BELLEVUE HOSPITAL FOUNDATION: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: BELLEVUE HOSPITAL FOUNDATION (EIN 34-1745374)
Tax period: 2020-01-01 to 2020-12-31
Filed: 2021-11-12
IRS object ID: 202133169349309428
Schema version: 2020v4.1
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 J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-11-12T14:42:26-06:00	ReturnTs
Tax Period End	2020-12-31	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	2020-01-01	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	CHRIS CAPUTO	PersonNm
Person Title	CHAIRPERSON	PersonTitleTxt
Phone	4194834040	PhoneNum
Signature	2021-11-10	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	CHRIS	PersonFirstNm
Person Last	CAPUTO	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	2021-11-10	PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

Field	Value	IRS element (for citing)
Trusted Customer	2	TrustedCustomerCd
Authentication Assurance Level	AAL1	AuthenticationAssuranceLevelCd
Identity Assurance Level	IAL1	IdentityAssuranceLevelCd

Field	Value	IRS element (for citing)
Tax	2020	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	CHRIS CAPUTO	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	$406,161	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	84	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$70,389	PYContributionsGrantsAmt
CY Contributions Grants	$60,686	CYContributionsGrantsAmt
PY Program Service Revenue	$0	PYProgramServiceRevenueAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
PY Investment Income	$151,100	PYInvestmentIncomeAmt
CY Investment Income	$127,665	CYInvestmentIncomeAmt
PY Other Revenue	$59,399	PYOtherRevenueAmt
CY Other Revenue	$79,126	CYOtherRevenueAmt
PY Total Revenue	$280,888	PYTotalRevenueAmt
CY Total Revenue	$267,477	CYTotalRevenueAmt
PY Grants And Similar Paid	$20,318	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$2,000	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	$651,800	PYOtherExpensesAmt
CY Other Expenses	$205,107	CYOtherExpensesAmt
PY Total Expenses	$672,118	PYTotalExpensesAmt
CY Total Expenses	$207,107	CYTotalExpensesAmt
PY Revenues Less Expenses	-$391,230	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$60,370	CYRevenuesLessExpensesAmt
Total Assets BOY	$2,487,913	TotalAssetsBOYAmt
Total Assets EOY	$3,125,362	TotalAssetsEOYAmt
Total Liabilities BOY	$434,283	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$843,863	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$2,053,630	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$2,281,499	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	$178,448	ExpenseAmt
Grant	$2,000	GrantAmt
Revenue	$0	RevenueAmt
Desc	RELATED PARTY GENERAL SUPPORT TO THE BELLEVUE HOSPITAL.	Desc
Total Program Service Expenses	$178,448	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	0	GrantsToOrganizationsInd
Grants To Individuals	0	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	1	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
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 (22 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
MICHAEL K WINTHROP
TRUSTEE (HOSPITAL PRESIDENT)	1.00	45.00	Yes (X)	Yes (X)	$0	$533,780	$24,680
TIMOTHY BUIT
TRUSTEE (HOSPITAL CFO, PRESIDENT)	1.00	45.00	Yes (X)	Yes (X)	$0	$409,587	$36,991
DENNIS SABO
FOUNDATION DIRECTOR	37.00	3.00	Yes (X)	Yes (X)	$0	$81,300	$29,789
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
LAUREN BURKHART
TRUSTEE	1.00	0.00	Yes (X)		$0	$0	$0
JIM DAVIS
TRUSTEE	1.00	0.00	Yes (X)		$0	$0	$0
CHRISTINE GREILICH
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
JENNIFER MCDONALD
TRISTEE	1.00	0.00	Yes (X)		$0	$0	$0
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
PAT SULLIVAN
EMERITUS TRUSTEE	1.00	0.00	Yes (X)		$0	$0	$0
GAIL FOOS
EMERITUS TRUSTEE	1.00	0.00	Yes (X)		$0	$0	$0
JAMES AVERY
EMERITUS 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	$1,024,667	TotReportableCompRltdOrgAmt
Total Other Compensation	$91,460	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	$32,079	FundraisingAmt
All Other Contributions	$28,607	AllOtherContributionsAmt
Total Contributions	$60,686	TotalContributionsAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$45,117	TotalRevenueColumnAmt
Exclusion	$45,117	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$82,548	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	$82,548	SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$82,548	TotalRevenueColumnAmt
Exclusion	$82,548	ExclusionAmt

Field	Value	IRS element (for citing)
Fundraising Gross Income	$15,833	FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event	$32,079	ContriRptFundraisingEventAmt
Fundraising Direct Expenses	$18,431	FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	-$2,598	TotalRevenueColumnAmt
Exclusion	-$2,598	ExclusionAmt

Field	Value	IRS element (for citing)
Gaming Gross Income	$201,977	GamingGrossIncomeAmt
Gaming Direct Expenses	$120,253	GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$81,724	TotalRevenueColumnAmt
Exclusion	$81,724	ExclusionAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$267,477	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$206,791	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$2,000	TotalAmt
Program Services	$2,000	ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$2,500	TotalAmt
Management And General	$2,500	ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$14,606	TotalAmt
Management And General	$14,606	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$115,082	TotalAmt
Program Services	$108,683	ProgramServicesAmt
Management And General	$6,399	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$1,510	TotalAmt
Program Services	$1,510	ProgramServicesAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$8,257	TotalAmt
Program Services	$4,096	ProgramServicesAmt
Management And General	$4,161	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$3,225	TotalAmt
Program Services	$2,669	ProgramServicesAmt
Management And General	$556	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
SPECIAL PROJECT EXPENSE	$59,490	$59,490
ADMINISTRATIVE FEES	$437		$437

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$207,107	TotalAmt
Program Services	$178,448	ProgramServicesAmt
Management And General	$28,659	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$13,673	BOYAmt
EOY	$172,261	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$474,118	BOYAmt
EOY	$688,078	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$706	BOYAmt
EOY	$5,441	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	$1,999,416	BOYAmt
EOY	$2,259,582	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,487,913	BOYAmt
EOY	$3,125,362	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$343,730	BOYAmt
EOY	$753,310	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	$434,283	BOYAmt
EOY	$843,863	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	$1,608,894	BOYAmt
EOY	$1,818,463	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$444,736	BOYAmt
EOY	$463,036	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,053,630	BOYAmt
EOY	$2,281,499	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$2,487,913	BOYAmt
EOY	$3,125,362	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$60,370	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$147,150	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$20,349	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	$0	SupportAmt
Other Support	$0	OtherSupportAmt

Field	Value	IRS element (for citing)
Supported Organizations Total	1	SupportedOrganizationsTotalCnt
Support Sum	$0	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	$36,371	GrossReceiptsEvent1Amt
Charitable Contri Event1	$32,079	CharitableContriEvent1Amt
Gross Revenue Event1	$4,292	GrossRevenueEvent1Amt
Cash Prizes Event1	$1,400	CashPrizesEvent1Amt
Non Cash Prizes Event1	$0	NonCashPrizesEvent1Amt
Rent Facility Costs Event1	$8,339	RentFacilityCostsEvent1Amt
Food And Beverage Event1	$2,675	FoodAndBeverageEvent1Amt
Other Direct Expenses Event1	$7,417	OtherDirectExpensesEvent1Amt
Gross Receipts Total	$36,371	GrossReceiptsTotalAmt
Charitable Contributions Tot	$32,079	CharitableContributionsTotAmt
Gross Revenue Total Events	$4,292	GrossRevenueTotalEventsAmt
Cash Prizes Total Events	$1,400	CashPrizesTotalEventsAmt
Rent Fclty Costs Total Events	$8,339	RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events	$2,675	FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events	$7,417	OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events	$19,831	DirectExpenseSummaryEventsAmt
Net Income Summary	-$15,539	NetIncomeSummaryAmt

Gaming Information GamingInformationGrp

Field	Value	IRS element (for citing)
Gross Revenue Other Gaming	$201,977	GrossRevenueOtherGamingAmt
Cash Prizes Other Gaming	$106,438	CashPrizesOtherGamingAmt
Oth Direct Expnss Other Gaming	$13,815	OthDirectExpnssOtherGamingAmt
Volunteer Labor Other Gaming	0	VolunteerLaborOtherGamingInd
Gross Revenue Total Gaming	$201,977	GrossRevenueTotalGamingAmt
Cash Prizes Total Gaming	$106,438	CashPrizesTotalGamingAmt
Oth Direct Expnss Total Gaming	$13,815	OthDirectExpnssTotalGamingAmt
Direct Expense Summary Gaming	$120,253	DirectExpenseSummaryGamingAmt
Net Gaming Income Summary	$81,724	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	$85,050	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 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 (2 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
MICHAEL K WINTHROP
TRUSTEE (HOSPITAL PRESIDENT)	$0	$379,077	$0	$145,043	$0	$9,660	$0	$11,400	$0	$13,280	$0	$558,460	$0	$0
TIMOTHY BUIT
TRUSTEE (HOSPITAL CFO, PRESIDENT)	$0	$370,127	$0	$26,460	$0	$13,000	$0	$11,400	$0	$25,591	$0	$446,578	$0	$0

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	PART I, LINE 3:	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (12 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 2020.
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 108,683. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 108,683. SOFTWARE CONSULTING FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 6,399. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,399.
FORM 990, PART XI, LINE 9:	TEMPORARILY RESTRICTED CONTRIBUTIONS 20,349.
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.
FORM 990, PAGE 1, BOX J	HTTPS://WWW.BELLEVUEHOSPITAL.COM/DEPARTMENTS/FOUNDATION

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