2014-11-17T15:16:43-06:00 2013-12-31 990 2013-01-01 431947644 CHRISTIAN HOSPITAL FOUNDATION CHRI 3146535000 11155 DUNN ROAD SUITE 300 NORTH ST LOUIS MO 63136 RON MCMULLEN PRESIDENT 3146535000 2014-11-17 2013 2015-11-30 17:44:51Z RON MCMULLEN 11155 DUNN ROAD ST LOUIS MO 63136 1080936 0 X N/A X 2001 MO TO PROVIDE SUPPORT TO CHRISTIAN HOSPITAL TO ACCOMPLISH ITS MISSION OF PROVIDING HEALTH CARE & CLINICAL EXCELLENCE TO OUR COMMUNITY. SEE MISSION STATEMENT. 14 11 0 30 0 0 985289 460629 0 0 1179554 603346 -7596 -18442 2157247 1045533 476178 582419 0 0 0 0 203000 116000 497299 329571 419000 1008749 1117419 1148498 -71886 8362531 7545040 1176975 469063 7185556 7075977 X WITH THE GRACIOUS, VITAL SUPPORT OF OUR DONORS, THE CHRISTIAN HOSPITAL FOUNDATION'S MISSION IS TO PARTNER WITH CHRISTIAN HOSPITAL TO PROVIDE SERVICE, COMPASSIONATE CARE AND CLINICAL EXCELLENCE TO OUR COMMUNITY. 0 0 407419 407419 IN AN EFFORT TO REDUCE HOSPITAL READMISSION RATES, THE CHRISTIAN HOSPITAL FOUNDATION (FOUNDATION) PROVIDED FUNDING TO SUPPORT PATIENTS OF CHRISTIAN HOSPITAL THROUGH COMMUNITY PROGRAMS INCLUDING THE "TRANSITION TO WELLNESS CLINIC." THIS PROGRAM PROVIDED ITEMS NECESSARY TO PATIENTS TRANSITIONING FROM HOSPITAL TO HOME. 95000 95000 FOUNDATION PROVIDED START UP FUNDING FOR INNOVATIVE HEALTHCARE DELIVERY METHODS INCLUDING THE "COMMUNITY HEALTH ACCESS PROGRAM" AT CHRISTIAN HOSPITAL. PROGRAM FUNDING INCLUDED STAFFING AND OTHER COSTS FOR THE INITIAL YEAR OF OERATIONS. 80000 80000 FOUNDATION FUNDS PROVIDED FINANCIAL ASSISTANCE TO MEDICALLY INDIGENT PATIENTS OF THE COMMUNITIES SERVED BY CHRISITAN HOSPITAL. 423925 FOUNDATION HAS NEARLY COMPLETED ITS FIRST CAPITAL CAMPAIGN TO CONSTRUCT A HYBRID OPERATING ROOM FACILITY AT CHRISTIAN HOSPITAL. TO DATE $1.373M HAS BEEN RAISED TOWARDS A REVENUE GOAL OF $1.9M. 423925 582419 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 5 0 1 0 0 0 0 0 0 1 1 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 IL X VALERIE GRAY 3142860572 4249 CLAYTON AVE STE 316 ST LOUIS MO 63110 DUMAS LILLIE DIRECTOR 1.00 X 0 0 0 HANCOCK MILDRED DIRECTOR 1.00 X 0 0 0 HORNING CAROL DIRECTOR 1.00 X 0 0 0 JENSEN JOSHUA II MD DIRECTOR 1.00 X 0 182784 16973 KEITH JUDI DIRECTOR 1.00 X 0 0 0 MALONE DAVID DIRECTOR 1.00 X 0 0 0 MILLER LORI DIRECTOR 1.00 X 0 0 0 MONAHAN DIANE DIRECTOR 1.00 X 0 0 0 OTTO DAVE DIRECTOR 1.00 X 0 0 0 WOODWARD TIM DIRECTOR 1.00 X 0 0 0 MCKEE PAUL J JR DIRECTOR/CHAIRMAN 1.00 X X 0 0 0 ZYKAN DONALD VICE CHAIRMAN/DIRECTOR 1.00 X X 0 0 0 MCMULLEN RON PRESIDENT/DIRECTOR 1.00 39.00 X X 0 467959 85788 HOEFT MICHELE EXECUTIVE DIRECTOR/DIRECTOR 40.00 X X 0 112829 8987 0 763572 111748 0 0 1 0 COMMUNITY COUNSELING SERVICE PO BOX 27462 NEW YORK NY 10087 FUNDRAISING CONSULTANT 116000 1 64125 396504 3104 460629 216623 216623 386723 0 386723 386723 386723 16961 64125 35403 -18442 -18442 1045533 0 0 584904 582419 582419 116000 116000 24057 24057 62452 62452 11924 1133 10791 1244 303 941 7950 93 7857 PURCHASED SERVICES 307580 12000 295580 BANK FEES 2133 2133 GIFTS/AWARDS 1145 1145 DEPT OF TREASURY (IRS R 400 400 115 115 1117419 582419 37701 497299 18804 39858 43084 644258 707826 5509491 5164790 2167784 1610536 1140 0 8362531 7545040 810975 35227 366000 433836 1176975 469063 X -74748 44239 7230204 7001638 30100 30100 7185556 7075977 8362531 7545040 X -71886 -92514 54821 X 0 1 X 1 0 X 1946104 113175 140788 985289 460629 3645985 1946104 113175 140788 985289 460629 3645985 130297 3515688 61777 33679 79802 152591 216623 544472 4190457 63374 0.83900 0.79710 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 39857 154 287 39724 39840 17 39857 39705 135 39840 40140 79 514 39705 39359 781 40140 0.24300 0.75700 0 0 0 HEDGE FUNDS 181480 F GSO BANK LOANS 619267 F LOW VOLUME HEDGE FUND 330377 F GLOBAL BONDS 479412 F 1610536 PART V, LINE 4: INVESTMENT EARNINGS ARE USED TO FUND NURSING SCHOLARSHIPS. X X X X X X 1 COMMUNITY COUNSELING SERVICES PO BOX 430159 NEW YORK NY 100877462 CONSULTING ON CAPITAL FUND RAISING CAMPAIGN 0 423925 116000 307925 423925 116000 307925 MO IL LEGACY LEADER DINNER 36860 30125 6735 8472 400 GOLF OUTING 44226 34000 10226 658 25873 81086 64125 16961 658 25873 8472 400 35403 -18442 1 CHRISTIAN HOSPITAL NE-NW 11133 DUNN ROAD ST LOUIS MO 63136 436057893 501(C)(3) 554819 PROVIDE SUPPORT FOR COMMUNITY PROGRAMS PHYSICIANS GROUP LC A DISREGARDED ENTITY OF BJC HEALTH SYSTEM 670 MASON RIDGE CENTER DR ST LOUIS MO 63141 431681957 501(C)(3) 27600 TRANSITION TO WELLNESS PROGRAM 2 0 PART I, LINE 2: CHRISTIAN HOSPITAL FOUNDATION WORKS CLOSELY WITH THE COMMUNITY RELATIONS COMMITTEE OF THE CHRISTIAN HOSPITAL BOARD WHEN APPROVING ALL COMMUNITY BENEFIT PROGRAMS, INCLUDING ASSISTANCE TO OTHERS. FUNDING FOR THE NEXT YEAR IS DETERMINED IN THE FALL. ALL EXPENSES ARE APPROVED THROUGH THE EXECUTIVE DIRECTOR OF THE CHRISTIAN HOSPITAL FOUNDATION. 0 1 0 0 0 0 0 1 0 JENSEN JOSHUA II MD DIRECTOR 0 176717 0 0 0 6067 0 425 0 16548 0 199757 0 0 MCMULLEN RON PRESIDENT/DIRECTOR 0 310448 0 152662 0 4849 0 70475 0 15313 0 553747 0 20605 PART I, LINE 4B DURING 2013, THE FOLLOWING INDIVIDUAL(S) RECEIVED SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN ACCRUALS FROM THE RELATED ORGANIZATION AS REPORTED IN THE DETAILS OF COMPENSATION AND BENEFITS (SEE FORM 990, PART VII AND SCHEDULE J, PART II): MCMULLEN, RONALD B $39,401 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 6 THE SOLE MEMBER OF THE FOUNDATION IS CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST, A MISSOURI NOT-FOR-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE SOLE MEMBER OF THE CHRISTIAN HOSPITAL FOUNDATION (FOUNDATION) IS CHRISTIAN HOSPITAL NORTHEAST-NORTHWEST. THE BOARD OF DIRECTORS OF THE FOUNDATION ARE CHOSEN BY ITS SOLE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B ALTHOUGH THE PROPERTY AND AFFAIRS OF THE FOUNDATION ARE MANAGED BY THE BOARD OF DIRECTORS, THE POWERS OF THE BOARD ARE LIMITED AND MUST BE APPROVED BY ITS SOLE MEMBER. THESE POWERS INCLUDE, BUT ARE NOT LIMITED TO: VARIOUS CAPITAL EXPENDITURES; BUYING, SELLING, LEASING OF REAL PROPERTY HELD BY THE FOUNDATION; ANNUAL OPERATING BUDGET; INCURRENCE OF DEBT; REVISIONS OR AMENDMENTS TO ARTICLES OF INCORPORATION OR BYLAWS OF THE FOUNDATION. FORM 990, PART VI, SECTION B, LINE 11 THE ORGANIZATION PREPARES DRAFT COPIES OF FORM 990 AND ATTACHMENTS FOR REVIEW BY MEMBERS OF MANAGEMENT INCLUDING THE EXECUTIVE OFFICER OF THE FOUNDATION. AFTER RESOLVING ANY OPEN ITEMS, THE FINAL DRAFT RETURN WAS SUBMITTED TO THE IRS. 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 A CENTRALIZED COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION TAKEN AS NECESSARY. SHOULD THE ORGANIZATION BECOME AWARE OF A CONFLICT NOT PREVIOUSLY REPORTED, MANAGEMENT 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. FORM 990, PART XI, LINE 9: EQUITY TRANSFER FROM BJC (AUXILIARY) 60,000. EQUITY TRANSFER FROM BJC (DRS. TO GOLF EVENT) 5,000. EQUITY TRANSFER TO AMH -10,179. 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 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 AVE STE 1200 ST LOUIS MO 63108 431617558 SUPPORTING ORG MO 501(C)(3) 11A N/A 0 BJC HOME CARE SERVICES 1935 BELTWAY DRIVE ST LOUIS MO 63114 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 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 PARKLAND HEALTH CENTER FOUNDATION 1101 WEST LIBERTY ST FARMINGTON MO 63640 900424964 SUPPORT TO PHC MO 501(C)(3) 7 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 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 THE HEART CARE INSTITUTE LLC 1020 NORTH MASON ROAD ST LOUIS MO 63141 431870517 MEDICAL SERVICES MO N/A GAMMA KNIFE CENTER AT BARNES JEWISH HOSP LLC 216 SOUTH KINGSHIGHWAY ST LOUIS MO 63110 431846941 OUTPATIENT CARE SERVICES MO N/A SURGERY CENTER OF FARMINGTON LLC 400 PARKLAND DRIVE FARMINGTON MO 63640 431811835 MEDICAL SERVICES MO N/A CHILDREN'S DISCOVERY INSTITUTE LLC 4901 FOREST PARK AVE ST LOUIS MO 63108 SEARCH FOR CURES OF PEDIATRIC DISEASES MO N/A ATG ASSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN CJ 980599167 INSURANCE CJ N/A C 1 PF SERVICES INC 11155 DUNN ROAD ST LOUIS MO 63136 431237767 MANAGEMENT SERVICES MO N/A C 1 MB MEDICAL SERVICES INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431437404 HEALTHCARE SERVICES MO N/A C 1 MISSOURI BAPTIST HOME HEALTH CARE INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431460430 INACTIVE MO N/A C 1 MB PHARMACY SERVICES INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431640730 INACTIVE MO N/A C 1 ST PETERS MED OFFICE BLDG A CONDO ASSN INC 1040 N MASON SUITE 109 ST LOUIS MO 63141 431472188 CONDOMINIUM ASSOCIATION MO N/A C 1 DMP MIDWEST INC ONE METROPOLITAN SQ 2600 ST LOUIS MO 63102 271943910 INACTIVE MO N/A C 1 WLA INVESTMENT LTD PO BOX 178 OKOTOKS ALBERTA CA INVESTMENT HOLDINGS CA N/A C 1 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0