2024-11-12T17:24:27-06:00 2023-12-31 990 2023-01-01 364147189 FAIRVIEW HEIGHTS MEDICAL GROUPSC C/O BJC MEDICAL GROUP LC FAIR 3149967601 2 MEMORIAL DRIVE 220 ALTON IL 62002 JOHN T ELLENA MD PRESIDENT/SECY/DIRECTOR 3149967601 2024-11-12 1 2023 2024-10-15 13:58:12Z BJC MEDICAL GROUP OF ILLINOIS JOHN T ELLENA MD 2 MEMORIAL DRIVE 220 ALTON IL 62002 148188435 0 X N/A X 1997 IL PROVIDE HEALTHCARE SERVICES TO PATIENTS 1 0 927 0 0 0 0 0 135835865 148188435 0 0 0 0 135835865 148188435 1200 0 0 0 101140625 104884763 0 0 0 34694040 43303672 135835865 148188435 0 0 20469452 29789138 21627912 26397048 -1158460 3392090 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 139056706 148188435 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 618,651 VISITS DURING 2023. 139056706 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 0 0 0 1 X 66 0 1 927 1 0 0 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 683370 104677 JAMOUS ABDULSALAM MD PHYSICIAN 40.00 X 1314948 0 11167 OMOTOLA AARON MD PHYSICIAN 40.00 X 1241911 0 57980 KANDULA PRASAD MD PHYSICIAN 40.00 X 1228079 33638 3506 TIWARI SUMIT MD PHYSICIAN 40.00 X 1117546 0 17534 STIRTON JOHN W MD PHYSICIAN 40.00 X 1032850 23400 47879 5935334 740408 242743 234 0 1 0 INTERIM PHYSICIANS 12647 OLIVE BLVD SUITE ST LOUIS MO 63141 PHYSICIAN STAFFING 2458412 SBG HEALTHCARE 7665 DAVIE RD HOLLYWOOD FL 33024 PHYSICIAN STAFFING 625087 MBR PROPERTY MGMT LLC 4990 SADLER PL UNIT 6360 GLEN ALLEN VA 23058 PROPERTY MGMT 207540 FIELDSTONE MALL LLC 808 S MAIN ST COLUMBIA IL 62236 CONTRACTING 195085 RIBEYE PROPERTIES LLC 13100 MANCHESTER RD ST LOUIS MO 63131 LEASING 168993 8 PROGRAM SERVICE REV 621110 101190295 101190295 SERVICES TO AFFILIATES 621110 46998140 46998140 148188435 148188435 148188435 0 0 88238879 88238879 3985874 3985874 7639056 7639056 5020954 5020954 558130 558130 10225856 10225856 622596 622596 1155881 1155881 6239903 6239903 46117 46117 8257 8257 2282163 2282163 4971315 4971315 MEDICAL SUPPLIES 7653267 7653267 EQUIP RENTAL & MAINT 229763 229763 RECRUITMENT 167904 167904 DUES & SUBSCRIPTIONS 45488 45488 9097032 523433 8573599 148188435 139056706 9131729 0 4666 5207 6718685 7689877 148000 180000 716426 825834 21127418 13725355 3239270 7402063 9642405 13686157 20469452 29789138 5401825 6119200 16226087 20277848 21627912 26397048 X -1158460 3392090 -1158460 3392090 20469452 29789138 X 0 4550550 X 0 1 X 1 0 X 12026826 7195082 4831744 61606 39798 21808 9038986 6490475 2548511 7402063 DEFERRED COMPENSATION 8087512 RIGHT OF USE ASSETS 5598645 13686157 DEFERRED COMPENSATION 7832216 LONG TERM OTHER OPER LEASE 4893174 MALPRACTICE RESERVE 7552458 20277848 0 0 0 0 0 0 0 0 0 JAMOUS ABDULSALAM MD PHYSICIAN 1265067 0 45752 0 4129 0 0 0 11167 0 1326115 0 0 0 OMOTOLA AARON MD PHYSICIAN 1187071 0 54009 0 831 0 40614 0 17366 0 1299891 0 0 0 KANDULA PRASAD MD PHYSICIAN 1120150 33638 104202 0 3727 0 0 0 3340 166 1231419 33804 0 0 TIWARI SUMIT MD PHYSICIAN 992871 0 124114 0 561 0 0 0 17534 0 1135080 0 0 0 STIRTON JOHN W MD PHYSICIAN 971056 23400 61162 0 632 0 31236 0 16548 95 1080634 23495 0 0 ELLENA JOHN MD PRES/SECY/DIRECTOR 0 620972 0 50566 0 11832 0 96424 0 8253 0 788047 0 0 PART I, LINE 7 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 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. 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 11B 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 4,550,550. ALTON MEMORIAL HEALTH SERVICES FOUNDATION 1109 N OXFORDSHIRE LANE EDWARDSVILLE IL 62025 371177053 SUPPORT TO AMH IL 501(C)(3) LINE 12C, III-FI ALTON MEMORIAL HOSPITAL 1 ALTON MEMORIAL HOSPITAL ONE MEMORIAL HOSPITAL DRIVE ALTON IL 62002 370661172 HEALTHCARE SERVICES IL 501(C)(3) LINE 3 CH HEALTH SERVICES DEV CORP 1 ALTON MEMORIAL HOSPITAL CHARITABLE TRUST PO BOX 0634 MILWAUKEE WI 53201 376039185 SUPPORT TO AMH IL 501(C)(3) LINE 12D, III-O ALTON MEMORIAL HOSPITAL 1 BARNES JEWISH ST PETERS & PROGRESS WEST FOUNDATION 10 HOSPITAL DRIVE ST PETERS MO 63376 454471497 SUPPORT TO BJSPH & PWHC MO 501(C)(3) LINE 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) LINE 3 BJC HEALTH SYSTEM 1 BARNES-JEWISH ST PETERS HOSPITAL INC 10 HOSPITAL DRIVE ST PETERS MO 63376 431452426 HEALTHCARE SERVICES MO 501(C)(3) LINE 3 BARNES-JEWISH HOSPITAL 0 BARNES-JEWISH WEST COUNTY HOSPITAL 12634 OLIVE STREET ROAD CREVE COEUR MO 63141 431527130 HEALTHCARE SERVICES MO 501(C)(3) LINE 3 BARNES-JEWISH HOSPITAL 1 BJC BEHAVIORAL HEALTH 1430 OLIVE STREET SUITE 400 ST LOUIS MO 63103 431610561 HEALTHCARE SERVICES MO 501(C)(3) LINE 3 BJC HEALTH SYSTEM 1 BJC CORPORATE HEALTH SERVICES 5000 MANCHESTER AVENUE ST LOUIS MO 63110 431324103 HEALTHCARE SERVICES MO 501(C)(3) LINE 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) LINE 12C, III-FI N/A 0 BJC HOME CARE SERVICES 1935 BELTWAY DRIVE ST LOUIS MO 63114 431450457 HEALTHCARE SERVICES MO 501(C)(3) LINE 10 BARNES-JEWISH HOSPITAL 1 CHILDREN'S ILLINOIS INC ONE CHILDRENS PLACE ST LOUIS MO 63110 872346178 HEALTHCARE SERVICES IL 501(C)(3) LINE 3 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) LINE 12C, III-FI BJC HEALTH SYSTEM 1 CHRISTIAN HOSP ILLINOIS SVCS 8 SUNSET HILLS EDWARDSVILLE IL 62025 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FOUNDATION 3015 N BALLAS ROAD ST LOUIS MO 63131 431472026 SUPPORT TO MBMC MO 501(C)(3) LINE 7 MISSOURI BAPTIST MEDICAL CENTER 1 MISSOURI BAPTIST HOSPITAL OF SULLIVAN 751 SAPPINGTON BRIDGE SULLIVAN MO 63080 431459495 HEALTHCARE SERVICES MO 501(C)(3) LINE 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) LINE 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) LINE 3 BJC HEALTH SYSTEM 1 PARKLAND HEALTH CENTER 1101 WEST LIBERTY ST FARMINGTON MO 63640 431332368 HEALTHCARE SERVICES MO 501(C)(3) LINE 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) LINE 12A, I 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) LINE 3 CH HEALTH SERVICES DEV CORP 1 PROGRESS WEST HEALTHCARE CENTER 2 PROGRESS POINT PARKWAY OFALLON MO 63368 412140764 HEALTHCARE SERVICES MO 501(C)(3) LINE 3 BJC HEALTH SYSTEM 1 PROTESTANT MEMORIAL MEDICAL CENTER INC 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 370635502 HEALTHCARE SERVICES IL 501(C)(3) LINE 3 BJC HEALTH SYSTEM 1 PROTESTANT MEMORIAL MEDICAL CENTER INC SELF-INSURANCE PROGRAM 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 371064809 PROVIDE MED MAL INSURANCE IL 501(C)(3) LINE 12C, III-FI PROTESTANT MEMORIAL MEDICAL CENTER INC 1 ST LOUIS CHILDREN'S HOSPITAL ONE CHILDRENS PLACE ST LOUIS MO 63110 430654870 HEALTHCARE SERVICES MO 501(C)(3) LINE 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) LINE 7 ST LOUIS CHILDREN'S HOSPITAL 1 THE HEART CARE INSTITUTE LLC 1020 NORTH MASON ROAD ST LOUIS MO 63141 431870517 MEDICAL SERVICES MO N/A 0 0 GAMMA KNIFE CENTER AT BARNES JEWISH HOSP LLC ONE BARNES-JEWISH HOSP PLAZA ST LOUIS MO 63110 431846941 OUTPATIENT CARE SERVICES MO N/A 0 0 THE REHABILITATION INSTITUTE OF ST LOUIS LLC 9001 LIBERTY PARKWAY BIRMINGHAM AL 35242 631254288 MEDICAL SERVICES AL N/A 0 0 THE REHABILITATION INSTITUTE OF SOUTHERN ILLINOIS LLC 9001 LIBERTY PARKWAY BIRMINGHAM AL 35242 834553991 MEDICAL SERVICES AL N/A 0 0 CHILDREN'S DISCOVERY INSTITUTE LLC 4901 FOREST PARK AVE ST LOUIS MO 63108 SEARCH FOR CURES OF PEDIATRIC DISEASES MO N/A 0 0 Y-SIHVI LLC 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 371385862 PHYSICAL THERAPY & FITNESS IL N/A 0 0 SOUTHWEST ILLINOIS HEALTH SERVICES REAL ESTATE LLP 4500 MEMORIAL DRIVE BELLEVILLE IL 62226 823633320 COMMERCIAL REAL ESTATE IL N/A 0 0 ST LOUIS HEALTHCARE SUPPORT SERVICES LLC 4901 FOREST PARK AVE ST LOUIS MO 63108 372121486 MEDICAL SERVICES MO N/A 0 0 ATG ASSURANCE COMPANY LTD PO BOX 1109 GRAND CAYMAN GEORGETOWN GR CAYMAN CJ KY1-1002 980599167 INSURANCE CJ N/A C 0 MB MEDICAL SERVICES INC 3015 N BALLAS ROAD ST LOUIS MO 63131 431437404 HEALTHCARE SERVICES MO N/A C 0 PF SERVICES INC 11155 DUNN ROAD ST LOUIS MO 63136 431237767 MANAGEMENT SERVICES MO N/A C 0 ACTIVUM SG FEEDER FUND VII LP ORDNANCE HOUISE 31 PIER ROAD ST. HELIER JE JE4 8PW 981641958 INVESTMENT HOLDINGS JE N/A C 0 1 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC A 61794474 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC B 59657 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC H 66962793 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC I 260479 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC J 4293157 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC K 37128303 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC L 301235041 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC M 363025811 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC O 674094505 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC P 21560874 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC Q 150897 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC R 46241192 BJC HEALTH SYSTEMPHYSICIAN GROUPS LC S 437606997