WEIGHT MANAGEMENT PROGRAMS (TEAM BARIATRICS SUPPORT GROUPS, DISORDERED EATING SUPPORT GROUPS). THE NUMBER OF PARTICIPANTS FOR 2015 IS 438.- HELD NUMEROUS OBESITY SCREENINGS (BMI SCREENINGS, HIGH SCHOOL HEALTH SCREENINGS, 4-H FAIR OBESITY SCREENINGS, BODY COMPOSITION SCREENINGS). THE NUMBER OF PARTICIPANTS FOR 2015 IS 330.HEALTH NEED IDENTIFIED: TOBACCO CESSATION- HELD CANCER EDUCATION PROGRAMS (SURVIVOR SPEAKER LUNCHEON, NOONTIME NOSH-COOKING PRESENTATIONS, RELAY FOR LIFE, NEWSLETTERS). THE NUMBER OF PARTICIPANTS FOR 2015 IS 3,945.- PROVIDED SUPPORT GROUPS FOR CANCER AND SMOKING CESSATION. THE NUMBER OF PARTICIPANTS FOR 2015 IS 490.HEALTH NEED IDENTIFIED: DIABETES- PROVIDED DIABETES EDUCATION (EDUCATIONAL CLASSES, DIABETIC FITNESS WORKSHOPS, ADULT DIABETES PREVENTION PROGRAM). THE NUMBER OF PARTICIPANTS FOR 2015 IS 69.- PROVIDED SUPPORT GROUPS FOR DIABETES (DIABETES SUPPORT GROUP, INSULIN RESISTANCE SEMINAR AND SUPPORT GROUPS). THE NUMBER OF PARTICIPANTS FOR 2015 IS 272.- HELD SCREENINGS FOR DIABETES (HUBBARD HILL HEALTH FAIR, ELKHART COUNTY FAIR, VALLEY HEALTH FAIR, WOMEN'S EXPOS, RISK ASSESSMENTS FOR CHILDREN). THE NUMBER OF PARTICIPANTS FOR 2015 IS 359.HEALTH NEED IDENTIFIED: ACCESS TO HEALTHCARE- PROVIDED HEALTH FAIRS ON ACCESS TO HEALTHCARE (HEALTH FAIRS AT HUBBARD HILL, IVY TECH, 4-H ELKHART COUNTY FAIR, CONCORD MALL, WOMEN'S EXPO, AND WORKSITE WELLNESS FAIRS AT LOCAL BUSINESSES, LAGRANGE COUNTY SENIOR EXPO). THE NUMBER OF PARTICIPANTS FOR 2015 IS 528.HEALTH NEED IDENTIFIED: BEHAVIORAL HEALTH- HELD HEALTH FAIRS ON BEHAVIORAL HEALTH (HEALTHY, HAPPY HOLIDAY'S PRESENTATION). NO SPECIFIC ACTIONS WERE TAKEN IN 2015. IU HEALTH GOSHEN HOSPITAL PART V, SECTION B, LINE 13H: FAMILY SIZE IS ANOTHER FACTOR IN DETERMINING DISCOUNTS GRANTED TO PATIENTS. IU HEALTH GOSHEN HOSPITAL: PART V, SECTION B, LINE 16A: THE FAP WAS WIDELY AVAILABLE AT THE FOLLOWING URL: HTTPS://GOSHENHEALTH.COM/GOSHENHOSPITAL/MEDIA/FORMS-AND-APPLICATIONS/FINAL-POLICY-FINANCIAL-ASSISTANCE-CHARITY-CARE-REVISED-07-28-2015-ENGLISH.PDFIU HEALTH GOSHEN HOSPITAL:PART V, SECTION B, LINE 16B: THE FAP APPLICATION FORM WAS WIDELY AVAILABLE AT THE FOLLOWING URL: HTTPS://GOSHENHEALTH.COM/PATIENT-TOOLS/PAY-ONLINE 5 1 - IU HEALTH GOSHEN 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 2018 SOUTH MAIN STREET GOSHEN IN 46526 CLINIC PART I, LINE 6A: GOSHEN HOSPITAL ASSOCIATION, INC. REPORTS COMMUNITY BENEFIT INFORMATION AS PART OF THE INDIANA UNIVERSITY HEALTH, INC. ANNUAL COMMUNITY BENEFIT REPORT (EIN: 35-1955872). 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 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 ASSOCIATION, 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 IU HEALTH GOSHEN: 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, TAKING INTO CONSIDERATION BUSINESS AND ECONOMIC CONDITIONS, 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 FOR UNCOLLECTED PATIENT ACCOUNTS AND THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN ADDITION, INDIANA UNIVERSITY HEALTH GOSHEN 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 COLLECTION POLICIES OF INDIANA UNIVERSITY HEALTH GOSHEN AND, IN CERTAIN CASES, ARE RECLASSIFIED TO CHARITY CARE IF DEEMED TO OTHERWISE MEET FINANCIAL ASSISTANCE POLICIES OF INDIANA UNIVERSITY HEALTH GOSHEN. 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 MONITORED. THIS IS DONE AS PART OF THE HOSPITAL'S MONTHLY CLOSE PROCESS. EXPLANATIONS TO VARIANCES (OR NON-VARIANCES WHEN EXPECTED) ARE RESEARCHED AND PROVIDED BY THE APPROPRIATE PERSONNEL AND REVIEWED WITH MANAGEMENT OF THE HOSPITAL. THE FINANCE DEPARTMENT ALSO CONSIDERS THESE KEY PERFORMANCE INDICATORS WHEN DEVELOPING THEIR ESTIMATES OF CONTRACTUAL ALLOWANCES TO ENSURE RECORDED AMOUNTS APPEAR REASONABLE BASED ON ACTUAL DATA AVAILABLE.FINANCIAL REPRESENTATIVES PREPARE AND UPDATE THE CONTRACTUAL ALLOWANCE MODEL AS A BASIS FOR ALL THIRD PARTY PAYORS BASED ON ACTUAL STATISTICS (E.G. DISCHARGES, DAYS, ETC.) AND ON CURRENT REIMBURSEMENT RATES. THE MODEL ANALYZES PATIENT RECEIVABLES AND CONTRACTUAL ALLOWANCE BY PAYOR AND BY PATIENT STATUS. THE MODEL ESTIMATES THE COLLECTABILITY OF PATIENT ACCOUNTS BASED ON HISTORICAL COLLECTION RATES. FINANCE COLLEAGUES ALSO UPDATE THE MODEL TO ACCOUNT FOR CHANGES IN REIMBURSEMENT RULES. AFTER THE MODEL IS PREPARED, IT IS REVIEWED BY THE 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. IU HEALTH GOSHEN HOSPITAL ALSO PARTNERS WITH A LOCAL FINANCING INSTITUTION TO PROVIDE A FLEXIBLE AND AFFORDING FINANCING SOLUTION. PART VI, LINE 2: AS A COMMUNITY HOSPITAL, IU HEALTH GOSHEN HOSPITAL IS DEDICATED 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.IU HEALTH 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 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, IU HEALTH GOSHEN HOSPITAL PROVIDES A FULL-SERVICE RESOURCE FOR COMPREHENSIVE 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 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 FOR ANY OTHER KNOWN SOURCES OF FINANCIAL ASSISTANCE. ALL REGISTRATION LOCATIONS HAVE FINANCIAL ASSISTANCE FORMS AVAILABLE FOR SELF-PAY PATIENTS TO COMPLETE AND WILL HAVE INFORMATION ON THE CRITERIA AND PROCESS FOR APPLYING FOR FINANCIAL ASSISTANCE. APPLICATIONS ARE ALSO PROVIDED TO ANY PATIENTS WITH A 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 FROM THE WEBSITE. THIS INFORMATION IS AVAILABLE IN ENGLISH AND SPANISH. PART VI, LINE 4: IU HEALTH GOSHEN HOSPITAL SERVES THE NORTHERN INDIANA AREA IN ELKHART COUNTY. ACCORDING TO THE 2015 CENSUS, THE POPULATION OF ELKHART COUNTY IS 203,474. THE MEDIAN INCOME FOR A HOUSEHOLD IN ELKHART COUNTY BASED ON THE 2015 CENSUS IS $46,983. APPROXIMATELY 12.6% OF FAMILIES AND 13.9% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 24.3% OF THOSE UNDER THE AGE 18 AND 6.2% OF THOSE AGE 65 AND OVER. THE RACIAL MAKEUP OF THE COUNTY WAS ABOUT 89.5% WHITE, 6.3% AFRICAN AMERICAN, AND 15.3% HISPANIC OR LATINO. THE REMAINING 4.2% OF THE POPULATION IS A MAKEUP OF ALL OTHER RACES. PART VI, LINE 5: ALL OF THE HOSPITAL'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 PRIVILEGES AS INDICATED IN THE ORGANIZATION'S CREDENTIALING AND PRIVILEGING POLICIES AND AS RECOMMENDED BY THE MEDICAL EXECUTIVE COMMITTEE OF THE HOSPITAL. THE HOSPITAL'S GOVERNING BODY APPROVES THE ANNUAL OPERATING BUDGET FOR THE HOSPITAL AND THE EXPENDITURE OF CAPITAL FUNDS ABOVE CERTAIN DOLLAR AMOUNTS. THE GOVERNING BODY ALSO PARTICIPATES IN STRATEGIC PLANNING INITIATIVES TO DETERMINE GOALS OBJECTIVES FOCUSED ON PATIENT CARE FOR THE COMMUNITY. PART VI, LINE 6: HOSPITAL MANAGEMENT PROVIDES IU HEALTH WITH THE HOSPITAL'S ANNUAL OPERATING BUDGET AND KEY STRATEGIC OBJECTIVES. IN ADDITION, THE HOSPITAL MANAGEMENT PROVIDES IU HEALTH WITH VARIOUS KEY METRICS INVOLVING PATIENT SATISFACTION, PATIENT QUALITY AND COLLEAGUE SATISFACTION. IU HEALTH 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 1 MAPLE CITY HEALTH CARE CENTER 213 MIDDLEBURY STREET GOSHEN IN 46528 351749398 501(C)(3) 395000 OPERATING SUPPORT THE HORIZON EDUCATION ALLIANCE 124 E WASHINGTON STREET GOSHEN IN 46528 460803293 501(C)(3) 30000 OPERATING SUPPORT UNITED CANCER SERVICES ELKHART COUNTY 23971 US HIGHWAY 33 ELKHART IN 46530 351091429 501(C)(3) 20407 OPERATING SUPPORT BOYS & GIRLS CLUBS ELKHART COUNTY 102 WEST LINCOLN SUITE 240 GOSHEN IN 46526 351033735 501(C)(3) 20000 OPERATING SUPPORT CARE FOUNDATION INC 64468 MEADOW RIDGE DRIVE GOSHEN IN 46526 352111562 501(C)(3) 16000 OPERATING SUPPORT NORTHERN INDIANA HISPANIC HEALTH COALITION 444 N NAPPANEE STREET ELKHART IN 46514 320039221 501(C)(3) 15000 OPERATING SUPPORT CENTER FOR HEALING AND HOPE 423 E JEFFERSON STREET GOSHEN IN 46528 020560511 501(C)(3) 13102 OPERATING SUPPORT LACASA INC 202 N COTTAGE AVE GOSHEN IN 46528 351554538 501(C)(3) 12850 OPERATING SUPPORT BASHOR HOME OF THE UMC INC 62226 COUNTY ROAD 15 GOSHEN IN 46526 350933555 501(C)(3) 11100 OPERATING SUPPORT OAKLAWN PSYCHIATRIC CENTER 330 LAKEVIEW DRIVE GOSHEN IN 46527 351070041 501(C)(3) 11000 OPERATING SUPPORT COUNCIL ON AGING OF ELKHART COUNTY INC 230 E JACKSON BLVD ELKHART IN 46516 510178910 501(C)(3) 10000 OPERATING SUPPORT CHILD AND PARENT SERVICES 100 W HIVELY AVENUE ELKHART IN 46517 350888765 501(C)(3) 10000 OPERATING SUPPORT ELKHART COUNTY CLUBHOUSE 114 S 5TH STREET GOSHEN IN 46528 271151738 501(C)(3) 10000 OPERATING SUPPORT MDC GOLDENROD 1514 COLLEGE AVENUE GOSHEN IN 46526 311205424 501(C)(3) 8200 OPERATING SUPPORT ELKHART COUNTY HEALTH DEPARTMENT 1400 HUDSON STREET ELKHART IN 46516 356000142 STATE OF INDIANA 8000 OPERATING SUPPORT GOSHEN COMMUNITY SCHOOLS 613 PURL STREET GOSHEN IN 46526 351099157 STATE OF INDIANA 8000 OPERATING SUPPORT FIRST MENNONITE CHURCH OF MIDDLEBURY FOOD PANTRY 201 E LAWRENCE ST MIDDLEBURY IN 46540 452475878 501(C)(3) 6794 OPERATING SUPPORT SPA WOMENS MINISTRY 23221 US 20 EAST ELKHART IN 46516 431998891 501(C)(3) 5340 OPERATING SUPPORT CHURCH COMMUNITY SERVICES PO BOX 2346 ELKHART IN 46515 351155054 501(C)(3) 5300 OPERATING SUPPORT FAMILY CHRISTIAN DEVELOPMENT CENTER 151 S LOCKE STREET NAPPANEE IN 46550 351979463 501(C)(3) 5000 OPERATING SUPPORT ELKHART COUNTY SUICIDE PREVENTION 608 OAKLAND AVE ELKHART IN 46516 320167537 501(C)(3) 5000 OPERATING SUPPORT COMMUNITY DENTAL CLINIC INC 7750 W 200 SOUTH TOPEKA IN 46571 352068053 501(C)(3) 5000 OPERATING SUPPORT THE WINDOW INC 223 S MAIN STREET GOSHEN IN 46526 351427937 501(C)(3) 5000 OPERATING SUPPORT UNITED HEALTH SERVICES ST JOSEPH 711 E COLFAX AVE SOUTH BEND IN 46617 351118647 501(C)(3) 5000 OPERATING SUPPORT 24 0 PART I, LINE 2: THE ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. CONSISTS OF REQUIRING THE COMPLETION OF A FOLLOW-UP REPORT FORM WITH SUBSEQUENT GRANT FUND APPLICATIONS. X X 1 1 X X X X X 1 1 0 0 0 0 0 0 0 JODY NEER MD DIRECTOR 0 341328 0 55841 0 5087 0 24097 0 7635 0 433988 0 0 DANIEL NAFZIGER MD VICE CHAIR 0 56383 0 91234 0 5107 0 13163 0 298 0 166185 0 0 RANDAL CHRISTOPHEL PRESIDENT AND CEO 457011 0 239300 0 36709 0 116140 0 7425 0 856585 0 0 0 MARGARET S FRANGER VP OF CANCER SERVICES 227971 0 62974 0 1195 0 37269 0 9991 0 339400 0 0 0 RICK TARSKE VP OF GOSHEN PHYSICIANS 167575 0 11773 0 6660 0 28246 0 2099 0 216353 0 0 0 ALAN WELDY VP OF HR AND COMPLIANCE 341903 0 100946 0 13422 0 49709 0 4995 0 510975 0 0 0 VLADIMIR RADIVOJEVIC VP OF SURGICAL SERVICES 163302 0 42990 0 5188 0 30753 0 6375 0 248608 0 0 0 MARK PODGORSKI VP OF HOSPITAL OPERATIONS 215549 0 56890 0 4126 0 40323 0 3050 0 319938 0 0 0 PAM KARSEN VP OF NURSING 249555 0 69747 0 8836 0 21439 0 2099 0 351676 0 0 0 STEVE GARBODEN VP PLANNING AND MANAGED CARE 168036 0 51716 0 36928 0 23828 0 6177 0 286685 0 0 0 AMY FLORIA CFO 308793 0 88003 0 13157 0 43582 0 5729 0 459264 0 0 0 RANDALL CAMMENGA MD COO 256742 0 213802 0 150055 0 10600 0 6574 0 637773 0 0 0 LARRY ALLEN MD CMO 294131 0 75353 0 8268 0 46885 0 4496 0 429133 0 0 0 JOHN LOWDEN SENIOR MEDICAL PHYSICIST 194544 0 13320 0 0 0 20700 0 1436 0 230000 0 0 0 VICTORIA OWENS ASSOCIATE PATHOLOGIST 195000 0 11250 0 35855 0 24924 0 0 0 267029 0 0 0 XI ZEE WANG ASSOCIATE PATHOLOGIST 244908 0 0 0 39566 0 18240 0 8466 0 311180 0 0 0 MIN YAN CHIEF PATHOLOGIST 323369 0 25000 0 38875 0 18259 0 8833 0 414336 0 0 0 POOPALASINGHAM POOVENDRAN MD PHYSICIAN 505505 0 0 0 18051 0 28840 0 4440 0 556836 0 0 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS IU HEALTH GOSHEN HOSPITAL 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 IU HEALTH GOSHEN HOSPITAL 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, LINE 4A: 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 RECEIVE SEVERANCE PAYMENTS REQUIRE THE EMPLOYEE TO SIGN A RELEASE OF CLAIMS FORM THAT COVERS ALL SITUATIONS SURROUNDING THE EMPLOYEE'S EMPLOYMENT AND SEPARATION FROM IU HEALTH GOSHEN. RANDALL CAMMENGA $108,570 PART I, LINE 4B: ELIGIBLE EXECUTIVES PARTICIPATE IN VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS ORGANIZED UNDER CODE SECTION 457(F). THE EXACT PURPOSE OF EACH PLAN VARIES, BUT THEY INCLUDE: COMPENSATION LIMITATION MAKE-UP PLANS, VOLUNTARY DEFERRAL PLANS, DEFERRAL OF A PORTION OF INCENTIVE BONUS TYPE PLANS, ETC. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO NON-QUALIFIED PLAN PAYMENTS WERE MADE DURING THE YEAR TO ANY LISTED PERSONS IN PART VII. FORM 990, PART VI, SECTION A, LINE 2 THE FOLLOWING OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE EMPLOYEES OF IU HEALTH GOSHEN HOSPITAL OR ITS RELATED ORGANIZATIONS, AND SERVE ON OTHER RELATED TAXABLE BOARDS: RANDAL CHRISTOPHEL AMY FLORIA ALAN WELDY FORM 990, PART VI, SECTION A, LINE 6 IU HEALTH GOSHEN IS THE SOLE MEMBER OF IU HEALTH GOSHEN HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A IU HEALTH GOSHEN AS THE SOLE MEMBER OF IU HEALTH 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 IU HEALTH GOSHEN INCLUDE ANY AMENDMENT 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 11 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 IU HEALTH GOSHEN HOSPITAL WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. FORM 990, PART XI, LINE 9: EQUITY TRANSFER -537,697. INTEREST RATE SWAP -28,922. 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