2021-11-11T15:17:33-06:00 2020-12-31 420714325 RSM US LLP 30 S Wacker Dr Ste 3300 Chicago IL 606063392 990 2020-01-01 350868178 South Bend Medical Foundation Inc SOUT 5742045233 530 North Lafayette Blvd South Bend IN 46601 Joyce Simpson MD President 5742045233 2021-11-02 1 Joyce Simpson MD 999009999 Rebekuh Eley P01247672 3126343400 2021-11-02 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z The Medical Foundation Joyce Simpson MD 530 North Lafayette Blvd South Bend IN 46601 28320170 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 8 493 8 3936 1359 1836 272104 56097268 19436130 73038734 -1680166 170901 225868 129308739 18253936 1514330 600385 0 0 30162105 15202179 0 0 0 33400876 13017567 65077311 28820131 64231428 -10566195 74047036 53552972 14237372 2772424 59809664 50780548 X See Schedule O 0 0 26962669 600385 19436130 South Bend Medical Foundation, Inc. (the Foundation), provides laboratory and 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. 26962669 1 1 0 0 0 0 0 0 0 0 1 0 0 1 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 59 0 1 493 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 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 Nita Gerig MD Pathologist 32.00 X 682276 0 28475 Ricky Hoover MD Pathologist 40.00 X 354052 0 32937 Joyce Simpson MD President 40.00 X X 360933 0 18684 Derrick Forchetti MD Chief Medical Info. & Pathologist 40.00 X 311192 0 41487 Odeta Lapkus MD Pathologist 40.00 X 306680 0 36500 James Dyer MD Pathologist 40.00 X 299216 0 14757 James L Frain VP of Human Resources 40.00 X 264776 0 22238 Samuel Milligan MD Chair 1.00 X 0 0 0 Robin Zon MD Vice Chair 1.00 X 0 0 0 Michael Blakesley 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 1.00 X 0 0 0 Mark A Thompson MD Board Member 1.00 X 0 0 0 Joe Barkman Board Member 1.00 X 0 0 0 Pedro Miro MD Board Member 1.00 X 0 0 0 Kevin Hochstedler Chief Financial Officer 40.00 X 0 0 0 2579125 0 195078 21 0 1 0 Medifleet Inc 30 Railroad Avenue New Haven CT 06516 Transportation Services 1264550 Cerner PO Box 959156 St Louis MO 63195 Equip Maintenance & Repair 906481 Versiti 638 North 18th Street Milwaukee WI 53233 Reference Lab 662086 Assoc Regional University Pathologists 500 Chipeta Way Salt Lake City UT 84108 Reference Lab 657918 Triage LLC PO Box 3291 Omaha NE 68103 Temporary Agency 377749 21 268856 3248 272104 Net Operating Revenues 621500 18911232 18911232 Clinical Pathology Fees 621500 524898 524898 19436130 180371 3936 176435 8205697 10066234 -1860537 -1860537 -1860537 Records Retrieval Fees 900099 2041 2041 223827 223827 225868 18253936 19436130 3936 -1458234 5431 5431 594954 594954 666631 618949 47682 10811794 10198456 613338 2947693 2778411 169282 776061 725480 50581 143408 143408 141639 141639 2517998 2338925 179073 42069 42069 585323 493605 91718 812352 783036 29316 204212 202926 1286 13200 12517 683 1636571 1561689 74882 707284 707284 Supplies 4084189 4082867 1322 Building Equip / Maint 710017 500676 209341 Freight Charges 133801 133801 Bad Debt 68694 68694 1216810 1112899 103911 28820131 26962669 1857462 0 725 200 45839761 34787182 11344679 5273524 556220 406291 691398 662162 77895516 69615052 14983488 8280464 522264 450622 108501 3692527 74047036 53552972 7642820 2517656 0 17715 68590 40769 6525962 196284 14237372 2772424 X 59809664 50780548 59809664 50780548 74047036 53552972 X -10566195 1537079 X 0 1 X 1 0 X 2072 23197 2057 1836 272104 301266 87413068 83576087 74742621 56097268 19436130 321265174 235177 132543 223632 170901 225868 988121 87650317 83731827 74968310 56270005 19934102 322554561 0 0 0 322554561 13013 13753 13997 292821 176435 510019 13013 13753 13997 292821 176435 510019 1359 1359 481876 523692 534672 1540240 88145206 84269272 75516979 56562826 20111896 324606179 0.99370 0.99350 0.00160 0.00110 X Schedule A, Part III, Line 12, Explanation of Other Income: Clinical Pathology Fees - 2016 Amount: $ 481,876. 2017 Amount: $ 523,692. 2018 Amount: $ 409,067. Partnership Income - 2018 Amount: $ 125,605. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1115906 1115906 42278390 35612264 6666126 34501220 34002788 498432 8280464 Escrow 3629894 Giordano Fund 14433 St. Joseph Valley Metronet 48200 3692527 Accrued Pension and Postretirement Benefits 196284 196284 X 19196061 1537079 1537079 17658982 594954 594954 18253936 28225177 0 28225177 594954 594954 28820131 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 subject to examination by federal and state taxing authorities for the years ended December 31, 2017 through 2020. 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 1,597,025. Loss from Joint Ventures -59,946. Part XI, Line 4b - Other Adjustments: Financial Assistance 594,954. Part XII, Line 4b - Other Adjustments: Financial Assistance 594,954. 1 Patient Medical Assistance 158 92443 FMV Free or reduced-cost medical care Time of Service Discounts 301 86765 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 2020 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. Schedule I, Part III, Column B: Currently, South Bend Medical Foundation does not have an effective way to track the unduplicated number of patients that receive free or reduced care and time of service discounts. X X X 0 1 0 0 0 0 0 0 0 Nita Gerig MD Pathologist 290009 0 2551 0 389716 0 2850 0 25625 0 710751 0 0 0 Ricky Hoover MD Pathologist 342238 0 2551 0 9263 0 2850 0 30087 0 386989 0 0 0 Joyce Simpson MD President 355008 0 51 0 5874 0 2850 0 15834 0 379617 0 0 0 Derrick Forchetti MD Chief Medical Info. & Pathologist 309708 0 51 0 1433 0 2850 0 38637 0 352679 0 0 0 Odeta Lapkus MD Pathologist 300122 0 2551 0 4007 0 0 0 36500 0 343180 0 0 0 James Dyer MD Pathologist 292706 0 2551 0 3959 0 2353 0 12404 0 313973 0 0 0 James L Frain VP of Human Resources 254897 0 51 0 9828 0 2402 0 19836 0 287014 0 0 0 Part I, Line 4b During the year, Nita Gerig received a payout of $385,757 from her 457(f) plan. This amount is reflected in her other reportable compensation amount on Schedule J, Part II, Column B. 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 1 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. 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 vice president of finance 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 XI, line 9: Pension Liability Settlement Gain 1,597,025. Loss from Joint Venture -59,946.