THE BELLEVUE HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- THE BELLEVUE HOSPITAL (EIN 34-4428205)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-10
- IRS object ID
- 201603159349303705
- Schema version
- 2015v2.1
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-10T15:41:45-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 344428205 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | 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 | TIMOTHY BUIT | PersonNm |
| Person Title | EXECUTIVE VICE PRESIDENT, CFO | PersonTitleTxt |
| Phone | 4194834040 | PhoneNum |
| Signature | 2016-11-02 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Bernie Ostrowski | PreparerPersonNm |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MICHAEL K WINTHROP | 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 | $52,490,037 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BELLEVUEHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1956 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | 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. | ActivityOrMissionDesc |
| Voting Members Governing Body | 16 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 473 | TotalEmployeeCnt |
| Total Volunteers | 44 | TotalVolunteersCnt |
| Total Gross UBI | $13,821 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $12,821 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $157,982 | PYContributionsGrantsAmt |
| CY Contributions Grants | $88,825 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $47,109,581 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $50,187,618 | CYProgramServiceRevenueAmt |
| PY Investment Income | $56,365 | PYInvestmentIncomeAmt |
| CY Investment Income | $753,937 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,449,782 | PYOtherRevenueAmt |
| CY Other Revenue | $915,763 | CYOtherRevenueAmt |
| PY Total Revenue | $48,773,710 | PYTotalRevenueAmt |
| CY Total Revenue | $51,946,143 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $110,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $143,213 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $21,579,830 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,751,921 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $24,364,177 | PYOtherExpensesAmt |
| CY Other Expenses | $25,440,323 | CYOtherExpensesAmt |
| PY Total Expenses | $46,054,007 | PYTotalExpensesAmt |
| CY Total Expenses | $48,335,457 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,719,703 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,610,686 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $65,246,251 | TotalAssetsBOYAmt |
| Total Assets EOY | $64,108,246 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $29,954,585 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $27,523,474 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $35,291,666 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $36,584,772 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $41,683,954 | ExpenseAmt |
| Grant | $143,213 | GrantAmt |
| Revenue | $50,675,906 | RevenueAmt |
| Desc | OUR IMPACT ON THE BELLEVUE COMMUNITY: FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2015, THE BELLEVUE HOSPITAL EMPLOYED A TOTAL OF 473 INDIVIDUALS AND MAINTAINED A MEDICAL STAFF MEMBERSHIP OF OVER 150 PHYSICIANS. THE HOSPITAL PAID A TOTAL OF NEARLY $18 MILLION IN WAGES AND SALARIES. OUR EMPLOYEES PAID A TOTAL OF $256,738 IN INCOME TAXES TO THE CITY OF BELLEVUE AND AN ADDITIONAL $33,921 IN BELLEVUE LOCAL SCHOOL DISTRICT TAXES TO SUPPORT THE BELLEVUE COMMUNITY INFRASTRUCTURE AND DUCATIONAL NEEDS. OUR EMPLOYEES LIVING IN OTHER LOCAL SCHOOL DISTRICTS PAID $16,391 IN CLYDE LOCAL SCHOOL DISTRICT TAXES, $12,497 IN FREMONT LOCAL SCHOOL DISTRICT TAXES, AND $6,384 IN SENECA EAST SCHOOL DISTRICT TAXES. IN ADDITION, A TOTAL OF $4,088,575 OF THE HOSPITAL'S TOTAL GOODS AND SERVICES EXPENSED DURING 2015 WERE PURCHASED LOCALLY FROM AREA BUSINESSES.SERVING THE BELLEVUE COMMUNITY: A TOTAL OF 1,780 COMMUNITY MEMBERS WERE ADMITTED TO OUR FACILITY DURING 2015. IN ADDITION, A TOTAL OF 66,237 VISITS WERE MADE FOR OUTPATIENT CARE. OUR EMERGENCY ROOM TREATED AN ADDITIONAL 16,473 PATIENTS DURING 2015 AND WE ASSISTED IN THE DELIVERY OF 409 BABIES. WE PROVIDED OVER $1 MILLION IN FREE CARE TO UNINSURED OR UNDERINSURED PATIENTS. | Desc |
| Total Program Service Expenses | $41,683,954 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | Yes (1) | 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 | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| 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 | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 58 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 473 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 16 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | 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 | 0 | 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 | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RACHEL HERMAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4194834040 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1400 W MAIN ST | 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 | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MICHAEL K WINTHROP | ||||||||
| PRESIDENT | 45.00 | 1.00 | Yes (X) | Yes (X) | $518,051 | $0 | $24,759 | |
| TOM BARTH | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NANCY BEIER | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JIMMIE FITZGERALD | ||||||||
| CHAIRMAN | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DOUG HOY MD | ||||||||
| VICE CHAIR | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DEAN MILLER | ||||||||
| CHAIRPERSON | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ALICIA CROCKETT | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DAVID WEST MD | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES HART | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS FORSTER | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES GERKEN | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL HOWARD | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| JOE WILSON | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| DONALD SMITH MD | ||||||||
| OFFICIO AS MEDICAL STAFF PRESIDENT | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| BEN BALL DO | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| NICHOLAS LIBEN DO | ||||||||
| TRUSTEE | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| TIMOTHY BUIT | ||||||||
| EXEC VP, CFO | 45.00 | 0.00 | Yes (X) | $346,656 | $0 | $31,400 | ||
| DEBORAH O'TOOLE | ||||||||
| PHARMACIST | 40.00 | 0.00 | $118,106 | $0 | $12,294 | Yes (X) | ||
| LISA SARTAIN | ||||||||
| VICE PRESIDENT, HR | 45.00 | 0.00 | $171,697 | $0 | $13,270 | Yes (X) | ||
| SARA BROKAW | ||||||||
| VICE PRESIDENT, PATIENT CARE | 40.00 | 0.00 | $211,773 | $0 | $6,489 | Yes (X) | ||
| PATRICIA SEMER | ||||||||
| VICE PRESIDENT, ADMINISTRA | 45.00 | 0.00 | $186,738 | $0 | $27,455 | Yes (X) | ||
| SHARI LOVE | ||||||||
| PHARMACIST | 40.00 | 0.00 | $132,900 | $0 | $13,665 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,685,921 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $129,332 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BELLEVUE ANESTHESIA ASSOCIATES LLC | |||||
| 1355 W MAIN ST | BELLEVUE | OH | 44811 | ANESTHESIA SERVICES | $778,513 |
| EMERGENCY PROFESSIONAL SERVICES INC | |||||
| PO BOX 634850 | CINCINNATI | OH | 45263 | EMERGENCY SERVICES | $600,000 |
| SOUTH SHORE RADIOLOGY | |||||
| PO BOX 1800 | SANDUSKY | OH | 44870 | RADIOLOGY SERVICES | $502,256 |
| CLEVELAND CLINIC FOUNDATION | |||||
| 9500 EUCLID AVE MAIL CODE H18 | CLEVELAND | OH | 44195 | CARDIAC AND VASCULAR SERVICES | $350,000 |
| BAYLESS PATHMARK INC | |||||
| 19250 E BAGLEY RD SUITE 101 | MIDDLEBURG HEIGHTS | OH | 44130 | PATHOLOGY SERVICES | $207,721 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $7,500 | RelatedOrganizationsAmt |
| All Other Contributions | $81,325 | AllOtherContributionsAmt |
| Total Contributions | $88,825 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT SERVICES | 622110 | $49,459,963 | $49,459,963 | |
| PASS THROUGH INCOME | 900003 | $463,810 | $449,989 | $13,821 |
| Health Department | 622110 | $171,843 | $171,843 | |
| Community Education | 622110 | $36,652 | $36,652 | |
| Contract Therapy | 622110 | $35,130 | $35,130 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,220 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $20,220 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $50,187,618 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $797,918 | TotalRevenueColumnAmt |
| Exclusion | $797,918 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $270,343 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $438,127 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$167,784 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$167,784 | TotalRevenueColumnAmt |
| Exclusion | -$167,784 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $61,786 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $105,767 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$43,981 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$43,981 | TotalRevenueColumnAmt |
| Exclusion | -$43,981 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| EHR PAYMENT ACCRUAL | 900099 | $447,589 | $447,589 | |
| CAFETERIA/CAFE | 722514 | $282,222 | $282,222 | |
| Gift Shop | 453220 | $54,520 | $54,520 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $299,216 | TotalRevenueColumnAmt |
| Exclusion | $299,216 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,083,547 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $51,946,143 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $50,675,906 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $13,821 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,167,591 | 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 | $128,213 | TotalAmt |
| Program Services | $128,213 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $920,866 | TotalAmt |
| Management And General | $920,866 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,032,650 | TotalAmt |
| Program Services | $14,056,183 | ProgramServicesAmt |
| Management And General | $1,976,467 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $586,928 | TotalAmt |
| Program Services | $509,500 | ProgramServicesAmt |
| Management And General | $77,428 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,968,417 | TotalAmt |
| Program Services | $3,479,200 | ProgramServicesAmt |
| Management And General | $489,217 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,243,060 | TotalAmt |
| Program Services | $1,100,905 | ProgramServicesAmt |
| Management And General | $142,155 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,011 | TotalAmt |
| Management And General | $188,011 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $472,199 | TotalAmt |
| Management And General | $472,199 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,256,411 | TotalAmt |
| Program Services | $4,608,413 | ProgramServicesAmt |
| Management And General | $647,998 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,070 | TotalAmt |
| Program Services | $289,580 | ProgramServicesAmt |
| Management And General | $39,490 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,382,780 | TotalAmt |
| Program Services | $3,044,502 | ProgramServicesAmt |
| Management And General | $338,278 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,016,615 | TotalAmt |
| Program Services | $894,621 | ProgramServicesAmt |
| Management And General | $121,994 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,700,316 | TotalAmt |
| Program Services | $3,152,975 | ProgramServicesAmt |
| Management And General | $547,341 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,239 | TotalAmt |
| Program Services | $2,850 | ProgramServicesAmt |
| Management And General | $389 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,710 | TotalAmt |
| Program Services | $136,514 | ProgramServicesAmt |
| Management And General | $19,196 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,956,802 | TotalAmt |
| Program Services | $3,469,017 | ProgramServicesAmt |
| Management And General | $487,785 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $437,964 | TotalAmt |
| Program Services | $434,253 | ProgramServicesAmt |
| Management And General | $3,711 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| UBI TAX | $205 | $205 | |
| MEDICAL SUPPLIES | $2,988,199 | $2,988,199 | |
| BAD DEBT EXPENSE | $2,448,751 | $2,448,751 | |
| FRANCHISE FEE | $663,285 | $663,285 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $440,766 | TotalAmt |
| Program Services | $261,993 | ProgramServicesAmt |
| Management And General | $178,773 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,335,457 | TotalAmt |
| Program Services | $41,683,954 | ProgramServicesAmt |
| Management And General | $6,651,503 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,081,952 | BOYAmt |
| EOY | $8,351,729 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,823,804 | BOYAmt |
| EOY | $4,997,530 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $399,180 | BOYAmt |
| EOY | $385,676 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $896,808 | BOYAmt |
| EOY | $789,900 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $73,229,857 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $37,358,533 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,101,134 | BOYAmt |
| EOY | $35,871,324 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,423,625 | BOYAmt |
| EOY | $9,748,587 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,250,078 | BOYAmt |
| EOY | $1,308,739 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,269,670 | BOYAmt |
| EOY | $2,654,761 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,246,251 | BOYAmt |
| EOY | $64,108,246 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,895,094 | BOYAmt |
| EOY | $6,795,554 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,513,824 | BOYAmt |
| EOY | $18,698,283 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,259,540 | BOYAmt |
| EOY | $1,295,257 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,286,127 | BOYAmt |
| EOY | $734,380 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,954,585 | BOYAmt |
| EOY | $27,523,474 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,291,666 | BOYAmt |
| EOY | $36,584,772 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $35,291,666 | BOYAmt |
| EOY | $36,584,772 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,246,251 | BOYAmt |
| EOY | $64,108,246 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,610,686 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$407,314 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$1,910,266 | 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) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteer Hours | 0 | VolunteerHoursCnt |
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,021 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,021 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | 3.6 PERCENT OF DUES TO THE OHIO HOSPITAL ASSOCIATION AND 22.12% OF THE AMERICAN HOSPITAL ASSOCIATION DUES WERE ALLOCATED TO LOBBYING ACTIVITIES BY THAT ORGANIZATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,161,317 | OtherCostOrOtherBasisAmt |
| Book Value | $2,161,317 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,457,206 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,744,326 | DepreciationAmt |
| Book Value | $26,712,880 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,188,051 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,757,769 | DepreciationAmt |
| Book Value | $6,430,282 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,423,283 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,856,438 | DepreciationAmt |
| Book Value | $566,845 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $35,871,324 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Third Party Settlement | $114,331 |
| Derivative Liability | $572,092 |
| DUE TO MEDICAL STAFF AND AUXILIARY | $47,957 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $734,380 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part X, Line 2: | FormAndLineReferenceDesc |
| 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $662,774 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $662,774 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01440 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,186,632 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,834,341 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,352,291 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02950 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,849,406 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,834,341 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,015,065 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04390 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $72,817 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,927 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $61,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,471 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $52,471 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $100 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $100 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,720 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $39,720 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $165,108 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,927 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $154,181 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,014,514 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,845,268 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,169,246 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04720 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $19,342 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,750 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $60,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $60,582 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $156 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $156 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $90,830 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $90,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,448,751 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $612,188 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,830,385 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,554,066 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$4,723,681 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| 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) |
|---|---|---|
| Website Address | WWW.BELLEVUEHOSPITAL.COM | WebsiteAddressTxt |
| State License | 1261 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Other | SWING BED - SNF HOME HEALTH | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.BELLEVUEHOSPITAL.COM | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.ALWAYSCHOOSEHEALTH.COM | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.BELLEVUEHOSPITAL.COM | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.BELLEVUEHOSPITAL.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.BELLEVUEHOSPITAL.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.BELLEVUEHOSPITAL.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| THE BELLEVUE HOSPITAL | Part V, Section B, Line 5: THE NEEDS OF THE POPULATION, ESPECIALLY THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS, WERE TAKEN INTO ACCOUNT THROUGH THE SAMPLE METHODOLOGY THAT SURVEYED THESE POPULATIONS AND OVER-SAMPLED MINORITY POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT AND COMMUNITY PLANNING PROCESS, SUCH AS MENTAL HEALTH AND RECOVERY SERVICES BOARD, WSOS, AND SANDUSKY COUNTY HEALTH PARTNERS. PARTICIPANTS INCLUDED THE FOLLOWING GROUPS AND ORGANIZATIONS: (A (PH) AFTER THEIR NAME INDICATES THEY WORK IN THE PUBLIC HEALTH FIELD.)MIKE WINTHROP, THE BELLEVUE HOSPITAL (PH); JOE LISZAK, COMMUNITY HEALTH SERVICES (PH); TIM WISE, FIRELANDS COUNSELING AND RECOVERY SERVICES (PH); TRACI MCCAUDY, FREMONT CITY SCHOOL DISTRICT; JOHN YANES, MEMORIAL HEALTH CARE SYSTEM (PH); NANCY COCHRAN, MENTAL HEALTH AND RECOVERY SERVICES BOARD (PH); FRANCIS AONA, M.D., PHYSICIAN; DEB YENRICK, SANDUSKY COUNTY BOARD OF DD (PH); CATHY GLASSFORD, SANDUSKY COUNTY FAMILY & CHILDREN FIRST COUNCIL; DAVE POLLICK, SANDUSKY COUNTY HEALTH DEPARTMENT (PH); AND NEIL MCCABE, WSOS. |
| THE BELLEVUE HOSPITAL | Part V, Section B, Line 6a: MEMORIAL HOSPITAL OF SANDUSKY COUNTY, FREMONT, OHIO. |
| THE BELLEVUE HOSPITAL | Part V, Section B, Line 6b: THE BELLEVUE HOSPITAL PARTNERED WITH OTHER LOCAL AGENCIES IN THE GROUP KNOWN AS SANDUSKY COUNTY HEALTH PARTNERS INCLUDING: SANDUSKY COUNTY HEALTH DEPARTMENT, COMMUNITY HEALTH SERVICES, FIRELANDS COUNSELING & RECOVERY SERVICES, FREMONT CITY SCHOOLS, MENTAL HEALTH AND RECOVERY SERVICES BOARD, SANDUSKY COUNTY BOARD OF DD, SANDUSKY COUNTY FAMILY AND CHILDREN FIRST COUNCIL AND WSOS. HEALTH PARTNERS THEN COLLABORATED WITH THE HOSPITAL COUNCIL OF NORTHWEST OHIO DATA DIVISION AND THE UNIVERSITY OF TOLEDO HEALTH AND HUMAN SERVICES DEPARTMENT TO CONDUCT THE FORMAL COUNTY HEALTH ASSESSMENT. |
| THE BELLEVUE HOSPITAL | Part V, Section B, Line 7d: THE CHNA IS ALSO AVAILABLE ONLINE AT: HTTP://WWW.HCNO.ORG/PDF/COUNTIES/SANDUSKYCOUNTY2013HEALTHASSESSMENT.PDF |
| THE BELLEVUE HOSPITAL | Part V, Section B, Line 11: THE HEALTH NEEDS LISTED IN THE CHNA ARE IMPORTANT ISSUES AND ARE BEING ADDRESSED BY NUMEROUS PROGRAMS AND INITIATIVES SUPPORTED BY THE BELLEVUE HOSPITAL AND OTHER GROUPS AND ORGANIZATIONS WITHIN THE COMMUNITY. PLEASE REFERENCE THE ONLINE CHNA AND IMPLEMENTATION STRATEGY FOR FURTHER INFORMATION ON THE ACTIONS THAT ARE BEING UNDERTAKEN TO ADDRESS THESE NEEDS. FURTHERMORE, THE BELLEVUE HOSPITAL WILL NOT SPECIFICALLY ADDRESS MENTAL HEALTH, RISKY BEHAVIOR IN YOUTH - TEEN PREGNANCY AND RX DRUG MISUSE AS PART OF OUR IMPLEMENTATION PLAN DUE TO LIMITED FINANCIAL AND HUMAN RESOURCES AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES ON THE PRIORITY HEALTH NEEDS IDENTIFIED. THE HEALTH NEEDS MAY ALSO BE ADDRESSED BY THE HEALTH DEPARTMENT OR ANOTHER AGENCY. FURTHER INFORMATION ON THE HEALTH NEEDS THAT ARE NOT BEING ADDRESSED BY THE BELLEVUE HOSPITAL CAN BE FOUND IN THE IMPLEMENTATION STRATEGY PART IX. |
| THE BELLEVUE HOSPITAL | Part V, Section B, Line 22d: 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. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | CHARITY CARE AND MEDICAID COSTS WERE CALCULATED USING A COST TO CHARGE RATIO USING THE WORKSHEET 2 METHOD TO CALCULATE THE COST TO CHARGE RATIO. THE REMAINING COSTS LISTED IN 7E-7I ARE DERIVED FROM ACTUAL COSTS PULLED FROM THE HOSPITAL'S ACCOUNTING SYSTEM. |
| Part I, Ln 7 Col(f): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,448,751. |
| Part II, Community Building Activities: | OUR HOSPITAL PARTICIPATES IN SEVERAL COMMUNITY BUILDING ACTIVITIES WHICH ARE INCLUDED IN PART II. THESE ACTIVITIES INCLUDE: - PHYSICAL IMPROVEMENTS: USED LAND OWNED BY HOSPITAL TO GROW A LOCAL CROP FOR DONATION TO BELLEVUE FISH & LOAVES FOR DISTRIBUTION TO LOW INCOME COMMUNITY MEMBERS TO ENSURE NUTRITIOUS FOOD CHOICES; CONTRIBUTED TO THE SANDUSKY COUNTY PARK DISTRICT WITH AN ANNUAL PLEDGE TO HELP MAINTAIN THE COUNTY PARKS AND BIKE AND WALKING TRAILS TO ENCOURAGE PHYSICAL ACTIVITY. - ECONOMIC DEVELOPMENT: ACTIVE ROLE WITH SANDUSKY COUNTY ECONOMIC DEVELOPMENT ORGANIZATION AND CLYDESCOPE ECONOMIC DEVELOPMENT CORPORATION TO CREATE NEW EMPLOYMENT OPPORTUNITIES INCLUDING HEALTHCARE COVERAGE. - COMMUNITY SUPPORT: PROVIDE SUPPORT FOR LOCAL UNITED SELECTIVE FUND CAMPAIGN AND OTHER LOCAL NON-PROFIT ORGANIZATIONS; AND CONTRIBUTED TO THE BELLEVUE RECREATION DEPARTMENT TO PURCHASE JUNGLE JUNCTION, THE LARGEST INDOOR PLAY STRUCTURE IN OHIO, TO ENCOURAGE PHYSICAL ACTIVITY FOR CHILDREN AGES 12 AND UNDER. PART III, LINE 2:EXPLANATION: BAD DEBT EXPENSE REPORTED IS RECORDED PER THE FINANCIAL STATEMENTS. |
| Part III, Line 3: | THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE THAT MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS MADE ON A PRESUMPTIVE BASIS BASED ON BEST INFORMATION AVAILABLE. THE IDENTIFICATION OF PATIENTS ELIGIBLE FOR CHARITY CARE IS SOLELY BASED ON THE COOPERATION OF THE PATIENT TO PROVIDE THE ORGANIZATION WITH THE APPROPRIATE FAMILY AND FINANCIAL INFORMATION TO DETERMINE THEIR ELIGIBILITY. IN ADDITION TO THE INTERNALLY IDENTIFIED CHARITY ACCOUNTS, 25% OF ACCOUNTS THAT WERE RETURNED FROM THE STATE COLLECTION IN 2015 HAVE BEEN IDENTIFIED AS CHARITY OR MEDICALLY INDIGENT. APPLYING THIS RATIO TO THE BAD DEBT EXPENSE REPORTED IN PART III, LINE 2, IT IS ESTIMATED THAT $752,364 OF OUR ORGANIZATION'S BAD DEBT EXPENSE MAY BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE AND SHOULD BE COUNTED AS COMMUNITY BENEFIT. AS A NOT-FOR-PROFIT HOSPITAL, PATIENT CARE IS PROVIDED TO ALL PATIENTS, REGARDLESS OF THEIR ECONOMIC MEANS, WHICH QUALIFIES BAD DEBT AS A COMMUNITY BENEFIT. THIS IS REPORTED ON PART III, LINE 3. |
| Part III, Line 4: | ACCOUNTS RECEIVABLE FROM PATIENTS, INSURANCE COMPANIES, AND GOVERNMENTAL AGENCIES ARE BASED ON GROSS CHARGES. AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ESTABLISHED ON AN AGGREGATE BASIS BY USING HISTORICAL WRITE-OFF RATE FACTORS APPLIED TO UNPAID ACCOUNTS BASED ON AGING. LOSS RATE FACTORS ARE BASED ON HISTORICAL LOSS EXPERIENCE AND ADJUSTED FOR ECONOMIC CONDITIONS AND OTHER TRENDS AFFECTING THE HOSPITAL'S ABILITY TO COLLECT OUTSTANDING AMOUNTS. UNCOLLECTIBLE AMOUNTS ARE WRITTEN OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS IN THE PERIOD THEY ARE DETERMINED TO BE UNCOLLECTIBLE. AN ALLOWANCE FOR CONTRACTUAL ADJUSTMENTS AND INTERIM PAYMENT ADVANCES IS BASED ON EXPECTED PAYMENT RATES FROM PAYORS BASED ON CURRENT REIMBURSEMENT METHODOLOGIES. THIS AMOUNT ALSO INCLUDES AMOUNTS RECEIVED AS INTERIM PAYMENTS AGAINST UNPAID CLAIMS BY CERTAIN PAYORS.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR A PORTION OF THE CLAIM, THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES, OR THE DISCOUNTED RATES IF NEGOTIATED, AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| Part III, Line 8: | MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO. THE HOSPITAL BELIEVES THAT THE $4,723,681 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 2015, MEDICARE ACCOUNTED FOR APPROXIMATELY 36% OF HOSPITAL REVENUES. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. |
| Part III, Line 9b: | COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. THE HOSPITAL WILL PURSUE PAYMENT FOR CARE FROM EVERY REASONABLE SOURCE, GOVERNMENTAL AND PRIVATE. TO ENSURE THIS IS COMPLETED, INSURANCE VERIFICATION IS PERFORMED, A SYSTEM REVIEW IS MADE OF THE PATIENT'S INSURANCE HISTORY, AND TELEPHONE CALLS ARE MADE TO THE PATIENT. IF THE PATIENT IS ELIGIBLE FOR HCAP, THE COVERED CHARGES ARE WRITTEN OFF TO HCAP. IF THE PATIENT IS LATER FOUND TO BE ELIGIBLE FOR MEDICAID, THE HCAP WRITE-OFF IS REVERSED AND THE ACCOUNT BILLED TO MEDICAID. BAD DEBT ACCOUNTS ELIGIBLE FOR CHARITY ARE REINSTATED FROM BAD DEBT AND POSTED TO THE APPROPRIATE ADJUSTMENT OR CHARITY WRITE-OFF CODES. |
| Part VI, Line 2: | N/A AS THE ORGANIZATION PERFORMED ALL HEALTH CARE NEEDS ASSESSMENTS AS PART OF THE CHNA THAT WAS FILED. PLEASE REFER TO THE CHNA FOR DETAILS. |
| Part VI, Line 3: | THE HOSPITAL POSTS NOTICES IN APPROPRIATE AREAS IN THE FACILITY, INCLUDING BUT NOT LIMITED TO THE ADMISSIONS AREAS, THE PATIENT FINANCE OFFICE, AND THE EMERGENCY DEPARTMENT. THE NOTICE SPECIFIES THE RIGHTS OF PERSONS WITH INCOMES AT OR BELOW THE FEDERAL POVERTY GUIDELINES (FPG) TO RECEIVE, WITHOUT CHARGE TO THE INDIVIDUAL, BASIC, MEDICALLY NECESSARY HOSPITAL-LEVEL SERVICES AT THE HOSPITAL. THE INITIAL BILL AND AT LEAST THE FIRST FOLLOW-UP BILL HAS A WRITTEN STATEMENT THAT EXPLAINS THAT INDIVIDUALS WITH INCOME AT OR BELOW THE FPG ARE ELIGIBLE FOR SERVICE WITHOUT CHARGE, SPECIFIES THE FPG FOR INDIVIDUALS AND FAMILIES OF VARIOUS SIZES AT THE TIME THE BILL IS SENT, AND DESCRIBES THE PROCEDURE TO APPLY FOR FREE CARE. THE PATIENT FINANCE OFFICE AND PATIENT ACCESS DEPARTMENTS WILL PROVIDE APPLICATIONS FOR FINANCIAL ASSISTANCE TO PATIENTS. A DETERMINATION OF EVERY APPLICATION WILL BE COMPLETED BY THE PATIENT FINANCE OFFICE AND A COPY SENT TO THE PATIENT. |
| Part VI, Line 4: | BELLEVUE, 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. THE FOUR COUNTY ESTIMATED POPULATION WAS 249,308 FOR 2015, A 2.04% DECLINE SINCE THE 2010 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 MOST RECENT ECONOMIC RECESSION, BUT HAS MADE A MODEST RECOVERY. THE U.S. DEPARTMENT OF LABOR, BUREAU OF LABOR STATISTICS, REPORTS THE AVERAGE UNEMPLOYMENT RATE FOR THE FOUR COUNTY AREA FOR 2015 WAS 5.4%, DOWN FROM 6.2% FOR 2014, AND SLIGHTLY HIGHER THAN OHIO'S STATEWIDE UNEMPLOYMENT RATE OF 4.6% AND THE NATIONWIDE UNEMPLOYMENT RATE OF 4.8% FOR DECEMBER 2015. HURON COUNTY RANKED 10TH IN THE STATE OF OHIO IN 2015 WITH AN ANNUAL AVERAGE UNEMPLOYMENT RATE OF 6.6%. ACCORDING TO THE U.S. CENSUS BUREAU, 2015 POVERTY RATES, THE LATEST AVAILABLE, HAVE REMAINED STEADY IN ALL FOUR COUNTIES AND RANGED FROM 5.7% FOR SANDUSKY COUNTY TO 6.5% FOR ERIE COUNTY. OHIO DEPARTMENT OF JOB & FAMILY SERVICES REPORTED THAT 59,666 RESIDENTS, OR 23.93% OF RESIDENTS IN THE FOUR COUNTY AREA WERE ELIGIBLE FOR MEDICAID AT 12/31/15, AND 12.52% OF RESIDENTS IN THE FOUR COUNTY AREA RECEIVED FOOD ASSISTANCE DURING DECEMBER 2015 COMPARED TO 13.5% OF RESIDENTS DURING DECEMBER 2014. SANDUSKY AND ERIE COUNTIES ARE BOTH DESIGNATED AS MEDICALLY UNDERSERVED AREAS, AND ALL FOUR COUNTIES ARE DESIGNATED AS PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREAS. |
| Part VI, Line 5: | MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL BOARD OF DIRECTORS IS COMPRISED OF LOCAL MEDICAL AND BUSINESS PROFESSIONALS WHO VOLUNTEER COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE OF GENERAL STEWARDSHIP. THE HOSPITAL EXPANDS ACCESS POINTS OF CARE THROUGHOUT THE COMMUNITY BY PROVIDING FREE OR LOW-COST BLOOD PRESSURE, DIABETES, CHOLESTEROL, SKIN CANCER, PROSTATE CANCER AND OTHER SCREENINGS. EDUCATIONAL PROGRAMS AND SUPPORT GROUPS ARE HELD TO PROVIDE INFORMATION ON SUCH TOPICS AS TOBACCO CESSATION, WEIGHT MAINTENANCE, DIABETES, CHILDBIRTH, INFANT CARE, AND MORE. HOSPITAL EMPLOYEES SERVE ON THE BOARDS OF MANY COMMUNITY AND HEALTH-ORIENTED ORGANIZATIONS. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY-WIDE AND REGIONAL-WIDE MASS CASUALTY AND DISASTER PREPAREDNESS WITH 33 OTHER REGIONAL HOSPITALS AS A MEMBER OF THE HOSPITAL COUNCIL OF NORTHWEST OHIO, TO ASSURE THE SAFETY AND HEALTH OF COMMUNITY RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT, BIOTERRORISM OR OTHER LARGE SCALE EMERGENCY. MEMBERSHIP BENEFITS INCLUDE INCREASED PURCHASING POWER FOR DISASTER SUPPLIES, EMERGENCY RESPONSE TRAINING, INCIDENT COMMAND, AND INFORMATION SHARING TO KEEP COMPLIANT WITH HOMELAND SECURITY REGULATIONS. |
| Part VI, Line 6: | THE BELLEVUE HOSPITAL IS A GENERAL ACUTE CARE PROVIDER AT ONE FACILITY IN THE BELLEVUE, OHIO AREA. THE BELLEVUE HOSPITAL IS THE PARENT ORGANIZATION OF BELLEVUE PROFESSIONAL SERVICES, INC. AND THE SOLE BENEFICIARY OF THE BELLEVUE HOSPITAL FOUNDATION. THE BELLEVUE HOSPITAL ASSOCIATION IS THE PARENT ORGANIZATION OF THE BELLEVUE HOSPITAL. THE BELLEVUE HOSPITAL ASSOCIATION MEETS ANNUALLY IN FEBRUARY TO ELECT THE BELLEVUE HOSPITAL BOARD OF TRUSTEES AND TO CONDUCT ANY NECESSARY BUSINESS. BELLEVUE PROFESSIONAL SERVICES, INC. PROVIDES CLINICAL AND MEDICAL PROFESSIONAL SERVICES TO RESIDENTS OF BELLEVUE AND CLYDE, OHIO AND THE SURROUNDING AREA. THE BELLEVUE HOSPITAL FOUNDATION SUPPORTS THE BELLEVUE HOSPITAL WITH FINANCIAL TRANSFERS IN THE FORM OF BOTH CASH AND NON-CASH TRANSFERS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt | Non Cash AssistanceNonCashAssistanceAmt | Non Cash AssistanceNonCashAssistanceDesc |
|---|---|---|---|---|---|---|---|---|---|
| PROMEDICA MEMORIAL HOSPITAL FOUNDATION | |||||||||
| 5217 MONROE ST SUITE A-1 | TOLEDO | OH | 43623 | 341517672 | 501(C)(3) | $25,000 | DOROTHY KERN CANCER CENTER PLEDGE 1 OF 2 | ||
| BELLEVUE RECREATION CLUB INC | |||||||||
| 110 CHERRY BLVD | BELLEVUE | OH | 44811 | 341462214 | 501(C)(3) | $12,500 | JUNGLE JUNCTION INDOOR PLAYGROUND PROJECT PLEDGE 1 OF 2 | ||
| BELLEVUE REDMEN ATHLETIC BOOSTERS INC | |||||||||
| PO BOX 486 | BELLEVUE | OH | 44811 | 341469153 | 501(C)(3) | $10,000 | PLEDGE 3 OF 5 - TURF PROJECT | ||
| SANDUSKY COUNTY PARK DISTRICT | |||||||||
| 1970 COUNTRYSIDE PLACE | FREMONT | OH | 43420 | 346401312 | STATE | $10,000 | PLEDGE 2 OF 5 ANNUAL PLEDGE PMTS | ||
| SANDUSKY COUNTY ECONOMIC DEVELOPMENT | |||||||||
| 2511 COUNTRYSIDE DR SUITE C | FREMONT | OH | 43420 | 341424666 | 501(C)(3) | $5,000 | PLEDGE 1 OF 5 - "PARTNERING FOR THE FUTURE" CAPITAL CAMPAIGN | ||
| CLYDESCOPE EDC | |||||||||
| 222 NORTH MAIN ST | CLYDE | OH | 43410 | 341811627 | 501(C)(3) | $5,000 | ANNUAL DONATION, ECONOMIC DEVELOPMENT | ||
| PERUVIAN AMERICAN MEDICAL SOCIETY ENDOWMENT | |||||||||
| 41360 FOX RUN RD 519 | NOVI | MI | 48377 | 382824781 | 501(C)(3) | $5,000 | MEDICAL SUPPLIES FOR MISSION TRIP TO IMPROVE ACCESS TO HEALTHCARE & PROMOTE WELLNESS AND EDUCATION FOR THE PEOPLE WHO LIVE ALONG THE RIVERS IN THE PERUVIAN AMAZON JUNGLE AND TO AID IN LONG-TERM MEDICAL DEVELOPMENT WITHIN THE REGION. | ||
| MESA (MEDICAL EQUIPMENT & SUPPLIES ABROAD FOUNDATION INC) | |||||||||
| 1092 BENDING BROOK LANE | WATERVILLE | OH | 43566 | 341522779 | 501(C)(3) | MEDICAL SUPPLIES FOR MESA PROGRAM | $55,713 | OUTDATED MEDICAL SUPPLIES FOR MESA PROGRAM | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 7 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | EMPLOYEE CHILDREN'S SCHOLARSHIP | GrantTypeTxt |
| Recipient | 10 | RecipientCnt |
| Cash Grant | $15,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL MADE ANNUAL PLEDGES TO PROMEDICA MEMORIAL HOSPITAL FOUNDATION, SANDUSKY COUNTY ECONOMIC DEVELOPMENT CORP., BELLEVUE ATHLETIC BOOSTERS, SANDUSKY COUNTY PARK DISTRICT, CLYDESCOPE ECONOMIC DEVELOPMENT CORP., PERUVIAN AMERICAN MEDICAL SOCIETY, AND MEDICAL EQUIPMENT & SUPPLIES ABROAD FOUNDATION INC. REPRESENTING OUR CONTINUED COMMITMENT FOR THE COMMUNITY. THE BELLEVUE REDMEN ATHLETIC BOOSTERS IS A 501(C)(3) ORGANIZATION. THE FIVE YEAR PLEDGE IS PROVIDED TO HELP SUPPORT THE SCHOOL'S TURF PROJECT. THE SANDUSKY COUNTY PARK DISTRICT PLEDGE IS TO PROVIDE A NATURE CENTER. THE CLYDESCOPE ANNUAL PLEDGE IS USED TO PROVIDE CONSULTING AND DEMOGRAPHIC STUDIES TO ASSIST IN PROMOTING ECONOMIC GROWTH IN THE COMMUNITY OF CLYDE AND THE SURROUNDING AREA. THE HOSPITAL ALSO DONATED MONEY TO THE BELLEVUE RECREATION CLUB INC. FOR THE PURCHASE OF A JUNGLE JUNCTION INDOOR PLAYGROUND. PART III: THE HOSPITAL HAS A COMMITTEE COMPOSED OF FOUR MEMBERS (AN HOURLY EMPLOYEE, A MEMBER OF THE MEDICAL STAFF, A MEMBER OF THE BOARD OF TRUSTEES AND A MEMBER OF THE COMMUNITY RELATIONS COMMITTEE OF THE FOUNDATION BOARD). ALL ELIGIBLE APPLICATIONS ARE REVIEWED BY THE COMMITTEE. EACH CANDIDATE IS SCORED BASED UPON THE INFORMATION PROVIDED IN THEIR APPLICATION. UPON THE DISCRETION OF THE COMMITTEE, INTERVIEWS OF THE APPLICANTS CAN TAKE PLACE. UP TO 10 CANDIDATES WILL BE SELECTED TO RECEIVE A $1,500.00 SCHOLARSHIP. THE HOSPITAL AWARDS THE SCHOLARSHIP PAYMENTS DIRECTLY TO THE COLLEGES TO OFFSET TUITION ONCE THE STUDENT PROVIDES THE HOSPITAL WITH PROOF OF ENROLLMENT FEES. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| 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 (5 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 | ||||||||||||||
| PRESIDENT | $426,268 | $0 | $79,468 | $0 | $12,315 | $0 | $10,600 | $0 | $14,159 | $0 | $542,810 | $0 | $0 | $0 |
| TIMOTHY BUIT | ||||||||||||||
| EXEC VP, CFO | $281,730 | $0 | $53,661 | $0 | $11,265 | $0 | $10,169 | $0 | $21,231 | $0 | $378,056 | $0 | $0 | $0 |
| LISA SARTAIN | ||||||||||||||
| VICE PRESIDENT, HR | $149,301 | $0 | $22,396 | $0 | $0 | $0 | $5,616 | $0 | $7,654 | $0 | $184,967 | $0 | $0 | $0 |
| SARA BROKAW | ||||||||||||||
| VICE PRESIDENT, PATIENT CARE | $184,138 | $0 | $27,635 | $0 | $0 | $0 | $5,921 | $0 | $568 | $0 | $218,262 | $0 | $0 | $0 |
| PATRICIA SEMER | ||||||||||||||
| VICE PRESIDENT, ADMINISTRA | $161,517 | $0 | $25,221 | $0 | $0 | $0 | $6,127 | $0 | $21,328 | $0 | $214,193 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION PAYS SOCIAL CLUB DUES ON THE BEHALF OF MICHAEL WINTHROP, CEO, TO CATAWBA ISLAND CLUB, AS A MEANS TO NETWORK WITH PHYSICIANS. NONE OF THE SOCIAL CLUB DUES WERE TREATED AS TAXABLE COMPENSATION TO MICHAEL WINTHROP. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (3 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| VILLAGE OF PORT JEFFERSON OHIO | ||||||||
| A | 341175548 | NONEAVAIL | 2012-08-28 | $9,992,500 | SEE PART VI | 0 | 0 | 0 |
| CITY OF BELLEVUE OHIO | ||||||||
| B | 346400096 | NONEAVAIL | 2012-09-12 | $8,500,000 | SEE PART VI | 0 | 0 | 0 |
| COUNTY OF SANDUSKY OHIO | ||||||||
| C | 346401312 | NONEAVAIL | 2012-10-03 | $2,569,153 | SEE PART VI | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (3 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Other Spent ProceedsOtherSpentProceedsAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,125,280 | $9,992,500 | $60,000 | $12,000 | $9,920,500 | 2005 | Yes (1) | 0 | Yes (1) | Yes (1) |
| B | $956,488 | $8,500,000 | $43,398 | $8,456,602 | 2004 | Yes (1) | 0 | Yes (1) | Yes (1) | |
| C | $289,102 | $2,569,153 | $30,573 | $2,538,580 | 2004 | Yes (1) | 0 | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (3 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Private Bus Use By OthersPrivateBusUseByOthersPct | Private Bus Concerning UBIPrivateBusConcerningUBIPct | Total Private Business UseTotalPrivateBusinessUsePct | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
| C | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | Yes (1) |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (3 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
| B | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
| C | 0 | 0 | Yes (1) | 0 | Yes (1) | 0 | 0 | 0 | Yes (1) |
Procedures Corrective Action ProceduresCorrectiveActionGrp (3 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
| C | Yes (1) |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART I, LINE A, COLUMN (F): | Currently refund the (1) 2003 Lease Obligations issued pursuant to the Master Lease-Purchase and Sublease-Purchase Agreement, dated as of July 1, 2003, by and among Fifth Third Bank, the City of Clyde, Ohio and The Bellevue Hospital, issued July 23, 2003 and (2) City of Bellevue, Ohio Adjustable Rate Demand Hospital Facilities Revenue Bonds, Series 2003 (The Bellevue Hospital Project) issued August 26, 2003. |
| SCHEDULE K, PART I, LINE B, COLUMN (F): | Currently refund the (1) 2003 Lease Obligations issued pursuant to the Master Lease-Purchase and Sublease-Purchase Agreement, dated as of July 15, 2003, by and among Fifth Third Bank, the County of Sandusky, Ohio and The Bellevue Hospital, issued August 8, 2003 and (2) 2003 Lease Obligations issued pursuant to the Master Lease-Purchase and Sublease-Purchase Agreement, dated as of July 1, 2003, by and among Fifth Third Bank, the City of Clyde, Ohio and The Bellevue Hospital, issued July 23, 2003. |
| SCHEDULE K, PART I, LINE C, COLUMN (F): | Currently refund the 2003 Lease Obligations issued pursuant to the Master Lease-Purchase and Sublease-Purchase Agreement, dated as of July 15, 2003, by and among Fifth Third Bank, the County of Sandusky, Ohio and The Bellevue Hospital, issued August 8, 2003. |
| SCHEDULE K, PART II, LINE 3, COLUMN C: | |
| SCHEDULE K, PART II, LINE 11, COLUMN B: |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| HASSELBACH & PAUL AGENCY INC | |||
| TOM BARTH IS OWNER OF HASSELBACH & PAUL AGENCY, INC | $172,975 | INSURANCE: DIRECTOR AND OFFICERS; PROFESSIONAL LIABILITY | 0 |
| SOUTH SHORE RADIOLOGY | |||
| DAVID WEST, M.D. IS OWNER OF SOUTH SHORE RADIOLOGY | $498,106 | RADIOLOGY SERVICES | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 THE BELLEVUE HOSPITAL ASSOCIATION, NORWALK AREA HEALTH SYSTEMS, AND FIRELANDS REGIONAL HEALTH SYSTEM. NAHS AND FIRELANDS EACH HAVE TWENTY PERCENT MEMBERSHIP INTEREST IN THE HOSPITAL AND REPRESENTATION ON THE BOARD OF TRUSTEES. THE BELLEVUE HOSPITAL ASSOCIATION HAS A 60% MEMBERSHIP INTEREST IN THE HOSPITAL AND REPRESENTATION ON THE BOARD OF TRUSTEES. |
| Form 990, Part VI, Section A, line 7a | NORWALK AREA HEALTH SYSTEMS AND FIRELANDS REGIONAL HEALTH SYSTEM CAN EACH APPOINT 2 MEMBERS TO THE BOARD OF DIRECTORS. THE BELLEVUE HOSPITAL ASSOCIATION APPOINTS THE REMAINING MEMBERS (UP TO 15) TO THE BOARD OF DIRECTORS. |
| Form 990, Part VI, Section B, line 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. IN ADDITION, EACH BOARD MEMBER RECEIVES A COPY OF THE FORM 990 PRIOR TO FILING. |
| Form 990, Part VI, Section B, line 12c | ON AN ANNUAL BASIS, THE PRESIDENT SHALL SEND TO ALL EXECUTIVE STAFF AND SELECTED EMPLOYEES, A COPY OF THE BOARD OF TRUSTEES CONFLICT OF INTEREST POLICY TO BE COMPLETED AND RETURNED. IN ADDITION, NEW BOARD MEMBERS THAT JOIN DURING THE YEAR FILL OUT AND COMPLETE THE CONFLICT OF INTEREST POLICY WHEN THEY FIRST JOIN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE BOARD OF TRUSTEES CONCERNING ANY INTERESTS TO BE DISCLOSED. IF ANY CONFLICTS DO ARISE, THAT TRUSTEE WILL ABSTAIN FROM VOTING ON THE ISSUE. PERIODIC REVIEWS ARE ALSO CONDUCTED TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES, AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. THE BOARD OF DIRECTORS REVIEW THE COMPLETED CONFLICT OF INTEREST POLICIES INCLUDING THE PRESIDENT'S. THE BOARD OF DIRECTORS REVIEW THE PRESIDENT'S COMPLETED CONFLICT OF INTEREST POLICY ONCE THE PRESIDENT LEAVES THE ROOM. |
| Form 990, Part VI, Section B, line 15 | IN DETERMINING EXECUTIVE STAFF COMPENSATION FOR THE CEO AND VICE PRESIDENTS, THE BOARD HAS A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT DIRECTORS. THE COMMITTEE UTILIZES AN OUTSIDE HEALTHCARE COMPENSATION CONSULTING COMPANY COMPARING COMPARABLE SIZED ORGANIZATIONS CONSISTENT WITH THE BOARD OF TRUSTEE COMPENSATION PHILOSOPHY STATEMENT. RECOMMENDATIONS ARE MADE FROM THE COMPENSATION COMMITTEE TO THE BOARD OF TRUSTEES. ANY COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMPENSATION COMMITTEE AND EXECUTIVE SESSION MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN NOVEMBER 2015. |
| Form 990, Part VI, Section C, line 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND THE FINANCIAL STATEMENTS ARE NOT CURRENTLY AVAILABLE TO THE PUBLIC. |
| Form 990, Part IX, line 11g | MEDICAL AND PLANT OPERATIONS: Program service expenses 4,608,413. Management and general expenses 647,998. Fundraising expenses 0. Total expenses 5,256,411. |
| Form 990, Part XI, line 9: | CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENTS 67,137. CONTRIBUTION OF CAPITAL TO BELLEVUE PROFESSIONAL SERVICES, INC. -1,660,000. BOOK TO TAX DIFFERENCE IN FLOW THROUGH INCOME -347,589. CONTRIBUTION OF CAPITAL FROM THE BELLEVUE HOSPITAL FOUNDATION 30,186. |
| 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
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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| THE BELLEVUE HOSPITAL FOUNDATION | |||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 341745374 | SUPPORT | OH | 501(C)(3) | LINE 11A, 1 | THE BELLEVUE HOSPITAL | Yes (1) | |
| THE BELLEVUE HOSPITAL ASSOCIATION | |||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 753102199 | ADMINISTRATIVE SUPPORT | OH | 501(C)(3) | LINE 11A, 1 | 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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Predominant Income TypePredominantIncomeTypeTxt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | Disproportionate AllocationsDisproportionateAllocationsInd | General Or Managing PartnerGeneralOrManagingPartnerInd | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BELLEVUE HEALTH NETWORK LLC | |||||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 341870470 | INSURANCE CONTRACTS | OH | THE BELLEVUE HOSPITAL | RELATED | -$1,358 | $349 | 0 | Yes (1) | 0.55560 |
| BELLEVUE HOSPITAL PAIN MANAGEMENT LLC | |||||||||||||
| 1400 WEST MAIN STREET | BELLEVUE | OH | 44811 | 464660177 | HEALTH CARE | OH | THE BELLEVUE HOSPITAL | RELATED | $394,413 | $295,795 | 0 | Yes (1) | 0.51000 |
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 WEST 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 Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE BELLEVUE HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $1,559,585 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $550,421 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| 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 | Yes (1) | 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 | Yes (1) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (4 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| BELLEVUE PROFESSIONAL SERVICES INC | ||
| J | $52,313 | LEASE AGREEMENT PAYMENT |
| BELLEVUE PROFESSIONAL SERVICES INC | ||
| R | $1,660,000 | CASH CAPITAL CONTRIBUTION |
| BELLEVUE HOSPITAL FOUNDATION | ||
| Q | $91,875 | REIMBURSEMENTS |
| BELLEVUE PAIN MANAGEMENT | ||
| Q | $387,595 | REIMBURSEMENTS |
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