2011-11-11T13:48:03-06:00 2010-12-31 DELOITTE TAX LLP TWO JERICHO PLAZA JERICHO NY 11753 990 2010-01-01 113192423 LMC PHYSICIAN SERVICES PC LMCP 7186307611 150 55TH STREET NO 2-36 BROOKLYN NY 11220 ALAN SICKLES 7186307611 2011-11-09 1 5169187000 2010 2016-02-24 21:20:13Z ALAN SICKLES 150 55TH STREET NO 2-36 BROOKLYN NY 11220 15132663 0 X N/A X 1994 NY HEALTHCARE PROVIDER OF PHYSICIAN SERVICES IN CONJUNCTION WITH, AND IN SUPPORT OF, LUTHERAN MEDICAL CENTER. 1 0 135 0 0 0 0 0 11949037 14626089 1989 2358 485764 504216 12436790 15132663 0 0 0 0 15378869 16745001 0 0 0 3988744 5050463 19367613 21795464 -6930823 -6662801 1880324 2071478 2001087 1612654 -120763 458824 X LMC PHYSICIAN SERVICES, PC ("PC") IS FORMED FOR THE SOLE PURPOSE OF PROMOTING HEALTH FOR THE BENEFIT OF THE COMMUNITY BY SERVING A LARGE AND INDEFINITE CLASS. THE ORGANIZATION PROMOTES HEALTH BY ENGAGING IN THE PROFESSION OF MEDICINE AND PROVIDING MEDICAL SERVICES, IN A MANNER THAT IS EXCLUSIVELY CHARITABLE WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE PROVISION OF MEDICAL SERVICES HAS BEEN CARRIED ON SINCE THE INCEPTION OF THE ORGANIZATION IN 1994. THE PC OPERATES IN SUPPORT OF LUTHERAN MEDICAL CENTER. LUTHERAN MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION ORGANIZED UNDER THE LAWS OF THE STATE OF NEW YORK, AND A CHARITABLE, TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. LUTHERAN MEDICAL CENTER IS AN ACUTE CARE HOSPITAL THAT CONDUCTS CHARITABLE AND HOSPITAL ACTIVITIES. THE PC PROVIDES PROFESSIONAL MEDICAL SERVICES TO PATIENTS, WITHOUT REGARD FOR THE PATIENT'S ABILITY TO PAY. THE ORGANIZATION HAS ADOPTED THE CHARITY CARE POLICY 0 0 20075465 15130305 LUTHERAN MEDICAL CENTER PHYSICIAN SERVICES, PC IS A PROFESSIONALCORPORATION THAT PROVIDES MULTI-SPECIALTY MEDICAL AND SURGICALSERVICES TO LUTHERAN MEDICAL CENTER AND THE SURROUNDING SOUTHWESTBROOKLYN COMMUNITIES. MANY OF THE PC'S EMPLOYED PHYSICIANS ALSOPROVIDE SERVICES TO THE LUTHERAN FAMILY HEALTH CENTER CLINICS,LOCATED AT LUTHERAN MEDICAL CENTER AND, A SATELLITE OFFICE LOCATEDIN BAY RIDGE. MAJOR SPECIALTIES REPRESENTED BY EMPLOYEES OF THEPC ARE AS FOLLOWS: MEDICINE- INTERNAL MEDICINE, CARDIOLOGY,NEUROLOGY, PHYSICAL MEDICINE AND REHABILITATION; MEDICAL ONCOLOGY,RHEUMATOLOGY, ENDOCRINOLOGY; SURGERY- THORACIC, VASCULAR,HAND/PLASTIC, UROLOGY, OPHTHALMOLOGY, ORTHOPEDICS, GENERAL/TRAUMA,BARIATRIC; OBGYN- REPRODUCTIVE ENDOCRINOLOGY, UROLOGICAL GYN; GYNONCOLOGY; BEHAVIORAL HEALTH- PSYCHIATRY AND SUBSTANCE ABUSE. IN2010, MORE THAN 143,000 VISITS AND PROCEDURES WERE PERFORMED ONLUTHERAN MEDICAL CENTER PATIENTS, WITHOUT REGARD FOR THE PATIENT'SABILITY TO PAY. 20075465 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 18 0 1 135 1 0 0 0 0 0 0 0 0 X 1 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NY X ALAN SICKLES 7186307611 150 55TH STREET BROOKLYN NY 11220 BETH RAUCHER MD 5.00 X X 0 416886 55920 NACHUM LEVIN MD 40.00 X 728861 0 31248 SALMAN AZHAR MD 40.00 X 640933 0 20293 FAUSTO VINCES DO 40.00 X 564002 0 30762 MICHAEL GERLING MD 40.00 X 454384 0 8898 STEVEN SCALFANIMD 40.00 X 395591 0 27898 2783771 416886 175019 50 0 1 0 MD EVERYWHERE 26 CENTRAL AVENUE HAUPPAUGE NY 11788 BILLING & AUDIT SERVICES 1250833 LOCUMTENENSCOM PO BOX 405547 ATLANTA GA 303845547 LOCUM TENENS 390232 OTOLARYNGOLOGY ASSOCIATES 7333 6TH AVE BROOKLYN NY 11209 PHYSICIAN SERVICES 220017 GPK COLORECTAL SURGERY PLLC 23 FOSTER AVENUE STATEN ISLAND NY 10314 PHYSICIAN SERVICES 149597 4 PATIENT SERVICE REVENU 621110 14626089 14626089 14626089 2358 2358 STAFFING REIMBURSEMENT 900099 504216 504216 504216 15132663 15130305 0 2358 14715565 14715565 537400 537400 709024 709024 783012 783012 227240 227240 18934 18934 265598 265598 977568 977568 325595 325595 354846 354846 7125 7125 30262 30262 1624575 1624575 BILLING EXPENSES 1009795 1009795 MISCELLANEOUS EXPENSE 198432 198432 COLLECTION FEES 5378 5378 ANSWERING SERVICES 5115 5115 21795464 20075465 1719999 0 37 37 382110 624124 688280 605399 369600 374829 288163 133764 66716 154399 373581 312690 1880324 2071478 1254511 1247040 746576 365614 2001087 1612654 X -120763 458824 -120763 458824 1880324 2071478 X -6662801 7242388 X 0 1 1 X 0 X X X X 0 0 0 LUTHERAN MEDICAL CENTER 111839567 HOSPITAL 1 1 1 924756 1 924756 39206 3151 36055 244098 128008 116090 4859 2605 2254 154399 DUE FROM AFFILIATES 207445 DUE FROM THIRD PARTY PAYORS 105245 312690 DUE TO AFFILIATES 365614 365614 X X X X 0 0 0 0 0 0 0 1 0 BETH RAUCHER MD 0 416886 0 0 0 0 0 19600 0 36320 0 472806 0 0 NACHUM LEVIN MD 431781 0 280002 0 17078 0 14700 0 16548 0 760109 0 16789 0 SALMAN AZHAR MD 395051 0 231022 0 14860 0 14700 0 5593 0 661226 0 15646 0 FAUSTO VINCES DO 563616 0 0 0 386 0 14700 0 16062 0 594764 0 19670 0 MICHAEL GERLING MD 226398 0 222089 0 5897 0 4948 0 3950 0 463282 0 0 0 STEVEN SCALFANIMD 379122 0 0 0 16469 0 14700 0 13198 0 423489 0 0 0 PART I, LINE 7 BONUS INFORMATION THE ORGANIZATION'S EMPLOYED PHYSICIANS ARE ELIGIBLE TO RECEIVE A BONUS BASED ON THE TERMS OF THEIR INDIVIDUAL CONTRACTS. THE EMPLOYED PHYSICIANS' CONTRACTS PROVIDE FOR A FIXED ANNUAL SALARY FOR EACH PHYSICIAN; HOWEVER, THAT SALARY MAY BE SUPPLEMENTED IF, ON AN ANNUAL BASIS, THE PHYSICIAN'S PROFESSIONAL FEE COLLECTIONS EXCEED A DEFINED THRESHOLD. THE PHYSICIAN IS ELIGIBLE TO RECEIVE A BONUS (DETERMINED WITHIN NINETY DAYS FOLLOWING THE END OF THE YEAR). THE PHYSICIANS' CONTRACTS SPECIFY THAT NO COMPENSATION PAYMENTS MAY EXCEED THE FAIR MARKET VALUE OF THE SERVICES PROVIDED BY THE PHYSICIAN. FORM 990, PART IV, LINE 12B LMC PHYSICIANS SERVICES, P.C. IS INCLUDED IN A COMBINED AUDITED FINANCIAL STATEMENT FOR THE YEAR ENDING DECEMBER 31ST, 2010. THE COMBINED FINANCIAL STATEMENTS ARE PREPARED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES IN THE UNITED STATES OF AMERICA ("GAAP"). THE COMBINED FINANCIAL STATEMENTS INCLUDE THE ACCOUNTS OF LUTHERAN MEDICAL CENTER AND ALL OF ITS AFFILIATED ORGANIZATIONS. PER THE INSTRUCTIONS TO THE FORM 990, THE ORGANIZATION IS REQUIRED TO RESPOND "YES" TO PART IV, QUESTION 12B IF THE ORGANIZATION IS PART OF A CONSOLIDATED FINANCIAL STATEMENT. SINCE SELECTING "YES" TO THIS QUESTION MAY BE MISCONSTRUED, THE TAXPAYER IS ATTACHING THIS EXPLANATION TO ITS FORM 990. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION IS A PROFESSIONAL SERVICE CORPORATION ("PC") WITH ONE SHAREHOLDER. UNDER APPLICABLE NYS LAW, ONLY A LICENSED PHYSICIAN MAY HOLD SHARES IN THE PC. DR. BETH RAUCHER, CHIEF MEDICAL OFFICER OF LUTHERAN MEDICAL CENTER, IS THE SOLE SHAREHOLDER OF THE PC, AND PURSUANT TO A SHAREHOLDER AGREEMENT AMONG DR. RAUCHER, THE PC AND THE MEDICAL CENTER, THE SHAREHOLDER HAS VERY LIMITED AUTHORITY. IN PARTICULAR, THE SHAREHOLDER MAY NOT TRANSFER OR ENCUMBER THE SHARES OR DECLARE DISTRIBUTIONS WITHOUT THE EXPRESS CONSENT OF THE MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE SHAREHOLDER HAS THE AUTHORITY TO APPOINT THE DIRECTORS AND OFFICERS OF THE PC. FORM 990, PART VI, SECTION A, LINE 7B PURSUANT TO THE SHAREHOLDER AGREEMENT, DR. BETH RAUCHER HAS LIMITED AUTHORITY AND ALL DECISIONS ARE CONTROLLED BY LUTHERAN MEDICAL CENTER. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION HAS ANSWERED THIS QUESTION "NO" AS THERE ARE NO COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY THE VICE PRESIDENT OF FINANCE OF THE ORGANIZATION'S PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER. A COPY OF THE FORM 990 IS PROVIDED TO THE SOLE DIRECTOR, DR. BETH RAUCHER, FOR HER COMMENT AND REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION OPERATES UNDER THE CONFLICT OF INTEREST POLICY OF ITS PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER. THE PRESIDENT AND SOLE DIRECTOR, DR. BETH RAUCHER, IS REQUIRED TO DISCLOSE POTENTIAL CONFLICTS OF INTEREST ON TWO ANNUAL SURVEY/QUESTIONNAIRES SUBMITTED TO THE MEDICAL CENTER'S GENERAL COUNSEL. ONE OF THE QUESTIONNAIRES PERTAINS TO HER ROLE AS A SENIOR EXECUTIVE FOR LUTHERAN MEDICAL CENTER AND THE OTHER, MORE COMPREHENSIVE, QUESTIONNAIRE PERTAINS TO HER ROLE AS PRESIDENT AND SOLE DIRECTOR FOR LMC PHYSICIAN SERVICES, PC. THE TWO SUBMITTED QUESTIONNAIRES ARE REVIEWED BY THE MEDICAL CENTER'S GENERAL COUNSEL TO ENSURE COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. FORM 990, PART VI, SECTION B, LINE 15 SENIOR MANAGEMENT AT THE PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER, REGULARLY REVIEWS VARIOUS OBJECTIVE DATA SOURCES THAT FACTOR INTO COMPENSATION FOR EMPLOYED AND CONTRACTED PHYSICIANS AND GROUPS PROVIDING SERVICES TO THE ORGANIZATION. THESE SOURCES INCLUDE NATIONAL AND REGIONAL SURVEY SAMPLES BY PHYSICIAN CLINICAL SPECIALTY, AS PUBLISHED BY SULLIVAN COTTER AND AS PURCHASED FROM OTHER CONSULTANTS, WHICH GUIDE THE ESTABLISHMENT OF FAIR MARKET VALUE FOR EACH PHYSICIAN'S/GROUP'S COMPENSATION LEVEL IN THE ORGANIZATION. WITH RESPECT TO CERTAIN PHYSICIANS WHO MIGHT BE CONSIDERED "LUMINARIES" OR WHOSE COMPENSATION FALLS INTO AN OUTLIER CATEGORY IN THE CLINICAL SPECIALTY, LMC SEEKS ADVICE AND OPINIONS FROM OUTSIDE CONSULTANTS WHO SPECIALIZE IN THIS WORK. FORM 990, PART VI, SECTION C, LINE 19 THE TAXPAYER MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC BY RETAINING A COPY OF EACH AT ITS HEAD OFFICES. ANY INDIVIDUAL REQUESTING A COPY OF THESE DOCUMENTS IS PROVIDED THAT COPY ON THE SAME BUSINESS DAY. THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION DOES NOT OBTAIN AUDITED FINANCIAL STATEMENTS SO THESE ARE NOT MADE AVAILABLE TO THE PUBLIC. THE SOLE PHYSICIAN-SHAREHOLDER OF LMC PHYSICIAN SERVICES, P.C. RECEIVES HER COMPENSATION THROUGH THE ORGANIZATION'S PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER. THE LUTHERAN MEDICAL CENTER BOARD OF TRUSTEES ENGAGES SULLIVAN COTTER & ASSOCIATES, INC. TO PROVIDE ANNUAL REPORTS AND SUPPORTING DATA RELATIVE TO EXECUTIVE COMPENSATION. THE COMPENSATION COMMITTEE, ACTING ON BEHALF OF THE FULL LUTHERAN BOARD OF TRUSTEES, RECEIVES AND REVIEWS THESE REPORTS WHICH CONTAIN: A) A MARKET ANALYSIS OF THE TOTAL COMPENSATION LEVELS OF SENIOR EXECUTIVES IN RELATION TO THEIR PEERS IN THE MARKETPLACE; B) A REVIEW OF CURRENT COMPENSATION AND BENEFIT PLAN DESIGNS TO ENSURE COMPETITIVENESS TO THE MARKETPLACE; AND C) COMPLIANCE WITH STATE AND/OR FEDERAL REGULATIONS. THE COMPENSATION COMMITTEE RELIES UPON THE DATA AND RECOMMENDATIONS PROVIDED BY SULLIVAN COTTER & ASSOCIATES TO DETERMINE THE COMPENSATION LEVEL OF THE CEO. FOR THE OTHER KEY EXECUTIVE POSITIONS, THE CEO RECOMMENDS ADJUSTMENTS TO THE COMMITTEE WHO, IN TURN, REVIEW THESE RECOMMENDATIONS UTILIZING THE SULLIVAN COTTER & ASSOCIATES REPORTS AND APPROVES, DISAPPROVES OR ALTERS THE PROPOSALS OF THE CEO FOR THE OTHER SENIOR EXECUTIVES. FORM 990, PART VI, LINES 13 & 14 THE ORGANIZATION OPERATES UNDER THE WHISTLEBLOWER AND DOCUMENT RETENTION POLICY OF ITS PARENT ORGANIZATION, LUTHERAN MEDICAL CENTER CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: TRANSFERS OF NET ASSETS FROM RELATED ENTITIES 7,242,388. TOTAL TO FORM 990, PART XI, LINE 5: 7,242,388. LUTHERAN MEDICAL CENTER 150 55TH STREET BROOKLYN NY 11220 111839567 HOSPITAL NY 501(C)(3) 3 N/A 0 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 0 0