2017-11-09T21:01:42-06:00 2016-12-31 350921680 CROWE HORWATH LLP 330 E Jefferson Blvd PO Box 7 South Bend IN 466240007 990 2016-01-01 350868178 South Bend Medical Foundation Inc SOUT 5742045291 530 North Lafayette Blvd South Bend IN 46601 JOYCE SIMPSON MD PRESIDENT 2017-10-25 true KENNETH J KEBER P00240883 5742323992 2016 2022-09-23 18:48:47Z The Medical Foundation Joyce Simpson MD 530 North Lafayette Blvd South Bend IN 46601 88165450 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 11 803 14 0 0 2021 2072 90903792 87413068 99937 -252633 823628 717053 91829378 87879560 1980310 1475695 0 41016819 39283873 0 0 48930546 47148175 91927675 87907743 -98297 -28183 43264513 41409672 39137662 38444435 4126851 2965237 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 72992187 1475695 87894944 SOUTH BEND MEDICAL FOUNDATION'S (SBMF) MORE THAN 800 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) 72992187 true false 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 64 0 true 803 true false false false false false false false false false false X 13 11 true false false false true true false true true false false true true true true true true true true false IN X James B Myers 5742045206 118 W Edison Road Mishawaka IN 46545 Joyce Simpson MD President 40.0 X X 325577 0 12583 Amobi Ezenekwe MD EXECUTIVE VP 40.0 X X 295555 0 26894 Bilal Ansari MD Board member (through May 2016) 1.0 X 0 0 0 BRIAN SUCHARETZA MD Board member (through May 2016) 1.0 X 0 0 0 CARLTON LYONS MD BOARD MEMBER (BEGINNING MAY 2016) 1.0 X 0 0 0 ROBIN ZON MD BOARD MEMBER (BEGINNING MAY 2016) 1.0 X 0 0 0 BINH TRAN 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 SAMUEL MILLIGAN BOARD MEMBER 1.0 X 0 0 0 John T Rice MD Chair 1.0 X 0 0 0 Richard H Seall MD Vice Chair (through May 2016)/Board Member 1.0 X 0 0 0 Samuel Borrelli MD Vice Chair (beginning May 2016)/Board Member 1.0 X 0 0 0 Derrick Forchetti MD Chief Medical Information Officer 40.0 X 270763 0 25947 James Frain VP of Human Resources 40.0 X 234779 0 21027 Diane Janowiak VP of Central Lab Operations (through April 2016) 40.0 X 255228 0 15648 Robert King Senior VP (through April 2016) 40.0 X 291968 0 13579 Ann Sullivan VP of Finance 40.0 X 233945 0 26787 SHADIA ALAM MD PATHOLOGIST 40.0 X 238991 0 12059 Nicole Anest MD Pathologist 40.0 X 231612 0 18437 Fred Busse MD Pathologist 24.0 X 156447 0 17158 Francisco Deogracias MD Pathologist 20.0 X 172180 0 20062 James Dyer MD Pathologist 40.0 X 251947 0 11723 Blair Chrenka MD PATHOLOGIST 40.0 X 218415 0 19361 Nita Gerig MD Pathologist 32.0 X 262789 0 19319 Ricky Hoover MD Pathologist 40.0 X 322793 0 21853 Kristen Jacobs MD Pathologist 24.0 X 199039 0 16662 John Landgraf MD Pathologist 40.0 X 265995 0 21370 Odeta Lapkus MD Pathologist 40.0 X 257243 0 24529 Bobbie Sutton MD Pathologist 40.0 X 281441 0 21184 Erica Martin MD PATHOLOGIST 40.0 X 238607 0 12059 PRENTISS JONES DIRECTOR - TOXICOLOGY 40.0 X 132589 0 14423 QING LI DIRECTOR - NEW TEST DEVELOPMENT 40.0 X 128467 0 17719 PATRICIA MILLER-CANFIELD MD PATHOLOGIST 40.0 X 213982 0 18525 CARRIE ROBINSON DIRECTOR - REGIONAL MARKETING 40.0 X 128994 0 24278 DANIEL NUSSBAUM DIRECTOR - SALES AND MARKETING 40.0 X 133567 0 23214 5742913 0 476400 30 false true false ASSOC REG AND UNIV PATHOLOGISTS PO BOX 27964 SALT LAKE CITY UT 84127 REFERENCE LAB 2989626 THERMO ASSET MANAGEMENT SERVICES INC 120 BISHOPS WAY BROOKFIELD WI 53005 EQUIPMENT MAINTENANCE / REPAIR 833655 AUREAUS RADIOLOGY LLC 13609 CALIFORNIA STREET OMAHA NE 68154 TEMPORARY MEDICAL STAFFING 814713 CERNER CORPORATION PO BOX 412702 KANSAS CITY MO 64141 SOFTWARE AND EQUIPMENT MAINTENANCE / REPAIR 796527 MICHIANA HEALTH INFORMATION NETWORK LLC 220 W COLFAX AVE SUITE 300 SOUTH BEND IN 46601 COMMUNITY BASED CLINICAL INFO SYSTEM 626400 20 X 2072 2072 Net operating revenues 621500 87413068 87413068 0 0 0 0 87413068 13013 13013 0 0 20244 285890 0 -265646 -265646 -265646 Clinical Pathology Fees 621500 481876 481876 Teaching Fees 611430 38204 38204 Records Retrieval Fees 900099 3827 3827 193146 0 0 193146 717053 87879560 87894944 0 -17456 62900 62900 1412795 1412795 5383555 3863141 1520414 25646894 20246889 5400005 188021 148631 39390 5959973 4711359 1248614 2105430 1644841 460589 136852 136852 71996 71996 2832121 1961785 870336 0 1458013 917749 540264 1933057 1769739 163318 72173 52917 19256 405794 405794 3075804 2133901 941903 747839 81452 666387 Medical Lab 22736640 22137216 599424 Reference Lab 4947375 4947375 Bad Debt 3498170 3498170 Building Equipment/Maintenance 3660338 2244646 1415692 1572003 1156681 415322 0 87907743 72992187 14915556 0 1250 750 3819451 4121165 11614102 12085361 0 0 0 1749280 1496163 1079634 816609 96101400 74180802 23966018 21920598 0 994132 827988 40646 141038 43264513 41409672 9466153 9591584 7260000 5950000 22411509 22902851 39137662 38444435 X 4126851 2965237 4126851 2965237 43264513 41409672 X -28183 277840 -1411271 X false true X true false X 429028 1736 2032 2021 2072 436889 99026282 99699838 94707654 90903792 87413068 471750634 170096 383067 336035 219490 235177 1343865 0 0 99625406 100084641 95045721 91125303 87650317 473531388 15082 0 0 0 0 15082 0 0 0 0 0 0 15082 0 0 0 0 15082 473516306 123674 302005 155693 101397 13013 695782 0 123674 302005 155693 101397 13013 695782 0 497425 468990 629322 604138 481876 2681751 100246505 100855636 95830736 91830838 88145206 476908921 0.9929 0.9931 0.0015 0.0015 X Schedule A, Part III, Line 12 Other Income DESCRIPTION - CLINICAL PATHOLOGY FEES, COLUMN A - 451445.0, COLUMN B - 468990.0, COLUMN C - 629322.0, COLUMN D - 604138.0, COLUMN E - 481876.0, COLUMN F - 2635771.0; DESCRIPTION - FUNDRAISING GROSS RECEIPTS, COLUMN A - 45980.0, COLUMN B - 0.0, COLUMN C - 0.0, COLUMN D - 0.0, COLUMN E - 0.0, COLUMN F - 45980.0; 1115906 1115906 43411738 35912156 7499582 772568 671556 101012 50801188 37597090 13204098 21920598 Fair value of interest rate swap 468130 Accrued pension and postretirement benefits 22434721 22902851 X 85333334 277840 -1411271 -1133431 86466765 1412795 1412795 87879560 86494948 0 0 86494948 1412795 1412795 87907743 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, 2013 through 2016. 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 postretirement benefit-related changes other than net periodic benefit cost - -1411271 Schedule D, Part XI, Line 4(b) Other revenues in form 990 not in audited financial statements FINANCIAL ASSISTANCE - 1412795 Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements FINANCIAL ASSISTANCE - 1412795 true AMERICAN CANCER SOCIETY 130 Red Coach Drive Mishawaka IN 46545 131788491 501(C)(3) 5000 GENERAL ASSISTANCE AMERICAN HEART ASSOCIATION 6100 WEST 96TH STREET SUITE 200 INDIANAPOLIS IN 46278 135613797 501(C)(3) 5050 GENERAL ASSISTANCE CONQUER CANCER FOUNDATION 2318 MILL ROAD SUITE 800 ALEXANDRIA VA 22314 311667995 501(C)(3) 5000 GENERAL ASSISTANCE THE FOUNDATION OF SAINT JOSEPH HEALTH SYSTEM 707 E CEDAR SUITE 175 SOUTH BEND IN 46617 351654543 501(C)(3) 8400 GENERAL ASSISTANCE 4 0 PATIENT MEDICAL ASSISTANCE 0 977262 FMV FREE OR REDUCED MEDICAL CARE TIME OF SERVICE DISCOUNTS 0 435533 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. true true false false false false false false Joyce Simpson MD President 324227 0 0 0 1350 0 2600 0 9983 0 338160 0 0 0 Amobi Ezenekwe MD EXECUTIVE VP 294205 0 0 0 1350 0 2600 0 24294 0 322449 0 0 0 Derrick Forchetti MD Chief Medical Information Officer 270763 0 0 0 0 0 2600 0 23347 0 296710 0 0 0 James Frain VP of Human Resources 233713 0 0 0 1066 0 2369 0 18658 0 255806 0 0 0 Diane Janowiak VP of Central Lab Operations (through April 2016) 91992 0 0 0 163236 0 1046 0 14602 0 270876 0 0 0 Robert King Senior VP (through April 2016) 94508 0 0 0 197460 0 1338 0 12241 0 305547 0 0 0 Ann Sullivan VP of Finance 232879 0 0 0 1066 0 2369 0 24418 0 260732 0 0 0 SHADIA ALAM MD PATHOLOGIST 238856 0 0 0 135 0 2285 0 9774 0 251050 0 0 0 Nicole Anest MD Pathologist 230666 0 0 0 946 0 901 0 17536 0 250049 0 0 0 Fred Busse MD Pathologist 155739 0 0 0 708 0 1573 0 15585 0 173605 0 0 0 Francisco Deogracias MD Pathologist 171414 0 0 0 766 0 1703 0 18359 0 192242 0 0 0 James Dyer MD Pathologist 250812 0 0 0 1135 0 1893 0 9830 0 263670 0 0 0 Blair Chrenka MD PATHOLOGIST 217438 0 0 0 977 0 0 0 19361 0 237776 0 0 0 Nita Gerig MD Pathologist 261574 0 0 0 1215 0 2033 0 17286 0 282108 0 0 0 Ricky Hoover MD Pathologist 321443 0 0 0 1350 0 2600 0 19253 0 344646 0 0 0 Kristen Jacobs MD Pathologist 198127 0 0 0 912 0 2027 0 14635 0 215701 0 0 0 John Landgraf MD Pathologist 264818 0 0 0 1177 0 2600 0 18770 0 287365 0 0 0 Odeta Lapkus MD Pathologist 257243 0 0 0 0 0 0 0 24529 0 281772 0 0 0 Bobbie Sutton MD Pathologist 281441 0 0 0 0 0 2600 0 18584 0 302625 0 0 0 Erica Martin MD PATHOLOGIST 238607 0 0 0 0 0 2285 0 9774 0 250666 0 0 0 PATRICIA MILLER-CANFIELD MD PATHOLOGIST 206782 0 0 0 7200 0 0 0 18525 0 232507 0 0 0 CARRIE ROBINSON DIRECTOR - REGIONAL MARKETING 82100 0 39890 0 7004 0 1146 0 23132 0 153272 0 0 0 DANIEL NUSSBAUM DIRECTOR - SALES AND MARKETING 94767 0 31000 0 7800 0 0 0 23214 0 156781 0 0 0 Schedule J, Part I, Line 4a Severance or change-of-control payment THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING 2016: DIANE JANOWIAK - $138,495. ROBERT KING - $150,389. 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 during 2016. 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 $402,000 FOR THE YEAR ENDED DECEMBER 31, 2016. 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 Prior to November 15, 2017, each board member is provided a copy of the return for their review and instructed to submit any questions or comments to the VP of Finance. After comments and questions are reviewed, the return will be completed and filed with the IRS on or before November 15, 2017. 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 VIII, Line 11d Other Miscellaneous Revenue Deposition Income - Total Revenue: 193, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 193; Miscellaneous Income - Total Revenue: 192953, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 192953; 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 - -1411271;