2023-09-05T09:54:30-05:00 2022-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2022-01-01 350868178 SOUTH BEND MEDICAL FOUNDATION SOUT 5742045233 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 TERRY PIPP CHIEF FINANCIAL OFFICER 5742045233 2023-08-31 1 TERRY PIPP 999009999 0 TYLER K GREENE CPA P00057872 3176334705 2023-08-31 0 AAL1 IAL1 2022 2023-04-26 12:10:37Z JOYCE SIMPSON MD 530 N LAFAYETTE BLVD SOUTH BEND IN 46601 24508856 0 X WWW.SBMF.ORG X 1946 IN SOUTH BEND MEDICAL FOUNDATION EXISTS FOR THE PURPOSE OF PROVIDING QUALITY AND COST EFFECTIVE PATHOLOGY AND BLOOD BANKING SERVICES TO HOSPITALS, PHYSICIANS, AND PATIENTS. 9 7 184 7 33471 0 2543 8375 18346550 15172749 1200076 -799291 1682011 1550614 21231180 15932447 74085 9321 0 0 13386532 11430320 0 0 0 12510848 11082383 25971465 22522024 -4740285 -6589577 52568816 48622291 5304570 12007241 47264246 36615050 X SOUTH BEND MEDICAL FOUNDATION EXISTS FOR THE PURPOSE OF PROVIDING QUALITY AND COST EFFECTIVE PATHOLOGY AND BLOOD BANKING SERVICES TO HOSPITALS, PHYSICIANS, AND PATIENTS.TO FULFILL OUR MISSION WE SHALL:(I) PROVIDE THE HOSPITALS WE SERVICE THE HIGHEST QUALITY PATHOLOGY RESOURCES AND -- TAKING INTO ACCOUNT THAT LENGTH OF STAY IS CRUCIAL FOR INPATIENT CARE -- WITH THE SHORTEST RESPONSE TIME WHILE ACHIEVING A HIGH DEGREE OF COST EFFECTIVENESS.(II) PROVIDE OUR PHYSICIAN CUSTOMERS WITH THE HIGHEST QUALITY PATHOLOGY RESULTS UTILIZING THE LATEST TECHNOLOGY AND MAKING AVAILABLE TO THEM READILY ACCESSIBLE CONSULTATIVE OPPORTUNITIES IN THE MEDICAL AND ADMINISTRATIVE ASPECTS OF THEIR PRACTICES. 0 0 20387334 9321 16690401 SOUTH BEND MEDICAL FOUNDATION, INC. (THE FOUNDATION), PROVIDES PATHOLOGY SERVICES FOR PATIENTS AND DOCTORS THROUGHOUT NORTHERN AND CENTRAL INDIANA AND SOUTHWESTERN MICHIGAN WITH A CONCENTRATION OF REVENUES FROM HOSPITALS LOCATED IN THE SURROUNDING AREAS. THE FOUNDATION ALSO HAS A BLOOD BANK LINE OF BUSINESS WHERE BLOOD IS DONATED BY VOLUNTEERS AND SUBSEQUENTLY PROCESSED AND SOLD TO LOCAL HOSPITALS IN THE SURROUNDING AREAS. THE FOUNDATION PROVIDES ASSISTANCE TO INDIVIDUALS IN THE FORM OF FREE OR REDUCED FEE MEDICAL CARE AT VARIOUS LOCATIONS THROUGHOUT THE COMMUNITIES SERVED. THESE INDIVIDUALS MEET SBMF'S CHARITY CARE ELIGIBILITY REQUIREMENTS, OR THE REQUIREMENTS OF THE REFERRING HEALTH CARE PROVIDER. DURING 2022, THE FOUNDATION PROVIDED $39,430 IN PATIENT MEDICAL ASSISTANCE.THE FOUNDATION ALSO PROVIDES DISCOUNTS FOR PAYMENT AT TIME OF SERVICE TO PATIENTS WHO DO NOT HAVE GOVERNMENT PROVIDED INSURANCE COVERAGE OR DO NOT WISH TO HAVE A CLAIM FILLED WITH THEIR COMMERCIAL INSURANCE CARRIER. DURING 2022, THE FOUNDATION PROVIDED $29,853 IN TIME OF SERVICE DISCOUNTS. 20387334 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 37 0 1 184 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 7 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X BARB RESNIK 5742045233 3355 DOUGLAS ROAD SOUTH BEND IN 46635 ROBIN ZON MD CHAIRMAN 1.00 X X 0 0 0 PEDRO MIRO MD VICE CHAIRMAN 1.00 X X 0 0 0 JOE BARKMAN TREASURER 1.00 X X 0 0 0 MICHAEL BLAKESLEY MD BOARD MEMBER 1.00 X 0 0 0 NITA GERIG MD BOARD MEMBER 32.00 X 282614 0 34335 JAMES KELLY MD BOARD MEMBER 1.00 X 0 0 0 CARLTON LYONS MD BOARD MEMBER 1.00 X 0 0 0 SHARON STACK PHD BOARD MEMBER 1.00 X 0 0 0 JOYCE SIMPSON MD PRESIDENT 40.00 X X 347153 0 22090 JAMES L FRAIN VP-HUMAN RESOURCES - PARTIAL YEAR 32.00 X 137517 0 21883 KEVIN HOCHSTEDLER CFO - PARTIAL YEAR 32.00 X 4000 0 0 TERRY PIPP CFO 40.00 X 163821 0 18745 RICKY HOOVER MD PATHOLOGIST 32.00 X 326927 0 42117 JONATHAN KONOPINSKI MD PATHOLOGIST 40.00 X 315899 0 20976 ODETA LAPKUS PATHOLOGIST 40.00 X 293437 0 36463 JAMES DYER PATHOLOGIST 40.00 X 286879 0 19056 NICOLE ANEST PATHOLOGIST 40.00 X 280183 0 32571 2438430 0 248236 17 0 1 0 CENTRAL INDIANA REGIONAL BLOOD 3450 NORTH MERIDIAN STREET INDIANAPOLIS IN 46208 REFERENCE LAB, MEDICAL DIRECTOR 1326878 US PACK MED LLC 2251 LYNX LANE SUITE 5 ORLANDO FL 32804 TRANSPORTATION SERVICE 564395 APS MEDICAL BILLING 5700 SOUTHWYCK BLVD TOLEDO OH 43614 MEDICAL BILLING SERVICES 336284 PACIFIC COMPANIES INC 7500 ENTERPRISE SUITE 220 ALISO VIEJO CA 92656 PHYSICIAN RECRUITING, TEMPORARY SERVICE 228502 OSTROM JANITORIAL PO BOX 533 GRANGER IN 46530 CLEANING SERVICE 218697 11 8375 8375 OTHER NET OPERATING REVENUE 621500 14252196 14252196 CLINICAL PATHOLOGY FEES 621500 920553 920553 15172749 511655 509 511146 212826 0 212826 212826 212826 6377627 887836 6815653 1760756 -438026 -872920 -1310946 -1310946 BLOOD RESEARCH 541900 552385 552385 SB CLINIC STAFFING 900099 453973 453973 PATH-AI, DIGITAL PATHOLOGY 541900 32962 32962 298468 298468 1337788 15932447 16690401 33471 -799800 X 9321 9321 721420 612504 108916 8415779 8092617 323162 60427 56232 4195 1651607 1536959 114648 581087 540750 40337 63082 63082 111592 111592 3228013 2980546 247467 33453 33453 599627 484590 115037 322340 237067 85273 2009671 1472297 537374 150685 150685 24402 15690 8712 43632 42953 679 780741 563270 217471 463122 463122 MEDICAL SUPPLIES 2939862 2906047 33815 DONOR INCENTIVES 201304 129430 71874 RECRUITMENT 83264 53535 29729 27593 6266 21327 22522024 20387334 2134690 0 873906 559647 2918675 2411054 1817459 24100 478418 426676 630506 456533 27183011 9769704 14449807 17413307 30610937 26749395 144930 50583 1175174 52568816 48622291 1874504 1548907 237270 3013013 9540336 179783 917998 5304570 12007241 X 47264246 36615050 47264246 36615050 52568816 48622291 X -6589577 -4108423 48804 X 0 1 X 1 0 X 2057 1836 272104 2543 8375 286915 74742621 56097268 19436130 18346550 15172749 183795318 223632 170901 225868 1035971 1304826 2961198 74968310 56270005 19934102 19385064 16485950 187043431 0 0 0 187043431 13997 292821 176435 864279 724481 2072013 13997 292821 176435 864279 724481 2072013 1359 1135 2494 534672 534672 75516979 56562826 20111896 20250478 17210431 189652610 0.98620 0.99060 0.01090 0.00530 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: CLINICAL PATHOLOGY FEES - 2018 AMOUNT: $ 409,067. PARTNERSHIP INCOME - 2018 AMOUNT: $ 125,605. 1357180 1357180 14945393 34286 14911107 10794619 9735418 1059201 85819 85819 17413307 LEASE LIABILITIES 765283 ACCRUED RETIREMENT LIABILITY 152715 917998 X 12164571 -4108423 291743 48804 -3767876 15932447 0 15932447 22813766 291743 291743 22522023 0 22522023 PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE FOUNDATION AND RECOGNIZE A TAX LIABILITY IF THE FOUNDATION HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE FOUNDATION, AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2022 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE FOUNDATION HAS FILED ITS FEDERAL AND STATE INCOME TAX RETURNS FOR PERIODS THROUGH DECEMBER 31, 2021. THESE INCOME TAX RETURNS ARE GENERALLY OPEN TO EXAMINATION BY THE RELEVANT TAXING AUTHORITIES FOR A PERIOD OF THREE YEARS FROM THE LATER OF THE DATE THE RETURN WAS FILED OR ITS DUE DATE (INCLUDING APPROVED EXTENSIONS). THE FOUNDATION IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. PART XI, LINE 2D - OTHER ADJUSTMENTS: GAIN ON JOINT VENTURE 48,804. X X X 0 0 0 0 0 0 0 0 0 JOYCE SIMPSON MD PRESIDENT 341396 0 51 0 5706 0 3050 0 19040 0 369243 0 0 0 RICKY HOOVER MD PATHOLOGIST 317931 0 51 0 8945 0 3050 0 39067 0 369044 0 0 0 JONATHAN KONOPINSKI MD PATHOLOGIST 269377 0 51 0 46471 0 2936 0 18040 0 336875 0 0 0 ODETA LAPKUS PATHOLOGIST 289478 0 51 0 3908 0 0 0 36463 0 329900 0 0 0 NITA GERIG MD BOARD MEMBER 278704 0 51 0 3859 0 2844 0 31491 0 316949 0 0 0 NICOLE ANEST PATHOLOGIST 279232 0 51 0 900 0 1067 0 31504 0 312754 0 0 0 JAMES DYER PATHOLOGIST 281588 0 51 0 5240 0 2845 0 16211 0 305935 0 0 0 TERRY PIPP CFO 159079 0 51 0 4691 0 1631 0 17114 0 182566 0 0 0 JAMES L FRAIN VP-HUMAN RESOURCES - PARTIAL YEAR 131558 0 600 0 5359 0 1335 0 20548 0 159400 0 0 0 FORM 990, PART III, LINE 1, DESCRIPTION OF ORG.'S MISSION CONTINUED: (III) CREATE AND MAINTAIN A WORK ENVIRONMENT WHERE EMPLOYEES CAN GROW PERSONALLY AND PROFESSIONALLY WITH COMPENSATION AND BENEFIT SYSTEMS THAT ARE COMPETITIVE, EQUITABLE, AND COST EFFECTIVE AS WELL AS AN ENVIRONMENT WHERE EMPLOYEES ARE PROVIDED STABLE EMPLOYMENT AND EACH INDIVIDUAL IS TREATED WITH RESPECT AND DIGNITY. (IV) PROVIDE TO THE PATIENT POPULATION IN THE COMMUNITIES WE SERVE READILY ACCESSIBLE, REASONABLY PRICED PATHOLOGY AND BLOOD BANK SERVICES, WITH AS WIDE A SCOPE AND VARIETY AS POSSIBLE TO MEET ALL THEIR NEEDS LOCALLY. (V) RECOGNIZING OUR SOCIAL RESPONSIBILITIES TO THE COMMUNITY, PROVIDE SERVICES WITHIN OUR MEANS TO THOSE LESS FORTUNATE, AND SUPPORT PUBLIC AND PRIVATE EFFORTS DIRECTED TO IMPROVE OUR HEALTH CARE ENVIRONMENT. FORM 990, PART VI, SECTION A, LINE 1A THE ADMINISTRATIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE CORPORATION. SUBJECT TO THE CONTROL OF THE BOARD OF DIRECTORS, THE ADMINISTRATIVE COMMITTEE SHALL HAVE FULL AUTHORITY TO ACT FOR AND ON BEHALF OF THE CORPORATION AND EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS THAT MAY BE LAWFULLY DELEGATED BY SUCH BOARD TO SUCH COMMITTEE EXCEPT, HOWEVER, THE ADMINISTRATIVE COMMITTEE SHALL HAVE NO POWER TO DONATE ANY PART OF THE ASSETS OF THE CORPORATION. THE ADMINISTRATIVE COMMITTEE SHALL RECEIVE STATUS REPORTS ON OTHER COMMITTEE ACTIVITIES AND DISCUSS ITEMS OF INTEREST TO THE GROUP AS A WHOLE OR TO INDIVIDUAL OFFICERS FOR THE PERFORMANCE OF THEIR DUTIES. THE ADMINISTRATIVE COMMITTEE SHALL KEEP MINUTES OF ITS MEETINGS. FORM 990, PART VI, SECTION A, LINE 4 THE FOLLOWING CHANGES WERE MADE TO THE ORGANIZATION'S GOVERNING DOCUMENTS DURING THE YEAR: -THE CORPORATION SHALL HAVE NO MEMBERS. -THE BOARD OF DIRECTORS CONSISTS OF NINE DIRECTORS. -THE BOARD SHALL BE COMPRISED OF TWO (2) PATHOLOGISTS, THREE (3) NON-PATHOLOGIST PHYSICIANS, AND FOUR (4) NON-PHYSICIAN PROFESSIONALS, PROVIDED THAT SUCH NON-PHYSICIAN PROFESSIONALS ARE NOT AFFILIATED WITH THE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS INITIALLY REVIEWED BY THE FINANCE DEPARTMENT AND FINANCE COMMITTEE. A FULL COPY OF THE FORM 990 IS PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ANNUAL CONFLICT OF INTEREST QUESTIONNAIRES ARE COMPLETED BY SUBSTANTIALLY ALL BOARD MEMBERS, OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES. THE ORGANIZATION'S CFO REVIEWS ALL RESPONSES TO DETERMINE WHETHER OR NOT A POTENTIAL OR ACTUAL CONFLICT OF INTEREST EXISTS. IF AN ACTUAL CONFLICT OF INTEREST IS DETERMINED TO EXIST, PERSONS WITH A CONFLICT ARE RECUSED FROM VOTING ON THE CONFLICTING ISSUE. FORM 990, PART VI, SECTION B, LINE 15 ON AN ANNUAL BASIS, THE ORGANIZATION'S COMPENSATION COMMITTEE REVIEWS AND APPROVES COMPENSATION FOR THE PRESIDENT/EXECUTIVE VICE PRESIDENT, AS WELL AS OTHER OFFICERS, ADMINISTRATORS, AND PROFESSIONAL STAFF, INCLUDING KEY EMPLOYEES. THE COMMITTEE REVIEWS CURRENT SALARIES AND PAY STRUCTURES AGAINST VARIOUS SOURCES OF COMPARABILITY DATA, INCLUDING: THE COLLEGE OF AMERICAN PATHOLOGY PATHOLOGISTS COMPENSATION SURVEY; PATHOLOGY COMPENSATION DATA FOR PATHOLOGISTS, WHICH OUTLINES PATHOLOGY AND PHYSICIAN SALARIES BY SPECIALTY, PROVIDED FROM MERRITT HAWKINS AND ASSOCIATES; THE GUIDESTAR NATIONAL COMPENSATION REPORT; AND COMPENSATION REPORTED ON LOCAL AREA HOSPITALS' FORMS 990. AFTER REVIEWING THE COMPARABILITY DATA, THE COMMITTEE DISCUSSES THE CURRENT ECONOMY AND FINANCIAL POSITION OF THE ORGANIZATION TO DETERMINE THE AMOUNT OF ANY COMPENSATION INCREASES AND/OR DECREASES, IF ANY, THAT WILL BE GIVEN. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICIES, AND GOVERNING DOCUMENTS ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G SECURITY SERVICES: PROGRAM SERVICE EXPENSES 155,539. MANAGEMENT AND GENERAL EXPENSES 13,097. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 168,636. REFERENCE LAB SERVICES: PROGRAM SERVICE EXPENSES 1,027,062. MANAGEMENT AND GENERAL EXPENSES 86,484. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,113,546. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 1,159,868. MANAGEMENT AND GENERAL EXPENSES 97,666. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,257,534. TEMPORARY LABOR: PROGRAM SERVICE EXPENSES 101,515. MANAGEMENT AND GENERAL EXPENSES 5,039. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 106,554. COURIER SERVICES: PROGRAM SERVICE EXPENSES 536,562. MANAGEMENT AND GENERAL EXPENSES 45,181. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 581,743. FORM 990, PART XI, LINE 9: GAIN ON JOINT VENTURE 48,804.