2013-11-15T10:28:12-06:00 2012-12-31 990 2012-01-01 900424964 PARKLAND HEALTH CENTER FOUNDATION PARK 5737608036 1101 WEST LIBERTY STREET FARMINGTON MO 63640 THOMAS KARL 5737608036 2013-11-15 2012 2016-03-07 17:11:31Z THOMAS KARL 1101 WEST LIBERTY STREET FARMINGTON MO 63640 140304 0 X N/A X 2008 MO THE MISSION OF THE PARKLAND HEALTH CENTER FOUNDATION IS TO SECURE PHILANTHROPIC SUPPORT FOR THE PARKLAND HEALTH CENTER TO ACCOMPLISH ITS MISSION OF PROVIDING EXTRAORDINARY CARE. 14 13 0 14 0 0 655489 6518 0 0 1042621 99913 1262 1296 1699372 107727 769017 402206 0 0 0 0 0 0 7790 2469 13418 771486 415624 927886 -307897 4467030 4746245 0 325143 4467030 4421102 X THE MISSION OF THE PARKLAND HEALTH CENTER FOUNDATION IS TO SECURE PHILANTHROPIC SUPPORT FOR PARKLAND HEALTH CENTER TO ACCOMPLISH ITS MISSION OF PROVIDING EXTRAORDINARY CARE. FOLLOWING ARE THE AREAS THE FOUNDATION WILL FOCUS ON TO FULFILL ITS MISSION: LEADING-EDGE TECHNOLOGY AND CLINICAL EQUIPMENT; CLINICAL SERVICES; HIGH-QUALITY PHYSICIANS AND OTHER MEDICAL PROFESSIONALS; A THRIVING WORKFORCE THAT PROVIDES SUPERIOR PATIENT CARE AND IS PASSIONATE ABOUT SERVICE EXCELLENCE; AND PUBLIC HEALTH EDUCATION. 0 0 300000 300000 IN FURTHERANCE OF ITS MISSION, THE FOUNDATION PROVIDED A PHILANTHROPIC GIFT TO PARKLAND HEALTH CENTER (HOSPITAL). DURING 2012, FUNDING WAS PROVIDED TO PURCHASE AND IMPLEMENT THE VOCERA COMMUNICATION SYSTEM THROUGHOUT THE HOSPITAL. 94206 94206 IN FURTHERANCE OF ITS MISSION, THE FOUNDATION PROVIDED FUNDING TO PARKLAND HEALTH CENTER (HOSPITAL) TO USE FOR PATIENT CARE. 5000 5000 IN FURTHERANCE OF ITS MISSION, THE FOUNDATION PROVIDED FUNDING TO WASHINGTON UNIVERSITY TO USE FOR SCHOLARSHIPS. 3000 3000 IN FURTHERANCE OF ITS MISSION,THE FOUNDATION PROVIDED FUNDING TO MEALS ON WHEELS TO USE TO ASSIST SENIORS IN THE COMMUNITY. 3000 3000 402206 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 X 14 13 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X VALERIE GRAY 3142860572 1001 HIGHLANDS PLZ DR WEST ST LOUIS MO 63110 BAKER MARY 1.00 X 0 0 0 COLSON JILL 1.00 X 0 0 0 COOK KEVIN 1.00 X 0 0 0 COULTER CAROL 1.00 X 0 0 0 GALLAGHER DONNA 1.00 X 0 0 0 JOHNSON LEANNA 1.00 X 0 0 0 RHODES CATHERINE 1.00 X 0 0 0 WILLIAMS PAUL 1.00 X 0 0 0 WOOD NICOLE 1.00 X 0 0 0 WOOD JOYCE 1.00 X 0 0 0 YAHNKE DAVID 1.00 X 0 0 0 CROUCH JOHN R 1.00 X X 0 0 0 OLIVER GEORGE DR 1.00 X X 0 0 0 KARL THOMAS P 1.00 39.00 X X 0 236073 106219 0 236073 106219 0 0 1 0 0 6518 5093 6518 125996 125996 26083 -26083 -26083 -26083 7790 6494 1296 1296 107727 0 0 101209 402206 402206 5615 5615 13 13 7011 7011 SPECIAL EVENTS 779 779 415624 402206 5628 7790 10006 26221 4345353 3920379 799645 111671 0 4467030 4746245 25143 300000 0 325143 X 3473818 3821902 993212 599200 4467030 4421102 4467030 4746245 -307897 369486 -107517 0 X 0 1 X 1 0 X 1699383 2207279 655489 6518 4568669 1699383 2207279 655489 6518 4568669 4568669 21890 8985 49670 125996 206541 4775210 18675 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 OTHER MISC SECURITIES 799645 C 799645 0 PARKLAND HEALTH CENTER 1101 W LIBERTY STREET FARMINGTON MO 63640 431332368 501(C)(3) 300000 VOCERA COMMUNICATION SYSTEM PARKLAND HEALTH CENTER 1101 W LIBERTY STREET FARMINGTON MO 63640 431332368 501(C)(3) 94206 PATIENT CARE 1 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE UNITED STATES FUNDS ARE DISTRIBUTED TO PARKLAND HEALTH CENTER WHEN THE HOSPITAL SUBMITS PROPER DOCUMENTATION OF EXPENSES PAID FOR THE PURPOSE OF THE GRANT. 0 1 0 0 0 0 0 1 0 KARL THOMAS P 0 156911 0 72369 0 6793 0 86029 0 20190 0 342292 0 10740 PART I, LINE 4B PART I, LINE 4B: DURING 2012, THE FOLLOWING INDIVIDUALS RECEIVED SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ACCRUALS FROM A RELATED ORGANIZATION AS REPORTED IN THE DETAILS OF COMPENSATION AND BENEFITS(SEE FORM 990, PART VII AND SCHEDULE J, PART II): KARL, THOMAS $20,464.86 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: THE COMPENSATION AND BENEFIT AMOUNTS OF THE ORGANIZATION'S OFFICERS ARE DETERMINED BY AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF BJC HEALTH SYSTEM, AN AFFILIATE OF THE SOLE CORPORATE MEMBER. THIS COMMITTEE IS COMPRISED OF INDEPENDENT PERSONS AND USES COMPENSATION CONSULTING STUDIES AND BENCHMARKING DATA PROVIDED BY AN INDEPENDENT MANAGEMENT CONSULTANT TO ESTABLISH COMPENSATION AMOUNTS AND GUIDELINES. THE PROCESS INCLUDES A VALIDATION OF JOB DESCRIPTIONS AS WELL AS REPORTING ALL FORMS OF COMPENSATION. THE CONSULTANT USES SURVEY DATA TO DETERMINE MARKET RATES OF BASE SALARY AND OTHER SHORT AND LONG TERM INCENTIVES FOR THE PRESIDENT OF THE ORGANIZATION. HIS COMPENSATION IS PROVIDED BY THE SOLE CORPORATE MEMBER, A RELATED ORGANIZATION. THE COMMITTEE REVIEWS, APPROVES, AND SUBSEQUENTLY RECONCILES EXECUTIVE COMPENSATION AS WELL AS DELIBERATES ON THE RESONABLENESS OF THE DATA. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE BOARD COMMITTEE MEETINGS. NUMBER REPORTED IN BOX 3 FORM 1096 FORM 990, PART V, LINE 1 THE ORGANIZATION IS AN AFFILIATE OF BJC HEALTH SYSTEM (BJC), A SUPPORTING ORGANIZATION DESCRIBED IN CODE SECTION 509(A)(3). BJC ASSUMES RESPONSIBILITY FOR REMITTING ALL PAYMENTS TO VENDORS THROUGH A CENTRALIZED ACCOUNTS PAYABLE SYSTEM. BJC ALSO ASSUMES RESPONSIBILITY FOR REPORTING THESE PAYMENTS TO THE IRS USING ITS EIN AS THE COMMON PAYOR ON FORM(S) 1099, 1098, 5498, AND W-2G. THE AMOUNT REPORTED ON LINE 1, IF ANY, REFLECTS THE NUMBER OF FORMS FILED BY BJC HEALTH SYSTEM (EIN 43-1617558) ON BEHALF OF THE FILING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN OFFICERS AND DIRECTORS OF THE ORGANIZATION MAY ALSO SERVE ON THE BOARDS OF OTHER RELATED OR UNRELATED ORGANIZATIONS. ADDITIONALLY, CERTAIN FAMILY MEMBERS OF OFFICERS AND DIRECTORS MAY, DURING THE NORMAL COURSE OF BUSINESS YET CONSISTENT WITH THE STATED EXEMPT PURPOSE OF THE ORGANIZATION, ENGAGE IN TRANSACTIONS IN WHICH POTENTIAL CONFLICTS OF INTEREST COULD EXIST. THESE OFFICERS, DIRECTORS AND RELATED PERSONS DISCLOSE THESE POTENTIAL CONFLICTS TO THE ORGANIZATION ANNUALLY AND DO NOT PARTICIPATE IN DECISIONS IN WHICH THEY HAVE SUCH CONFLICTS. SUCH CONFLICTS AND RELATIONSHIPS ARE REVIEWED TO ENSURE THAT ANY PAYMENTS RECEIVED OR AMOUNTS PAID DO NOT EXCEED THE FAIR MARKET VALUE OF THE GOODS AND SERVICES RECEIVED BY THE REPORTING ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS THE PARKLAND HEALTH CENTER, A MISSOURI NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE CORPORATE MEMBER HAS THE POWER TO APPOINT AND REMOVE DIRECTORS AND OFFICERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE CORPORATE MEMBER MUST APPROVE ACTIONS TAKEN BY THE BOARD INCLUDING CAPITAL & OPERATING BUDGETS; AFFILIATION AGREEMENTS; INVESTING OR FINANCING ARRANGEMENTS; & OTHER ORGANIZATIONAL ACTIVITIES OF THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 MEMBERS OF THE BOARD HAVE DISCUSSED THE FINANCIAL AND NARRATIVE DISCLOSURES INCLUDED IN THE FORM 990 FOR THE PARKLAND HEALTH CENTER FOUNDATION. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS COMPLIANCE WITH THE POLICY BY ISSUING ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE REMINDING COVERED INDIVIDUALS OF THEIR OBLIGATIONS TO DISCLOSE POTENTIAL CONFLICTS AND REQUESTING THAT THEY COMPLETE A CONFLICTS OF INTEREST QUESTIONNAIRE. THE QUESTIONNAIRE REQUIRES THE DISCLOSURE OF CONFLICTS AND AN ATTESTATION TO THEIR CONTINUING OBLIGATION TO DISCLOSE SAID CONFLICTS SHOULD THE NEED ARISE. THE RESULTS OF THE CONFLICT OF INTEREST QUESTIONNAIRE ARE REVIEWED BY THE CENTRALIZED COMPLIANCE DEPARTMENT OF THE SOLE CORPORATE MEMBER AND APPROPRIATE ACTION TAKEN AS NECESSARY. SHOULD THE ORGANIZATION BECOME AWARE OF A CONFLICT NOT PREVIOUSLY REPORTED, GENERAL COUNSEL FOR THE CORPORATE MEMBER WOULD INVESTIGATE THE ISSUE AND RESPOND IN ACCORDANCE WITH THE POLICY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE FOR INSPECTION BY THE GENERAL PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICES. ALTON MEMORIAL HOSPITAL ONE MEMORIAL HOSPITAL DRIVE ALTON IL 62002 370661172 HEALTHCARE SERVICES IL 501(C)(3) 3 CH ALLIED SERVICES INC 1 ALTON MEMORIAL HEALTH SERVICES FOUNDATION 1109 N OXFORDSHIRE LANE EDWARDSVILLE IL 62025 371177053 SUPPORT TO AMH IL 501(C)(3) 11C ALTON MEMORIAL HOSPITAL 1 BARNES-JEWISH HOSPITAL ONE BARNES-JEWISH HOSPITAL PLAZA ST LOUIS MO 63110 237309937 HEALTHCARE SERVICES MO 501(C)(3) 3 BJC HEALTH SYSTEM 1 THE FOUNDATION FOR BARNES-JEWISH HOSPITAL 1001 HIGHLANDS PLAZA DR WEST SUITE ST LOUIS MO 63110 431648435 SUPPORT TO BJH MO 501(C)(3) 7 BARNES-JEWISH HOSPITAL 1 BARNES JEWISH HOSP AUXILIARY PARKVIEW CHAPTER 216 SO KINGSHIGHWAY CAB 140 ST LOUIS MO 63110 237000410 SUPPORT TO BJH MO 501(C)(3) 11C BARNES-JEWISH HOSPITAL 1 BARNES JEWISH ST PETERS & PROGRESS WEST FOUNDATION 10 HOSPITAL DRIVE ST PETERS MO 63376 454471497 SUPPORT TO BJSPH & PROGRESS WEST MO 501(C)(3) 7 BJSP HOSPITAL & PROGRESS WEST 1 BARNES-JEWISH ST PETERS HOSPITAL INC 10 HOSPITAL DRIVE ST PETERS MO 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65203 430998347 HEALTHCARE SERVICES MO 501(C)(3) 9 CH ALLIED SERVICES INC 1 CH ALLIED SERVICES INC 1600 E BROADWAY COLUMBIA MO 65201 431279063 HEALTHCARE SERVICES MO 501(C)(3) 3 CH HEALTH SERVICES DEV CORP 1 CHRISTIAN HEALTH SERVICES DEV CORP 11133 DUNN ROAD ST LOUIS MO 63136 431230583 HEALTHCARE SERVICES MO 501(C)(3) 11A BJC HEALTH SYSTEM 1 CHILDREN'S HEALTH NETWORK ONE CHILDRENS PLACE ST LOUIS MO 63110 431640467 HEALTHCARE SERVICES MO 501(C)(3) 9 ST LOUIS CHILDREN'S HOSPITAL 1 CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST 11133 DUNN ROAD ST LOUIS MO 63136 436057893 HEALTHCARE SERVICES MO 501(C)(3) 3 CH HEALTH SERVICES DEV CORP 1 CHRISTIAN HOSPITAL FOUNDATION 11155 DUNN ROAD SUITE 300 N ST LOUIS MO 63136 431947644 SUPPORT TO CHNE MO 501(C)(3) 7 CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST 1 CHRISTIAN HOSP ILLINOIS SVCS 8 SUNSET HILLS EDWARDSVILLE IL 62025 260131339 HEALTHCARE SERVICES MO 501(C)(3) 3 CH ALLIED SERVICES INC 1 COMMUNITY HEALTH CONNECTION 4353 CLAYTON AVE ROOM 164 ST LOUIS MO 63110 460819384 HEALTHCARE SERVICES MO 501(C)(3) 9 BJC HEALTH SYSTEM 1 FAIRVIEW HEIGHTS MEDICAL GROUP SC 670 MASON RIDGE CENTER DR SUITE 300 ST LOUIS MO 63141 364147189 HEALTHCARE SERVICES IL 501(C)(3) 3 BJC HEALTH SYSTEM 1 MISSOURI BAPTIST HOSPITAL OF SULLIVAN AUXILIARY 751 SAPPINGTON BRIDGE SULLIVAN MO 63080 431349641 SUPPORT TO MBHS MO 501(C)(3) 3 MISSOURI BAPTIST HOSPITAL OF SULLIVAN 1 MISSOURI BAPTIST HOSPITAL OF SULLIVAN 751 SAPPINGTON BRIDGE SULLIVAN MO 63080 431459495 HEALTHCARE SERVICES MO 501(C)(3) 3 MISSOURI BAPTIST MEDICAL CENTER 1 MISSOURI BAPTIST MEDICAL CENTER 3015 N BALLAS ROAD ST LOUIS MO 63131 430652656 HEALTHCARE SERVICES MO 501(C)(3) 3 BJC HEALTH SYSTEM 1 PARKLAND HEALTH CENTER 1101 WEST LIBERTY ST FARMINGTON MO 63640 431332368 HEALTHCARE SERVICES MO 501(C)(3) 3 MISSOURI BAPTIST MEDICAL CENTER 1 PROGRESS EAST HEALTHCARE CENTER 11155 DUNN ROAD SUITE 300 N ST LOUIS MO 63136 261343214 HEALTHCARE SERVICES IL 501(C)(3) 3 CH ALLIED SERVICES INC 1 PROGRESS WEST HEALTHCARE CENTER 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