BELLEVUE HOSPITAL FOUNDATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- BELLEVUE HOSPITAL FOUNDATION (EIN 34-1745374)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-09
- IRS object ID
- 202223139349305767
- Schema version
- 2021v4.2
- 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 D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-09T16:54:03-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 381357951 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 S HIGH ST SUITE 100 | AddressLine1Txt |
| City | COLUMBUS | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43215 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341745374 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLEVUE HOSPITAL FOUNDATION THE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BELL | BusinessNameControlTxt |
| Phone | 4194834040 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44811 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CARRIE CONDON | PersonNm |
| Person Title | CFO-THE BELLEVUE HOSPITAL | PersonTitleTxt |
| Phone | 4194834040 | PhoneNum |
| Signature | 2022-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | CARRIE | PersonFirstNm |
| Person Last | CONDON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | AMY CIMINELLO | PreparerPersonNm |
| PTIN | P00796388 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Preparation | 2022-11-07 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CARRIE CONDON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $379,711 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Group Exemption | 0000 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.BELLEVUEHOSPITAL.COM/DEPARTMENTS/FOUN | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1993 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | THE BELLEVUE HOSPITAL FOUNDATION CONTINUES TO SPONSOR PROGRAMS, PROJECTS AND SERVICES WITH BENEFIT TO THE BELLEVUE HOSPITAL. | ActivityOrMissionDesc |
| Voting Members Governing Body | 19 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 16 | VotingMembersIndependentCnt |
| Total Employee | 0 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $60,686 | PYContributionsGrantsAmt |
| CY Contributions Grants | $75,235 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $127,665 | PYInvestmentIncomeAmt |
| CY Investment Income | $105,184 | CYInvestmentIncomeAmt |
| PY Other Revenue | $79,126 | PYOtherRevenueAmt |
| CY Other Revenue | $64,555 | CYOtherRevenueAmt |
| PY Total Revenue | $267,477 | PYTotalRevenueAmt |
| CY Total Revenue | $244,974 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $22,239 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $0 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $0 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $205,107 | PYOtherExpensesAmt |
| CY Other Expenses | $163,870 | CYOtherExpensesAmt |
| PY Total Expenses | $207,107 | PYTotalExpensesAmt |
| CY Total Expenses | $186,109 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $60,370 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $58,865 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,125,362 | TotalAssetsBOYAmt |
| Total Assets EOY | $3,615,632 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $843,863 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,068,084 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,281,499 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,547,548 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO ASSIST THE HOSPITAL IN THE EXPANSION OF COMMUNITY HEALTH THROUGH EDUCATION AND COMMUNITY PARTICIPATION. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $150,538 | ExpenseAmt |
| Grant | $22,239 | GrantAmt |
| Revenue | $0 | RevenueAmt |
| Desc | RELATED PARTY GENERAL SUPPORT TO THE BELLEVUE HOSPITAL. | Desc |
| Total Program Service Expenses | $150,538 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 2 | IRPDocumentCnt |
| IRP Document W2 G | 1 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 0 | EmployeeCnt |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 19 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 16 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | 0 | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARRIE CONDON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4194834040 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W MAIN STREET | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44811 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| CHRIS CAPUTO | |||||||
| CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| GARY STEINLE | |||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DONNA HALL | |||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MARIE ARCHER | |||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| DENNIS SABO | |||||||
| FOUNDATION DIRECTOR | 40.00 | 0.00 | Yes (X) | Yes (X) | $0 | $88,839 | $14,272 |
| CARRIE CONDON | |||||||
| TRUSTEE (HOSPITAL CFO) | 1.00 | 45.00 | Yes (X) | Yes (X) | $0 | $150,163 | $150,163 |
| TIMOTHY BUIT | |||||||
| TRUSTEE (HOSPITAL PRESIDENT) | 1.00 | 45.00 | Yes (X) | Yes (X) | $0 | $568,579 | $568,579 |
| LAUREN BURKHART | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JIM DAVIS | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL K WINTHROP | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DAN HIGGINS | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| DAVE JARVIS | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BILL BRUGNONE | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BETTE WOODS | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| NATHAN SAMSA | |||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $431,561 | $11,114 | |
| SHERRI WILHELM | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| MICHAEL KERN | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| BRETT BARTH | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| CALEB WYNBISSINGER | |||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $0 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,239,142 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $744,128 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $37,619 | FundraisingAmt |
| All Other Contributions | $37,616 | AllOtherContributionsAmt |
| Total Contributions | $75,235 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,461 | TotalRevenueColumnAmt |
| Exclusion | $45,461 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $59,723 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $59,723 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,723 | TotalRevenueColumnAmt |
| Exclusion | $59,723 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $4,292 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $37,619 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $18,897 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$14,605 | TotalRevenueColumnAmt |
| Exclusion | -$14,605 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $195,000 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $115,840 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $79,160 | TotalRevenueColumnAmt |
| Exclusion | $79,160 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $244,974 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $169,739 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,739 | TotalAmt |
| Program Services | $13,739 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,500 | TotalAmt |
| Program Services | $8,500 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $380 | TotalAmt |
| Management And General | $380 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,400 | TotalAmt |
| Management And General | $5,400 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,764 | TotalAmt |
| Management And General | $19,764 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,018 | TotalAmt |
| Program Services | $117,778 | ProgramServicesAmt |
| Management And General | $240 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $765 | TotalAmt |
| Program Services | $765 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,972 | TotalAmt |
| Program Services | $335 | ProgramServicesAmt |
| Management And General | $8,637 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450 | TotalAmt |
| Management And General | $450 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SPECIAL PROJECT EXPENSE | $9,421 | $9,421 | |
| ADMINISTRATIVE FEES | $700 | $700 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $186,109 | TotalAmt |
| Program Services | $150,538 | ProgramServicesAmt |
| Management And General | $35,571 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $172,261 | BOYAmt |
| EOY | $287,347 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $688,078 | BOYAmt |
| EOY | $992,383 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,441 | BOYAmt |
| EOY | $1,435 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,106 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,106 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,259,582 | BOYAmt |
| EOY | $2,334,467 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,125,362 | BOYAmt |
| EOY | $3,615,632 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $753,310 | BOYAmt |
| EOY | $977,531 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,553 | BOYAmt |
| EOY | $90,553 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $843,863 | BOYAmt |
| EOY | $1,068,084 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,818,463 | BOYAmt |
| EOY | $2,070,771 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $463,036 | BOYAmt |
| EOY | $476,777 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,281,499 | BOYAmt |
| EOY | $2,547,548 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,125,362 | BOYAmt |
| EOY | $3,615,632 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $58,865 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $189,506 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $17,678 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | Yes (X) | SupportingOrganization509a3Ind |
| Supporting Org Type1 | Yes (X) | SupportingOrgType1Ind |
| Supported Organizations | 1 | SupportedOrganizationsCnt |
Supported Org Information SupportedOrgInformationGrp
Supported Organization Name SupportedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344428205 | EIN |
| Organization Type | 3 | OrganizationTypeCd |
| Governing Document Listed | Yes (1) | GoverningDocumentListedInd |
| Support | $13,739 | SupportAmt |
| Other Support | $0 | OtherSupportAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supported Organizations Total | 1 | SupportedOrganizationsTotalCnt |
| Support Sum | $13,739 | SupportSumAmt |
| Other Support Sum | $0 | OtherSupportSumAmt |
Form990 Sch A Supporting Org Form990SchASupportingOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Listed By Name Governing Doc | Yes (1) | ListedByNameGoverningDocInd |
| Suprt Org No IRS Determination | 0 | SuprtOrgNoIRSDeterminationInd |
| Supported Org Section C456 | 0 | SupportedOrgSectionC456Ind |
| Supported Org Not Organized US | 0 | SupportedOrgNotOrganizedUSInd |
| Organization Change Suprt Org | 0 | OrganizationChangeSuprtOrgInd |
| Support Non Supported Org | 0 | SupportNonSupportedOrgInd |
| Payment Substantial Contribtr | 0 | PaymentSubstantialContribtrInd |
| Loan Disqualified Person | 0 | LoanDisqualifiedPersonInd |
| Controlled Disqualified Prsn | 0 | ControlledDisqualifiedPrsnInd |
| Disqualified Prsn Controll Int | 0 | DisqualifiedPrsnControllIntInd |
| Disqualified Prsn Ownr Int | 0 | DisqualifiedPrsnOwnrIntInd |
| Excess Business Holdings Rules | 0 | ExcessBusinessHoldingsRulesInd |
| Contribution Controller | 0 | ContributionControllerInd |
| Contribution Family | 0 | ContributionFamilyInd |
| Contribution35 Controlled | 0 | Contribution35ControlledInd |
Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Power Appoint Majority Dir Trst | Yes (1) | PowerAppointMajorityDirTrstInd |
| Operate Benefit Non Suprt Org | 0 | OperateBenefitNonSuprtOrgInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $368,672 | BeginningYearBalanceAmt |
| End Year Balance | $368,672 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $368,672 | BeginningYearBalanceAmt |
| End Year Balance | $368,672 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $368,672 | BeginningYearBalanceAmt |
| End Year Balance | $368,672 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $368,672 | BeginningYearBalanceAmt |
| End Year Balance | $368,672 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $368,672 | BeginningYearBalanceAmt |
| End Year Balance | $368,672 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,106 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,106 | DepreciationAmt |
| Book Value | $0 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INTERCOMPANY PLEDGES PAYABLE | Desc |
| Amt | $90,553 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $90,553 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | THE ENDOWMENT FUND INVESTMENTS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS UNRESTRICTED. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $41,911 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $37,619 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $4,292 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,600 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $0 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $10,003 | RentFacilityCostsEvent1Amt |
| Food And Beverage Event1 | $2,870 | FoodAndBeverageEvent1Amt |
| Entertainment Event1 | $0 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $4,423 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $41,911 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $37,619 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $4,292 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,600 | CashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $10,003 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $2,870 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $4,423 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $18,896 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$14,604 | NetIncomeSummaryAmt |
Gaming Information GamingInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Revenue Other Gaming | $195,000 | GrossRevenueOtherGamingAmt |
| Cash Prizes Other Gaming | $106,938 | CashPrizesOtherGamingAmt |
| Oth Direct Expnss Other Gaming | $8,902 | OthDirectExpnssOtherGamingAmt |
| Volunteer Labor Other Gaming | 0 | VolunteerLaborOtherGamingInd |
| Gross Revenue Total Gaming | $195,000 | GrossRevenueTotalGamingAmt |
| Cash Prizes Total Gaming | $106,938 | CashPrizesTotalGamingAmt |
| Oth Direct Expnss Total Gaming | $8,902 | OthDirectExpnssTotalGamingAmt |
| Direct Expense Summary Gaming | $115,840 | DirectExpenseSummaryGamingAmt |
| Net Gaming Income Summary | $79,160 | NetGamingIncomeSummaryAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| States Where Gaming Conducted | OH | StatesWhereGamingConductedCd |
| Licensed | 0 | LicensedInd |
| Explanation If No | IN THE STATE OF OHIO, A CHARITABLE ORGANIZATION THAT IS EXEMPT FROM FEDERAL INCOME TAXATION UNDER SUBSECTION 501(A) AND IS DESCRIBED IN SUBSECTION 501(C)(3) IS NOT REQUIRED TO OBTAIN A GAMING LICENSE TO CONDUCT A RAFFLE TO RAISE MONEY FOR THE ORGANIZATION. OHIO REVISED CODE 2915.092. | ExplanationIfNoTxt |
| License Suspended Etc | 0 | LicenseSuspendedEtcInd |
| Gaming With Nonmembers | Yes (1) | GamingWithNonmembersInd |
| Member Of Other Entity | 0 | MemberOfOtherEntityInd |
| Gaming Own Facility | 0.67000 | GamingOwnFacilityPct |
| Gaming Other Facility | 0.33000 | GamingOtherFacilityPct |
| Individual With Books | TIMOTHY BUIT | IndividualWithBooksNm |
Persons With Books US Address PersonsWithBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct With3rd Prty For Game Rev | 0 | CntrctWith3rdPrtyForGameRevInd |
| Gaming Manager Person | DENNIS SABO | GamingManagerPersonNm |
| Gaming Manager Compensation | $84,432 | GamingManagerCompensationAmt |
| Gaming Manager Services Prov | COORDINATION OF ALL ACTIVITIES, SUCH AS, ADVERTISING, MAILINGS, TICKET PURCHASES, TICKET SALES, DRAWINGS, AND WORKING WITH THE BOARD MEMBERS TO HOLD A CORVETTE FOR THE WINNER. | GamingManagerServicesProvTxt |
| Gaming Manager Is Director Ofcr | Yes (X) | GamingManagerIsDirectorOfcrInd |
| Charitable Distribution Rqr | 0 | CharitableDistributionRqrInd |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 WEST MAIN STREET | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 344428205 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $0 | CashGrantAmt |
| Non Cash Assistance | $13,739 | NonCashAssistanceAmt |
| Valuation Method Used | COST | ValuationMethodUsedDesc |
| Non Cash Assistance | 5 AEDS AND 1 TOURNIQUET SYSTEM | NonCashAssistanceDesc |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 10 | RecipientCnt |
| Cash Grant | $8,500 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Valuation Method Used | N/A | ValuationMethodUsedDesc |
| Non Cash Assistance | N/A | NonCashAssistanceDesc |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE FOUNDATION IS A SUPPORTING ORGANIZATION TO THE BELLEVUE HOSPITAL. IT REGULARLY TRANSFERS FUNDS TO FURTHER THE HOSPITAL'S EXEMPT PURPOSES PER FOUNDATION BOARD APPROVAL. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TIMOTHY BUIT | ||||||||||||||
| TRUSTEE (HOSPITAL PRESIDENT) | $0 | $465,231 | $0 | $90,000 | $0 | $13,348 | $0 | $11,600 | $0 | $25,542 | $0 | $605,721 | $0 | $0 |
| NATHAN SAMSA | ||||||||||||||
| TRUSTEE | $0 | $431,561 | $0 | $0 | $0 | $0 | $0 | $713 | $0 | $0 | $0 | $432,274 | $0 | $0 |
| CARRIE CONDON | ||||||||||||||
| TRUSTEE (HOSPITAL CFO) | $0 | $150,163 | $0 | $0 | $0 | $0 | $0 | $4,646 | $0 | $7,413 | $0 | $162,222 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3: | COMPENSATION PAID TO THE ORGANIZATION'S PRESIDENT IS ESTABLISHED BY A RELATED ORGANIZATION AND INCLUDES USE OF A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| SCHEDULE J, PART II | NATHAN SAMSA RECEIVED COMPENSATION FOR THE ROLE AS EX-OFFICIO AS MEDICAL STAFF OF THE BELLEVUE HOSPITAL ORGANIZATION AND NOT FOR A ROLE ON THE BOARD. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE BELLEVUE HOSPITAL FOUNDATION IS ORGANIZED AS A SUBSIDIARY OF THE BELLEVUE HOSPITAL, THE PARENT ORGANIZATION AND SOLE VOTING MEMBER FOR THE CONSOLIDATED GROUP. |
| FORM 990, PART VI, SECTION A, LINE 7A | BELLEVUE HOSPITAL HAS THE POWER TO ELECT OR APPOINT MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | DECISIONS MADE BY THE BELLEVUE HOSPITAL FOUNDATION'S BOARD OF DIRECTORS CAN BE OVERRULED BY THE BELLEVUE HOSPITAL'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF FORM 990 IS MADE AVAILABLE TO THE BELLEVUE HOSPITAL'S PRESIDENT & EXECUTIVE VICE PRESIDENT/CFO AT THE FINANCE MEETING FOR REVIEW AS WELL AS PRESENTATION TO THE BOARD OF DIRECTORS. IN ADDITION, EACH BOARD MEMBER RECEIVES A COPY OF FORM 990 PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE FOUNDATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICY WHEN APPLICABLE AS DESCRIBED BELOW. 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 | THE FOUNDATION DOES NOT HAVE ITS OWN COMPENSATION POLICY. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICIES WHEN APPLICABLE, AS DESCRIBED BELOW. 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 2021. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FOUNDATION MAKES ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION B, LINES 13 AND 14 | THE FOUNDATION DOES NOT HAVE ITS OWN WHISTLEBLOWER OR DOCUMENT RETENTION POLICIES. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICIES WHEN APPLICABLE. |
| FORM 990, PART IX, LINE 11G | STAFFING & MEAL FEES: PROGRAM SERVICE EXPENSES 117,778. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 117,778. SOFTWARE CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 240. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 240. |
| FORM 990, PART XI, LINE 9: | TEMPORARILY RESTRICTED CONTRIBUTIONS 17,678. |
| FORM 990, PAGE 12, PART XII, LINE 2C | THE BELLEVUE HOSPITAL HAS A COMMITTEE RESPONSIBLE FOR SELECTION OF THE INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT. 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
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BELLEVUE HOSPITAL | |||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 344428205 | HEALTH CARE | OH | 501(C)3 | LINE 3 | THE BELLEVUE HOSPITAL ASSOCIATION | Yes (1) | |
| THE BELLEVUE HOSPITAL ASSOCIATION | |||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 753102199 | ADMINISTRATIVE SUPPORT | OH | 501(C)3 | LINE 12B, II | 0 | N/A | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|---|
| BELLEVUE HEALTH NETWORK | |||||||||
| 1400 W MAIN STREET | BELLEVUE | OH | 44811 | 341870470 | INSURANCE CONTRACTS | OH | N/A | 0 | Yes (1) |
| BELLEVUE HOSPITAL PAIN MANAGEMENT LLC | |||||||||
| 1400 W MAIN STREET | BELLEVUE | OH | 44811 | 464660177 | HEALTH CARE | OH | N/A | 0 | Yes (1) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLEVUE PROFESSIONAL SERVICES INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W MAIN STREET | AddressLine1Txt |
| City | BELLEVUE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 44811 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 341828724 | EIN |
| Primary Activities | PHYSICIAN SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (1) | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Comments