FAIRVIEW HEIGHTS MEDICAL GROUP SC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
FAIRVIEW HEIGHTS MEDICAL GROUP SC (EIN 36-4147189)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-15
IRS object ID
201333199349302538
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-15T10:28:12-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN364147189EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1FAIRVIEW HEIGHTS MEDICAL GROUPSCBusinessNameLine1
Business Name Line2C/O BJC MEDICAL GROUP LCBusinessNameLine2
FieldValueIRS element (for citing)
Name ControlFAIRNameControl
Phone3149967601Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12 MEMORIAL DRIVE NO 220AddressLine1
CityALTONCity
StateILState
ZIP Code62002ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN T ELLENA MDName
TitlePRESIDENT/SECY/DIRECTORTitle
Phone3149967601Phone
Date Signed2013-11-15DateSigned
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1BJC MEDICAL GROUP OF ILLINOISBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN T ELLENA MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12 MEMORIAL DRIVE NO 220AddressLine1
CityALTONCity
StateILState
ZIP Code62002ZIPCode
FieldValueIRS element (for citing)
Gross Receipts39848206GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileILStateLegalDomicile
Activity Or Mission DescriptionPROVIDE HEALTHCARE SERVICES TO PATIENTSActivityOrMissionDescription
Nbr Voting Members Governing Body1NbrVotingMembersGoverningBody
Nbr Independent Voting Members0NbrIndependentVotingMembers
Total Nbr Employees317TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI50017TotalGrossUBI
Net Unrelated Business Txbl Income-28915NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year35335038ProgramServiceRevenuePriorYear
Program Service Revenue CY39848206ProgramServiceRevenueCY
Investment Income Prior Year0InvestmentIncomePriorYear
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year35335038TotalRevenuePriorYear
Total Revenue Current Year39848206TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year10050GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1920GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year23024410SalariesEtcPriorYear
Salaries Etc Current Year27063036SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year12300566OtherExpensePriorYear
Other Expenses Current Year12789925OtherExpensesCurrentYear
Total Expenses Prior Year35335026TotalExpensesPriorYear
Total Expenses Current Year39854881TotalExpensesCurrentYear
Revenues Less Expenses Prior Year12RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-6675RevenuesLessExpensesCY
Total Assets BOY6034544TotalAssetsBOY
Total Assets EOY6229062TotalAssetsEOY
Total Liabilities BOY7924765TotalLiabilitiesBOY
Total Liabilities EOY4325958TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY-1890221NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY1903104NetAssetsOrFundBalancesEOY
Mission DescriptionAS AN AFFILIATE OF BJC HEALTH SYSTEM (BJC), FAIRVIEW HEIGHTS MEDICAL GROUP SC IS COMMITTED TO IMPROVING THE HEALTH AND WELL-BEING OF THE PEOPLE AND COMMUNITIES IT SERVES THROUGH LEADERSHIP, EDUCATION, INNOVATION AND EXCELLENCE IN MEDICINE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense36498865Expense
Grants1920Grants
Revenue39848206Revenue
DescriptionDURING THE YEAR, THE ORGANIZATION PROVIDED QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. THE ORGANIZATION HAD 164,430 VISITS DURING 2012.Description
Total Program Service Expense36498865TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote0ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With109658NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees317NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members1NbrVotingGoverningBodyMembers
Number Independent Voting Members0NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
States Where Copy Of Return Is FiledILStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DIANNE NEWMANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number3149967601TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1670 MASON RIDGE CENTER DR STE 300AddressLine1
CityST LOUISCity
StateMOState
ZIP Code63141ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
ELLENA JOHN MD
PRES/SECY/DIRECTOR1.0039.00XX056919049687
HESSJOHN P
PHYSICIAN40.00913632023796X
RAIAJITESH
PHYSICIAN40.00652834037778X
OMOTOLAAARON P
PHYSICIAN40.00601832027701X
LEHMANROBERT B
PHYSICIAN40.00574484014463X
RAFIQREHAN
PHYSICIAN40.00652834037778X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3395616TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs569190TotalReportableCompFrmRltdOrgs
Total Other Compensation191203TotalOtherCompensation
Number Individuals GT100 K54NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
STAT MED TRANSCRIPTION
12016 TESSON FERRY RD STE CST LOUISMO63128PHYSICIAN LOCUM STAFFING178593
INTERIM PHYSICIANS LLC
12140 WOODCREST EXECUTIVE DR STE 3ST LOUISMO63141PHYSICIAN LOCUM STAFFING100681
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PROGRAM SERVICE REV6211102812611928126119
SERVICES TO AFFILIATES6211101166745811667458
REFERENCE LAB/RAD REV6215005001750017
PROGRAM RENTAL INCOME62111046124612
FieldValueIRS element (for citing)
Total Program Service Revenue39848206TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column39848206TotalRevenueColumn
Related Or Exempt Function Income39798189RelatedOrExemptFunctionIncome
Unrelated Business Revenue50017UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total1920Total
Program Services1920ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total23182258Total
Program Services22702446ProgramServices
Management And General479812ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1240683Total
Program Services1240683ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1509021Total
Program Services1509021ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1131074Total
Program Services1131074ProgramServices

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total140Total
Program Services140ProgramServices

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total2459688Total
Management And General2459688ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total987208Total
Program Services987208ProgramServices

Advertising Advertising

FieldValueIRS element (for citing)
Total23226Total
Program Services23226ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total165895Total
Program Services165895ProgramServices

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total358882Total
Program Services358882ProgramServices

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1503532Total
Program Services1503532ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total26619Total
Program Services26619ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total1697Total
Program Services1697ProgramServices

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total776792Total
Program Services776792ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total2363827Total
Program Services2363827ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS17948211794821
MEDICAL SUPPLIES13127331312733
MISCELLANEOUS702593286077416516
EQUIP RENTAL & MAINTENA240021240021

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total72251Total
Program Services72251ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total39854881Total
Program Services36498865ProgramServices
Management And General3356016ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2351BOY
EOY2006EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY2244590BOY
EOY3003701EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY2793837BOY
EOY2287854EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY420523BOY
EOY394614EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis2485982LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1945095LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY573243BOY
EOY540887EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY6034544BOY
EOY6229062EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1746423BOY
EOY1645398EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY6178342BOY
EOY2680560EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY7924765BOY
EOY4325958EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY-1890221BOY
EOY1903104EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY-1890221BOY
EOY1903104EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY6034544BOY
EOY6229062EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-6675ReconcilationRevenueExpenses
Reconcilation Other Changes3800000ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis778230OtherCostOrOtherBasis
Depreciation641527Depreciation
Book Value136703BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis1707752OtherCostOrOtherBasis
Depreciation1303568Depreciation
Book Value404184BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings540887TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
DUE TO AFFILIATES$810,684
MALPRACTICE RESERVE$1,869,876
FieldValueIRS element (for citing)
Total Of Amounts2680560TotalOfAmounts

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
ELLENA JOHN MD
PRES/SECY/DIRECTOR03368810975010134808034665015022061887700
HESSJOHN P
PHYSICIAN9136320000043750194210937428000
RAIAJITESH
PHYSICIAN578495065279090600164390213390690612000
OMOTOLAAARON P
PHYSICIAN6018320000077620199390629533000
LEHMANROBERT B
PHYSICIAN5744840000043750100880588947000
RAFIQREHAN
PHYSICIAN578495065279090600164390213390690612000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
Return ReferencePART IIIReturnReference
ExplanationPART I LINE 3: THE COMPENSATION AND BENEFIT AMOUNTS OF THE ORGANIZATION'S OFFICER AND TOP MANAGEMENT OFFICIALS ARE DETERMINED BY AN INDEPENDENT COMMITTEE OF THE BOARD OF DIRECTORS OF BJC HEALTH SYSTEM. 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 BJC HEALTH SYSTEM CEO AND OTHER SENIOR EXECUTIVES. THE COMPENSATION COMMITTEE REVIEWS AND APPROVES, AND SUBSEQUENTLY RECONCILES EXECUTIVE COMPENSATION AS WELL AS DELIBERATES ON THE REASONABLENESS OF THE DATA. THIS REVIEW IS DOCUMENTED IN THE MINUTES OF THE COMPENSATION COMMITTEE MEETINGS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
NUMBER REPORTED IN BOX 3 FORM 1096FORM 990, PART V, LINE 1THE 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 2CERTAIN OFFICERS, DIRECTORS OR KEY EMPLOYEES OF THE ORGANIZATION AND BJC HEALTH SYSTEM (BJC) MAY ALSO SERVE ON THE BOARDS OF OTHER RELATED OR UNRELATED ORGANIZATIONS. ADDITIONALLY, CERTAIN FAMILY MEMBERS OF OFFICERS, DIRECTORS OR KEY EMPLOYEES MAY, DURING THE NORMAL COURSE OF BUSINESS YET CONSISTENT WITH ITS STATED EXEMPT PURPOSE, ENGAGE IN TRANSACTIONS IN WHICH POTENTIAL CONFLICTS OF INTEREST COULD EXIST. THESE OFFICERS, DIRECTORS, KEY EMPLOYEES AND RELATED PERSONS DISCLOSE THESE POTENTIAL CONFLICTS TO BJC HEALTH SYSTEM 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 B, LINE 11THE ORGANIZATION PREPARES DRAFT COPIES OF FORM 990 AND ATTACHMENTS FOR REVIEW BY MEMBERS OF MANAGEMENT. AFTER RESOLVING ANY OPEN ITEMS, THE FINAL DRAFT RETURNS ARE MADE AVAILABLE TO THE BOARD FOR REVIEW. QUESTIONS AND COMMENTS THAT ARISE DURING THE REVIEW OF THE FORMS ARE ADDRESSED IN ADVANCE OF SUBMISSION TO THE APPROPRIATE TAXING AUTHORITIES.
FORM 990, PART VI, SECTION B, LINE 12CTHE 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 CONFLICTS OF INTEREST QUESTIONNAIRE ARE REVIEWED BY A CENTRALIZED COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION TAKEN AS NECESSARY. SHOULD THE ORGANIZATION BECOME AWARE OF A CONFLICT NOT PREVIOUSLY REPORTED, ITS GENERAL COUNSEL WOULD INVESTIGATE THE ISSUE AND RESPOND IN ACCORDANCE WITH THE POLICY.
FORM 990, PART VI, SECTION C, LINE 19THE NET ASSETS AND ACTIVITIES OF FAIRVIEW HEIGHTS MEDICAL GROUP, S.C. (THE ORGANIZATION) ARE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF BJC HEALTH SYSTEM AND AFFILIATES (BJC). BJC AND THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS, CONSOLIDATED AUDITED FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE FOR INSPECTION BY THE GENERAL PUBLIC UPON REQUEST AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION.
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 9:ENTITY TRANSFERS TO FROM AFFILIATES 3,800,000.
FORM 990, PART IV, LINE 20FAIRVIEW HEIGHTS MEDICAL GROUP, S.C. (ORGANIZATION) IS AN ILLINOIS PROFESSIONAL SERVICE CORPORATION ORGANIZED TO SATISFY THE REQUIREMENTS UNDER THE ILLINOIS MEDICAL PRACTICE ACT. THE ORGANIZATION EMPLOYS LICENSED PHYSICIANS TO PROVIDE HEALTH CARE SERVICES TO PATIENTS. THE ORGANIZATION IS NOT A LICENSED HOSPITAL WITHIN THE STATE OF ILLINOIS AND DOES NOT OPERATE ONE OR MORE FACILITES THAT SATISFY THE DEFINITION OF A HOSPITAL. ACCORDINGLY, THE ORGANIZATION IS NOT REQUIRED TO COMPLETE AND FILE FORM 990, SCHEDULE H FOR 2012.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (32 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
ALTON MEMORIAL HOSPITAL
ONE MEMORIAL HOSPITAL DRIVEALTONIL62002370661172HEALTHCARE SERVICESIL501(C)(3)3CH ALLIED SERVICES INC1
ALTON MEMORIAL HEALTH SERVICES FOUNDATION
1109 N OXFORDSHIRE LANEEDWARDSVILLEIL62025371177053SUPPORT TO AMHIL501(C)(3)11CALTON MEMORIAL HOSPITAL1
BARNES-JEWISH HOSPITAL
ONE BARNES-JEWISH HOSPITAL PLAZAST LOUISMO63110237309937HEALTHCARE SERVICESMO501(C)(3)3BJC HEALTH SYSTEM1
THE FOUNDATION FOR BARNES-JEWISH HOSPITAL
1001 HIGHLANDS PLAZA DR WEST SUITEST LOUISMO63110431648435SUPPORT TO BJHMO501(C)(3)7BARNES-JEWISH HOSPITAL1
BARNES JEWISH HOSP AUXILIARY PARKVIEW CHAPTER
216 SO KINGSHIGHWAY CAB 140ST LOUISMO63110237000410SUPPORT TO BJHMO501(C)(3)11CBARNES-JEWISH HOSPITAL1
BARNES-JEWISH ST PETERS HOSPITAL INC
10 HOSPITAL DRIVEST PETERSMO63376431452426HEALTHCARE SERVICESMO501(C)(3)3BARNES-JEWISH HOSPITAL1
BARNES-JEWISH ST PETERS HOSPITAL AUXILIARY
10 HOSPITAL DRIVEST PETERSMO63376431232811SUPPORT TO BJSP HOSPITALMO501(C)(3)3BARNES-JEWISH ST PETERS HOSPITAL1
BARNES-JEWISH WEST COUNTY HOSPITAL
12634 OLIVE STREET ROADCREVE COEURMO63141431527130HEALTHCARE SERVICESMO501(C)(3)3BARNES-JEWISH HOSPITAL1
BJC BEHAVIORAL HEALTH
1430 OLIVE STREET SUITE 400ST LOUISMO63103431610561HEALTHCARE SERVICESMO501(C)(3)3BJC HEALTH SYSTEM1
BJC CORPORATE HEALTH SERVICES
5000 MANCHESTER AVENUEST LOUISMO63110431324103HEALTHCARE SERVICESMO501(C)(3)3BARNES-JEWISH HOSPITAL1
BJC HEALTH SYSTEM
4901 FOREST PARKST LOUISMO63108431617558SUPPORTING ORGMO501(C)(3)11A0
BJC HOME CARE SERVICES
9890 CLAYTON ROAD 200ST LOUISMO63124431450457HEALTHCARE SERVICESMO501(C)(3)9BARNES-JEWISH HOSPITAL1
BOONE HOSPITAL CENTER'S VISITING NURSES INC
601 BUSINESS LOOP 70 W SUITE 280COLUMBIAMO65203430998347HEALTHCARE SERVICESMO501(C)(3)9CH ALLIED SERVICES INC1
CH ALLIED SERVICES INC
1600 E BROADWAYCOLUMBIAMO65201431279063HEALTHCARE SERVICESMO501(C)(3)3CH HEALTH SERVICES DEV CORP1
CHRISTIAN HEALTH SERVICES DEV CORP
11133 DUNN ROADST LOUISMO63136431230583HEALTHCARE SERVICESMO501(C)(3)11ABJC HEALTH SYSTEM1
CHILDREN'S HEALTH NETWORK
ONE CHILDRENS PLACEST LOUISMO63110431640467HEALTHCARE SERVICESMO501(C)(3)9ST LOUIS CHILDREN'S HOSPITAL1
CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST
11133 DUNN ROADST LOUISMO63136436057893HEALTHCARE SERVICESMO501(C)(3)3CH HEALTH SERVICES DEV CORP1
CHRISTIAN HOSPITAL FOUNDATION
11155 DUNN ROAD SUITE 300 NST LOUISMO63136431947644SUPPORT TO CHNEMO501(C)(3)11ACHRISTIAN HOSPITAL NORTHEAST-NORTHWEST1
CHRISTIAN HOSP ILLINOIS SVCS
8 SUNSET HILLSEDWARDSVILLEIL62025260131339HEALTHCARE SERVICESMO501(C)(3)3CH ALLIED SERVICES INC1
COMMUNITY HEALTH CONNECTION
4353 CLAYTON AVE RM 164ST LOUISMO63110460819384HEALTHCARE SERVICESMO501(C)(3)9BJC HEALTH SYSTEM1
MISSOURI BAPTIST HEALTHCARE FOUNDATION
3015 N BALLAS ROADST LOUISMO63131431472026SUPPORT TO MBMCMO501(C)(3)7MISSOURI BAPTIST MEDICAL CENTER1
MISSOURI BAPTIST HOSPITAL OF SULLIVAN AUXILIARY
751 SAPPINGTON BRIDGESULLIVANMO63080431349641SUPPORT TO MBHSMO501(C)(3)3MISSOURI BAPTIST HOSPITAL OF SULLIVAN1
MISSOURI BAPTIST HOSPITAL OF SULLIVAN
751 SAPPINGTON BRIDGESULLIVANMO63080431459495HEALTHCARE SERVICESMO501(C)(3)3MISSOURI BAPTIST MEDICAL CENTER1
MISSOURI BAPTIST MEDICAL CENTER
3015 N BALLAS ROADST LOUISMO63131430652656HEALTHCARE SERVICESMO501(C)(3)3BJC HEALTH SYSTEM1
PARKLAND HEALTH CENTER
1101 WEST LIBERTY STFARMINGTONMO63640431332368HEALTHCARE SERVICESMO501(C)(3)3MISSOURI BAPTIST MEDICAL CENTER1
PARKLAND HEALTH CENTER FOUNDATION
1101 WEST LIBERTY STFARMINGTONMO63640900424964SUPPORT TO PHCMO501(C)(3)7PARKLAND HEALTH CENTER1
PROGRESS EAST HEALTHCARE CENTER
11155 DUNN ROAD SUITE 300 NST LOUISMO63136261343214HEALTHCARE SERVICESIL501(C)(3)3CH ALLIED SERVICES INC1
PROGRESS WEST HEALTHCARE CENTER
2 PROGRESS POINT PARKWAYOFALLONMO63368412140764HEALTHCARE SERVICESMO501(C)(3)3BJC HEALTH SYSTEM1
ST LOUIS CHILDREN'S HOSPITAL FOUNDATION
ONE CHILDRENS PLACEST LOUISMO63110431626863SUPPORT TO SLCHMO501(C)(3)7ST LOUIS CHILDREN'S HOSPITAL1
ST LOUIS CHILDREN'S HOSPITAL
ONE CHILDRENS PLACEST LOUISMO63110430654870HEALTHCARE SERVICESMO501(C)(3)3BJC HEALTH SYSTEM1
VILLAGE NORTH INC
11160 VILLAGE NORTH DRIVEST LOUISMO63136431207154HEALTHCARE SERVICESMO501(C)(3)9CH HEALTH SERVICES DEV CORP1
BARNES JEWISH ST PETERS & PROGRESS WEST FOUNDATION
10 HOSPITAL DRIVEST PETERSMO63376454471497SUPPORT TO BBJSPH & PROGRESS WESTMO501(C)(3)7BJSP HOSPITAL & PROGRESS WEST1

Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
THE HEART CARE INSTITUTE LLC
1020 NORTH MASON ROADST LOUISMO63141431870517MEDICAL SERVICESMO00
GAMMA KNIFE CENTER AT BARNES JEWISH HOSP LLC
216 SOUTH KINGSHIGHWAYST LOUISMO63110431846941OUTPATIENT CARE SERVICESMO00
SURGERY CENTER OF FARMINGTON LLC
400 PARKLAND DRIVEFARMINGTONMO63640431811835MEDICAL SERVICESMO00
CHILDREN'S DISCOVERY INSTITUTE LLC
4901 FOREST PARK BLVDST LOUISMO63108SEARCH FOR CURES OF PEDIATRIC DISEASESMO00

Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)

Address Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryEINEINPrimary ActivityPrimaryActivityLegal Domicile Foreign CountryLegalDomicileForeignCountryType Of EntityTypeOfEntityControlled OrgControlledOrgAddress Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeLegal Domicile StateLegalDomicileState
ATG ASSURANCE COMPANY LTD
PO BOX 1109GRAND CAYMANGRAND CAYMANCJ980599167INSURANCEUKC0
PF SERVICES INC
431237767MANAGEMENT SERVICESC011155 DUNN ROADST LOUISMO63136MO
MB MEDICAL SERVICES INC
431437404HEALTHCARE SERVICESC03015 N BALLAS ROADST LOUISMO63131MO
MISSOURI BAPTIST HOME HEALTH CARE INC
431460430INACTIVEC03015 N BALLAS ROADST LOUISMO63131MO
MB PHARMACY INC
431640730INACTIVEC03015 N BALLAS ROADST LOUISMO63131MO
ST PETERS MED OFFICE BLDG A CONDO ASSN INC
431472188CONDOMINIUM ASSOCIATIONC01040 N MASON SUITE 109ST LOUISMO63141MO
DMP MIDWEST INC
271943910INACTIVEC0ONE METROPOLITAN SQ 2600ST LOUISMO63102MO
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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