2019-11-15T15:35:16-06:00 2018-12-31 420714325 RSM US LLP One South Wacker Dr Ste 800 Chicago IL 606063392 990 2018-01-01 350868178 South Bend Medical Foundation Inc SOUT 5742045233 530 North Lafayette Blvd South Bend IN 46601 James L Frain VP of Human Resources 5742045233 2019-11-15 1 Zachary A Fortsch P00052725 3126343400 2019-11-14 66.98.98.135 2019-11-15 15:25:52 CS P 31EF5E39DB87B0F26870F9B735D03662AFC585D8 336FD8F0FA5A347F3EEB7148290E7297C3B1C7D5 2018 2020-03-31 21:24:44Z The Medical Foundation Joyce Simpson MD 530 North Lafayette Blvd South Bend IN 46601 75848502 0 X www.sbmf.org X 1946 IN South Bend Medical Foundation exists for the purpose of providing quality and cost effective laboratory and blood banking services to hospitals, physicians, and patients. 9 8 675 14 0 42530 23197 2057 83576087 74742621 1231830 303694 656235 758304 85487349 75806676 1580063 1711522 0 0 33870104 33541533 0 0 0 46852345 42187526 82302512 77440581 3184837 -1633905 40920365 35340362 37501935 34676773 3418430 663589 X See Schedule O 0 0 73635644 1711522 75277293 South Bend Medical Foundation's (SBMF) approximately 650 employees provide a wide range of top-quality, cost-effective health care services for communities in Indiana, Michigan, Kentucky, Ohio, and Illinois. By working together with local health care providers, SBMF preserves the critical relationship between laboratory, physician and patient. Unlike many large commercial laboratories, SBMF offers its services 24 hours a day, 365 days a year. SBMF personnel are dedicated to being a trusted physician resource, handling everything from routine outpatient orders to providing inpatient services at hospital and other health care facilities throughout the region. SBMF's commitment to delivering consistent, reliable, quality medical care has played an instrumental role in helping the foundation achieve its position of leadership among the nation's diagnostic laboratories.The altruistic activities of the organization are intended to relieve disease, suffering, and constraint. Many services are provided as charity or pro bono. The amount of charity care, provided at SBMF's established rates, was approximately $440,500 for the year ended December 31, 2018. 73635644 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 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 68 0 1 675 1 0 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 0 1 1 1 1 1 1 1 1 1 IN X Barbara Resnik 5742045233 530 N Lafayette Blvd South Bend IN 46601 Joyce Simpson MD President 40.00 0.00 X X 330946 0 13634 Samuel Milligan MD Chair 1.00 0.00 X 0 0 0 Robin Zon MD Vice Chair 1.00 0.00 X 0 0 0 Michael Blakesley MD Board Member 1.00 0.00 X 0 0 0 John Landgraf MD Board Member/Pathologist 40.00 0.00 X 275090 0 25914 Samuel Borrelli MD Board Member (until 5/18) 1.00 0.00 X 0 0 0 Carlton Lyons MD Board Member 1.00 0.00 X 0 0 0 Binh Tran MD Board Member 1.00 0.00 X 0 0 0 Daniel E Scherb MD Board Member (until 5/18) 1.00 0.00 X 0 0 0 Walter H Halloran MD Board Member (until 5/18) 1.00 0.00 X 0 0 0 Eric D Knapp DO Board Member (until 5/18) 1.00 0.00 X 0 0 0 Mark A Thompson MD Board Member 1.00 0.00 X 0 0 0 Joe Barkman Board Member (as of 5/18) 1.00 0.00 X 0 0 0 Pedro Miro MD Board Member (as of 5/18) 1.00 0.00 X 0 0 0 Trish Hankila CFO 40.00 0.00 X 165688 0 23677 James L Frain VP of Human Resources 40.00 0.00 X 242466 0 14170 Derrick Forchetti MD Chief Medical Information Officer 40.00 0.00 X 288453 0 29556 Nita Gerig MD Pathologist 32.00 0.00 X 263579 0 23863 Ricky Hoover MD Pathologist 40.00 0.00 X 323514 0 26199 Odeta Lapkus MD Pathologist 40.00 0.00 X 276744 0 27559 Nicole Anest MD Pathologist 40.00 0.00 X 261906 0 22698 James Dwyer MD Pathologist 40.00 0.00 X 272057 0 13578 2700443 0 220848 19 0 1 0 Assoc Regional University Pathologists 500 Chipeta Way Salt Lake City UT 84108 Reference Lab 3443375 Medifleet Inc 30 Railroad Avenue New Haven CT 06516 Transportation Services 1353875 Cerner Corporation 2800 Rockcreek Parkway Kansas City MO 64117 Software & Equip. Maintenance 1163935 Thermo Asset Management Services Inc 2202 N Bartlett Avenue Milwaukee WI 53202 Equip. Maintenance & Repair 789931 Chikol Equities PO Box 774 Granger IN 46530 Consulting 727963 24 2057 2057 Net Operating Revenues 621500 74742621 74742621 74742621 13997 13997 331523 41826 289697 289697 289697 Clinical Pathology Fees 621500 409067 409067 Partnership Income 900099 125605 125605 Records Retrieval Fees 900099 3833 3833 219799 219799 758304 75806676 75277293 0 527326 39764 39764 1671758 1671758 238654 238654 27114609 25090690 2023919 4424404 4049283 375121 1763866 1608608 155258 131124 131124 81170 81170 8167020 7827180 339840 46076 46029 47 1173725 1096813 76912 833147 798078 35069 267359 258445 8914 235667 235086 581 2320389 2235808 84581 775502 775502 Supplies 20631918 20631206 712 Building Equip/Maint 4821549 4593670 227879 Freight Charges 495575 495575 Bad Debt 324376 324376 1882929 1857773 25156 77440581 73635644 3804937 0 750 950 5747585 1897977 10981028 10842852 2973070 3037132 774147 892555 93818345 76209069 19456004 17609276 931099 972887 56682 86733 40920365 35340362 9160813 9392754 4530000 2973441 23811122 22310578 37501935 34676773 X 3418430 663589 3418430 663589 40920365 35340362 X -1633905 147838 -1268774 X 0 1 X 1 0 X 2032 2021 2072 23197 2057 31379 94707654 90903792 87413068 83576087 74742621 431343222 336035 219490 235177 132543 223632 1146877 95045721 91125303 87650317 83731827 74968310 432521478 0 0 0 432521478 155693 101397 13013 13753 13997 297853 155693 101397 13013 13753 13997 297853 629322 604138 481876 523692 534672 2773700 95830736 91830838 88145206 84269272 75516979 435593031 0.99290 0.99290 0.00070 0.00130 X Schedule A, Part III, Line 12, Explanation of Other Income: Clinical Pathology Fees - 2014 Amount: $ 629,322. 2015 Amount: $ 604,138. 2016 Amount: $ 481,876. 2017 Amount: $ 523,692. 2018 Amount: $ 409,067. Partnership Income - 2018 Amount: $ 125,605. 1115906 1115906 42305394 34778531 7526863 200003 164419 35584 50197042 41266119 8930923 17609276 Accrued Pension and Postretirement Benefits 22224298 Fair Value of Interest Rate Swap 86280 22310578 X 74282736 147838 147838 74134898 1671778 1671778 75806676 77037577 1268754 1268754 75768823 1671758 1671758 77440581 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, 2015 through 2018. 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 1,671,758. Partnership Income - Book/Tax Differences 20. Part XII, Line 2d - Other Adjustments: Pension and Post Retirement Benefit Charges 1,268,754. Part XII, Line 4b - Other Adjustments: Financial Assistance 1,671,758. 1 American Heart Association Midwest Affiliate-Accts RBC PO Box 50035 Prescott AZ 863045035 135613797 501(c)(3) 10000 General Support 1 0 Patient Medical Assistance 0 1102154 FMV Free or reduced-cost medical care Time of Service Discounts 0 569604 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. 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 0 0 0 0 0 0 0 0 Joyce Simpson MD President 325298 0 0 0 5648 0 2750 0 10884 0 344580 0 0 0 John Landgraf MD Board Member/Pathologist 266251 0 0 0 8839 0 2710 0 23204 0 301004 0 0 0 Trish Hankila CFO 163428 0 0 0 2260 0 0 0 23677 0 189365 0 0 0 James L Frain VP of Human Resources 233476 0 0 0 8990 0 2379 0 11791 0 256636 0 0 0 Derrick Forchetti MD Chief Medical Information Officer 287553 0 0 0 900 0 2750 0 26806 0 318009 0 0 0 Nita Gerig MD Pathologist 260980 0 0 0 2599 0 2709 0 21154 0 287442 0 0 0 Ricky Hoover MD Pathologist 318204 0 0 0 5310 0 2749 0 23450 0 349713 0 0 0 Odeta Lapkus MD Pathologist 275364 0 0 0 1380 0 0 0 27559 0 304303 0 0 0 Nicole Anest MD Pathologist 261014 0 0 0 892 0 1016 0 21682 0 284604 0 0 0 James Dwyer MD Pathologist 268258 0 0 0 3799 0 2032 0 11546 0 285635 0 0 0 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 laboratory and blood banking services to hospitals, physicians, and patients. To fulfill our mission we shall: (i) Provide the hospitals we service the highest quality laboratory 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 laboratory 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 laboratory 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 and are eligible for nomination for open board positions. Form 990, Part VI, Section A, line 7a Members of the organization vote on open board positions and are eligible for nomination for open board positions. Form 990, Part VI, Section B, line 11b The Form 990 was prepared by RSM US LLP and was reviewed by the finance department.The return will be completed and filed with the Internal Revenue Service on or before November 15, 2019. 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 -1,268,754. Partnership Income - Book/Tax Differences -20.