TY 2021 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Randal Christophel...................................................................... President and CEO	40.00 ................. 2.00	X	X		959,009	0	166,347
(2) Jody Neer MD...................................................................... Director	1.00 ................. 40.00	X			0	483,130	53,804
(3) Andrew Vorhis NP...................................................................... Director	1.00 ................. 40.00	X			0	157,626	28,962
(4) Bonita Schrock...................................................................... Chair	1.00 ................. 0.00	X	X		0	0	0
(5) Susan Stiffney RN...................................................................... Secretary/Treasurer	1.00 ................. 0.00	X	X		0	0	0
(6) Harshil Bhatt MD...................................................................... Director	1.00 ................. 0.00	X			0	0	0
(7) Randy Cripe...................................................................... Director	1.00 ................. 0.00	X			0	0	0
(8) Bruce Hughes MD...................................................................... Director	1.00 ................. 1.00	X			0	0	0
(9) Karen Pletcher...................................................................... Director	1.00 ................. 0.00	X			0	0	0
(10) Liliana Quintero...................................................................... Director	1.00 ................. 0.00	X			0	0	0
(11) Karen Smith...................................................................... Director	1.00 ................. 0.00	X			0	0	0
(12) Jewel Yoder...................................................................... Director	1.00 ................. 0.00	X			0	0	0
(13) Rob Myers...................................................................... Chief Operating Officer	40.00 ................. 1.00		X		543,676	0	86,115
(14) Ben Bontrager...................................................................... CFO until 12/2021	40.00 ................. 2.00		X		460,615	0	29,499
(15) Chris Hutfless Chief Legal...................................................................... HR & Compliance Officer	40.00 ................. 1.00		X		397,410	0	72,365
(16) Daniel Nafziger MD...................................................................... Chief Medical Officer	40.00 ................. 0.00			X	514,055	0	78,038
(17) Margaret S Franger...................................................................... VP of Population Health & Bus Devlp.	40.00 ................. 0.00			X	384,366	0	77,275

(A) Name and business address	(B) Description of services	(C) Compensation
Hagerman Inc 510 W Washington Blvd Ft Wayne,IN46802	Construction	23,157,683
Quest Diagnostics PO Box 775460 Chicago,IL60677	Medical Services	3,374,139
DJ Construction Co Inc 3414 Elkhart Road Goshen,IN46526	Construction	3,124,482
AYA Healthcare Inc 5930 Cornerstone Crt W Suite 300 San Diago,CA92121	Contracted Staffing	2,967,490
Fastaff LLC 5700 S Quebec St Suite 300 Greenwood Village,CO80111	Contracted Staffing	2,598,064
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 56

- TIN:

SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990) 2021

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. If the organization did not check the box on line 13, and line 14 is 33 1/3 % or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2020. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2021. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2020. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990) 2021

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2020. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990) 2021

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer lines 2a and 2b below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer lines 3a and 3b below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990) 2021

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by 0.035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990) 2021

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization Goshen Hospital Association Inc

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization Goshen Hospital Association Inc		Employer identification number 35-6001540

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization Goshen Hospital Association Inc			Employer identification number 35-6001540
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

Political campaign activity expenditures. See instructions .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities. See instructions ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990) 2021

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2018	(b) 2019	(c) 2020	(d) 2021	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990) 2021

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

10,095

Total. Add lines 1c through 1i ....................................................................................................

10,095

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures. See Instructions .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Part II-B, Line 1:	Lobbying expenses represent the portion of dues paid to the American Hospital Association and the Indiana Hospital Association that are specifically allocable to lobbying.

Schedule C (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2021

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	4,848,692	4,848,513		9,697,205
b	Buildings ....		124,148,658	51,263,148	72,885,510
c	Leasehold improvements	158,142	36,948	122,345	72,745
d	Equipment ....		137,423,802	97,482,869	39,940,933
e	Other .....		59,716,818		59,716,818
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					182,313,211

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	19,738,759
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2021

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

Part X, Line 2:

The Internal Revenue Service has determined that Goshen Health and certain affiliated entities are tax-exempt organizations as defined in Section 501(c)(3) of the Internal Revenue Code. Certain subsidiaries of Goshen Health are taxable entities, the tax expense and liabilities of which are not material to the consolidated financial statements. Goshen Health and its tax-exempt affiliated entities each file a Form 990 (Return of Organization Exempt from Income Tax) annually. When these returns are filed, it is highly certain that some positions taken would be sustained upon examination by the taxing authorities, while others are subject to uncertainty about the merits of the position taken or the amount of the position that would ultimately be sustained. Examples of tax positions common to health systems include such matters as the tax-exempt status of each entity, the continued tax-exempt status of bonds, the nature, characterization and taxability of joint venture income, and various positions relating to potential sources of unrelated business taxable income (reported on Form 990T). As of December 31, 2021 and 2020, 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 2018 and prior.

Schedule D (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	4,400	2,729,657	0	2,729,657	1.000 %
b	Medicaid (from Worksheet 3, column a) . . . . .	9,863	45,730,647	31,869,993	13,860,654	5.060 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	14,263	48,460,304	31,869,993	16,590,311	6.060 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	25,937	24,370,320	8,535	24,361,785	8.900 %
f	Health professions education (from Worksheet 5) . . .	851	1,486,662	10,221	1,476,441	0.540 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	19	19,203	0	19,203	0.010 %
j	Total. Other Benefits . .	26,807	25,876,185	18,756	25,857,429	9.450 %
k	Total. Add lines 7d and 7j .	41,070	74,336,489	31,888,749	42,447,740	15.510 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	0	56,571	0	56,571	0.020 %
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total		56,571		56,571	0.020 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,350,133

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

41,253,133

Enter Medicare allowable costs of care relating to payments on line 5.....

50,040,780

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-8,787,647

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)					Other (describe)
1	Goshen Hospital Association Inc 200 High Park Avenue Goshen,IN46526 https://goshenhealth.com License #XXX-XX-XXXX	X	X	X	N/A

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Goshen Hospital Association Inc
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 21

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): See Part V, Page 8

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): See Part V, Page 8

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Goshen Hospital Association Inc
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

https://goshenhealth.com/patient-information/estimates-financial-assistance

The FAP application form was widely available on a website (list url):

https://goshenhealth.com/patient-information/estimates-financial-assistance

A plain language summary of the FAP was widely available on a website (list url):
https://goshenhealth.com/patient-information/estimates-financial-assistance

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	Goshen Hospital Association Inc
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Goshen Hospital Association Inc
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
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

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address		Type of Facility (describe)
1	1 - Goshen Hospital 200 High Park Avenue Goshen,IN46526	Clinic
2	2 - The Retreat Women's Health Center 1135 Professional Drive Goshen,IN46526	Clinic
3	3 - Indiana Lakes Accountable Care 2018 South Main Street Goshen,IN46526	ACO: Ambulatory Care Coordination
4	4 - Indiana Lakes Managed Care 2018 South Main Street Goshen,IN46526	Health Care Management
5	5 - New Paris Medical Clinic 200 High Park Avenue Goshen,IN46526	Clinic
6
7
8
9
10

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
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 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 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 VI, Line 7, Reports Filed With States	IN

Schedule H (Form 990) 2021

Additional Data

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
Goshen Hospital Association Inc

Employer identification number
35-6001540

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) Goshen Health System Inc 200 High Park Avenue Goshen,IN46526	35-1974765	501(c)(3)	22,970,147	0	FMV		Operating Support
(2) Goshen Health Foundation Inc 200 High Park Avenue Goshen,IN46526	46-2565300	501(c)(3)	233,652	0	FMV		Operating Support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2021

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
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.

Schedule I (Form 990) 2021

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....

Yes

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2021

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Randal Christophel President and CEO	(i) (ii)	636,738 ------------- 0	301,945 ------------- 0	20,326 ------------- 0	134,772 ------------- 0	31,575 ------------- 0	1,125,356 ------------- 0	0 ------------- 0
2Ebenezer Kio MD Physician	(i) (ii)	0 ------------- 625,829	0 ------------- 112,188	0 ------------- 0	0 ------------- 22,148	0 ------------- 26,327	0 ------------- 786,492	0 ------------- 0
3Houman Vaghefi MD Physician	(i) (ii)	0 ------------- 578,468	0 ------------- 90,602	0 ------------- 18,536	0 ------------- 18,277	0 ------------- 29,311	0 ------------- 735,194	0 ------------- 0
4Leonard Henry MD Physician	(i) (ii)	0 ------------- 524,191	0 ------------- 122,256	0 ------------- 0	0 ------------- 19,228	0 ------------- 26,880	0 ------------- 692,555	0 ------------- 0
5Urs Von Holzen MD Physician	(i) (ii)	0 ------------- 450,132	0 ------------- 158,984	0 ------------- 10,000	0 ------------- 22,790	0 ------------- 30,893	0 ------------- 672,799	0 ------------- 0
6Rob Myers Chief Operating Officer	(i) (ii)	415,456 ------------- 0	118,158 ------------- 0	10,062 ------------- 0	66,196 ------------- 0	19,919 ------------- 0	629,791 ------------- 0	0 ------------- 0
7Daniel Nafziger MD Chief Medical Officer	(i) (ii)	407,401 ------------- 0	101,110 ------------- 0	5,544 ------------- 0	61,647 ------------- 0	16,391 ------------- 0	592,093 ------------- 0	0 ------------- 0
8Bolanle Adepoju MD Physician	(i) (ii)	0 ------------- 452,375	0 ------------- 36,303	0 ------------- 8,750	0 ------------- 23,246	0 ------------- 26,531	0 ------------- 547,205	0 ------------- 0
9Jody Neer MD Director	(i) (ii)	0 ------------- 409,448	0 ------------- 73,682	0 ------------- 0	0 ------------- 22,318	0 ------------- 31,486	0 ------------- 536,934	0 ------------- 0
10Ben Bontrager CFO until 12/2021	(i) (ii)	360,963 ------------- 0	98,812 ------------- 0	840 ------------- 0	11,600 ------------- 0	17,899 ------------- 0	490,114 ------------- 0	0 ------------- 0
11Chris Hutfless Chief Legal HR & Compliance Officer	(i) (ii)	353,325 ------------- 0	35,308 ------------- 0	8,777 ------------- 0	58,946 ------------- 0	13,419 ------------- 0	469,775 ------------- 0	0 ------------- 0
12Margaret S Franger VP of Population Health & Bus Devlp.	(i) (ii)	344,953 ------------- 0	37,291 ------------- 0	2,122 ------------- 0	58,651 ------------- 0	18,624 ------------- 0	461,641 ------------- 0	0 ------------- 0
13Mark Podgorski VP of Hospital Operations	(i) (ii)	260,821 ------------- 0	68,120 ------------- 0	30,097 ------------- 0	46,694 ------------- 0	29,480 ------------- 0	435,212 ------------- 0	0 ------------- 0
14Beau McNeff until 102021 VP of Goshen Physicians/Cancer Srvs	(i) (ii)	244,046 ------------- 0	118,266 ------------- 0	770 ------------- 0	11,600 ------------- 0	23,834 ------------- 0	398,516 ------------- 0	0 ------------- 0
15Julie Crossley Chief Nursing Officer	(i) (ii)	261,681 ------------- 0	65,199 ------------- 0	3,263 ------------- 0	42,273 ------------- 0	22,932 ------------- 0	395,348 ------------- 0	0 ------------- 0
16Andrew Vorhis NP Director	(i) (ii)	0 ------------- 98,444	0 ------------- 59,182	0 ------------- 0	0 ------------- 11,250	0 ------------- 17,712	0 ------------- 186,588	0 ------------- 0

Schedule J (Form 990) 2021

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
Part I, Line 1a	Goshen Hospital grossed up the taxable value of an automobile for 1 of the officers listed on Form 990, Part VII and included the amount in the employees' W-2 as additional compensation.
Part I, Line 1b	Goshen Hospital does not have a specific written policy for the use of automobiles, but does gross up the taxable value of automobiles to include in the employees' W-2 as additional compensation.
Part I, Line 4b	Eligible executives participate in various non-qualified deferred compensation plans organized under code Section 457(f). The exact purpose of each plan varies, but they include: compensation limitation make-up plans, voluntary deferral plans, deferral of a portion of incentive bonus type plans, etc. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals participate in the plan: Randal Christophel Rob Myers Daniel Nafziger, MD Ben Bontrager Chris Hutfless Margaret S. Franger Mark Podgorski Beau McNeff Julie Crossley No non-qualified plan payments were made during the year to any listed persons in Part VII.

Schedule J (Form 990) 2021

Additional Data

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Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax-Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization
Goshen Hospital Association Inc

Employer identification number
35-6001540

Part Ⅰ

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	Indiana Finance Authority - 2019A	35-1602316	45471ATA0	07-31-2019	50,630,944	Campus improvement project		X		X		X
B	Indiana Finance Authority - 2019B	35-1602316	45471ATA0	07-31-2019	25,360,000	Campus improvement project		X		X		X

Part Ⅱ

Proceeds

	A		B		C		D
	1 Amount of bonds retired ..................
2 Amount of bonds legally defeased ..............
3 Total proceeds of issue ..................	50,630,944		25,360,000
4 Gross proceeds in reserve funds .............
5 Capitalized interest from proceeds .............
6 Proceeds in refunding escrows ...............
7 Issuance costs from proceeds ...............	628,854		359,751
8 Credit enhancement from proceeds .............
9 Working capital expenditures from proceeds .............
10 Capital expenditures from proceeds .............	50,002,090		7,953,965
11 Other spent proceeds .............
12 Other unspent proceeds .............			17,046,284
13 Year of substantial completion .............	2022		2022
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue of tax-exempt bonds (or, if issued prior to 2020, a current refunding issue)? ........		X		X
15 Were the bonds issued as part of an advance refunding issue of taxable bonds (or, if issued prior to 2020, an advance refunding issue)? ........		X		X
16 Has the final allocation of proceeds been made? ..........		X		X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? ..................	X		X

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2021

Page 2

Part Ⅲ

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............		X		X
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? .............		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........
6 Total of lines 4 and 5 .............
7 Does the bond issue meet the private security or payment test? ...		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? ........	X		X

Part Ⅳ

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...		X		X
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......	X		X
b Exception to rebate? ........		X		X
c No rebate due? .........		X		X
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate computation was performed ......
3 Is the bond issue a variable rate issue? .....		X	X

Schedule K (Form 990) 2021

Page 3

Part Ⅳ

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X
b Name of provider ..........
c Term of hedge .........
d Was the hedge superintegrated? ......
e Was the hedge terminated? ........
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?		X		X
b Name of provider ..........
c Term of GIC .........
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........
6 Were any gross proceeds invested beyond an available temporary period?		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? ...		X		X

Part Ⅴ

Procedures To Undertake Corrective Action

---------------------------------------------------------------------------------------------------------------	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?	X		X

Part Ⅵ

Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).

Return Reference	Explanation

Schedule K (Form 990) 2021

Additional Data

Software ID:
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- TIN:

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Return Reference	Explanation
Form 990, Part III, Line 4a, Program Service Description:	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. The organization created the current three-year strategic plan during 2019 to run from 1/1/2020 through 12/31/2022. The current strategic priorities for 2023 are as follows: 1. Access & Consumerism: Provide more access to convenient health services than any competitor in order to grow and secure our market position. 2. Provider Network: Attract and retain the highest-quality providers through a variety of alignment mechanisms. 3. Service Complement: Selectively grow and deepen our service offerings to meet the evolving needs of our community. 4. Value-Based Care: Build new and leverage our existing population health management capabilities as we prepare for value-based care to become increasingly prevalent. 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 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 American Nurses Credentialing Center's (ANCC) magnet recognition program for excellence in nursing services has designated Goshen Hospital as a magnet hospital since 2004. 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 hospitals in the nation to be re-designated as a magnet facility. The Goshen Center for Cancer Care is accredited by the Commission on Cancer (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, 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. The Goshen Health Community Benefit Fund is one example of how Goshen Health re-invests money into the communities we serve. 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 $6 million in grants to community organizations and projects that meet the health needs of our community. 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 2021, the hospital extended charity care to 4,400 accounts totaling $7.9 million. Goshen Hospital also partners with a financial institution to provide flexible and affordable financing solutions for a patient's medical care. Goshen Hospital first received the beacon award for excellence from the American Association of Critical Care Nurses in 2010. This is a three-year accreditation and 2019 marks the fourth time Goshen has won the award and the third time Goshen has achieved the highest status, gold. The National Accreditation Program for Breast Centers (NAPBC) has awarded multiple three-year, full accreditation to Goshen Health Retreat Women's Health Center beginning in 2010. Press Ganey has awarded Goshen Health with 7 summit awards. In addition, Goshen Health has received the H&V Platinum Performance Achievement Award (NCDR) and the WHO baby-friendly designation.
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, Chris Hutfless, Rob Myers, Ben Bontrager, Mark Podgorski, and Beau McNeff.
Form 990, Part VI, Section A, line 6	The sole member of Goshen Hospital Association, Inc. is Goshen Health System, Inc. an Indiana not-for-profit corporation that serves as the corporate parent of the health system.
Form 990, Part VI, Section A, line 7a	Goshen Health System, Inc., a section 501(c)(3) exempt organization and the parent of the exempt healthcare system, is the sole corporate member of the filing organization. Directors shall be appointed as provided in the Bylaws by the member to a term as designated at the time of appointment.
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 for the same period of disclosure as set forth in IRC Section 6104(d).
Form 990, Part IX, line 11g	Outside Purchased Services: Program service expenses 16,038,596. Management and general expenses 0. Fundraising expenses 0. Total expenses 16,038,596. Temp Staffing: Program service expenses 8,484,511. Management and general expenses 0. Fundraising expenses 0. Total expenses 8,484,511. Outside Purchased Anesthesia: Program service expenses 2,100,471. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,100,471. Goshen Marketing: CRM: Program service expenses 360,488. Management and general expenses 0. Fundraising expenses 0. Total expenses 360,488. Collection Services: Program service expenses 274,001. Management and general expenses 0. Fundraising expenses 0. Total expenses 274,001. Snow Removal: Program service expenses 137,990. Management and general expenses 0. Fundraising expenses 0. Total expenses 137,990. Trash Removal: Program service expenses 113,758. Management and general expenses 0. Fundraising expenses 0. Total expenses 113,758. Medical Professional Fees: Program service expenses 111,801. Management and general expenses 0. Fundraising expenses 0. Total expenses 111,801. Outside Purchased Grounds: Program service expenses 100,290. Management and general expenses 0. Fundraising expenses 0. Total expenses 100,290.
Form 990, Part XI, line 9:	Equity Transfer -440,969.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

Goshen Hospital Association Inc

Employer identification number

35-6001540

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity
(1) Indiana Lakes Managed Care Org LLC 200 High Park Avenue Goshen,IN46526 35-1946663	Healthcare	IN	248,829	125,826	Goshen Hospital Association Inc
(2) Indiana Lakes Accountable Care Org LLC 200 High Park Avenue Goshen,IN46526 45-5450141	Healthcare	IN	2,811,980	3,051,319	Goshen Hospital Association Inc

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)Goshen Health System Inc 200 High Park Avenue Goshen,IN46526 35-1974765	Healthcare	IN	501(c)(3)	Line 12c, III-FI	N/A		No
(2)Goshen Health Foundation Inc 200 High Park Avenue Goshen,IN46526 46-2565300	Fundraising	IN	501(c)(3)	Line 7	Goshen Health System Inc	Yes
(3)Goshen Hospital Women's Auxiliary Inc 200 High Park Avenue Goshen,IN46526 23-7017521	Healthcare	IN	501(c)(3)	Line 12d, III-O	N/A		No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership
(1) New Paris Clinic LLC 2018 S Main Street Goshen,IN46526 35-2075244	Commerical Rentals	IN	Goshen Health System Inc	n/a				No			No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) Parkmor Drug Inc 1501 S Main Street Goshen,IN46526 35-1394980	Pharmacy Sales	IN	Goshen Health System Inc	C				Yes
(2) PILR Inc 200 High Park Avenue Goshen,IN46526 20-4294750	Development	IN	Goshen Health System Inc	C				Yes
(3) Radiation Oncology Resources Inc 200 High Park Avenue Goshen,IN46526 26-2008424	Healthcare	IN	Goshen Health System Inc	C				Yes

Schedule R (Form 990) 2021

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

Yes

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Goshen Health Foundation Inc	C	90,864	FMV
(2) Goshen Health Foundation Inc	R	233,652	FMV
(3) Goshen Health Foundation Inc	D	100,000	FMV

Schedule R (Form 990) 2021

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: To improve the health of our communities by providing innovative, outstanding care and services.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	1,879
6	Total number of volunteers (estimate if necessary) .............	6	227
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	39,934
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	16,773,624	2,237,312
9	Program service revenue (Part VIII, line 2g) .........	239,044,458	252,833,700
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	12,668,964	14,983,069
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	8,724,343	8,291,131
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	277,211,389	278,345,212
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	25,829,846	23,203,799
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	107,723,723	108,103,120
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	128,710,172	142,359,150
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	262,263,741	273,666,069
19	Revenue less expenses. Subtract line 18 from line 12.......	14,947,648	4,679,143
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	540,424,850	566,570,613
21	Total liabilities (Part X, line 26).............	139,430,343	141,588,273
22	Net assets or fund balances. Subtract line 21 from line 20.....	400,994,507	424,982,340

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 253,782,083 including grants of $ 23,203,799 ) (Revenue $ 259,350,410 )
	See Schedule O

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses253,782,083

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Mark Podgorski........................................................................ VP of Hospital Operations	40.00 .......................0.00	X		359,038	0	76,174
(19) Julie Crossley........................................................................ Chief Nursing Officer	40.00 .......................0.00	X		330,143	0	65,205
(20) Beau McNeff until 102021........................................................................ VP of Goshen Physicians/Cancer Srvs	20.00 .......................20.00	X		363,082	0	35,434
(21) Ebenezer Kio MD........................................................................ Physician	40.00 .......................0.00		X	0	738,017	48,475
(22) Houman Vaghefi MD........................................................................ Physician	40.00 .......................0.00		X	0	687,606	47,588
(23) Leonard Henry MD........................................................................ Physician	40.00 .......................0.00		X	0	646,447	46,108
(24) Bolanle Adepoju MD........................................................................ Physician	40.00 .......................0.00		X	0	497,428	49,777
(25) Urs Von Holzen MD........................................................................ Physician	40.00 .......................0.00		X	0	619,116	53,683

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,311,394	3,829,370	1,014,849

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	90,864
e	Government grants (contributions)		1e	2,146,448

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		2,237,312

		Business Code
2a	Patient Care	622110	252,833,700	252,833,700
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		252,833,700

3 Investment income (including dividends, interest, and othersimilar amounts) ......			5,827,655		39,934	5,787,721
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		1,545,931	6a
b	Less: rental expenses		0	6b
c	Rental income or (loss)		1,545,931	6c
d	Net rental income or (loss).......			1,545,931			1,545,931
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	218,848	12,316,620	7a
b	Less: cost or other basis and sales expenses	0	3,380,054	7b
c	Gain or (loss)	218,848	8,936,566	7c
d	Net gain or (loss).........			9,155,414			9,155,414
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	Food Service Revenue		722514	224,313			224,313
b	Other Oncology Rev Misc		621500	37,099	37,099
c	Finance Charges		900099	4,177			4,177
d	All other revenue ....			6,479,611	6,479,611
e	Total. Add lines 11a–11d ......			6,745,200
12	Total revenue. See instructions.....			278,345,212	259,350,410	39,934	16,717,556

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	23,203,799	23,203,799
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	4,311,393	844,198	3,467,195
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	77,734,210	69,183,447	8,550,763
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	5,084,882	4,525,545	559,337
9	Other employee benefits .......	15,418,908	13,722,828	1,696,080
10	Payroll taxes ...........	5,553,727	4,942,817	610,910
11	Fees for services (non-employees):
a	Management ......	2,925,675		2,925,675
b	Legal .........	367,494		367,494
c	Accounting ...........	290,000		290,000
d	Lobbying ...........	10,095		10,095
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	549,243		549,243
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	27,721,906	27,721,906
12	Advertising and promotion ....	2,703,464	2,703,464
13	Office expenses .......	3,301,913	3,301,913
14	Information technology ......	465,297	465,297
15	Royalties ..
16	Occupancy ...........	2,388,674	2,388,674
17	Travel ............	443,526	443,526
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	857,194		857,194
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	12,983,163	12,983,163
23	Insurance ...	2,356,077	2,356,077
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Drugs & Medical Supplie	58,743,581	58,743,581
b	Hospital Assessment Fee	11,500,308	11,500,308
c	Repairs & Maintenance	10,503,951	10,503,951
d	Bad Debt Expense	1,376,013	1,376,013
e	All other expenses	2,871,576	2,871,576
25	Total functional expenses. Add lines 1 through 24e	273,666,069	253,782,083	19,883,986	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			10,387,899	1	11,776,343
2	Savings and temporary cash investments .........			28,512,016	2	13,851,162
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			32,777,356	4	34,014,022
5	Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			7,055,481	8	7,766,020
9	Prepaid expenses and deferred charges ......			14,744,882	9	15,755,023
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	331,181,573
b	Less: accumulated depreciation	10b	148,868,362	153,690,356	10c	182,313,211
11	Investments—publicly traded securities .			286,961,017	11	292,930,927
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			6,295,843	15	8,163,905
16	Total assets. Add lines 1 through 15 (must equal line 33)...			540,424,850	16	566,570,613

17	Accounts payable and accrued expenses .....	27,616,537	17	39,813,799
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	74,566,658	20	74,186,506
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..	11,762,398	24	7,849,209
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	25,484,750	25	19,738,759
26	Total liabilities. Add lines 17 through 25..	139,430,343	26	141,588,273

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	400,994,507	27	424,982,340
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	400,994,507	32	424,982,340
33	Total liabilities and net assets/fund balances ........	540,424,850	33	566,570,613