2018-11-14T17:30:26-06:00 2017-12-31 350921680 CROWE LLP 330 E Jefferson Blvd PO Box 7 South Bend IN 466240007 990 2017-01-01 350868178 South Bend Medical Foundation Inc SOUT 5742045291 530 North Lafayette Blvd South Bend IN 46601 JOYCE SIMPSON MD PRESIDENT 2018-11-14 true KENNETH J KEBER P00240883 5742323992 2017 2019-02-21 02:37:17Z The Medical Foundation Joyce Simpson MD 530 North Lafayette Blvd South Bend IN 46601 85487349 false 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. 13 10 751 14 0 0 2072 23197 87413068 83576087 -252633 1231830 717053 656235 87879560 85487349 1475695 1580063 0 39283873 33870104 0 0 47148175 46852345 87907743 82302512 -28183 3184837 41409672 40920365 38444435 37501935 2965237 3418430 South Bend Medical Foundation exists for the purpose of providing quality and cost effective laboratory and blood banking services to hospitals, physicians, and patients. (Continued in Schedule O). false false 69814866 1580063 84099779 SOUTH BEND MEDICAL FOUNDATION'S (SBMF) MORE THAN 750 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. (CONTINUED IN SCHEDULE O) 69814866 true true false false false false false false false false true false false false true true true false false false false false false false false false false true true true false false false false false false false false false false false false false false false false false true 78 0 true 751 true false false false false false false true false false false X 13 10 true false false false true true false true true false false true true true true true true true true true true IN X Trish Hankila 5742344176 118 W Edison Road Mishawaka IN 46545 Joyce Simpson MD President 40.0 X X 331988 0 12587 Amobi Ezenekwe MD EXECUTIVE VP 40.0 X X 288604 0 26714 Samuel Borrelli MD BOARD MEMBER 1.0 X 0 0 0 CARLTON LYONS MD BOARD MEMBER 1.0 X 0 0 0 BINH TRAN MD BOARD MEMBER 1.0 X 0 0 0 Daniel E Scherb MD BOARD MEMBER 1.0 X 0 0 0 Walter H Halloran MD BOARD MEMBER 1.0 X 0 0 0 ERIC D KNAPP DO BOARD MEMBER 1.0 X 0 0 0 Mark A Thompson MD Board Member 1.0 X 0 0 0 John T Rice MD Chair (through May 2017) 1.0 X 0 0 0 SAMUEL MILLIGAN MD CHAIR (BEGINNING MAY 2017) 1.0 X 0 0 0 ROBIN ZON MD VICE CHAIR 1.0 X 0 0 0 Richard H Seall MD Board Member (THROUGH MAY 2017) 1.0 X 0 0 0 Michael Blakesley MD Board member (beginning May 2017) 1.0 X 0 0 0 John Landgraf MD Board member (beginning May 2017)/Pathologist 40.0 X 273840 0 20740 Ann Sullivan VP of Finance (through August 2017) 40.0 X 257114 0 19967 Trish Hankila VP OF FINANCE (beginning December 2017) 40.0 X 47128 0 1360 James Frain VP of Human Resources 40.0 X 236886 0 14239 Derrick Forchetti MD Chief Medical Information Officer 40.0 X 284567 0 25766 SHADIA ALAM MD PATHOLOGIST 40.0 X 240068 0 11899 James Dyer MD Pathologist 40.0 X 270448 0 11690 Nita Gerig MD Pathologist 32.0 X 262637 0 18965 Ricky Hoover MD Pathologist 40.0 X 322640 0 20915 Kristen Jacobs MD Pathologist 24.0 X 199851 0 14553 Odeta Lapkus MD Pathologist 40.0 X 271178 0 23941 Bobbie Sutton MD Pathologist 40.0 X 178615 0 12376 Erica Martin MD PATHOLOGIST 40.0 X 238658 0 11899 Nicole Anest MD Pathologist 40.0 X 259550 0 18237 DR QIN CHANG PATHOLOGIST 40.0 X 191992 0 24741 DANIEL NUSSBAUM DIRECTOR - SALES AND MARKETING 40.0 X 121720 0 26540 QING LI DIRECTOR - NEW TEST DEVELOPMENT 40.0 X 130865 0 3340 PATRICIA MILLER-CANFIELD MD PATHOLOGIST 40.0 X 213687 0 17797 Brett Colter Executive Director of Technical Operations 40.0 X 114174 0 9665 Dr Frederick Wreford Pathologist (through October 2017) 40.0 X 127048 0 11924 4863258 0 359855 26 false true false ASSOC REG AND UNIV PATHOLOGISTS 500 CHIPETA WAY SALT LAKE CITY UT 84108 REFERENCE LAB 3252826 MEDIFLEET INC 30 RAILROAD AVENUE NEW HAVEN CT 06516 TRANSPORTATION SERVICES 1479451 CERNER CORPORATION 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 SOFTWARE AND EQUIPMENT MAINTENANCE / REPAIR 872190 THERMO ASSET MANAGEMENT SERVICES INC 120 BISHOPS WAY BROOKFIELD WI 53005 EQUIPMENT MAINTENANCE / REPAIR 844978 AUREUS RADIOLOGY LLC 13609 CALIFORNIA STREET OMAHA NE 68154 TEMPORARY MEDICAL STAFFING 679580 21 23197 23197 Net operating revenues 621500 83576087 83576087 0 0 0 0 83576087 13753 13753 0 0 1218077 0 0 1218077 1218077 1218077 Clinical Pathology Fees 621500 523692 523692 Records Retrieval Fees 900099 4497 4497 Miscellaneous income 900099 128046 128046 0 0 0 0 656235 85487349 84099779 0 1364373 52231 52231 1527832 1527832 4411905 3433058 978847 23043241 18709808 4333433 112719 91573 21146 4439065 3606296 832769 1863174 1505020 358154 107196 107196 72485 72485 4607933 3076563 1531370 0 1320301 880181 440120 2263368 2104215 159153 59648 44589 15059 316199 316199 2814517 1960987 853530 733985 36818 697167 Medical Lab 21153840 21153647 193 Reference Lab 5136874 5136874 Bad Debt 3084488 3084488 Building Equipment/Maintenance 3816477 2452757 1363720 1365034 957929 407105 0 82302512 69814866 12487646 0 750 750 4121165 5747585 12085361 10981028 0 0 0 1496163 2973070 816609 774147 95697570 76241566 21920598 19456004 0 827988 931099 141038 56682 41409672 40920365 9591584 9160813 5950000 4530000 0 22902851 23811122 38444435 37501935 X 2965237 3418430 2965237 3418430 41409672 40920365 X 3184837 234012 -2965656 X false true X true false X 1736 2032 2021 2072 23197 31058 99699838 94707654 90903792 87413068 83576087 456300439 383067 336035 219490 235177 132543 1306312 0 0 100084641 95045721 91125303 87650317 83731827 457637809 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 457637809 302005 155693 101397 13013 13753 585861 0 302005 155693 101397 13013 13753 585861 0 468990 629322 604138 481876 523692 2708018 100855636 95830736 91830838 88145206 84269272 460931688 0.9929 0.9929 0.0013 0.0015 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - CLINICAL PATHOLOGY FEES, COLUMN A - 468990.0, COLUMN B - 629322.0, COLUMN C - 604138.0, COLUMN D - 481876.0, COLUMN E - 523692.0, COLUMN F - 2708018.0; 1115906 1115906 43440672 37715582 5725090 772568 769709 2859 50368424 37756275 12612149 19456004 Fair value of interest rate swap 234118 Accrued pension and postretirement benefits 23577004 23811122 X 81227873 234012 -2965656 -2731644 83959517 1527832 1527832 85487349 80774680 0 0 80774680 1527832 1527832 82302512 Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote 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, 2014 through 2017. The Foundation follows guidance issued by the Financial Accounting Standards Board 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 and does not expect this to change over the next 12 months. Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 Pension and post-retirement benefit-related changes other than net periodic benefit cost - -2965656 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements Financial assistance - 1527832 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements Financial assistance - 1527832 true AMERICAN CANCER SOCIETY 130 RED COACH DRIVE MISHAWAKA IN 46545 131788491 501(C)(3) 5600 GENERAL ASSISTANCE AMERICAN HEART ASSOCIATION 6100 WEST 96TH STREET SUITE 200 INDIANAPOLIS IN 46278 135613797 501(C)(3) 10000 GENERAL ASSISTANCE THE FOUNDATION OF SAINT JOSEPH HEALTH SYSTEM 707 E CEDAR SUITE 175 SOUTH BEND IN 46617 351654543 501(C)(3) 8700 GENERAL ASSISTANCE UNITED WAY OF SAINT JOSEPH COUNTY 3517 E JEFFERSON BLVD SOUTH BEND IN 46615 351063368 501(C)(3) 6000 GENERAL ASSISTANCE 4 0 PATIENT MEDICAL ASSISTANCE 0 993162 FMV Free or reduced-cost medical care TIME OF SERVICE DISCOUNTS 0 534670 FMV Discount provided at time of payment Schedule I, Part III, Column (b) NUMBER OF RECIPIENTS 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 I, Part I, Line 2 Procedures for monitoring use of grant funds. 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 is 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 filed 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 true true false false false false false false false Joyce Simpson MD President 327800 0 0 0 4188 0 2700 0 9887 0 344575 0 0 0 Amobi Ezenekwe MD EXECUTIVE VP 286306 0 0 0 2298 0 2600 0 24114 0 315318 0 0 0 John Landgraf MD Board member (beginning May 2017)/Pathologist 265006 0 0 0 8834 0 2698 0 18042 0 294580 0 0 0 Ann Sullivan VP of Finance (through August 2017) 180119 0 0 0 76995 0 2095 0 17872 0 277081 0 0 0 James Frain VP of Human Resources 231859 0 0 0 5027 0 2370 0 11869 0 251125 0 0 0 Derrick Forchetti MD Chief Medical Information Officer 283667 0 0 0 900 0 2600 0 23166 0 310333 0 0 0 SHADIA ALAM MD PATHOLOGIST 238448 0 0 0 1620 0 2285 0 9614 0 251967 0 0 0 James Dyer MD Pathologist 266656 0 0 0 3792 0 2020 0 9670 0 282138 0 0 0 Nita Gerig MD Pathologist 260041 0 0 0 2596 0 2033 0 16932 0 281602 0 0 0 Ricky Hoover MD Pathologist 317330 0 0 0 5310 0 2700 0 18215 0 343555 0 0 0 Kristen Jacobs MD Pathologist 194978 0 0 0 4873 0 2028 0 12525 0 214404 0 0 0 Odeta Lapkus MD Pathologist 269798 0 0 0 1380 0 0 0 23941 0 295119 0 0 0 Bobbie Sutton MD Pathologist 177027 0 0 0 1588 0 1785 0 10591 0 190991 0 0 0 Erica Martin MD PATHOLOGIST 238178 0 0 0 480 0 2285 0 9614 0 250557 0 0 0 Nicole Anest MD Pathologist 258950 0 0 0 600 0 1008 0 17229 0 277787 0 0 0 DR QIN CHANG PATHOLOGIST 191092 0 0 0 900 0 1077 0 23664 0 216733 0 0 0 PATRICIA MILLER-CANFIELD MD PATHOLOGIST 202527 0 0 0 11160 0 0 0 17797 0 231484 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING 2017: ANN SULLIVAN - $50,113. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan The organization has a supplemental nonqualified retirement plan that was designed to replace retirement benefits lost by individuals due to 1998 changes in pension laws and a redesign of the pension plan to maximize benefits for lower compensated employees. The organization's board of directors elected to freeze this plan, and therefore no benefits were provided to the remaining one participant of the plan during 2017. Form 990, Part III, Line 1 ORGANIZATION'S MISSION (CONTINUED FROM PART III) TO FULFILL OUR MISSION WE SHALL: (I) PROVIDE THE HOSPITALS WE SERVICE WITH 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 III, Line 4a PROGRAM SERVICE ACCOMPLISHMENTS (CONTINUED FROM PART III) 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 $392,000 FOR THE YEAR ENDED DECEMBER 31, 2017. Form 990, Part VI, Line 1a Delegate broad authority to a committee 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, Line 2 Family/business relationships amongst interested persons BOB SUTTON (HUSBAND OF BOBBIE SUTTON) AND FRED BUSSE - Business relationship Form 990, Part VI, Line 6 Classes of members or stockholders 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, Line 7a Members or stockholders electing members of governing body MEMBERS OF THE ORGANIZATION VOTE ON OPEN BOARD POSITIONS AND ARE ELIGIBLE FOR NOMINATION FOR OPEN BOARD POSITIONS. Form 990, Part VI, Line 11b Review of form 990 by governing body A presentation of the organization's 990 was given by our tax partner at Crowe LLP to our Board of Directors at the September 6, 2018 meeting. The presentation was followed by a short Question & Answer session. Copies of the draft 990 were also available for review. Instructions were given that any subsequent questions or comments should be directed to our Chief Financial Officer. The return will be completed and filed with the Internal Revenue Service on or before November 15, 2018. Form 990, Part VI, Line 12c Conflict of interest policy Annual conflict of interest questionnaires are completed by all board members, officers, key employees, and highest compensated employees. The organization's Vice President of Finance and tax advisers review 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, Line 15a Process to establish compensation of top management official 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. This process is documented in the compensation committee's meeting minutes. Form 990, Part VI, Line 15b Process to establish compensation of other employees See narrative for Form 990, Part VI, Section B, Line 15a. Form 990, Part VI, Line 19 Required documents available to the public 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 Other changes in net assets or fund balances PENSION AND POSTRETIREMENT BENEFIT-RELATED CHANGES OTHER THAN NET PERIODIC BENEFIT COST - -2965656;