2013-11-15T10:28:12-06:00 2012-12-31 990 2012-01-01 431947644 CHRISTIAN HOSPITAL FOUNDATION CHRI 3146535000 11155 DUNN ROAD SUITE 300 NORTH ST LOUIS MO 63136 RON MCMULLEN 3146535000 2013-11-15 2012 2016-02-25 16:41:14Z RON MCMULLEN 11155 DUNN ROAD ST LOUIS MO 63136 2179843 0 X N/A X 2001 MO WITH THE GRACIOUS, VITAL SUPPORT OF OUR DONORS, THE CHRISTIAN HOSPITAL FOUNDATION'S MISSION IS TO PARTNER WITH OUR HOSPITAL TO PROVIDE SERVICE, COMPASSIONATE CARE AND CLINICAL EXCELLENCE TO OUR COMMUNITY. 14 11 0 20 0 0 140788 985289 0 0 1101644 1179554 -14158 -7596 1228274 2157247 154757 476178 0 0 0 0 0 203000 490205 414808 329571 569565 1008749 658709 1148498 6982584 8362531 615936 1176975 6366648 7185556 X WITH THE GRACIOUS, VITAL SUPPORT OF OUR DONORS, THE CHRISTIAN HOSPITAL FOUNDATION'S MISSION IS TO PARTNER WITH OUR HOSPITAL TO PROVIDE SERVICE, COMPASSIONATE CARE AND CLINICAL EXCELLENCE TO OUR COMMUNITY. 0 0 0 0 948651 CHRISTIAN HOSPITAL FOUNDATION IS WORKING TOWARDS FINISHING A MAJOR CAPITAL CAMPAIGN TO CONSTRUCT HYBRID OPERATING ROOM AT CHRISTIAN HOSPITAL. APPROXIMATELY 62% OF THE $2.5 MILLION DOLLAR GOAL HAS BEEN MET. 308625 308625 THE CHRISTIAN HOSPITAL FOUNDATION HELPED RENOVATE AND RESTOCK THE DIABETES MOBILE UNIT (DMU) WHICH PROVIDES EDUCATIONAL MATERIAL AND FREE SCREENINGS IN VARIOUS LOCATIONS THROUGHOUT THE ST. LOUIS AND METRO-EAST AREA. IN 2012, APPROXIMATELY 5,500 PEOPLE WERE SCREENED. 16438 16438 THE HEART FAIR EVENT WAS SPONSORED BY CHRISTIAN HOSPITAL FOUNDATION FOR THE BENEFIT OF LOCAL COMMUNITY MEMBERS. IN 2012, EDUCATIONAL MATERIALS AND HEALTH SCREENINGS WERE PROVIDED AT NO CHARGE FOR 425 COMMUNITY MEMBERS IN ATTENDANCE. 151115 151115 THE CHRISTIAN HOSPITAL FOUNDATION PROVIDED FUNDING TO CHRISTIAN HOSPITAL, THE EMPLOYEE ASSISTANCE FUND AT CHRISTIAN HOSPITAL, AND SEVERAL LOCAL CHARITIES TO PROVIDE NEEDS IN THE COMMUNITY. 151115 151115 476178 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 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 2 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 1001 HIGHLAND PLZ DR WEST ST LOUIS MO 63110 BOLLINGERHENRY DDS 1.00 X 0 0 0 COOPER DEBORAH ENDED 72312 1.00 X 0 0 0 DUMAS LILLIE 1.00 X 0 0 0 HANCOCK MILDRED 1.00 X 0 0 0 HORNING CAROL 1.00 X 0 0 0 JENSEN JOSHUA II MD 1.00 X 0 0 0 KEITH JUDI 1.00 X 0 0 0 LANG SUSAN ENDED 12412 1.00 X 0 0 0 MALONE DAVID 1.00 X 0 0 0 MONAHAN DIANE 1.00 X 0 0 0 OTTO DAVE 1.00 X 0 0 0 PLENDER CAROL ENDED 83012 1.00 X 0 0 0 WOODWARD TIM 1.00 X 0 0 0 MCKEE PAUL J JR 1.00 X X 0 0 0 ZYKAN DONALD 1.00 X X 0 0 0 MCMULLEN RON 1.00 39.00 X X 0 487327 82100 SELLERS REBECCA ENDED 83112 40.00 X 0 114696 11422 HOEFT MICHELE STARTED 9112 40.00 X 0 37061 2563 0 639084 96085 0 0 1 0 COMMUNITY COUNSELING SERVICE PO BOX 27462 NEW YORK NY 10087 FUNDRAISING CONSULTANT 203000 1 39302 945987 985289 152591 152591 1026963 0 1026963 1026963 1026963 15000 39302 22596 -7596 -7596 2157247 0 0 1171958 470524 470524 5654 5654 203000 203000 9416 9416 58200 58200 5247 365 4882 1805 1805 9480 190 9290 10637 10637 PURCHASED SERVICES 202391 202391 RESERVE FOR BAD DEBT EX 31000 31000 BANK FEES 1280 1280 ILLINOIS CHARITY BUREAU 115 115 1008749 476178 42366 490205 39876 39858 644258 6942708 5509491 2167784 1140 6982584 8362531 615936 810975 366000 615936 1176975 X -123910 -74748 6460458 7230204 30100 30100 6366648 7185556 6982584 8362531 X 1148498 -435590 106000 X 0 1 X 1 0 X 81391 1946104 113175 140788 914987 3196445 81391 1946104 113175 140788 914987 3196445 242349 2954096 181550 61777 33679 79802 152592 509400 3705845 85715 0.79710 0.77580 X SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: THE FILING ORGANIZATION RECENTLY REQUESTED AND RECEIVED A RE-DETERMINATION OF ITS PUBLIC CHARITY STATUS FROM THE IRS. ACCORDINGLY, THE PUBLIC CHARITY STATUS OF THE ORGANIZATION HAS BEEN REVISED TO SEC 509(A)(1) AND SEC 170(B)(1)(A)(VI) OF THE INTERNAL REVENUE CODE. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 39840 17 39857 39705 135 39840 40140 79 514 39705 39359 781 40140 37647 1712 39359 0.24500 0.75500 0 0 0 NON-PUBLICLY TRADED SECURITIES 2167784 C 2167784 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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 949992 203000 746992 949992 203000 746992 MO IL LEGACY LEADER DINNER 26345 18845 7500 7707 GOLF OUTING 27957 20457 7500 1601 13288 54302 39302 15000 1601 13288 7707 22596 -7596 1 CHRISTIAN HOSPITAL NE-NW 11133 DUNN ROAD ST LOUIS MO 63136 436057893 501(C)(3) 469674 PROVIDE SUPPORT FOR COMMUNITY PROGRAMS 1 CHRISTIAN HOSPITAL SPECIAL HELP FUND PROVIDES DIRECT PAYMENT TO BANKS/ CREDITORS ON BEHALF OF CHRISTIAN HOSPTIAL EMPLOYEES WHO ARE IN NEED OF FINANCIAL HELP. 8 5654 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, 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 MCMULLEN RON 0 301944 0 180896 0 4487 0 67123 0 14977 0 569427 0 20060 PART I, LINE 4B DURING 2012, 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 $38,416 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 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY TRANSFER FROM BJC (AUXILIARY) 106,000. 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 RELATED 0 0 GAMMA KNIFE CENTER AT BARNES JEWISH HOSP LLC 216 SOUTH KINGSHIGHWAY ST LOUIS MO 63110 431846941 OUTPATIENT CARE SERVICES MO N/A RELATED 0 0 SURGERY CENTER OF FARMINGTON LLC 400 PARKLAND DRIVE FARMINGTON MO 63640 431811835 MEDICAL SERVICES MO N/A RELATED 0 0 CHILDREN'S DISCOVERY INSTITUTE LLC 4901 FOREST PARK AVE ST LOUIS MO 63108 SEARCH FOR CURES OF PEDIATRIC 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LTD 90 FORT ST PO BOX 32021 GRAND CAYMAN CJ INACTIVE CJ BJC HEALTH SYSTEM C 1.00000 1 WLA INVESTMENT LTD PO BOX 178 OKOTOKS ALBERTA CA INVESTMENT HOLDINGS CA BMCA PRIVATE EQUITY LLC C 5768863 23239524 1.00000 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0