2022-09-06T12:50:39-05:00 2021-12-31 420714325 RSM US LLP 30 S Wacker Dr Ste 3300 Chicago IL 606063392 990 2021-01-01 350868178 South Bend Medical Foundation Inc SOUT 5742045233 530 North Lafayette Blvd South Bend IN 46601 Terry Pipp Chief Financial Officer 5742045233 2022-09-06 1 Terry Pipp XXX-XX-XXXX Rebekuh Eley P01247672 3126343400 2022-09-06 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Joyce Simpson MD 530 North Lafayette Blvd South Bend IN 46601 28105024 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. 7 6 190 8 16416 1135 272104 2543 19436130 18346550 -1680166 1200076 225868 1682011 18253936 21231180 600385 74085 0 0 15202179 13386532 0 0 0 13017567 12510848 28820131 25971465 -10566195 -4740285 53552972 52568816 2772424 5304570 50780548 47264246 X See Schedule O 0 0 24574474 74085 18346550 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. 24574474 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 41 0 1 190 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 IN X Barbara Resnik 5742045233 530 North Lafayette Blvd South Bend IN 46601 Joyce Simpson MD President 40.00 X X 378184 0 19685 Ricky Hoover MD Pathologist 40.00 X 341057 0 37366 Derrick Forchetti MD Pathologist 40.00 X 299055 0 48603 Odeta Lapkus MD Pathologist 40.00 X 293635 0 32944 Jonathan Konopinski MD Pathologist 40.00 X 300724 0 19685 James Dyer MD Pathologist 40.00 X 294236 0 17630 James L Frain VP of Human Resources 32.00 X 206832 0 37321 Kevin Hochstedler Chief Financial Officer 40.00 X 123388 0 36381 Samuel Milligan MD Chair (term end) 1.00 X 0 0 0 Robin Zon MD Chair 1.00 X 0 0 0 Pedro Miro MD Vice Chair 1.00 X 0 0 0 Joe Barkman Board Member 1.00 X 0 0 0 Michael Blakesley MD Board Member 1.00 X 0 0 0 James Kelly MD Board Member 1.00 X 0 0 0 Carlton Lyons MD Board Member 1.00 X 0 0 0 Binh Tran MD Board Member (term end) 1.00 X 0 0 0 2237111 0 249615 20 0 1 0 Central Indiana Regional Blood 3450 N Meridian Street Indianapolis IN 46208 Reference Lab 1139245 Cerner Corporation 2800 Rock Creek Parkway Kansas City MO 64117 Equip Maintenance & Repair 732473 US Pack Services LLC 2251 Lynx Lane Ste 5 Orlando FL 32804 Transportation Services 476983 APS Medical Billing 5700 Southwick Blvd Toledo OH 43614 Medical Billing Service 403575 Ostrom Janitorial PO Box 533 Granger IN 46530 Janitorial Services 343412 11 2543 2543 Net Operating Revenues 621500 17713050 17713050 Clinical Pathology Fees 621500 563619 563619 MHIN Data Center 621500 48336 48336 Pipettes & Thermometer Calibratio 621500 21545 21545 18346550 234655 3696 230959 633320 0 633320 633320 633320 2848326 4990939 2803097 4070747 45229 920192 965421 965421 LIS and Tech Support 900099 1027804 1027804 Path-AI, Digital Pathology 541900 12720 12720 SB Clinic Staffing 900099 3871 3871 4296 4296 1048691 21231180 18346550 16416 2865671 X 6862 6862 67223 67223 642022 597713 44309 9965341 9532107 433234 2076098 1992046 84052 703071 667195 35876 68546 68546 116432 116432 3074990 2975091 99899 45355 45355 580546 528421 52125 893863 861605 32258 140992 139263 1729 7474 5963 1511 786976 695938 91038 575110 575110 Supplies 3142025 3141489 536 Building Equip / Mainte 2129848 1801481 328367 Bad Debt 294662 294662 Freight Charges 124382 124382 529647 522568 7079 25971465 24574474 1396991 0 200 873906 34787182 2918675 5273524 2411054 406291 478418 662162 630506 50340455 35890648 8280464 14449807 0 30610937 450622 144930 3692527 50583 53552972 52568816 2517656 1874504 17715 237270 40769 3013013 196284 179783 2772424 5304570 X 50780548 47264246 50780548 47264246 53552972 52568816 X -4740285 669575 554408 X 0 1 X 1 0 X 23197 2057 1836 272104 2543 301737 83576087 74742621 56097268 19436130 18346550 252198656 132543 223632 170901 225868 1035971 1788915 83731827 74968310 56270005 19934102 19385064 254289308 0 0 0 254289308 13753 13997 292821 176435 864279 1361285 13753 13997 292821 176435 864279 1361285 1359 1135 2494 523692 534672 1058364 84269272 75516979 56562826 20111896 20250478 256711451 0.99060 0.99370 0.00530 0.00160 X Schedule A, Part III, Line 12, Explanation of Other Income: Clinical Pathology Fees - 2017 Amount: $ 523,692. 2018 Amount: $ 409,067. Partnership Income - 2018 Amount: $ 125,605. 549980 549980 3809211 2466189 1343022 34969863 33424459 1545404 11011401 11011401 14449807 Accrued Pension and Postretirement Benefits 179783 179783 X 22387940 669575 487185 1156760 21231180 0 21231180 25904242 0 25904242 67223 67223 25971465 Part X, Line 2: The Foundation is a not-for-profit organization pursuant to Section 501(c)(3) of the Internal Revenue Code and is exempt from federal and state income taxes pursuant to Section 501(a). Accordingly, no provision for income taxes is reflected in the Foundation's financial statements. The Foundation is generally subject to examination by federal and state taxing authorities for the years ended December 31, 2018 through 2021. The Foundation follows guidance issued by the Financial Accounting Standards Board (FASB) with respect to accounting for uncertainty in income taxes. A tax position is a benefit only if it is "more likely than not" that the tax position would be sustained in a tax examination, with a tax examination being presumed to occur. The amount recognized is the largest amount of tax benefit that is greater than 50% likely of being realized on examination. For tax positions not meeting the "more likely than not" test, no tax benefit is recorded. Management has determined that there is no liability for uncertain tax positions. Part XI, Line 2d - Other Adjustments: Pension Liability Settlement 511,135. Gain (Loss) from Joint Ventures 43,273. Financial Assistance -67,223. Part XII, Line 4b - Other Adjustments: Financial Assistance 67,223. 1 Patient Medical Assistance 135 45496 FMV Free or reduce-cost medical care Time of Service Discounts 1818 21726 FMV Discount provided at time of payment Part I, Line 2: South Bend Medical Foundation (SBMF) provides funding to other community not-for-profit organizations. Generally, these are unrestricted contributions that the receiving organization can use to further their mission and programs at their discretion. The use of these contributions are not monitored. There were no grants over $5,000 during the 2021 tax year. SBMF also 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. Determination and monitoring of charity care is performed on a case-by-case basis. SBMF 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. There is no actual exchange of funds, as the discounts are credited directly to the patients' accounts. Time of service discounts are monitored at the organization level, in the aggregate. X X X 0 0 0 0 0 0 0 1 0 Joyce Simpson MD President 342478 0 30000 0 5706 0 2900 0 16785 0 397869 0 0 0 Ricky Hoover MD Pathologist 332087 0 0 0 8970 0 2900 0 34466 0 378423 0 0 0 Derrick Forchetti MD Pathologist 297675 0 0 0 1380 0 2900 0 45703 0 347658 0 0 0 Odeta Lapkus MD Pathologist 289727 0 0 0 3908 0 0 0 32944 0 326579 0 0 0 Jonathan Konopinski MD Pathologist 300244 0 0 0 480 0 2900 0 16785 0 320409 0 0 0 James Dyer MD Pathologist 290376 0 0 0 3860 0 2845 0 14785 0 311866 0 0 0 James L Frain VP of Human Resources 197523 0 0 0 9309 0 2056 0 35265 0 244153 0 0 0 Kevin Hochstedler Chief Financial Officer 121362 0 0 0 2026 0 717 0 35664 0 159769 0 0 0 Part I, Line 7 Joyce Simpson, M.D. received a disrectionary bonus of $30,000 during the calendar year. The payment is included in Part VII, Column (D) and Schedule J, Part II, Column (b)(iii). Form 990, Part III, Line 1, Description of Organization's Mission: 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. (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 6 The organization consists of one class of members. Each member must be a physician, licensed to practice medicine as such in either the state of Indiana or the state of Michigan and residing in either the state of Indiana or the state of Michigan. Each year, an invitation to become a member of the organization is mailed to physicians in the area. Members vote on open board positions that each have a 3 year term. Form 990, Part VI, Section A, line 7a Members vote on open board positions that each have a 3 year term and are limited to two consecutive terms. 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 200,828. Management and general expenses 6,744. Fundraising expenses 0. Total expenses 207,572. Transportation Services: Program service expenses 418,541. Management and general expenses 14,054. Fundraising expenses 0. Total expenses 432,595. Reference Lab Services: Program service expenses 1,106,450. Management and general expenses 37,153. Fundraising expenses 0. Total expenses 1,143,603. Professional Services: Program service expenses 1,172,314. Management and general expenses 39,365. Fundraising expenses 0. Total expenses 1,211,679. Other Services: Program service expenses 76,958. Management and general expenses 2,583. Fundraising expenses 0. Total expenses 79,541. Form 990, Part XI, line 9: Pension Liability Settlement Gain 511,135. Gain from Joint Venture 43,273.