THE BELLEVUE HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- THE BELLEVUE HOSPITAL (EIN 34-4428205)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-14
- IRS object ID
- 201243199349304474
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-14T14:02:59-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE ST STE 600 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344428205 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BELL | NameControl |
| Phone | 4194834040 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1 |
| City | BELLEVUE | City |
| State | OH | State |
| ZIP Code | 44811 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEAN MILLER | Name |
| Title | CHAIRMAN | Title |
| Phone | 4194834040 | Phone |
| Date Signed | 2012-11-05 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MICHAEL K WINTHROP | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1 |
| City | BELLEVUE | City |
| State | OH | State |
| ZIP Code | 44811 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 47906189 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.BELLEVUEHOSPITAL.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1956 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 17 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 16 | NbrIndependentVotingMembers |
| Total Nbr Employees | 459 | TotalNbrEmployees |
| Total Nbr Volunteers | 85 | TotalNbrVolunteers |
| Total Gross UBI | 1811 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 811 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 160422 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 146449 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 44514219 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 47057883 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 110156 | InvestmentIncomePriorYear |
| Investment Income Current Year | 129189 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 333320 | OtherRevenuePriorYear |
| Other Revenue Current Year | 342340 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 45118117 | TotalRevenuePriorYear |
| Total Revenue Current Year | 47675861 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 35000 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 58000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 20519344 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 22313735 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 23239678 | OtherExpensePriorYear |
| Other Expenses Current Year | 21076362 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 43794022 | TotalExpensesPriorYear |
| Total Expenses Current Year | 43448097 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1324095 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 4227764 | RevenuesLessExpensesCY |
| Total Assets BOY | 54550412 | TotalAssetsBOY |
| Total Assets EOY | 59041350 | TotalAssetsEOY |
| Total Liabilities BOY | 29135676 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 30270807 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 25414736 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 28770543 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 37660665 | Expense |
| Grants | 58000 | Grants |
| Revenue | 47088301 | Revenue |
| Description | SEE SCHEDULE OTHE BELLEVUE HOSPITAL IS A COMMUNITY BASED GENERAL ACUTE CARE HOSPITAL THAT PROVIDES CARE TO THE BELLEVUE AND SURROUNDING COMMUNITY WITHOUT REGARD TO ABILITY TO PAY.OUR IMPACT ON THE BELLEVUE COMMUNITY: FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2011, THE BELLEVUE HOSPITAL EMPLOYED A TOTAL OF 459 INDIVIDUALS AND MAINTAINED A MEDICAL STAFF MEMBERSHIP OF OVER 150 PHYSICIANS. THE HOSPITAL PAID A TOTAL OF OVER $16 MILLION IN WAGES AND SALARIES. OUR EMPLOYEES PAID A TOTAL OF $231,187 IN BELLEVUE CITY INCOME TAX AND AN ADDITIONAL $31,789 IN BELLEVUE CITY SCHOOL TAXES TO SUPPORT THE BELLEVUE COMMUNITY INFRASTRUCTURE AND EDUCATIONAL NEEDS. OUR EMPLOYEES LIVING IN OTHER LOCAL SCHOOL DISTRICTS PAID $18,513 IN CLYDE-GREEN SPRINGS LOCAL SCHOOL DISTRICT TAXES, $8,207 IN FREMONT LOCAL SCHOOL DISTRICT TAXES, AND $5,561 IN SENECA EAST SCHOOL DISTRICT TAXES. IN ADDITION, A TOTAL OF $2,714,095 OF THE HOSPITAL'S TOTAL GOODS AND SERVICES EXPENSED DURING 2011 WERE PURCHASED LOCALLY FROM AREA BUSINESSES.SERVING THE BELLEVUE COMMUNITY: A TOTAL OF 2,085 COMMUNITY MEMBERS WERE ADMITTED TO OUR FACILITY DURING 2011. IN ADDITION, A TOTAL OF 58,037 VISITS WERE MADE FOR OUTPATIENT CARE. OUR EMERGENCY ROOM TREATED AN ADDITIONAL 17,194 PATIENTS DURING 2011 AND WE ASSISTED IN THE DELIVERY OF 345 BABIES. WE PROVIDED A TOTAL OF $9,177,691 IN FREE CARE TO OVER 5,000 UNINSURED OR UNDERINSURED PATIENTS. | Description |
| Total Program Service Expense | 37660665 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 47 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 459 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 17 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 16 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RACHEL HERMAN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4194834040 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W MAIN ST | AddressLine1 |
| City | BELLEVUE | City |
| State | OH | State |
| ZIP Code | 44811 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| MICHAEL K WINTHROP | |||||||
| PRESIDENT | 45.00 | X | X | 439962 | 0 | 23294 | |
| MARK PIFER OD | |||||||
| CHAIRPERSON | 1.00 | X | X | 0 | 0 | 0 | |
| DEAN MILLER | |||||||
| 2ND VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| JAMES SHELLEY | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| JOE WILSON | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| JOHN BACON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| TOM BARTH | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PAUL DOUGLAS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| GORDON GIBBS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| NANCY GREENSLADE | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DWIGHT HOGUE | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PAUL HOWARD | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| DOUG HOY MD | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| PATRICK MARTIN | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| BENJAMIN BALL DO | |||||||
| 1ST VICE CHAIR | 1.00 | X | X | 0 | 0 | 0 | |
| NANCY BEIER | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| J WILLIAM SPRINGER | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| TIMOTHY BUIT | |||||||
| EXECUTIVE VP, CFO | 45.00 | X | 242373 | 0 | 1234 | ||
| PATRICIA SEMER | |||||||
| VP ADMINISTRATION | 45.00 | 149951 | 0 | 28087 | X | ||
| JANET RUNNER | |||||||
| VP PATIENT CARE SERVICES | 45.00 | 148912 | 0 | 18213 | X | ||
| DEBORAH GANCI | |||||||
| VP HUMAN RESOURCES | 45.00 | 141622 | 0 | 7933 | X | ||
| CHRISTOPHER HIRT | |||||||
| CLINICAL SVCS DIRECTOR | 45.00 | 119645 | 0 | 7193 | X | ||
| DEBORAH O'TOOLE | |||||||
| PHARMACIST | 40.00 | 100769 | 0 | 10821 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1343234 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 96775 | TotalOtherCompensation |
| Number Individuals GT100 K | 7 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NET REVENUE ASSOCIATES | |||||
| 3918 CLOCK POINT TR | STOW | OH | 44224 | OR CHARGE RECOVERY | 1097060 |
| BELLEVUE ANESTHESIA ASSOCIATES LLC | |||||
| 1355 W MAIN ST | BELLEVUE | OH | 44811 | ANESTHESIA SERVICES | 408319 |
| SOUTH SHORE RADIOLOGY | |||||
| PO BOX 1800 | SANDUSKY | OH | 44870 | RADIOLOGIST SERVICES | 348107 |
| 3M COMPANY | |||||
| PO BOX 844127 | DALLAS | TX | 752844127 | CLINICAL DOCUMENTATION IMPROVEMENT | 228288 |
| GENZYME GENETICS | |||||
| PO BOX 223614 | PITTSBURGH | PA | 152513614 | LAB SCREENING SERVICES | 206048 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 10 | NumberOfContractorsGT100K |
| Related Organizations | 120807 | RelatedOrganizations |
| All Other Contributions | 25642 | AllOtherContributions |
| Noncash Contributions | 10327 | NoncashContributions |
| Total Contributions | 146449 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICES | 621110 | 46821227 | 46821227 |
| HEALTH DEPARTMENT | 621110 | 98887 | 98887 |
| COMMUNITY EDUCATION | 621110 | 53631 | 53631 |
| PURCHASE DISCOUNTS | 621110 | 50292 | 50292 |
| CONTRACT THERAPY | 621110 | 33846 | 33846 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 47057883 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 144027 | TotalRevenueColumn |
| Exclusion | $144,027 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 222993 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 204740 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 18253 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18253 | TotalRevenueColumn |
| Exclusion | $18,253 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 10750 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 25588 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -14838 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -14838 | TotalRevenueColumn |
| Exclusion | -$14,838 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 3618 | GrossIncomeGaming |
| Gaming Direct Expenses | 0 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3618 | TotalRevenueColumn |
| Exclusion | $3,618 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA/CAFE | 621110 | 258047 | $258,047 |
| VENDING MACHINES | 621110 | 9704 | $9,704 |
| DIET CONSULTATION | 621110 | 6665 | $6,665 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 46053 | TotalRevenueColumn |
| Related Or Exempt Function Income | 30418 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1811 | UnrelatedBusinessRevenue |
| Exclusion | $13,824 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 320469 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 47675861 | TotalRevenueColumn |
| Related Or Exempt Function Income | 47088301 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1811 | UnrelatedBusinessRevenue |
| Exclusion | $439,300 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43000 | Total |
| Program Services | 43000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15000 | Total |
| Program Services | 15000 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 714973 | Total |
| Management And General | 714973 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15447572 | Total |
| Program Services | 13543232 | ProgramServices |
| Management And General | 1904340 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 702954 | Total |
| Program Services | 610220 | ProgramServices |
| Management And General | 92734 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4274268 | Total |
| Program Services | 3747347 | ProgramServices |
| Management And General | 526921 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1173968 | Total |
| Program Services | 1039715 | ProgramServices |
| Management And General | 134253 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192537 | Total |
| Management And General | 192537 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 106946 | Total |
| Management And General | 106946 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5334874 | Total |
| Program Services | 4677203 | ProgramServices |
| Management And General | 657671 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 233992 | Total |
| Program Services | 205912 | ProgramServices |
| Management And General | 28080 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6423260 | Total |
| Program Services | 5780934 | ProgramServices |
| Management And General | 642326 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11455 | Total |
| Program Services | 10080 | ProgramServices |
| Management And General | 1375 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2897549 | Total |
| Program Services | 2468951 | ProgramServices |
| Management And General | 428598 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16589 | Total |
| Program Services | 14598 | ProgramServices |
| Management And General | 1991 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 602285 | Total |
| Program Services | 528037 | ProgramServices |
| Management And General | 74248 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2054141 | Total |
| Program Services | 1800911 | ProgramServices |
| Management And General | 253230 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1032930 | Total |
| Program Services | 1024178 | ProgramServices |
| Management And General | 8752 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 1666332 | 1666332 | |
| FRANCHISE FEE | 242008 | 242008 | |
| RECRUITMENT | 117480 | 100484 | 16996 |
| PROFESSIONAL DEVELOPMEN | 112605 | 112605 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 31379 | Total |
| Program Services | 29918 | ProgramServices |
| Management And General | 1461 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 43448097 | Total |
| Program Services | 37660665 | ProgramServices |
| Management And General | 5787432 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4664604 | BOY |
| EOY | 7218587 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4004563 | BOY |
| EOY | 5451361 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 24776 | BOY |
| EOY | 109128 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 314835 | BOY |
| EOY | 315707 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 409001 | BOY |
| EOY | 412208 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 61672714 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 24874248 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 36931597 | BOY |
| EOY | 36798466 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6748272 | BOY |
| EOY | 6971440 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 650530 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1452764 | BOY |
| EOY | 1113923 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54550412 | BOY |
| EOY | 59041350 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4736499 | BOY |
| EOY | 4844987 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11500 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22788326 | BOY |
| EOY | 21869098 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 153161 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1446190 | BOY |
| EOY | 3556722 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 29135676 | BOY |
| EOY | 30270807 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25414736 | BOY |
| EOY | 28770543 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25414736 | BOY |
| EOY | 28770543 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54550412 | BOY |
| EOY | 59041350 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 4227764 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -871957 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $1,942 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 1942 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | 5.9 PERCENT OF DUES TO THE OHIO HOSPITAL ASSOCIATION WAS ALLOCATED TO LOBBYING ACTIVITIES BY THAT ORGANIZATION. | Explanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2031680 | OtherCostOrOtherBasis |
| Book Value | 2031680 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 37641646 | OtherCostOrOtherBasis |
| Depreciation | 7852891 | Depreciation |
| Book Value | 29788755 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 15813288 | OtherCostOrOtherBasis |
| Depreciation | 11991284 | Depreciation |
| Book Value | 3822004 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6186100 | OtherCostOrOtherBasis |
| Depreciation | 5030073 | Depreciation |
| Book Value | 1156027 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 36798466 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| THIRD PARTY SETTLEMENT | $2,536,441 |
| DERIVATIVE LIABILITY | $865,209 |
| DUE TO MEDICAL STAFF AND AUXILIARY | $155,072 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3556722 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2011, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE AND LOCAL, OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1526675 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1158683 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 367992 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00880 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6426899 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4272725 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2154174 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05160 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7953574 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5431408 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2522166 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06040 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 158536 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 46463 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 112073 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 37231 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 37231 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 43158 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 43158 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00100 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15381 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 15381 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 254306 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 46463 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 207843 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00500 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8207880 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5477871 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2730009 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06540 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1698 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1698 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 13580 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 13580 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 10859 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 10859 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 29137 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 29137 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $1,666,332 | BadDebtExpenseAmount |
| Amount Attributable To | 117232 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8694397 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 12407368 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -3712971 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1 |
| City | BELLEVUE | City |
| State | OH | State |
| ZIP Code | 44811 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
| Other | SWING BED - SNF HOME HEALTH | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 400.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Attached To Invoices | X | AttachedToInvoices |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| PART I, LINE 3C: THE HOSPITAL USES FEDERAL POVERTY GUIDELINES. | |
| PART I, LINE 6A: NOT APPLICABLE | |
| 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. | |
| PART I, LINE 7G: NOT APPLICABLE | |
| PART I, LINE 7, COLUMN (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 $ 1666332. | |
| PART II: 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. ECONOMIC DEVELOPMENT: ACTIVE ROLE WITH SANDUSKY COUNTY ECONOMIC DEVELOPMENT ORGANIZATION TO CREATE NEW EMPLOYMENT OPPORTUNITIES, INCLUDING HEALTHCARE COVERAGE, IN AN AREA EXPERIENCING HIGH JOBLESS RATES. COMMUNITY SUPPORT: PROVIDE SUPPORT FOR LOCAL UNITED SELECTIVE FUND CAMPAIGN AND OTHER LOCAL NON-PROFIT ORGANIZATIONS. WORKFORCE DEVELOPMENT: PARTNERSHIP WITH COMMUNITY COLLEGE/VOCATIONAL SCHOOL TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE AS WELL AS PARTICIPATION ON ADVISORY BOARDS OF SCHOOL-BASED PROGRAMS FOR HEALTH CARE CAREERS. | |
| PART III, LINE 4: FOOTNOTE IN FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE: 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. BAD DEBT EXPENSE REPORTED IN PART III, LINE 2, IS RECORDED PER THE FINANCIAL STATEMENTS. 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. HISTORICALLY, IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY ACCOUNTS, 7% OF ACCOUNTS SENT TO THE STATE COLLECTION HAVE BEEN SUBSEQUENTLY IDENTIFIED AS CHARITY OR MEDICALLY INDIGENT AND RETURNED. APPLYING THIS RATIO, IT IS ESTIMATED THAT $117,232 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. | |
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE HOSPITAL BELIEVES THAT THE $3,712,971 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 2011, MEDICARE ACCOUNTED FOR 34.14% 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 V, SECTION B, LINE 19D: 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. | THE BELLEVUE HOSPITAL |
| PART VI, LINE 2: THE BELLEVUE HOSPITAL IS A MEMBER OF HEALTH PARTNERS, A GROUP OF HEALTH ORGANIZATION CEO'S IN SANDUSKY COUNTY. THE GROUP DETERMINES THE ONGOING NEEDS OF THE COMMUNITY BY CONDUCTING COMPREHENSIVE HEALTH ASSESSMENTS FOR ADULTS AGES 19-75 EVERY FOUR YEARS, AND EVERY TWO YEARS FOR YOUTH AGES 12-18. IN ADDITION, THE BOARD STRATEGIC PLANNING COMMITTEE IS COMPRISED OF SEVERAL COMMUNITY BUSINESS LEADERS WHO ASSESS THE NEEDS OF THE COMMUNITY AND MAKES RECOMMENDATIONS. THE HOSPITAL ALSO USES ITS PATIENT SATISFACTION SURVEY TO OBTAIN SUGGESTIONS FOR SERVICES. | |
| 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, OHIO IS A CITY IN ERIE, HURON, SANDUSKY AND SENECA COUNTIES OF OHIO. IT IS THE ONLY MUNICIPALITY IN THE STATE OF OHIO TO SPAN FOUR COUNTIES. ACCORDING TO THE U.S. CENSUS BUREAU, THE FOUR COUNTY AREA HAS A TOTAL LAND AREA OF 1707.34 SQUARE MILES. AS OF THE 2010 CENSUS, THE FOUR COUNTY POPULATION WAS 254,394, A 2.01% DECLINE SINCE THE 2000 CENSUS, WITH A DENSITY OF 149 PEOPLE PER SQUARE MILE, PREDOMINANTLY WHITE, HIGH SCHOOL EDUCATED. THE FOUR COUNTY AREA WAS HIT EXTREMELY HARD DURING THE RECENT ECONOMIC RECESSION, BUT IS SLOWLY RECOVERING. THE U.S. DEPARTMENT OF LABOR, BUREAU OF LABOR STATISTICS, REPORTS THE UNEMPLOYMENT RATE FOR THE FOUR COUNTY AREA AS 9.0% FOR DECEMBER 2011, DOWN FROM 10.6% IN DECEMBER 2010, AND SLIGHTLY HIGHER THAN OHIO'S STATEWIDE UNEMPLOYMENT RATE OF 8.1% AND THE NATIONWIDE UNEMPLOYMENT RATE OF 8.5%. HURON COUNTY RANKED 10TH IN THE STATE OF OHIO IN 2011 WITH AN ANNUAL AVERAGE UNEMPLOYMENT RATE OF 11.7%. MEDIAN HOUSEHOLD INCOMES RANGED FROM $42,573 IN SENECA COUNTY TO $48,056 IN SANDUSKY COUNTY. ACCORDING TO THE BUREAU OF THE CENSUS, 2010 POVERTY RATES, THE LATEST AVAILABLE, RANGED FROM 10.9% FOR SANDUSKY COUNTY TO 14.5% FOR HURON COUNTY. OHIO DEPARTMENT OF JOB & FAMILY SERVICES REPORTED THAT 46,170 RESIDENTS, OR 18.15% OF RESIDENTS IN THE FOUR COUNTY AREA WERE ENROLLED IN MEDICAID DURING 2010. SANDUSKY COUNTY IS ALSO DESIGNATED AS BOTH A MEDICALLY UNDERSERVED AREA AND AS A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA. | |
| 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: BELLEVUE HOSPITAL IS A GENERAL ACUTE CARE PROVIDER AT ONE FACILITY IN THE BELLEVUE, OHIO AREA. BELLEVUE HOSPITAL IS THE PARENT ORGANIZATION OF BELLEVUE PROFESSIONAL SERVICES 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 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. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| THE UNIVERSITY OF TOLEDO FOUNDATION | |||||||
| 2801 BANKCROFT ST | TOLEDO | OH | 43606 | 346555110 | 501(C)(3) | 25000 | UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE SCHOLARSHIP FUND |
| TERRA COLLEGE FOUNDATION | |||||||
| 2830 NAPOLEON RD | FREMONT | OH | 43420 | 341650500 | 501(C)(3) | 10000 | UNRESTRICTED NURSING/ALLIED HEALTH FUND |
| VILLAGE HOUSE | |||||||
| 350 RAWSON AVE | FREMONT | OH | 43420 | 311807056 | 501(C)(3) | 5000 | TO ASSIST CHILDREN OF SANDUSKY CO. WHO HAVE BEEN AFFECTED BY ABUSE, NEGLECT, DOMESTIC VIOLENCE OR DIVORCE/SEPARATION. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | EMPLOYEE CHILDREN'S SCHOLARSHIPS | TypeOfGrant |
| Number Of Recipients | 10 | NumberOfRecipients |
| Amount Of Cash Grant | 15000 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE HOSPITAL HAS REPRESENTATION ON THE BOARD OF VILLAGE HOUSE. THE HOSPITAL PROVIDED SCHOLARSHIP PAYMENTS MADE DIRECTLY TO THE COLLEGES AFTER PROOF OF ENROLLMENT IS RECEIVED. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | 1 | WrittenPolicyReTAndEExpenses |
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (4 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MICHAEL K WINTHROP | |||||||||||||
| 399230 | 0 | 30000 | 0 | 10732 | 0 | 8605 | 0 | 14689 | 0 | 463256 | 0 | 0 | 0 |
| TIMOTHY BUIT | |||||||||||||
| 217373 | 0 | 25000 | 0 | 0 | 0 | 0 | 0 | 1234 | 0 | 243607 | 0 | 0 | 0 |
| PATRICIA SEMER | |||||||||||||
| 134951 | 0 | 15000 | 0 | 0 | 0 | 5461 | 0 | 22626 | 0 | 178038 | 0 | 0 | 0 |
| JANET RUNNER | |||||||||||||
| 138912 | 0 | 10000 | 0 | 0 | 0 | 4441 | 0 | 13772 | 0 | 167125 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 1A | ReturnReference |
| Explanation | THE ORGANIZATION PAYS SOCIAL CLUB DUES ON THE BEHALF OF MICHAEL WINTHROP AS A MEANS TO NETWORK WITH PHYSICIANS. NONE OF THE SOCIAL CLUB DUES WERE TREATED AS TAXABLE COMPENSATION TO MICHAEL WINTHROP. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| CITY OF BELLEVUE | |||||||
| 346400096 | 079277BC2 | 2003-08-26 | 11000000 | ACQUISITION, CONSTRUCTION AND EQUIPPING OF NEW HOSPITAL FACILITY | 0 | 0 | 0 |
| CITY OF CLYDE | |||||||
| 346400315 | 9940680S4 | 2003-07-23 | 10000000 | SEE PART VI | 0 | 0 | 0 |
| COUNTY OF SANDUSKY | |||||||
| 346401312 | 9940680T2 | 2003-08-08 | 6000000 | ACQUISITION, CONSTRUCTION AND EQUIPPING OF NEW HOSPITAL FACILITY | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Credit EnhancementCreditEnhancement | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Other Spent ProceedsOtherSpentProceeds |
|---|---|---|---|---|---|---|---|---|---|---|
| 2060068 | 11323999 | 121742 | 97199 | 11105058 | 2005 | 0 | 0 | 1 | 1 | |
| 1989289 | 10023197 | 77750 | 5534858 | 2004 | 1 | 0 | 1 | 1 | 4410589 | |
| 1082449 | 6055301 | 44500 | 6010801 | 2004 | 0 | 0 | 1 | 1 |
Form990 Schedule K Part III Form990ScheduleKPartIII (3 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (3 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 1 | 0 | 0 | 0 | 0 |
| 0 | 1 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Form990 Schedule K Part VI Form990ScheduleKPartVI (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| SCHEDULE K, PART I, LINE B, COLUMN (F): | $4,410,588.89 OF BOND PROCEEDS WERE USED TO CURRENTLY REFUND A LOAN. $5,589,411.11 OF BOND PROCEEDS WERE USED TO ACQUIRE, CONSTRUCT AND EQUIP A NEW HOSPITAL FACILITY AND TO PAY COSTS OF ISSUANCE. |
| SCHEDULE K, PART II, LINE 3, COLUMN A: | TOTAL PROCEEDS OF THE ISSUE ARE COMPRISED OF $11,000,000 SALE PROCEEDS PLUS INVESTMENT PROCEEDS OF $323,999. |
| SCHEDULE K, PART II, LINE 3, COLUMN B: | TOTAL PROCEEDS OF THE ISSUE ARE COMPRISED OF $10,000,000 SALE PROCEEDS PLUS INVESTMENT PROCEEDS OF $23,197. |
| SCHEDULE K, PART II, LINE 3, COLUMN C: | TOTAL PROCEEDS OF THE ISSUE ARE COMPRISED OF $6,000,000 SALE PROCEEDS PLUS INVESTMENT PROCEEDS OF $55,301. |
| SCHEDULE K, PART II, LINE 11, COLUMN B: | $4,410,588.89 OF BOND PROCEEDS WERE USED TO CURRENTLY REFUND A LOAN. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (10 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | PRESIDENT MICHAEL WINTHROP AND TRUSTEE DEAN MILLER HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE BELLEVUE HOSPITAL ENTERED INTO AN AGREEMENT WITH 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. | |
| 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. | |
| FORM 990, PART VI, SECTION B, LINE 11 | 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 AT THE OCTOBER MEETING. IN ADDITION, EACH BOARD MEMBER RECEIVES A COPY OF 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 NOVEMBER 2011. | |
| 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, PAGE 7, PART VII: | THE FOLLOWING OFFICER DEVOTED TIME TO BELLEVUE HOSPITAL FOUNDATION: MICHAEL WINTHROP 1 HOUR PER WEEK | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED LOSSES ON INVESTMENTS: -172,462. CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENTS -287,495. CONTRIBUTION OF CAPITAL TO BELLEVUE PROFESSIONAL SERVICES, INC. -412,000. TOTAL TO FORM 990, PART XI, LINE 5: -871,957. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| THE BELLEVUE HOSPITAL FOUNDATION | ||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 341745374 | SUPPORT | OH | 501(C)(3) | LINE 11A, I | THE BELLEVUE HOSPITAL | 1 |
| THE BELLEVUE HOSPITAL ASSOCIATION | ||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 753102199 | ADMINISTRATIVE SUPPORT | OH | 501(C)(3) | LINE 11A, I | THE BELLEVUE HOSPITAL | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLEVUE HEALTH NETWORK LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1 |
| City | BELLEVUE | City |
| State | OH | State |
| ZIP Code | 44811 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341870470 | EIN |
| Primary Activity | INSURANCE CONTRACTS | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | -3029 | ShareOfTotalIncome |
| Share Of EOY Assets | 183 | ShareOfEOYAssets |
| Disproportionate Allocations | 0 | DisproportionateAllocations |
| General Or Managing Partner | 1 | GeneralOrManagingPartner |
| Percentage Ownership | 0.55560 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLEVUE PROFESSIONAL SERVICES INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1 |
| City | BELLEVUE | City |
| State | OH | State |
| ZIP Code | 44811 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341828724 | EIN |
| Primary Activity | PHYSICIAN SERVICES | PrimaryActivity |
| Legal Domicile State | OH | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Share Of Total Income | 1390264 | ShareOfTotalIncome |
| Share Of EOY Assets | 332337 | ShareOfEOYAssets |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 1 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| BELLEVUE PROFESSIONAL SERVICES INC | ||
| A | 48662 | LEASE PAYMENT |
| BELLEVUE PROFESSIONAL SERVICES INC | ||
| B | 412000 | CASH TRANSACTION |
| THE BELLEVUE HOSPITAL FOUNDATION | ||
| C | 120807 | CASH & BOOK VALUE TRANSACTIONS |
| THE BELLEVUE HOSPITAL FOUNDATION | ||
| K | 60179 | TIME SHEETS |