2012-11-15T14:35:36-06:00 2011-12-31 990 2011-01-01 364147189 FAIRVIEW HEIGHTS MEDICAL GROUPSC C/O BJC MEDICAL GROUP LC FAIR 3149967601 2 MEMORIAL DRIVE NO 220 ALTON IL 62002 JOHN T ELLENA MD 3149967601 2012-11-15 2011 2016-02-24 21:20:13Z BJC MEDICAL GROUP OF ILLINOIS JOHN T ELLENA MD 2 MEMORIAL DRIVE NO 220 ALTON IL 62002 35335038 0 X N/A X 1997 IL PROVIDE HEALTHCARE SERVICES TO PATIENTS 1 0 307 0 48241 -24274 0 0 27806492 35335038 0 0 0 0 27806492 35335038 0 10050 0 0 19312144 23024410 0 0 0 8494347 12300566 27806491 35335026 1 12 4484492 6034544 6374724 7924765 -1890232 -1890221 AS 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. 0 0 32528582 10050 35335038 DURING 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 148,809 VISITS DURING 2011. 32528582 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 0 0 0 1 49 0 1 307 1 1 1 0 0 0 0 0 0 0 X 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 IL X DIANNE NEWMAN 3149967601 670 MASON RIDGE CENTER DR STE 300 ST LOUIS MO 63141 ELLENA JOHN MD 40.00 X X 0 536631 40850 CHATHADI KRISHNAVEL 40.00 X 547424 0 14771 OMOTOLA AARON P 40.00 X 610579 0 31454 RAI AJITESH 40.00 X 614449 0 29162 SIKORSKI CHRISTIAN 40.00 X 794648 0 29409 WUELLNER JOHN C 40.00 X 499716 0 45418 3066816 536631 191064 49 0 1 0 CARDIOLOGY SPECIALISTS PC 3023 N BALLAS RD STE 400D ST LOUIS MO 63141 PRACTICE ACQUISITION 323639 INTERIM PHYSICIANS LLC 12140 WOODCREST EXECUTIVE DR STE 3 ST LOUIS MO 63128 PHYSICIAN LOCUM STAFFING 292128 STAT MED TRANSCRIPTION 12016 TESSON FERRY RD STE C ST LOUIS MO 63141 TRANSCRIPTION SERVICES 190710 GIUSEPPE ALIPERTI MD 12855 N FORTY DRIVE STE 175 ST LOUIS MO 63131 MANAGEMENT SERVICES 170174 4 PROGRAM SERVICE REV 621110 24690009 24690009 SERVICES TO AFFILIATES 621110 10593652 10593652 REFERENCE LAB/RAD REV 621500 48241 48241 PROGRAM RENTAL INCOME 621110 3136 3136 35335038 35335038 35286797 48241 0 10050 10050 19992978 19639671 353307 930904 930904 1142892 1142892 957636 957636 14463 14463 2180032 2180032 1222829 1222829 25017 25017 190309 190309 511773 511773 1491279 1491279 12079 12079 2772 2772 443584 443584 2432765 2432765 BAD DEBTS 1588480 1588480 MEDICAL SUPPLIES 1222700 1222700 MISCELLANEOUS 581297 308192 273105 EQUIP RENTAL & MAINTENA 283565 283565 97622 97622 35335026 32528582 2806444 0 1965 2351 1718301 2244590 2219636 2793837 390618 420523 2497570 1924327 153972 573243 4484492 6034544 1371322 1746423 5003402 6178342 6374724 7924765 X -1890232 -1890221 -1890232 -1890221 4484492 6034544 12 0 X 0 1 1 X 0 X 778230 591554 186676 1706923 1327599 379324 12417 5174 7243 573243 DUE TO AFFILIATES 4802597 MALPRACTICE RESERVE 1375745 6178342 0 AMERICAN HEART ASSOCIATION 460 N LINDBERGH BLVD ST LOUIS MO 63141 6000 HEART BALL - HELP ADVANCED VITAL RESEARCH, SUPPORT PUBLIC AND PROFESSIONAL EDUCATION INITIATIVES, COMMUNITY SERVICE PROGRAMS AND ADVOCACY EFFORTS OF THE AMERICAN HEART ASSOCIATION. 1 0 0 0 0 0 0 0 0 0 0 ELLENA JOHN MD 0 332191 0 147946 0 56494 0 25971 0 14879 0 577481 0 0 CHATHADI KRISHNAVEL 545684 0 0 0 1740 0 4288 0 10483 0 562195 0 0 0 OMOTOLA AARON P 608952 0 600 0 1027 0 4288 0 27166 0 642033 0 0 0 RAI AJITESH 532183 0 81726 0 540 0 11871 0 17291 0 643611 0 0 0 SIKORSKI CHRISTIAN 793298 0 0 0 1350 0 7590 0 21819 0 824057 0 0 0 WUELLNER JOHN C 458366 0 39028 0 2322 0 27360 0 18058 0 545134 0 0 0 SUPPLEMENTAL INFORMATION PART III PART 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. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN 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 11 THE 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 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 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 19 THE 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. FORM 990, PART IV, LINE 20 FAIRVIEW 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 2011. 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 HOSPITAL INC 10 HOSPITAL DRIVE ST PETERS MO 63376 431452426 HEALTHCARE SERVICES MO 501(C)(3) 3 BARNES-JEWISH HOSPITAL 1 BARNES-JEWISH ST PETERS HOSPITAL AUXILIARY 10 HOSPITAL DRIVE ST PETERS MO 63376 431232811 SUPPORT TO BJSP HOSPITAL MO 501(C)(3) 3 BARNES-JEWISH ST PETERS HOSPITAL 1 BARNES-JEWISH WEST COUNTY HOSPITAL 12634 OLIVE STREET ROAD CREVE COEUR MO 63141 431527130 HEALTHCARE SERVICES MO 501(C)(3) 3 BARNES-JEWISH HOSPITAL 1 BJC BEHAVIORAL HEALTH 1430 OLIVE STREET SUITE 400 ST LOUIS MO 63103 431610561 HEALTHCARE SERVICES MO 501(C)(3) 3 BJC HEALTH SYSTEM 1 BJC CORPORATE HEALTH SERVICES 5000 MANCHESTER AVENUE ST LOUIS MO 63110 431324103 HEALTHCARE SERVICES MO 501(C)(3) 3 BARNES-JEWISH HOSPITAL 1 BJC HEALTH SYSTEM 4901 FOREST PARK ST LOUIS MO 63108 431617558 SUPPORTING ORG MO 501(C)(3) 11A 0 BJC HOME CARE SERVICES 9890 CLAYTON ROAD 200 ST LOUIS MO 63124 431450457 HEALTHCARE SERVICES MO 501(C)(3) 9 BARNES-JEWISH HOSPITAL 1 BOONE HOSPITAL CENTER'S VISITING NURSES INC 601 BUSINESS LOOP 70 W SUITE 280 COLUMBIA MO 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) 11A 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 RM 164 ST LOUIS MO 63110 460819384 HEALTHCARE SERVICES MO 501(C)(3) 9 BJC HEALTH SYSTEM 1 MISSOURI BAPTIST HEALTHCARE FOUNDATION 3015 N BALLAS ROAD ST LOUIS MO 63131 431472026 SUPPORT TO MBMC MO 501(C)(3) 7 MISSOURI BAPTIST MEDICAL CENTER 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 PARKLAND HEALTH CENTER FOUNDATION 1101 WEST LIBERTY ST FARMINGTON MO 63640 900424964 SUPPORT TO PHC MO 501(C)(3) 7 PARKLAND HEALTH 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 2 PROGRESS POINT PARKWAY OFALLON MO 63368 412140764 HEALTHCARE SERVICES MO 501(C)(3) 3 BJC HEALTH SYSTEM 1 ST LOUIS CHILDREN'S HOSPITAL FOUNDATION ONE CHILDRENS PLACE ST LOUIS MO 63110 431626863 SUPPORT TO SLCH MO 501(C)(3) 7 ST LOUIS CHILDREN'S HOSPITAL 1 ST LOUIS CHILDREN'S HOSPITAL ONE CHILDRENS PLACE ST LOUIS MO 63110 430654870 HEALTHCARE SERVICES MO 501(C)(3) 3 BJC HEALTH SYSTEM 1 VILLAGE NORTH INC 11160 VILLAGE NORTH DRIVE ST LOUIS MO 63136 431207154 HEALTHCARE SERVICES MO 501(C)(3) 9 CH HEALTH SERVICES DEV CORP 1 TWIN RIVERS MRI LLC ONE MEMORIAL DRIVE ALTON IL 62002 371400120 HEALTH SERVICES IL 0 0 THE HEART CARE INSTITUTE LLC 1020 NORTH MASON ROAD ST LOUIS MO 63141 431870517 MEDICAL SERVICES MO 0 0 GAMMA KNIFE CENTER AT BARNES JEWISH HOSP LLC 216 SOUTH KINGSHIGHWAY ST LOUIS MO 63110 431846941 OUTPATIENT CARE SERVICES MO 0 0 SURGERY CENTER OF FARMINGTON LLC 400 PARKLAND DRIVE FARMINGTON MO 63640 431811835 MEDICAL SERVICES MO 0 0 CHILDREN'S DISCOVERY INSTITUTE LLC 4901 FOREST PARK BLVD ST LOUIS MO 63108 SEARCH FOR CURES OF PEDIATRIC DISEASES MO 0 0 ATG ASSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN GRAND CAYMAN CJ 980599167 INSURANCE UK C PF SERVICES INC 11155 DUNN ROAD ST LOUIS MO 63136 431237767 MANAGEMENT SERVICES MO C MB MEDICAL SERVICES INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431437404 HEALTHCARE SERVICES MO C MISSOURI BAPTIST HOME HEALTH CARE INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431460430 INACTIVE MO C MB PHARMACY INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431640730 INACTIVE MO C ST PETERS MED OFFICE BLDG A CONDO ASSN INC 1040 N MASON SUITE 109 ST LOUIS MO 63141 431472188 CONDOMINIUM ASSOCIATION MO C DMP MIDWEST INC ONE METROPOLITAN SQ 2600 ST LOUIS MO 63102 271943910 INACTIVE MO C 0 0 0 0 0 0 1 1 1 1 1 1 0 1 1 1 1 1 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC G 277372 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC H 1111171 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC I 58245 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC J 588576 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC K 12622317 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC L 5736246 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC N 15823039 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC O 9637141 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC P 3582904 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC Q 22980588 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC R 7262430