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Goshen Hospital Association Inc
Goshen Hospital
200 High Park AvenueGoshen, IN 46526
| Bed count | 123 | Medicare provider number | 150026 | Member of the Council of Teaching Hospitals | YES | Children's hospital | NO |
EIN: 356001540
Display data for year:
Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
15.51%
Spending by Community Benefit Category- 2021
(as % of total functional expenses)
(as % of total functional expenses)
Community Benefit Spending Compared to Functional Expenses, 2010-2021
Additional data
Community Benefit Expenditures: 2021
All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Operating expenses $ 273,666,069 Total amount spent on community benefits as % of operating expenses$ 42,447,740 15.51 %- Amount spent in the following IRS community benefit categories:
Financial Assistance at cost as % of operating expenses$ 2,729,657 1.00 %Medicaid as % of operating expenses$ 13,860,654 5.06 %Costs of other means-tested government programs as % of operating expenses$ 0 0 %Health professions education as % of operating expenses$ 1,476,441 0.54 %Subsidized health services as % of operating expenses$ 0 0 %Research as % of operating expenses$ 0 0 %Community health improvement services and community benefit operations*
as % of operating expensesNote: these two community benefit categories are reported together on the Schedule H, part I, line 7e.$ 24,361,785 8.90 %Cash and in-kind contributions for community benefit* as % of operating expenses$ 19,203 0.01 %Community building*
as % of operating expenses$ 56,571 0.02 %- * = CBI denoted preventative categories
- Community building activities details:
Did tax-exempt hospital report community building activities? YES Number of activities or programs (optional) 0 Physical improvements and housing 0 Economic development 0 Community support 0 Environmental improvements 0 Leadership development and training for community members 0 Coalition building 0 Community health improvement advocacy 0 Workforce development 0 Other 0 Persons served (optional) 0 Physical improvements and housing 0 Economic development 0 Community support 0 Environmental improvements 0 Leadership development and training for community members 0 Coalition building 0 Community health improvement advocacy 0 Workforce development 0 Other 0 Community building expense
as % of operating expenses$ 56,571 0.02 %Physical improvements and housing as % of community building expenses$ 0 0 %Economic development as % of community building expenses$ 0 0 %Community support as % of community building expenses$ 0 0 %Environmental improvements as % of community building expenses$ 0 0 %Leadership development and training for community members as % of community building expenses$ 0 0 %Coalition building as % of community building expenses$ 56,571 100 %Community health improvement advocacy as % of community building expenses$ 0 0 %Workforce development as % of community building expenses$ 0 0 %Other as % of community building expenses$ 0 0 %Direct offsetting revenue $ 0 Physical improvements and housing $ 0 Economic development $ 0 Community support $ 0 Environmental improvements $ 0 Leadership development and training for community members $ 0 Coalition building $ 0 Community health improvement advocacy $ 0 Workforce development $ 0 Other $ 0
Other Useful Tax-exempt Hospital Information: 2021
In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.
Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt
as % of operating expenses$ 6,350,133 2.32 %Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program? NO - Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.
Does the organization have a written financial assistance (charity care) policy? YES Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients? YES Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy
as % of operating expenses$ 0 0 %- Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Reported to credit agency Not available Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
After enactment of the ACA, has the state in which this tax-exempt hospital is located expanded Medicaid? YES The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
If not, is the state's Medicaid threshold for working parents at or below 76% of the federal poverty guidelines? Not available In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.
Does the state in which the tax-exempt hospital is located have a mandatory community benefit reporting statute? YES
Community Health Needs Assessment Activities: 2021
The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.
Did the tax-exempt hospital report that they had conducted a CHNA? YES Did the CHNA define the community served by the tax-exempt hospital? YES Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital? YES Did the tax-exempt hospital make the CHNA widely available (i.e. post online)? YES Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA? YES
Supplemental Information: 2021
This section presents qualitative information submitted by the hospital, verbatim from the 990H record.
- Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4A (Expenses $ 253782083 including grants of $ 23203799) (Revenue $ 259350410) See Schedule O
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Facility Information
Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.
Goshen Hospital Association, Inc. Part V, Section B, Line 5: In 2021, Goshen Hospital completed an evaluation of the communities' healthcare needs as required by the Patient Protection and Affordable Care Act. The Community Advisory Council met over multiple months and received input from community representatives, including those with special knowledge or expertise in public health. This process continues Goshen Hospital's long-standing practice of regularly identifying and addressing health needs within the community.In an effort to further identify health needs for the 2021 Community Health Needs Assessment (CHNA), additional data was collected from other sources. These sources include Latino and non-Latino parents and guardians, community leaders, focus groups, key informants from business, not-for-profit organizations, service organizations, healthcare workers, mental health workers, and vulnerable or medically underserved populations.
Goshen Hospital Association, Inc. Part V, Section B, Line 11: Health needs were identified after an extensive analysis of primary and secondary data. Working with community stakeholders in the Community Advisory Council, this data was analyzed to identify and prioritize health needs in Goshen Hospital communities. The committee identified 29 health needs and prioritized the top 7 accordingly. Prioritized Health Needs1. Mental health2. Diabetes treatment and prevention3. Poverty4. Obesity/Weight management5. Lack of access to health care6. Substance abuse/Addictions7. Heath educationGoshen Hospital will begin reporting on the results of the 2021 CHNA Action Plan in 2022. The following results from the 2019-2021 Action Plan was based on the 2018 CHNA.Health needs were identified after an extensive analysis of primary and secondary data that included surveys, focus groups and key informants. Working with community stakeholders in the Community Action Council, this data was analyzed to identify and prioritize health needs in Goshen Hospital communities. The committee identified 13 needs and ranked accordingly. Prioritized Health Need1. Mental health2. Obesity3. Substance abuse: alcohol, drugs, addiction4. Diabetes5. Mental health providers6. Tobacco use/smoking7. Poverty8. Nutrition9. Physical fitness10. Physicians: primary care and other11. Insurance coverage12. Family support13. Health educationGoshen Hospital reviewed the prioritized list and evaluated based on the following questions:-How much control or influence do we have over each particular category? Can we make a material change in 2-3 years?-Are some of these categories related in a way that we can address more than one with our efforts?-Do we have key community partners we can collaborate with in these efforts?This evaluation process collapsed the original priorities list to the 7 below. Condensed Categories1. Mental Health and Mental Health Provider Access2. Obesity/Nutrition/Physical Fitness3. Substance Abuse4. Diabetes5. Tobacco/Smoking6. PCP Access/Availability7. Insurance CoverageTo accomplish meaningful and measurable change, the decision was made to target interrelated health conditions and behaviors, including obesity, nutrition, health education, physical fitness, and diabetes. Resources may be refocused to best address the needs of the community as they change over time. Goshen Hospital took the following actions in 2021 with respect to the Community Health Needs Assessment conducted in 2018.PRIORITY AREA: Obesity/Physical Fitness/Nutrition/Health EducationGOAL: Reduce the rate of obesity in Goshen Hospital service areas through internal and external programs.LONG TERM INDICATORS OF IMPACT1. Slow or halt the accelerating rate of adult obesity within the community Baseline Values - Elkhart County: 32.8%, 11.2% increase over 4 years2. Reduce the percentage of adults reporting physical inactivity within the community Baseline Values - 25.9% reporting physical inactivity in Elkhart County in 2013 and 26.4% from 2014-20183. Increase engagement in health education related to nutrition, physical fitness, and obesity within the community.STRATEGY #1: Lead a community coalition focused on improving and expanding broad access obesity initiatives with outcomes measures. This group will focus on high risk populations and cultural minorities, leveraging community assets and advancing the role of social determinants of health in programming.2021 ActivityThe COVID-19 pandemic continued to impact Goshen Hospital outreach efforts in 2021. Most activities were still required to remain virtual or significantly modified during the year to comply with public health guidelines. Toward the end of the year, restrictions began to ease and were allowed to implement more traditional methods of outreach.593 total outreach efforts addressing obesity/diabetes were implemented in 2021. Goshen Hospital continued to build partnerships and adjust programming to meet the health education needs of the community. A total of 107 partnership collaborations occurred in 2021. Noteworthy partnerships included: Purdue Extension, Minority Health, Hispanic Latino Health Coalition, Elkhart County Health Department, Elkhart County Food Council, local parks departments, local school systems, Goshen Farmers Market, Elkhart Educational Foundation, Boys and Girls Club, Middlebury Day Camp, Goshen College, Goshen Public Library and the Elkhart County Fairgrounds. New or enhanced noteworthy efforts included; Best in Snow, Active Trac, SFW Challenge, Kahoot Trivia Challenges, Head 2 Toe on the Go, and the Great Lakes Great Apple Crunch event. These programs served a total of 18,231 participants in 2021. STRATEGY #2: Establish a consistent, evidence based pathway for obese patients within the Accountable Care Organization2021 ActivityBMI tracking continued as an indicator throughout our medical homes. Patients with a BMI over 35 are connected with our PAM assessment system for activation. This provides patients with a curriculum to help them move forward on a continuum of success. Progress is recorded as patients show improvement. In 2021, 76 patients completed the PAM assessment.STRATEGY #3: Establish an evidence-based pathway for overweight or obese pediatric patients while considering social determinants of health.2021 ActivityWhile this has a natural connection to the first strategy, the focus of this strategy is the health needs of children. In 2021, Goshen Hospital developed a tiered approach for intervention and started building a community resource document to serve providers during interventions. SUMMARYIn 2021, Goshen Hospital addressed prioritized health needs by: - Informing 25,406 participants through community health education events - Serving 531 individuals with community based clinical services - Expanding access to care by educating 851 doctors, nurses, and other health professional students - Partnering with 19 other organizations across the community in support of their health-building initiatives
Goshen Hospital Association, Inc. Part V, Section B, Line 13h: Family size is another factor in determining discounts granted to patients.
Goshen Hospital Association, Inc. Part V, Section B, Line 7, CHNA Policy Website:https://goshenhealth.com/health-library/community-health-needsGoshen Hospital Association, Inc.Part V, Section B, Line 10, Implementation Strategy Website:https://goshenhealth.com/health-library/community-health-needs
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Supplemental Information
Schedule H (Form 990) Part VI
Part I, Line 6a: Goshen Hospital Association, Inc. reports community benefit information as part of the Goshen Health, Inc. annual community benefit report (EIN: 35-1955872).
Part I, Line 7: Goshen Hospital calculated the cost of financial assistance and means-tested government programs, using the cost-to-charge ratio derived from Schedule H, Worksheet 2, and 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 promoted the health of the community by supporting various local organizations that engage in community building activities.
Part III, Line 2: "Goshen Hospital'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 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.In 2018 and prior years, the provision for uncollected patient accounts was recognized when services were 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 assessed 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 were then used to make any modifications to the provision of uncollectible accounts and the allowance for uncollectible accounts. In addition, Goshen Hospital followed established guidelines for placing certain past due patient balances with collection agencies. Patient accounts that are uncollected, including those placed with collection agencies, were initially charged against the allowance for uncollectible accounts in accordance with collection policies of Goshen Hospital and, in certain cases, were reclassified to charity care if deemed to otherwise meet financial assistance policies of Goshen Hospital.In 2019, Goshen Hospital adopted ASU 2014-09 requiring an entity to recognize the amount of revenue to which it expects to be entitled for the transfer of promised good or services to customers. The effect of adopting ASU 2014-09 is considered immaterial as revenue recognition under the new standard is not materially different compared to Goshen Hospital's current practice. The primary effect is certain amounts previously reported as provision for uncollectible accounts are now considered implicit price concessions reported as a reduction of patient service revenue. The remaining provision for uncollectible accounts is reported as an operating expense under the new revenue recognition standard rather than as a reduction of patient service revenue.
Part III, Line 8: Actual month and year to date revenue, contractuals, accounts receivable balances, ratios and statistics are compared to prior years on a monthly basis. Variances are reviewed and analyzed by finance representatives, hospital directors and the CFO. Additionally, actual contractual allowance as a percentage of gross accounts receivable and contractual provision as a percentage of gross patient charges are compared to prior years. 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 CFO 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 VI, Line 4: Goshen Hospital serves the northern Indiana area in Elkhart County. According to the 2021 census, the population of Elkhart County is 206,921. The median income for a household in Elkhart County is $58,509. Approximately 9.8% of the population were below the poverty line. The racial makeup of the county was about 73.2% White, 6.2% African-American, and 17.6% Hispanic or Latino. The remaining 3.0% 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 or secondary service areas. 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 Goshen Health with the hospital's annual operating budget and key strategic objectives. In addition, the hospital management provides Goshen Hospital with various key metrics involving patient satisfaction, patient quality and colleague satisfaction. Goshen Hospital 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 Goshen Health to provide necessary nursing education and physician recruitment to assist in meeting the health needs of the community.
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 financial assistance, payment plans and lump sum settlements are available. 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, Goshen Hospital is dedicated to meeting the specific health care needs of our community. The hospital has 122 patient beds and over 275 physicians on its medical staff in 30 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 specifically trained surgical oncologists, breast surgeons, 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 paramedics. 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.
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 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 form the website, this information is available in English and Spanish.
Part VI, Line 7, Reports Filed With States IN
