SOUTH BEND MEDICAL FOUNDATION INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- SOUTH BEND MEDICAL FOUNDATION INC (EIN 35-0868178)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-10
- IRS object ID
- 202043159349303824
- Schema version
- 2019v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-10T14:05:30-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 420714325 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RSM US LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1 S Wacker Dr Ste 800 | AddressLine1Txt |
| City | Chicago | CityNm |
| State Abbreviation | IL | StateAbbreviationCd |
| ZIP | 606063392 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 350868178 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | South Bend Medical Foundation Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SOUT | BusinessNameControlTxt |
| Phone | 5742045233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 530 North Lafayette Blvd | AddressLine1Txt |
| City | South Bend | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46601 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Joyce Simpson MD | PersonNm |
| Person Title | President | PersonTitleTxt |
| Phone | 5742045233 | PhoneNum |
| Signature | 2020-10-29 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rebekuh Eley | PreparerPersonNm |
| PTIN | P01247672 | PTIN |
| Phone | 3126343400 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 98.226.130.40 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2020-10-29 | IPDt |
| IP Tm | 18:30:17 | IPTm |
| IP Timezone | ED | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 49D5A1596642B6DD837368B1E984A310120BB776 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | The Medical Foundation | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Joyce Simpson MD | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 530 North Lafayette Blvd | AddressLine1Txt |
| City | South Bend | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $137,617,701 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.sbmf.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | IN | LegalDomicileStateCd |
| Activity Or 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. | ActivityOrMissionDesc |
| Contract Termination | Yes (X) | ContractTerminationInd |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 623 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $2,057 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,836 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $74,742,621 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $56,097,268 | CYProgramServiceRevenueAmt |
| PY Investment Income | $303,694 | PYInvestmentIncomeAmt |
| CY Investment Income | $73,038,734 | CYInvestmentIncomeAmt |
| PY Other Revenue | $758,304 | PYOtherRevenueAmt |
| CY Other Revenue | $170,901 | CYOtherRevenueAmt |
| PY Total Revenue | $75,806,676 | PYTotalRevenueAmt |
| CY Total Revenue | $129,308,739 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,711,522 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,514,330 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $33,541,533 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $30,162,105 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $42,187,526 | PYOtherExpensesAmt |
| CY Other Expenses | $33,400,876 | CYOtherExpensesAmt |
| PY Total Expenses | $77,440,581 | PYTotalExpensesAmt |
| CY Total Expenses | $65,077,311 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,633,905 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $64,231,428 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $35,340,362 | TotalAssetsBOYAmt |
| Total Assets EOY | $74,047,036 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $34,676,773 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $14,237,372 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $663,589 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $59,809,664 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | See Schedule O | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | Yes (1) | SignificantChangeInd |
| Expense | $60,983,575 | ExpenseAmt |
| Grant | $1,514,330 | GrantAmt |
| Revenue | $56,097,268 | RevenueAmt |
| Desc | 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. On September 20, 2019, the Foundation completed the sale of its clinical laboratory services business specifically related to its diagnostic testing operations for cash consideration to Labcorp Indiana, Inc. | Desc |
| Total Program Service Expenses | $60,983,575 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | Yes (1) | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 69 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 623 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | IN | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Barbara Resnik | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5742045233 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 530 North Lafayette Blvd | AddressLine1Txt |
| City | South Bend | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| Ricky Hoover MD | ||||||||
| Pathologist | 40.00 | 0.00 | Yes (X) | $330,881 | $0 | $27,184 | ||
| Joyce Simpson MD | ||||||||
| President | 40.00 | 0.00 | $334,712 | $0 | $15,653 | Yes (X) | Yes (X) | |
| Derrick Forchetti MD | ||||||||
| Chief Medical Information | 40.00 | 0.00 | Yes (X) | $317,817 | $0 | $27,994 | ||
| Odeta Lapkus MD | ||||||||
| Pathologist | 40.00 | 0.00 | Yes (X) | $281,186 | $0 | $28,680 | ||
| Nita Gerig MD | ||||||||
| Pathologist | 32.00 | 0.00 | Yes (X) | $271,719 | $0 | $23,316 | ||
| James L Frain | ||||||||
| VP of Human Resources | 40.00 | 0.00 | $275,637 | $0 | $15,097 | Yes (X) | ||
| James Dyer MD | ||||||||
| Pathologist | 40.00 | 0.00 | Yes (X) | $275,200 | $0 | $11,739 | ||
| Patricia Hankila | ||||||||
| CFO (until 11/4/19) | 40.00 | 0.00 | $205,363 | $0 | $23,265 | Yes (X) | ||
| John Landgraf MD | ||||||||
| Board Member (until 10/20/19) | 1.00 | 0.00 | $11,923 | $0 | $302 | Yes (X) | ||
| Samuel Milligan MD | ||||||||
| Chair | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Robin Zon MD | ||||||||
| Vice Chair | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Michael Blakesley MD | ||||||||
| Board Member | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Carlton Lyons MD | ||||||||
| Board Member | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Binh Tran MD | ||||||||
| Board Member | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Mark A Thompson MD | ||||||||
| Board Member | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Joe Barkman | ||||||||
| Board Member | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Pedro Miro MD | ||||||||
| Board Member | 1.00 | 0.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,304,438 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $173,230 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Assoc Regional University Pathologists | |||||
| 500 Chipeta Way | Salt Lake City | UT | 84108 | Reference Lab | $3,909,287 |
| Medifleet Inc | |||||
| 30 Railroad Avenue | New Haven | CT | 06516 | Transportation Services | $1,288,863 |
| Triage LLC | |||||
| PO Box 3291 | Omaha | NE | 68103 | Temporary Agency | $1,059,079 |
| Barnes & Thornburg LLC | |||||
| 700 1st Source Bank Center 100 Nor | South Bend | IN | 46601 | Legal Services | $722,501 |
| Thermo Asset Management Services Inc | |||||
| 2202 N Bartlett Avenue | Milwaukee | WI | 53202 | Equip Maintenance & Repair | $636,338 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 25 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $1,836 | AllOtherContributionsAmt |
| Total Contributions | $1,836 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Operating Revenues | 621500 | $55,618,618 | $55,618,618 |
| Clinical Pathology Fees | 621500 | $478,650 | $478,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $56,097,268 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $292,821 | TotalRevenueColumnAmt |
| Exclusion | $292,821 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $81,054,875 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $8,308,962 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $72,745,913 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $72,745,913 | TotalRevenueColumnAmt |
| Exclusion | $72,745,913 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Records Retrieval Fees | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $4,327 | TotalRevenueColumnAmt |
| Exclusion | $4,327 | ExclusionAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $166,574 | TotalRevenueColumnAmt |
| Exclusion | $166,574 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $170,901 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $129,308,739 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $56,097,268 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $73,209,635 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,953 | TotalAmt |
| Program Services | $31,953 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,482,377 | TotalAmt |
| Program Services | $1,482,377 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $888,346 | TotalAmt |
| Program Services | $611,159 | ProgramServicesAmt |
| Management And General | $277,187 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,537,927 | TotalAmt |
| Program Services | $20,903,371 | ProgramServicesAmt |
| Management And General | $1,634,556 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,044,140 | TotalAmt |
| Program Services | $4,659,117 | ProgramServicesAmt |
| Management And General | $385,023 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,691,692 | TotalAmt |
| Program Services | $1,541,747 | ProgramServicesAmt |
| Management And General | $149,945 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $716,746 | TotalAmt |
| Management And General | $716,746 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,795 | TotalAmt |
| Management And General | $123,795 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,110,671 | TotalAmt |
| Program Services | $6,846,905 | ProgramServicesAmt |
| Management And General | $263,766 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,389 | TotalAmt |
| Program Services | $36,389 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,137,631 | TotalAmt |
| Program Services | $970,535 | ProgramServicesAmt |
| Management And General | $167,096 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $806,755 | TotalAmt |
| Program Services | $766,952 | ProgramServicesAmt |
| Management And General | $39,803 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $172,400 | TotalAmt |
| Program Services | $169,826 | ProgramServicesAmt |
| Management And General | $2,574 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,421 | TotalAmt |
| Program Services | $146,345 | ProgramServicesAmt |
| Management And General | $3,076 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,907,967 | TotalAmt |
| Program Services | $1,831,468 | ProgramServicesAmt |
| Management And General | $76,499 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $670,150 | TotalAmt |
| Program Services | $670,150 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Supplies | $15,991,597 | $15,991,530 | $67 |
| Building Equip/Maint | $3,002,757 | $2,777,628 | $225,129 |
| Freight Charges | $422,237 | $422,237 | |
| Bad Debt | $57,746 | $57,746 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,094,614 | TotalAmt |
| Program Services | $1,066,140 | ProgramServicesAmt |
| Management And General | $28,474 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,077,311 | TotalAmt |
| Program Services | $60,983,575 | ProgramServicesAmt |
| Management And General | $4,093,736 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $950 | BOYAmt |
| EOY | $725 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,897,977 | BOYAmt |
| EOY | $45,839,761 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,842,852 | BOYAmt |
| EOY | $11,344,679 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,037,132 | BOYAmt |
| EOY | $556,220 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $892,555 | BOYAmt |
| EOY | $691,398 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $79,073,744 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $64,090,256 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,609,276 | BOYAmt |
| EOY | $14,983,488 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $972,887 | BOYAmt |
| EOY | $522,264 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $86,733 | BOYAmt |
| EOY | $108,501 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,340,362 | BOYAmt |
| EOY | $74,047,036 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,392,754 | BOYAmt |
| EOY | $7,642,820 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,973,441 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $68,590 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,310,578 | BOYAmt |
| EOY | $6,525,962 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,676,773 | BOYAmt |
| EOY | $14,237,372 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $663,589 | BOYAmt |
| EOY | $59,809,664 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $663,589 | BOYAmt |
| EOY | $59,809,664 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,340,362 | BOYAmt |
| EOY | $74,047,036 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $64,231,428 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $48,380 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$5,133,733 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | Yes (X) | PubliclySupportedOrg509a2Ind |
Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $2,021 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $2,072 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $23,197 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $2,057 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,836 | CurrentTaxYearAmt |
| Total | $31,183 | TotalAmt |
Gross Receipts Admissions GrossReceiptsAdmissionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $90,903,792 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $87,413,068 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $83,576,087 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $74,742,621 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $56,097,268 | CurrentTaxYearAmt |
| Total | $392,732,836 | TotalAmt |
Gross Receipts Non Unrlt Bus GrossReceiptsNonUnrltBusGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $219,490 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $235,177 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $132,543 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $223,632 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $170,901 | CurrentTaxYearAmt |
| Total | $981,743 | TotalAmt |
Total509 Total509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $91,125,303 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $87,650,317 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $83,731,827 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $74,968,310 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $56,270,005 | CurrentTaxYearAmt |
| Total | $393,745,762 | TotalAmt |
Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Substantial Contributors Amt SubstantialContributorsAmtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | $393,745,762 | PublicSupportTotal509Amt |
Gross Investment Income509 GrossInvestmentIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $101,397 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,013 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,753 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,997 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $292,821 | CurrentTaxYearAmt |
| Total | $434,981 | TotalAmt |
Investment Income And UBTI InvestmentIncomeAndUBTIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $101,397 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $13,013 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $13,753 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $13,997 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $292,821 | CurrentTaxYearAmt |
| Total | $434,981 | TotalAmt |
Other Income509 OtherIncome509Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $604,138 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $481,876 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $523,692 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $534,672 | CurrentTaxYearMinus1YearAmt |
| Total | $2,144,378 | TotalAmt |
Total Support Calendar Year TotalSupportCalendarYearGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $91,830,838 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $88,145,206 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $84,269,272 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $75,516,979 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $56,562,826 | CurrentTaxYearAmt |
| Total | $396,325,121 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY509 | 0.99350 | PublicSupportCY509Pct |
| Public Support PY509 | 0.99290 | PublicSupportPY509Pct |
| Investment Income CY | 0.00110 | InvestmentIncomeCYPct |
| Investment Income PY | 0.00070 | InvestmentIncomePYPct |
| Thirty Thr Pct Suprt Tests CY509 | Yes (X) | ThirtyThrPctSuprtTestsCY509Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule A, Part III, Line 12, Explanation of Other Income: | FormAndLineReferenceDesc |
| Explanation | Clinical Pathology Fees - 2015 Amount: $ 604,138. 2016 Amount: $ 481,876. 2017 Amount: $ 523,692. 2018 Amount: $ 409,067. Partnership Income - 2018 Amount: $ 125,605. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,115,906 | OtherCostOrOtherBasisAmt |
| Book Value | $1,115,906 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,273,585 | OtherCostOrOtherBasisAmt |
| Depreciation | $35,129,120 | DepreciationAmt |
| Book Value | $7,144,465 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $35,684,253 | OtherCostOrOtherBasisAmt |
| Depreciation | $28,961,136 | DepreciationAmt |
| Book Value | $6,723,117 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,983,488 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Accrued Pension and Postretirement Benefits | Desc |
| Amt | $6,525,962 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,525,962 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $128,014,057 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $48,380 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $48,380 | RevenueNotReportedAmt |
| Revenue Subtotal | $127,965,677 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,343,062 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,343,062 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $129,308,739 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $63,734,249 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $63,734,249 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,343,062 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,343,062 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $65,077,311 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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, 2016 through 2019. 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 4b - Other Adjustments: | Financial Assistance 1,343,062. |
| Part XII, Line 4b - Other Adjustments: | Financial Assistance 1,343,062. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | American Heart Association Midwest Affiliate-Accts RBC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 50035 | AddressLine1Txt |
| City | Prescott | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 863045035 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 135613797 | RecipientEIN |
| IRC Section | 501(c)(3) | IRCSectionDesc |
| Cash Grant | $12,000 | CashGrantAmt |
| Purpose Of Grant | General Support | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)
| Grant TypeGrantTypeTxt | Cash GrantCashGrantAmt | Non Cash AssistanceNonCashAssistanceAmt | Valuation Method UsedValuationMethodUsedDesc | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|
| Patient Medical Assistance | $0 | $892,808 | FMV | Free or reduced-cost medical care |
| Time of Service Discounts | $0 | $429,319 | FMV | Discount provided at time of payment |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | Yes (1) | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ricky Hoover MD | ||||||||||||||
| Pathologist | $321,911 | $0 | $0 | $0 | $8,970 | $0 | $2,800 | $0 | $26,957 | $0 | $360,638 | $0 | $0 | $0 |
| Joyce Simpson MD | ||||||||||||||
| President | $329,006 | $0 | $0 | $0 | $5,706 | $0 | $2,800 | $0 | $15,446 | $0 | $352,958 | $0 | $0 | $0 |
| Derrick Forchetti MD | ||||||||||||||
| Chief Medical Information | $291,917 | $0 | $25,000 | $0 | $900 | $0 | $2,714 | $0 | $27,697 | $0 | $348,228 | $0 | $0 | $0 |
| Odeta Lapkus MD | ||||||||||||||
| Pathologist | $278,606 | $0 | $0 | $0 | $2,580 | $0 | $0 | $0 | $31,049 | $0 | $312,235 | $0 | $0 | $0 |
| Nita Gerig MD | ||||||||||||||
| Pathologist | $269,105 | $0 | $0 | $0 | $2,614 | $0 | $2,740 | $0 | $22,899 | $0 | $297,358 | $0 | $0 | $0 |
| James L Frain | ||||||||||||||
| VP of Human Resources | $236,171 | $0 | $30,000 | $0 | $9,466 | $0 | $2,310 | $0 | $14,970 | $0 | $292,917 | $0 | $0 | $0 |
| James Dyer MD | ||||||||||||||
| Pathologist | $271,385 | $0 | $0 | $0 | $3,815 | $0 | $2,056 | $0 | $12,007 | $0 | $289,263 | $0 | $0 | $0 |
| Patricia Hankila | ||||||||||||||
| CFO (until 11/4/19) | $145,360 | $0 | $20,000 | $0 | $40,003 | $0 | $0 | $0 | $24,885 | $0 | $230,248 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 4a | FormAndLineReferenceDesc |
| Explanation | 2019 Severance Payment: Patricia Hankila - $13,812 (terms and conditions available to IRS upon request) | ExplanationTxt |
Schedule N IRS990ScheduleN
Disposition Of Assets Detail DispositionOfAssetsDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Assets Distri Or Expnss Paid | All assets related to clinical laboratory services specifically related to its diagnostic testing operations | AssetsDistriOrExpnssPaidDesc |
| Distribution | 2019-09-20 | DistributionDt |
| Fair Market Value Of Asset | $81,054,375 | FairMarketValueOfAssetAmt |
| Method Of FMV Determination | Consideration received from sale | MethodOfFMVDeterminationTxt |
| EIN | 133757370 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Laboratory Corp of America Holdings | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 358 South Main Street | AddressLine1Txt |
| City | Burlington | CityNm |
| State Abbreviation | NC | StateAbbreviationCd |
| ZIP | 27215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRC Section | C Corp | IRCSectionTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Director Of Successor2 | 0 | DirectorOfSuccessor2Ind |
| Employee Of Successor2 | 0 | EmployeeOfSuccessor2Ind |
| Owner Of Successor2 | 0 | OwnerOfSuccessor2Ind |
| Receive Compensation2 | 0 | ReceiveCompensation2Ind |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 III, line 3 | Due to increasing competition within the clinical laboratory services business in the United States and declining liquidity, on July 26, 2019, the Foundation entered into an asset purchase agreement with Labcorp to purchase all assets of the Foundation used in connection with its clinical laboratory services business specifically related to its diagnostic testing operations. The sale to Labcorp closed on September 20, 2019. |
| 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 and Post Retirement Benefit Charges -4,695,560. Gain/Loss in Joint Venture -438,173. |
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