2025-12-17T12:11:06-06:00 2023-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2023-01-01 344428205 THE BELLEVUE HOSPITAL BELL 4194834040 1400 WEST MAIN STREET BELLEVUE OH 44811 SARA BROKAW PRESIDENT & CEO 4194834040 2025-12-15 1 1 AMY CIMINELLO P00796388 6148493000 2025-12-15 2023 2025-03-06 01:10:19Z SARA BROKAW 1400 WEST MAIN STREET BELLEVUE OH 44811 57918221 0 X WWW.BELLEVUEHOSPITAL.COM X 1956 OH THE BELLEVUE HOSPITAL IS A COMMUNITY BASED GENERAL ACUTE CARE HOSPITAL THAT PROVIDES CARE TO THE BELLEVUE AND SURROUNDING AREA WITHOUT REGARD TO ABILITY TO PAY. 13 12 486 40 0 0 707792 1507728 54822453 53370572 767658 461205 -32781 1573869 56265122 56913374 32500 33131 0 0 26733665 25218997 0 0 0 31506120 36044824 58272285 61296952 -2007163 -4383578 74576425 69191810 35035133 36180268 39541292 33011542 X WE CARE FOR PATIENTS AS MEMBERS OF OUR FAMILY. WE WORK TO HEAL THE SICK, TREAT THE INJURED, AND PREVENT ILLNESS. WE PROTECT THE TRUST OF OUR COMMUNITY AND EMPLOYEES, TO BE A PROGRESSIVE, QUALITY HEALTH CARE ORGANIZATION. OUR PRIMARY GOAL IS AND ALWAYS WILL BE TO CARE. 0 0 47753072 33131 52299370 OUR IMPACT ON THE BELLEVUE COMMUNITY: FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2023, THE BELLEVUE HOSPITAL EMPLOYED A TOTAL OF 468 INDIVIDUALS AND MAINTAINED A MEDICAL STAFF MEMBERSHIP OF OVER 260 PHYSICIANS REPRESENTING 36 SPECIALTIES. THE HOSPITAL PAID A TOTAL OF OVER $21 MILLION IN WAGES AND SALARIES. OUR EMPLOYEES PAID A TOTAL OF $393,839 IN INCOME TAXES TO THE CITY OF BELLEVUE AND AN ADDITIONAL $33,223 IN BELLEVUE LOCAL SCHOOL DISTRICT TAXES TO SUPPORT THE BELLEVUE COMMUNITY INFRASTRUCTURE AND EDUCATIONAL NEEDS. OUR EMPLOYEES LIVING IN OTHER LOCAL SCHOOL DISTRICTS PAID $26,936 IN CLYDE/GREENSPRINGS LOCAL SCHOOL DISTRICT TAXES, $19,615 IN FREMONT LOCAL SCHOOL DISTRICT TAXES, AND $7,657 IN SENECA EAST SCHOOL DISTRICT TAXES. IN ADDITION, MORE THAN$3 MILLION OF THE HOSPITAL'S TOTAL GOODS AND SERVICES EXPENSED DURING 2023 WERE PURCHASED LOCALLY FROM AREA BUSINESSES.SERVING THE BELLEVUE COMMUNITY: A TOTAL OF 1,117 COMMUNITY MEMBERS WERE ADMITTED TO OUR FACILITY DURING 2023. IN ADDITION, A TOTAL OF 65,159 VISITS WERE MADE FOR OUTPATIENT CARE. OUR EMERGENCY ROOM TREATED AN ADDITIONAL 12,867 PATIENTS DURING 2023 AND WE ASSISTED IN THE DELIVERY OF 348 BABIES. WE PROVIDED OVER $972,541 IN FREE CARE TO UNINSURED OR UNDERINSURED PATIENTS.THE BELLEVUE HOSPITAL EMERGENCY DEPARTMENT RECEIVED THE WOMEN'S CHOICE AWARD, AS ONE OF AMERICA'S BEST HOSPITALS FOR EMERGENCY CARE FOR 2015, 2016, 2017, 2018, 2019,2021,2022 AND 2023. 47753072 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 54 0 1 486 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X SARA BROKAW 4194834040 1400 W MAIN ST BELLEVUE OH 44811 TOM BARTH TREASURER 1.00 0.00 X X 0 0 0 RODNEY COOK 1ST VICE CHAIR 1.00 0.00 X X 0 0 0 JIMMIE FITZGERALD SECRETARY 1.00 0.00 X X 0 0 0 DEAN MILLER CHAIRMAN 1.00 0.00 X X 0 0 0 NANCY BEIER 2ND VICE CHAIR 1.00 0.00 X X 0 0 0 MICHAEL NILL MD EX-OFFICIO AS MEDICAL STAFF 1.00 0.00 X 0 0 0 DOUG HOY MD TRUSTEE 1.00 40.00 X 0 343962 41948 ROBERT GENTZEL TRUSTEE 1.00 0.00 X 0 0 0 PAUL DOLCE TRUSTEE 1.00 0.00 X 0 0 0 DWIGHT HOGUE EMERITUS TRUSTEE 1.00 0.00 X 0 0 0 PETE KOWALSKI TRUSTEE 1.00 0.00 X 0 0 0 PAUL KOCH TRUSTEE 1.00 0.00 X 0 0 0 AARON WILSON TRUSTEE 1.00 0.00 X 0 0 0 TIMOTHY BUIT PRESIDENT 45.00 1.00 X 586642 0 42118 LISA SARTAIN VICE PRESIDENT, HR 40.00 0.00 X 212069 0 29523 PATRICIA SEMER VICE PRESIDENT, ADMINISTRA 40.00 0.00 X 213424 0 29065 SARA BROKAW VICE PRESIDENT, PATIENT CA 40.00 0.00 X 263129 0 8335 CHASITY BAPTISTA NURSING SERVICE SENIOR DIRECTOR 40.00 0.00 X 140619 0 35440 SHARI LOVE PHARMACIST 40.00 0.00 X 160561 0 26055 CARLA NITKIEWICZ PHARMACIST 40.00 0.00 X 141569 0 26000 SHAIKH FAWWAD MD PHYSICIAN 40.00 0.00 X 362043 0 41597 NICOLE WETOSKEY PHARMACIST 40.00 0.00 X 130997 0 28433 CARRIE CONDON FORMER VICE PRESIDENT FINANCE & CEO 45.00 1.00 X 256613 0 5381 2467666 343962 313895 30 1 1 0 CLINICAL COLLEAGUES INC PO BOX 824246 PHILADELPHIA PA 19182 ANESTHESIA SERVICES 1396721 RIVERSIDE RADIOLOGY & INTERVENTIONAL ASS 100 E CAMPUS VIEW BLVD STE 100 COLUMBUS OH 43235 RADIOLOGY SERVICES 687000 EMERGENCY PROFESSIONAL SERVICES INC PO BOX 634850 CINCINNATI OH 45263 EMERGENCY SERVICES 600000 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 PHYSICIAN ON CALL SERVICES 443037 EAGLE TELEMEDICINE 280 INTERSTATE NORTH CIR SE STE 600 ATLANTA GA 30339 TELEHOSPITALIST SERVICES 292445 11 240000 1174950 92778 1507728 PATIENT SERVICES 621110 53242512 53242512 PASS-THROUGH INCOME 900003 109733 109733 COMMUNITY EDUCATION 621110 18327 18327 53370572 256196 256196 344708 909472 -564764 -564764 -564764 239893 60491 0 95375 239893 -34884 205009 205009 CAFETERIA/CAFE 722514 233148 233148 VEIN & BODY 621110 209853 209853 GIFT SHOP 459420 37049 37049 1658583 18945 1639638 2138633 56913374 53599370 0 1806276 X 18131 18131 15000 15000 1384306 1384306 18200420 15335620 2864800 683840 570626 113214 3436817 2804008 632809 1513614 1195755 317859 261044 261044 134665 134665 5230 5230 13243229 11370126 1873103 183229 163027 20202 3970297 1736321 2233976 4873493 2038553 2834940 620 568 52 49190 43092 6098 3025619 2350379 675240 540322 540322 MEDICAL SUPPLIES 4358458 4354606 3852 BAD DEBT EXPENSE 3382363 3382363 FRANCHISE FEE 1626349 1626349 RECRUITMENT 131839 131839 258877 208226 50651 61296952 47753072 13543880 0 6638690 1088263 5714501 7549381 39500 39500 840644 1518477 2394530 1511460 92463748 55050675 38791109 37413073 8056271 5519782 1270961 1255611 10830219 13296263 74576425 69191810 12441566 12344340 19757053 18299136 271777 281687 2564737 5255105 35035133 36180268 X 39541292 33011542 39541292 33011542 74576425 69191810 X -4383578 297398 -2443570 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5230 5230 0 PART II-B, LINE 1: A PERCENTAGE OF DUES TO THE OHIO HOSPITAL ASSOCIATION AND DUES TO THE AMERICAN HOSPITAL ASSOCIATION WERE ALLOCATED TO LOBBYING ACTIVITIES BY THAT ORGANIZATION. 2582129 2582129 49486457 21791963 27694494 38138984 31333629 6805355 2256178 1925083 331095 37413073 INTERCOMPANY RECEIVABLES 8535570 DEFERRED COMPENSATION PLAN ASSETS 1270600 RIGHT OF USE OPERATING LEASE ASSETS 389730 FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 100363 PROFESSIONAL LIABILITY CLAIM 3000000 13296263 DUE TO MEDICAL STAFF AND AUXILIARY 34051 THIRD PARTY SETTLEMENT 555309 DEFERRED COMPENSATION PLAN LIABILITIES 1270600 ROU ASSET LEASE LIABILITY 395145 PROFESSIONAL LIABILITY CLAIM 3000000 5255105 1 1 X 1 X 1 X 1 1 1 0 1 1 2180244 0 2180244 0.03760 9106998 5114492 3992506 0.06890 0 0 11287242 5114492 6172750 0.10650 0 0 0 0 3200 0 3200 0.00010 20000 0 20000 0.00030 23200 23200 0.00040 11310442 5114492 6195950 0.10690 1 3382363 7064911 9898857 -2833946 X 1 1 1 1 THE BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 WWW.BELLEVUEHOSPITAL.COM 1261 X SWING BED - SNF HOME HEALTH THE BELLEVUE HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X WWW.BELLEVUEHOSPITAL.COM X SEE ATTACHED LIST X X 1 22 1 WWW.BELLEVUEHOSPITAL.COM 0 1 X 100.000000000000 400.000000000000 1 1 X X X 1 X HTTPS://WWW.BELLEVUEHOSPITAL.COM/FINANCIAL-ASSISTANCE X HTTPS://WWW.BELLEVUEHOSPITAL.COM/FINANCIAL-ASSISTANCE X HTTPS://WWW.BELLEVUEHOSPITAL.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X 1 X 0 0 THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 5: THE NEEDS OF THE POPULATION, ESPECIALLY THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS, WERE TAKEN INTO ACCOUNT THROUGH THE SAMPLE METHODOLOGY THAT SURVEYED THESE POPULATIONS AND OVER-SAMPLED MINORITY POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT AND COMMUNITY PLANNING PROCESS, SUCH AS MENTAL HEALTH AND RECOVERY SERVICES BOARD, WSOS, AND SANDUSKY COUNTY HEALTH PARTNERS. PARTICIPANTS INCLUDED THE FOLLOWING GROUPS AND ORGANIZATIONS: (A (PH) AFTER THEIR NAME INCIDATES THEY WORK IN THE PUBLIC HEALTH FIELD.) MIKE WINTHROP, THE BELLEVUE HOSPITAL (PH); JOE LISZAK, COMMUNITY HEALTH SERVICES (PH); TIM WISE, FIRELANDS COUNSELING AND RECOVERY SERVICES (PH); TRACI MCCAUDY, FREMONT CITY SCHOOL DISTRICT; PAM JENSEN, PROMEDICA MEMORIAL HOSPITAL (PH); MIRCEA HANDRU, MENTAL HEALTH AND RECOVERY SERVICES BOARD (PH); FRANCIS AONA, M.D., PHYSICIAN; SARAH ZIMMERMAN, SANDUSKY COUNTY BOARD OF DD (PH); CATHY GLASSFORD, SANDUSKY COUNTY FAMILY & CHILDREN FIRST COUNCIL; BETHANY BROWN, SANDUSKY COUNTY HEALTH DEPARTMENT (PH); STACEY GIBSON LSW, OCPC, SANDUSKY COUNTY HEALTH DEPARTMENT (PH), ABBY SLEMMER, UNITED WAY OF SANDUSKY COUNTY; AND RUTHANN HOUSE, WSOS COMMUNITY ACTION COMMISSION. THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 6A: PROMEDICA MEMORIAL HOSPITAL, FREMONT, OHIO. THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 6B: THE BELLEVUE HOSPITAL PARTNERED WITH OTHER LOCAL AGENCIES IN THE GROUP KNOWN AS SANDUSKY COUNTY HEALTH PARTNERS INCLUDING: SANDUSKY COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH SERVICES, FIRELANDS COUNSELING & RECOVERY SERVICES, FREMONT CITY SCHOOLS, MENTAL HEALTH AND RECOVERY SERVICES BOARD OF SENECA, SANDUSKY AND WYANDOT COUNTIES, PROMEDICA MEMORIAL HOSPITAL, SANDUSKY COUNTY BOARD OF DD, SANDUSKY COUNTY FAMILY AND CHILDREN FIRST COUNCIL, UNITED WAY OF SANDUSKY COUNTY AND WSOS. HEALTH PARTNERS THEN COLLABORATED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO DATA DIVISION AND THE UNIVERSITY OF TOLEDO HEALTH AND HUMAN SERVICES DEPARTMENT TO CONDUCT THE FORMAL COUNTY HEALTH ASSESSMENT. THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 7D: HTTPS://WWW.BELLEVUEHOSPITAL.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS, HTTP://WWW.BELLEVUEHOSPITAL.COM, WWW.FREMONTCHS.COM, WWW.FIRELANDS.COM, HTTP://WWW.FREMONTSCHOOLS.NET, WWW.MHRSB.ORG, WWW.PROMEDICA.ORG/MEMORIAL-HOSPITAL, WWW.SCBDD.ORG, WWW.SANDUSKYCOUNTYFCFC.ORG, WWW.ALWAYSCHOOSHEALTH.COM, WWW.UWSANDCO.ORG, WWW.WSOS.ORG, WWW.HCNO.ORG/COMMUNITY/REPORTS.HTML. THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 11: THE HEALTH NEEDS LISTED IN THE CHNA ARE IMPORTANT ISSUES AND ARE BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES SUPPORTED BY THE BELLEVUE HOSPITAL AND OTHER GROUPS AND ORGANIZATIONS WITHIN THE COMMUNITY. PLEASE REFERENCE THE ONLINE CHNA AND IMPLMENTATION STRATEGY FOR FURTHER INFORMATION ON THE ACTIONS THAT ARE BEING UNDERTAKEN TO ADDRESS THESE NEEDS. FURTHER, THE BELLEVUE HOSPITAL DOES NOT HAVE PROGRAMS OR SERVICES DESIGNED TO HELP THE MENTALLY ILL, BUT ACTS AS A REFERRAL CENTER TO COMMUNITY MENTAL HEALTH POGRAMS. THE HEALTH NEEDS MAY ALSO BE ADDRESSED BY THE HEALTH DEPARTMENT OR ANOTHER AGENCY. FURTHER INFORMATION ON THE HEALTH NEEDS THAT ARE NOT BEING ADDRESSED BY THE BELLEVUE HOSPITAL CAN BE FOUND IN THE IMPLEMENTATION STRATEGY PART IX. PART V, SECTION B, LINE 20D: PATIENTS WITH INCOMES AT OR BELOW THE FPG WOULD QUALIFY FOR HCAP AT 100%. PATIENTS WITH INCOMES EXCEEDING THE FPG MAY QUALIFY FOR CHARITY. A PERSON IS ELIGIBLE FOR WRITE-OFF OF THE SELF-PAY PORTION OF THE BILL; WRITE-OFF AMOUNT IS CALCULATED ACCORDING TO SLIDING SCHEDULE FROM 200%-400% OF FPG AND DISCOUNT RANGES FROM 20%-100% OF PATIENT'S BILL. THE DISCOUNT IS WRITTEN OFF TO CHARITY. PART I, LINE 7: CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO USING THE WORKSHEET 2 METHOD TO CALCULATE THE COST TO CHARGE RATIO. THE REMAINING COSTS LISTED IN 7E-7I ARE DERIVED FROM ACTUAL COSTS PULLED FROM THE HOSPITAL'S ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $3,382,363. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL PARTICIPATES IN SEVERAL COMMUNITY BUILDING ACTIVITIES WHICH ARE INCLUDED IN PART II. THESE ACTIVITIES INCLUDE: - PHYSICAL IMPROVEMENTS: USED LAND OWNED BY HOSPITAL TO GROW A LOCAL CROP FOR DONATION TO BELLEVUE FISH & LOAVES FOR DISTRIBUTION TO LOW INCOME COMMUNITY MEMBERS TO ENSURE NUTRITIOUS FOOD CHOICES; CONTRIBUTED TO THE SANDUSKY COUNTY PARK DISTRICT WITH AN ANNUAL PLEDGE TO HELP MAINTAIN THE COUNTY PARKS AND BIKE AND WALKING TRAILS TO ENCOURAGE PHYSICAL ACTIVITY. - ECONOMIC DEVELOPMENT: ACTIVE ROLE WITH SANDUSKY COUNTY ECONOMIC DEVELOPMENT ORGANIZATION AND BELLEVUE DEVELOPMENT CORP. TO CREATE NEW EMPLOYMENT OPPORTUNITIES, INCLUDING HEALTHCARE COVERAGE. - COMMUNITY SUPPORT: PROVIDE SUPPORT FOR LOCAL UNITED SELECTIVE FUND CAMPAIGN AND OTHER LOCAL NON-PROFIT ORGANIZATIONS.PART III, LINE 2:THE AMOUNT OF BAD DEBT EXPENSE IS REPORTED PER THE FINANCIAL STATEMENTS. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE THAT MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS MADE ON A PRESUMPTIVE BASIS BASED ON BEST INFORMATION AVAILABLE. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLELY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION WITH THE APPROPRIATE FAMILY AND FINANCIAL INFORMATION TO DETERMINE THEIR ELIGIBILITY. FOR 2023, NO PATIENT ACCOUNTS WERE RETURNED FROM THE STATE COLLECTION. BASED ON ESTATE AND BANKRUPTCY ACCOUNTS, IT IS ESTIMATED THAT $332,263 OF OUR ORGANIZATION'S BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE AND SHOULD BE COUNTED AS COMMUNITY BENEFIT. AS A NOT-FOR-PROFIT HOSPITAL, PATIENT CARE IS PROVIDED TO ALL PATIENTS, REGARDLESS OF THEIR ECONOMIC MEANS, WHICH QUALIFIES BAD DEBT AS A COMMUNITY BENEFIT. THIS IS REPORTED ON PART III, LINE 3. PART III, LINE 4: ACCOUNTS RECEIVABLE FROM PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE CLAIM, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES, OR THE DISCOUNTED RATES IF NEGOTIATED, AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE HOSPITAL BELIEVES THAT THE $2,833,946 SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE PAYMENTS THAT ARE LESS THAN COST MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. IN 2023, MEDICARE ACCOUNTED FOR APPROXIMATELY 41% OF HOSPITAL REVENUES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. PART III, LINE 9B: COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. THE HOSPITAL WILL PURSUE PAYMENT FOR CARE FROM EVERY REASONABLE SOURCE, GOVERNMENTAL AND PRIVATE. TO ENSURE THIS IS COMPLETED, INSURANCE VERIFICATION IS PERFORMED, A SYSTEM REVIEW IS MADE OF THE PATIENT'S INSURANCE HISTORY, AND TELEPHONE CALLS ARE MADE TO THE PATIENT. IF THE PATIENT IS ELIGIBLE FOR HCAP, THE COVERED CHARGES ARE WRITTEN OFF TO HCAP. IF THE PATIENT IS LATER FOUND TO BE ELIGIBLE FOR MEDICAID, THE HCAP WRITE-OFF IS REVERSED AND THE ACCOUNT BILLED TO MEDICAID. BAD DEBT ACCOUNTS ELIGIBLE FOR CHARITY ARE REINSTATED FROM BAD DEBT AND POSTED TO THE APPROPRIATE ADJUSTMENT OR CHARITY WRITE-OFF CODES. PART VI, LINE 2: N/A AS THE ORGANIZATION PERFORMED ALL HEALTH CARE NEEDS ASSESSMENTS AS PART OF THE CHNA THAT WAS FILED. PLEASE REFER TO THE CHNA FOR DETAILS. PART VI, LINE 3: THE HOSPITAL POSTS NOTICES IN APPROPRIATE AREAS IN THE FACILITY, INCLUDING BUT NOT LIMITED TO THE ADMISSIONS AREAS, THE PATIENT FINANCE OFFICE, AND THE EMERGENCY DEPARTMENT. THE NOTICE SPECIFIES THE RIGHTS OF PERSONS WITH INCOMES AT OR BELOW THE FEDERAL POVERTY GUIDELINES (FPG) TO RECEIVE, WITHOUT CHARGE TO THE INDIVIDUAL, BASIC, MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES AT THE HOSPITAL. THE INITIAL BILL AND AT LEAST THE FIRST FOLLOW-UP BILL HAS A WRITTEN STATEMENT THAT EXPLAINS THAT INDIVIDUALS WITH INCOME AT OR BELOW THE FPG ARE ELIGIBLE FOR SERVICE WITHOUT CHARGE, SPECIFIES THE FPG FOR INDIVIDUALS AND FAMILIES OF VARIOUS SIZES AT THE TIME THE BILL IS SENT, AND DESCRIBES THE PROCEDURE TO APPLY FOR FREE CARE. THE PATIENT FINANCE OFFICE AND PATIENT ACCESS DEPARTMENTS WILL PROVIDE APPLICATIONS FOR FINANCIAL ASSISTANCE TO PATIENTS. A DETERMINATION OF EVERY APPLICATION WILL BE COMPLETED BY THE PATIENT FINANCE OFFICE AND A COPY SENT TO THE PATIENT. PART VI, LINE 4: BELLEVUE IS A CITY IN ERIE, HURON, SANDUSKY AND SENECA COUNTIES IN OHIO WITH A POPULATION WAS 8,202 ACCORDING TO THE 2010 U.S. CENSUS. THE BELLEVUE HOSPITAL PARTICIPATED IN THE SANDUSKY COUNTY SURVEYS AND PLANS AND IN THE HURON COUNTY SURVEYS, 2017 HURON COUNTY HEALTH ASSESSMENT REPORT AND THE 2017 HURON COUNTY COMMUNITY HEALTH IMPROVEMENT PLAN, AS WE ALSO SERVE A SECTION OF THE POPULATION FROM HURON COUNTY.THE BELLEVUE HOSPITAL CONTINUES TO PROVIDE CONVENIENT ACCESS TO HIGH QUALITY PRIMARY AND SPECIALTY CARE TO INDIVIDUALS AND FAMILIES LIVING IN OUR PRIMARY SERVICE AREA DEFINED AS THE CITIES OF BELLEVUE, GREEN SPRINGS, AND CLYDE, OHIO WITH APPROXIMATELY 43% OF THE PATIENTS PROVIDED CARE COMING FROM THESE CITIES. THE CITIES OF GREEN SPRINGS AND CLYDE ARE ENTIRELY IN SANDUSKY COUNTY, OHIO. THE CITY OF BELLEVUE IS LOCATED IN THE FOUR COUNTIES OF ERIE, HURON, SANDUSKY AND SENECA COUNTIES. FOR THE PURPOSES OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND THIS PLAN, THE HEALTH STATISTICS AND FACTORS FOR ALL FOUR COUNTIES WERE REVIEWED; HOWEVER, THE INFORMATION USED AND CONTAINED WITHIN THIS REPORT UTILIZES THE PRIMARY COUNTY OF SANDUSKY COUNTY AND USED THE INFORMATION IN COMPLETING THIS COMMUNITY HEALTH ASSESSMENT.DEMOGRAPHIC REVIEW OF SANDUSKY COUNTY, OHIO IN US CENSUS BUREAU INDICATED THAT IT IS HOME TO 60,187 RESIDENTS. NEARLY 74% OF RESIDENTS WERE ADULTS 18 YEARS OF AGE OR OLDER, OVER 18% WERE YOUTH AGES 5-17 YEARS, AND 6.3% WERE CHILDREN UNDER THE AGE OF 5 YEARS. THE MAJORITY (91%) OF THE POPULATION ARE CAUCASIAN. THE RESTS OF THE POPULATION IS AFRICAN AMERICAN (3.4%), HISPANIC (9.4%), ASIANS (.4%) AND TWO OR MORE RACES (2.2%) COMPRISE THE REST OF THE POPULATION (SOURCE: CENSUS, 2015).THE MEDIAN HOUSEHOLD INCOME FOR SANDUSKY COUNTY IS $52,500. TWELVE PERCENT OF ALL SANDUSKY COUNTY RESIDENTS HAD AN INCOME BELOW THE POVERTY LEVEL IN 2015. OF ALL THE HOUSEHOLDS WITH CHILDREN UNDER 18, 18% HAD INCOMES WHICH FELL BELOW THE FEDERAL POVERTY LEVEL. EIGHT PERCENT OF ADULTS ARE UNINSURED AND 1% OF CHILDREN ARE UNINSURED. PART VI, LINE 5: MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL BOARD OF DIRECTORS IS COMPRISED OF LOCAL MEDICAL AND BUSINESS PROFESSIONALS WHO VOLUNTEER COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE OF GENERAL STEWARDSHIP. THE HOSPITAL EXPANDS ACCESS POINTS OF CARE THROUGHOUT THE COMMUNITY BY PROVIDING FREE OR LOW-COST BLOOD PRESSURE, DIABETES, CHOLESTEROL, SKIN CANCER, PROSTATE CANCER AND OTHER SCREENINGS. EDUCATIONAL PROGRAMS AND SUPPORT GROUPS ARE HELD TO PROVIDE INFORMATION ON SUCH TOPICS AS TOBACCO CESSATION, WEIGHT MAINTENANCE, DIABETES, CHILDBIRTH, INFANT CARE, AND MORE. HOSPITAL EMPLOYEES SERVE ON THE BOARDS OF MANY COMMUNITY AND HEALTH-ORIENTED ORGANIZATIONS. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY-WIDE AND REGIONAL-WIDE MASS CASUALTY AND DISASTER PREPAREDNESS WITH 33 OTHER REGIONAL HOSPITALS AS A MEMBER OF THE HOSPITAL COUNCIL OF NORTHWEST OHIO, TO ASSURE THE SAFETY AND HEALTH OF COMMUNITY RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT, BIOTERRORISM OR OTHER LARGE-SCALE EMERGENCY. MEMBERSHIP BENEFITS INCLUDE INCREASED PURCHASING POWER FOR DISASTER SUPPLIES, EMERGENCY RESPONSE TRAINING, INCIDENT COMMAND, AND INFORMATION SHARING TO KEEP COMPLIANT WITH HOMELAND SECURITY REGULATIONS. PART VI, LINE 6: THE BELLEVUE HOSPITAL IS A GENERAL ACUTE CARE PROVIDER AT ONE FACILITY IN THE BELLEVUE, OHIO AREA. THE BELLEVUE HOSPITAL IS THE PARENT ORGANIZATION OF BELLEVUE PROFESSIONAL SERVICES, INC. AND THE SOLE BENEFICIARY OF THE BELLEVUE HOSPITAL FOUNDATION. THE BELLEVUE HOSPITAL ASSOCIATION IS THE PARENT ORGANIZATION OF THE BELLEVUE HOSPITAL. THE BELLEVUE HOSPITAL ASSOCIATION MEETS ANNUALLY IN FEBRUARY TO ELECT THE BELLEVUE HOSPITAL BOARD OF TRUSTEES AND TO CONDUCT ANY NECESSARY BUSINESS. BELLEVUE PROFESSIONAL SERVICES, INC. PROVIDES CLINICAL AND MEDICAL PROFESSIONAL SERVICES TO RESIDENTS OF BELLEVUE AND CLYDE, OHIO AND THE SURROUNDING AREA. THE BELLEVUE HOSPITAL FOUNDATION SUPPORTS THE BELLEVUE HOSPITAL WITH FINANCIAL TRANSFERS IN THE FORM OF BOTH CASH AND NON-CASH TRANSFERS. 1 BELLEVUE UNITED SELECTIVE FUND 250 W MAIN ST BELLEVUE OH 44811 237418730 501(C)(3) 18131 0 N/A N/A COMMUNITY FUND 1 0 EMPLOYEE CHILDREN'S SCHOLARSHIP 10 15000 N/A N/A PART I, LINE 2: THE HOSPITAL PRIMARILY PROVIDES GRANTS TO GOVERNMENT PROGRAMS AND CHARITABLE ORGANIZATIONS. THE GRANTS ARE ONLY MADE TO 501(C)(3) AND/OR GOVERNMENT ENTITIES. PART III: THE HOSPITAL HAS A COMMITTEE COMPOSED OF FOUR MEMBERS (AN HOURLY EMPLOYEE, A MEMBER OF THE MEDICAL STAFF, A MEMBER OF THE BOARD OF TRUSTEES AND A MEMBER OF THE COMMUNITY RELATIONS COMMITTEE OF THE FOUNDATION BOARD). ALL ELIGIBLE APPLICATIONS ARE REVIEWED BY THE COMMITTEE. EACH CANDIDATE IS SCORED BASED UPON THE INFORMATION PROVIDED IN THEIR APPLICATION. UPON THE DISCRETION OF THE COMMITTEE, INTERVIEWS OF THE APPLICANTS CAN TAKE PLACE. UP TO 10 CANDIDATES WILL BE SELECTED TO RECEIVE A $1,500.00 SCHOLARSHIP. THE HOSPITAL AWARDS THE SCHOLARSHIP PAYMENTS DIRECTLY TO THE COLLEGES TO OFFSET TUITION ONCE THE STUDENT PROVIDES THE HOSPITAL WITH PROOF OF ENROLLMENT FEES. X 1 1 X X X X 0 0 0 0 0 0 0 1 0 TIMOTHY BUIT PRESIDENT 481002 0 91860 0 13780 0 13200 0 28918 0 628760 0 0 0 SHAIKH FAWWAD MD PHYSICIAN 362043 0 0 0 0 0 13200 0 28397 0 403640 0 0 0 DOUG HOY MD TRUSTEE 0 335562 0 7500 0 900 0 13200 0 28748 0 385910 0 0 SARA BROKAW VICE PRESIDENT, PATIENT CA 239208 0 23810 0 111 0 7820 0 515 0 271464 0 0 0 CARRIE CONDON FORMER VICE PRESIDENT FINANCE & CEO 148613 0 17000 0 91000 0 2992 0 2389 0 261994 0 0 0 PATRICIA SEMER VICE PRESIDENT, ADMINISTRA 194624 0 18800 0 0 0 8648 0 20417 0 242489 0 0 0 LISA SARTAIN VICE PRESIDENT, HR 192059 0 20010 0 0 0 8804 0 20719 0 241592 0 0 0 SHARI LOVE PHARMACIST 160561 0 0 0 0 0 6500 0 19555 0 186616 0 0 0 CHASITY BAPTISTA NURSING SERVICE SENIOR DIRECTOR 122532 0 18087 0 0 0 5889 0 29551 0 176059 0 0 0 CARLA NITKIEWICZ PHARMACIST 141569 0 0 0 0 0 5856 0 20144 0 167569 0 0 0 NICOLE WETOSKEY PHARMACIST 130997 0 0 0 0 0 5455 0 22978 0 159430 0 0 0 PART I, LINE 1A THE ORGANIZATION PAID SOCIAL CLUB DUES ON THE BEHALF OF TIMOTHY BUIT, CEO, TO CATAWBA ISLAND CLUB, AS A MEANS TO NETWORK WITH PHYSICIANS. NONE OF THE SOCIAL CLUB DUES WERE TREATED AS TAXABLE COMPENSATION TO TIMOTHY BUIT. PART I, LINE 7 PERSONS LISTED ON PART VII RECEIVED NON-FIXED COMPENSATION IN THE FORM OF BONUSES. BONUS COMPENSATION IS DETERMINED BY WHETHER THE PERSON MEETS PERFORMANCE MEASURES SET AT THE BEGINNING OF EACH PERFORMANCE YEAR. TIMOTHY BUIT RECEIVED COMPENSATION FOR HIS ROLE AS PRESIDENT OF THE BELLEVUE HOSPITAL ORGANIZATION AND NOT FOR HIS ROLE ON THE BOARD. SCHEDULE J, PART II TIMOTHY BUIT RECEIVED COMPENSATION FOR THE ROLE AS PRESIDENT OF THE BELLEVUE HOSPITAL ORGANIZATION AND NOT FOR A ROLE ON THE BOARD. A COUNTY OF SANDUSKY OHIO 346401312 NONEAVAIL 2017-11-30 9000000 SEE PART VI 0 0 0 B VILLAGE OF PORT JEFFERSON OHIO 341175548 NONEAVAIL 2019-11-06 7196936 SEE PART VI 0 0 0 C CITY OF BELLEVUE OHIO 346400096 NONEAVAIL 2019-11-21 6117395 SEE PART VI 0 0 0 D COUNTY OF SANDUSKY OHIO 346401312 NONEAVAIL 2019-11-21 1849003 SEE PART VI 0 0 0 A 271777 9069705 74082 8995623 2019 0 0 1 1 B 499530 7196936 7196936 2005 1 0 1 1 C 424600 6117395 6117395 2004 1 0 1 1 D 129167 1849003 1849003 2004 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 1 0 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 D 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K, PART I, LINE A, COLUMN (F): ACQUIRE, CONSTRUCT, EQUIP AND INSTALL HOSPITAL FACILITIES SCHEDULE K, PART I, LINE B, COLUMN (F): A REISSUANCE OF 2012 LEASE OBLIGATIONS WHICH CURRENTLY REFUND THE (1) 2003 LEASE OBLIGATIONS ISSUED PURSUANT TO THE MASTER LEASE-PURCHASE AND SUBLEASE-PURCHASE AGREEMENT DATED AS OF JULY 1, 2003, BY AND AMONG FIFTH THIRD BANK, THE CITY OF CLYDE, OHIO AND THE BELLEVUE HOSPITAL, ISSUED JULY 23, 2003 AND (2) CITY OF BELLEVUE, OHIO ADJUSTABLE RATE DEMAND HOSPITAL FACILITIES REVENUE BONDS, SERIES 2003 (THE BELLEVUE HOSPITAL PROJECT) ISSUED AUGUST 26, 2003. SCHEDULE K, PART I, LINE C, COLUMN (F): A REISSUANCE OF 2012 LEASE OBLIGATIONS WHICH CURRENTLY REFUND THE (1) 2003 LEASE OBLIGATIONS ISSUED PURSUANT TO THE MASTER LEASE-PURCHASE AND SUBLEASE-PURCHASE AGREEMENT, DATED AS OF JULY 15, 2003 BY AND AMONG FIFTH THIRD BANK, THE COUNTY OF SANDUSKY, OHIO AND THE BELLEVUE HOSPITAL, ISSUED AUGUST 8, 2003 AND (2) 2003 LEASE OBLIGATIONS ISSUED PURSUANT TO THE MASTER LEASE-PURCHASE AND SUBLEASE-PURCHASE AGREEMENT, DATED AS OF JULY 1, 2003, BY AND AMONG FIFTH THIRD BANK, THE CITY OF CLYDE, OHIO AND THE BELLEVUE HOSPITAL, ISSUED JULY 23, 2003. SCHEDULE K, PART I, LINE D, COLUMN (F): A REISSUANCE OF 2012 LEASE OBLIGATIONS WHICH CURRENTLY REFUND THE 2003 LEASE OBLIGATIONS ISSUED PURSUANT TO THE MASTER-LEASE PURCHASE AND SUBLEASE-PURCHASE AGREEMENT, DATED AS OF JULY 15, 2003 BY AND AMONG FIFTH THIRD BANK, THE COUNTY OF SANDUSKY, OHIO AND THE BELLEVUE HOSPITAL, ISSUED AUGUST 8, 2003. SCHEDULE K, PART II, LINE 3A: TOTAL PROCEEDS OF THE ISSUE $9,069,705.13, WHICH ARE TOTAL PROCEEDS OF 9,000,000 PLUS INVESTMENT EARNINGS OF $69,705.13. HASSELBACH & PAUL AGENCY INC TOM BARTH IS OWNER OF HASSELBACH & PAUL AGENCY, INC 149465 INSURANCE: DIRECTOR AND OFFICERS; PROFESSIONAL LIABILITY 0 FORM 990, PART VI, SECTION A, LINE 2 TOM BARTH AND DEAN MILLER HAVE BUSINESS RELATIONSHIPS WITH THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 6 THE BELLEVUE HOSPITAL ENTERED INTO AN AGREEMENT WITH THE BELLEVUE HOSPITAL ASSOCIATION, NORWALK AREA HEALTH SYSTEMS, AND FIRELANDS REGIONAL HEALTH SYSTEM. NAHS AND FIRELANDS EACH HAVE TWENTY PERCENT MEMBERSHIP INTEREST IN THE HOSPITAL AND REPRESENTATION ON THE BOARD OF TRUSTEES. THE BELLEVUE HOSPITAL ASSOCIATION HAS A 60% MEMBERSHIP INTEREST IN THE HOSPITAL AND REPRESENTATION ON THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A NORWALK AREA HEALTH SYSTEMS AND FIRELANDS REGIONAL HEALTH SYSTEM CAN EACH APPOINT 2 MEMBERS TO THE BOARD OF DIRECTORS. THE BELLEVUE HOSPITAL ASSOCIATION APPOINTS THE REMAINING MEMBERS (UP TO 15) TO THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS MADE AVAILABLE BY THE PRESIDENT & VP FINANCE AT THE FINANCE MEETING FOR REVIEW AS WELL AS PRESENTATION TO THE BOARD OF DIRECTORS. IN ADDITION, EACH BOARD MEMBER RECEIVES A COPY OF THE FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C ON AN ANNUAL BASIS, THE PRESIDENT SHALL SEND TO ALL EXECUTIVE STAFF AND SELECTED EMPLOYEES, A COPY OF THE BOARD OF TRUSTEES CONFLICT OF INTEREST POLICY TO BE COMPLETED AND RETURNED. IN ADDITION, NEW BOARD MEMBERS THAT JOIN DURING THE YEAR FILL OUT AND COMPLETE THE CONFLICT OF INTEREST POLICY WHEN THEY FIRST JOIN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE BOARD OF TRUSTEES CONCERNING ANY INTERESTS TO BE DISCLOSED. IF ANY CONFLICTS DO ARISE, THAT TRUSTEE WILL ABSTAIN FROM VOTING ON THE ISSUE. PERIODIC REVIEWS ARE ALSO CONDUCTED TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES, AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. THE BOARD OF DIRECTORS REVIEW THE COMPLETED CONFLICT OF INTEREST POLICIES INCLUDING THE PRESIDENT'S. THE BOARD OF DIRECTORS REVIEW THE PRESIDENT'S COMPLETED CONFLICT OF INTEREST POLICY ONCE THE PRESIDENT LEAVES THE ROOM. FORM 990, PART VI, SECTION B, LINE 15 IN DETERMINING EXECUTIVE STAFF COMPENSATION FOR THE CEO AND VICE PRESIDENTS, THE BOARD HAS A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT DIRECTORS. THE COMMITTEE UTILIZES AN OUTSIDE HEALTHCARE COMPENSATION CONSULTING COMPANY COMPARING COMPARABLE SIZED ORGANIZATIONS CONSISTENT WITH THE BOARD OF TRUSTEE COMPENSATION PHILOSOPHY STATEMENT. RECOMMENDATIONS ARE MADE FROM THE COMPENSATION COMMITTEE TO THE BOARD OF TRUSTEES. ANY COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMPENSATION COMMITTEE AND EXECUTIVE SESSION MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN 2023. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE NOT CURRENTLY AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER MEDICAL AND PLANT OPERATIONS: PROGRAM SERVICE EXPENSES 5,681,753. MANAGEMENT AND GENERAL EXPENSES 1,873,103. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,554,856. ER PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 600,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 600,000. VEIN CENTER PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 87,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 87,000. LABORATORY PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 110,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110,000. NEUROLOGY PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 55,425. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,425. OCC HEALTH PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 65,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 65,000. DIAG IMAGING PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 700,000. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 700,000. ADMIN PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 4,070,948. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,070,948. FORM 990, PART XI, LINE 9: CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENTS -41,909. CONTRIBUTION OF CAPITAL TO BELLEVUE PROFESSIONAL SERVICES, INC. -2,441,111. BOOK TO TAX DIFFERENCE IN FLOWTHROUGH INCOME 39,450. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT OF THE AUDIT AS WELL AS SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. THE BELLEVUE HOSPITAL ASSOCIATION 1400 WEST MAIN STREET BELLEVUE OH 44811 753102199 ADMINISTRATIVE SUPPORT OH 501(C)(3) LINE 11A, 1 N/A 0 THE BELLEVUE HOSPITAL FOUNDATION 1400 WEST MAIN STREET BELLEVUE OH 44811 341745374 SUPPORT OH 501(C)(3) LINE 11A, 1 THE BELLEVUE HOSPITAL 1 BELLEVUE HOSPITAL PAIN MANAGEMENT LLC 1400 WEST MAIN STREET BELLEVUE OH 44811 464660177 HEALTH CARE OH THE BELLEVUE HOSPITAL RELATED 163751 60518 0 1 0.51000 BELLEVUE PROFESSIONAL SERVICES INC 1400 WEST MAIN STREET BELLEVUE OH 44811 341828724 PHYSICIAN SERVICES OH THE BELLEVUE HOSPITAL C -3380284 1240044 1.00000 1 0 0 1 0 0 1 0 0 0 1 0 1 0 1 1 0 1 1 0 BELLEVUE PROFESSIONAL SERVICES INC R 2237500 CASH CAPITAL CONTRIBUTION BELLEVUE PAIN MANAGEMENT Q 590617 REIMBURSEMENTS BELLEVUE PAIN MANAGEMENT F 102601 DIVIDENDS BELLEVUE PROFESSIONAL SERVICES INC J 54728 LEASE AGREEMENT PAYMENT