2016-11-15T13:49:45-06:00 2015-12-31 990 2015-01-01 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 PRESIDENT/SECY/DIRECTOR 3149967601 2016-11-15 2015 2017-02-10 21:41:12Z BJC MEDICAL GROUP OF ILLINOIS JOHN T ELLENA MD 2 MEMORIAL DRIVE NO 220 ALTON IL 62002 37747538 0 X N/A X 1997 IL PROVIDE HEALTHCARE SERVICES TO PATIENTS 1 0 280 0 0 0 0 0 36504633 37747538 0 0 0 0 36504633 37747538 1520 2920 0 0 25783162 27402982 0 0 0 10719951 10341636 36504633 37747538 0 0 8224288 4473036 4116308 3714604 4107980 758432 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 34361947 2920 37747538 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 173,777 VISITS DURING 2015. 34361947 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 58 0 1 280 1 0 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 3142862057 670 MASON RIDGE CENTER DR STE 300 ST LOUIS MO 63141 ELLENA JOHN MD PRES/SECY/DIRECTOR 1.00 39.00 X X 0 529442 61994 OMOTOLAAARON PHYSICIAN 40.00 X 1117966 0 42944 RAIAJITESH PHYSICIAN 40.00 X 631298 9750 49761 FLEISSNER MICHAEL J PHYSICIAN 40.00 X 590029 0 45999 STIRTON JOHN W PHYSICIAN 40.00 X 574191 47488 33330 OLAGBEGIOLAYIWOLA PHYSICIAN 40.00 X 552704 9720 49817 3466188 596400 283845 54 0 1 0 MAXIM HEALTHCARE SERVICES INC 12559 COLLECTION CENTER DR CHICAGO IL 60693 983345 OMNISCIENT HEALTHCARE LLC 123 WILSON COURT GRANITE CITY IL 62040 405588 STAT MED TRANS 12016 TESSON FERRY RD STE C ST LOUIS MO 63128 140712 3 PROGRAM SERVICE REV 621110 25276545 25276545 SERVICES TO AFFILIATES 621110 12470993 12470993 37747538 37747538 37747538 0 0 2920 2920 22658747 22658747 1868251 1868251 1779352 1779352 1096632 1096632 -10000 -10000 2230983 2230983 908223 908223 13347 13347 120557 120557 59006 59006 1384141 1384141 17260 17260 3597 3597 696216 696216 1616656 1616656 MEDICAL SUPPLIES 1750496 1750496 EQUIP RENTAL & MAINT 64280 64280 DUES & SUBSCRIPTIONS 36008 36008 RECRUITMENT 12286 12286 1438580 283972 1154608 37747538 34361947 3385591 0 2193 2369 2993352 302807 3166428 2489500 109705 93667 5901569 4316876 1952610 1584693 8224288 4473036 1191659 1067460 2924649 2647144 4116308 3714604 X 4107980 758432 4107980 758432 8224288 4473036 X 0 -3349548 X 0 1 X 1 0 X 3166994 2179223 987771 1293 739 554 2733282 2136914 596368 1584693 MALPRACTICE RESERVE 2647144 2647144 0 0 0 0 0 0 0 1 0 ELLENA JOHN MD PRES/SECY/DIRECTOR 0 483973 0 41317 0 4152 0 39001 0 22993 0 591436 0 0 OMOTOLAAARON PHYSICIAN 983872 0 112570 0 21524 0 13540 0 29404 0 1160910 0 0 0 RAIAJITESH PHYSICIAN 555217 9750 75271 0 810 0 0 20156 29537 68 660835 29974 0 0 FLEISSNER MICHAEL J PHYSICIAN 550647 0 37060 0 2322 0 18318 0 27681 0 636028 0 0 0 STIRTON JOHN W PHYSICIAN 570393 24300 0 0 3798 23188 0 5979 27241 110 601432 53577 0 0 OLAGBEGIOLAYIWOLA PHYSICIAN 551462 9720 0 0 1242 0 0 20565 29167 85 581871 30370 0 0 PART I, LINE 7 DURING 2015 THE ORGANIZATION PROVIDED INCENTIVE PAYMENTS THAT ARE CALCULATED USING A PERCENT OF BASE PAY AFTER CERTAIN PERFORMANCE AND OPERATING GOALS ARE MET. THE AMOUNT OF INCENTIVE PAYMENTS DO NOT ACCRUE TO THE BENEFIT OF THE INDIVIDUALS UNTIL AFTER THE FINANCIAL RESULTS HAVE BEEN DETERMINED FOR THE CALENDAR YEAR. SCH J PART 1, 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 V, LINE 1 NUMBER REPORTED IN BOX 3 FORM 1096 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, 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 XI, LINE 9: ENTITY TRANSFERS TO FROM AFFILIATES -3,349,548. 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 2015. 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 ALTON MEMORIAL HOSPITAL ONE MEMORIAL HOSPITAL DRIVE ALTON IL 62002 370661172 HEALTHCARE SERVICES IL 501(C)(3) 3 CH ALLIED SERVICES INC 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 BBJSPH & PROGRESS WEST MO 501(C)(3) 7 BJSP HOSPITAL & PROGRESS WEST 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 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 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 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 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 HEALTH SERVICES DEV CORP 11133 DUNN ROAD ST LOUIS MO 63136 431230583 HEALTHCARE SERVICES MO 501(C)(3) 7 BJC HEALTH SYSTEM 1 CHRISTIAN HOSP ILLINOIS SVCS 8 SUNSET HILLS EDWARDSVILLE IL 62025 260131339 HEALTHCARE SERVICES MO 501(C)(3) 3 CH ALLIED SERVICES INC 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 HOSPITAL NORTHEAST-NORTHWEST 11133 DUNN ROAD ST LOUIS MO 63136 436057893 HEALTHCARE SERVICES MO 501(C)(3) 3 CH HEALTH SERVICES DEV CORP 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 751 SAPPINGTON BRIDGE SULLIVAN MO 63080 431459495 HEALTHCARE SERVICES MO 501(C)(3) 3 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 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 PARKLAND HEALTH CENTER WEBER ROAD 1101 WEST LIBERTY ST FARMINGTON MO 63640 473251218 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 2 PROGRESS POINT PARKWAY OFALLON MO 63368 412140764 HEALTHCARE SERVICES MO 501(C)(3) 3 BJC HEALTH SYSTEM 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 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 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 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 0 PF SERVICES INC 11155 DUNN ROAD ST LOUIS MO 63136 431237767 MANAGEMENT SERVICES MO C 0 MB MEDICAL SERVICES INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431437404 HEALTHCARE SERVICES MO C 0 ST PETERS MED OFFICE BLDG A CONDO ASSN INC 1040 N MASON SUITE 109 ST LOUIS MO 63141 431472188 CONDOMINIUM ASSOCIATION MO C 0 DMP MIDWEST INC ONE METROPOLITAN SQ 2600 ST LOUIS MO 63102 271943910 INACTIVE MO C 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 BJC HEALTH SYSTEMPHYSICAN GROUPS LC I 54076 BJC HEALTH SYSTEMPHYSICAN GROUPS LC K 1017468 BJC HEALTH SYSTEMPHYSICAN GROUPS LC L 3247989 BJC HEALTH SYSTEMPHYSICAN GROUPS LC M 4678737 BJC HEALTH SYSTEMPHYSICAN GROUPS LC O 14364812 BJC HEALTH SYSTEMPHYSICAN GROUPS LC P 71327623 BJC HEALTH SYSTEMPHYSICAN GROUPS LC Q 95723743 BJC HEALTH SYSTEMPHYSICAN GROUPS LC R 3103507 BJC HEALTH SYSTEMPHYSICAN GROUPS LC S 32462515