2015-10-29T13:06:33-05:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2014-01-01 344428205 THE BELLEVUE HOSPITAL BELL 4194834040 1400 WEST MAIN STREET BELLEVUE OH 44811 DEAN MILLER CHAIRMAN 4194834040 2015-10-28 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-02-25 16:41:14Z MICHAEL K WINTHROP 1400 WEST MAIN STREET BELLEVUE OH 44811 49973883 0 X WWW.BELLEVUEHOSPITAL.COM X 1956 OH THE BELLEVUE HOSPITAL IS A COMMUNITY BASED GENERAL ACUTE CARE HOSPITAL THAT PROVIDES CARE TO THE BELLEVUE AND SURROUNDING AREA WITHOUT REGARD TO ABILITY TO PAY. 15 13 505 127 7019 6019 280944 157982 46377948 47109581 177045 56365 1725617 1449782 48561554 48773710 50000 110000 0 0 22018052 21579830 0 0 0 24067531 24364177 46135583 46054007 2425971 2719703 65323439 65246251 32521918 29954585 32801521 35291666 X WE CARE FOR PATIENTS AS MEMBERS OF OUR FAMILY. WE WORK TO HEAL THE SICK, TREAT THE INJURED, AND PREVENT ILLNESS. WE PROTECT THE TRUST OF OUR COMMUNITY AND EMPLOYEES, TO BE A PROGRESSIVE, QUALITY HEALTH CARE ORGANIZATION. OUR PRIMARY GOAL IS AND ALWAYS WILL BE TO CARE. 0 1 40141097 110000 48160975 OUR IMPACT ON THE BELLEVUE COMMUNITY: FOR THE CALENDAR YEAR ENDING DECEMBER 31, 2014, THE BELLEVUE HOSPITAL EMPLOYED A TOTAL OF 505 INDIVIDUALS AND MAINTAINED A MEDICAL STAFF MEMBERSHIP OF OVER 150 PHYSICIANS. THE HOSPITAL PAID A TOTAL OF OVER $16 MILLION IN WAGES AND SALARIES. OUR EMPLOYEES PAID A TOTAL OF $241,028 IN INCOME TAXES TO THE CITY OF BELLEVUE AND AN ADDITIONAL $32,607 IN BELLEVUE LOCAL SCHOOL DISTRICT TAXES TO SUPPORT THE BELLEVUE COMMUNITY INFRASTRUCTURE AND DUCATIONAL NEEDS. OUR EMPLOYEES LIVING IN OTHER LOCAL SCHOOL DISTRICTS PAID $16,940 IN CLYDE LOCAL SCHOOL DISTRICT TAXES, $11,058 IN FREMONT LOCAL SCHOOL DISTRICT TAXES, AND $6,302 IN SENECA EAST SCHOOL DISTRICT TAXES. IN ADDITION, A TOTAL OF $2,787,992 OF THE HOSPITAL'S TOTAL GOODS AND SERVICES EXPENSED DURING 2014 WERE PURCHASED LOCALLY FROM AREA BUSINESSES.SERVING THE BELLEVUE COMMUNITY: A TOTAL OF 1,547 COMMUNITY MEMBERS WERE ADMITTED TO OUR FACILITY DURING 2014. IN ADDITION, A TOTAL OF 58,711 VISITS WERE MADE FOR OUTPATIENT CARE. OUR EMERGENCY ROOM TREATED AN ADDITIONAL 15,573 PATIENTS DURING 2014 AND WE ASSISTED IN THE DELIVERY OF 382 BABIES. WE PROVIDED OVER $1 MILLION IN FREE CARE TO UNINSURED OR UNDERINSURED PATIENTS. 40141097 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 48 0 1 505 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 1 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 OH X RACHEL HERMAN 4194834040 1400 W MAIN ST BELLEVUE OH 44811 MICHAEL K WINTHROP PRESIDENT 45.00 1.00 X X 483406 0 29365 DEAN MILLER CHAIRPERSON 1.00 0.00 X X 0 0 0 BENJAMIN BALL DO 1ST VICE CHAIR 1.00 0.00 X X 0 0 0 TOM BARTH 2ND VICE CHAIR 1.00 0.00 X X 0 0 0 NANCY BEIER TREASURER 1.00 0.00 X X 0 0 0 JIMMIE FITZGERALD SECRETARY 1.00 0.00 X X 0 0 0 JOE WILSON TRUSTEE 1.00 0.00 X 0 0 0 PAUL HOWARD TRUSTEE 1.00 0.00 X 0 0 0 DOUG HOY MD TRUSTEE 1.00 0.00 X 0 0 0 NICHOLAS LIBEN DO TRUSTEE 1.00 0.00 X 0 0 0 JAMES GERKEN TRUSTEE 1.00 0.00 X 0 0 0 THOMAS FORSTER TRUSTEE 1.00 0.00 X 0 0 0 JAMES HART TRUSTEE 1.00 0.00 X 0 0 0 DAVID WEST MD TRUSTEE 1.00 0.00 X 0 0 0 ALICIA CROCKETT TRUSTEE 1.00 0.00 X 0 0 0 TIMOTHY BUIT EXEC VP, CFO 45.00 0.00 X 322184 0 28933 PATRICIA SEMER VICE PRESIDENT, ADMINISTRATION 40.00 0.00 X 185909 0 27642 SARA BROKAW VICE PRESIDENT, PATIENT CARE 40.00 0.00 X 186231 0 686 LISA SARTAIN VICE PRESIDENT, HUMAN RESOURCES 40.00 0.00 X 160396 0 7212 DEBORAH O'TOOLE PHARMACIST 40.00 0.00 X 110879 0 13297 1449005 0 107135 6 0 1 0 EMERGENCY PROFESSIONAL SERVICES INC PO BOX 634850 CINCINNATI OH 45263 EMERGENCY SERVICES 600000 SOUTH SHORE RADIOLOGY PO BOX 1800 SANDUSKY OH 44870 RADIOLOGY SERVICES 488218 BELLEVUE ANESTHESIA ASSOCIATES LLC 1355 W MAIN ST BELLEVUE OH 44811 ANESTHESIA SERVICES 375237 BAYLESS PATHMARK INC 19250 E BAGLEY RD SUITE 101 MIDDLEBURG HEIGHTS OH 44130 PATHOLOGY SERVICES 188122 CLEVELAND CLINIC FOUNDATION 9500 EUCLID AVE MAIL CODE H18 CLEVELAND OH 44195 CARDIAC AND VASCULAR SERVICES 187500 8 105871 52111 1493 157982 PATIENT SERVICES 622110 46795067 46795067 PASS THROUGH INCOME 900003 120757 113738 7019 HEALTH DEPARTMENT 622110 92322 92322 COMMUNITY EDUCATION 622110 42416 42416 CONTRACT THERAPY 622110 31244 31244 27775 27775 47109581 107325 107325 276520 342444 -65924 -65924 -65924 803444 3325 852010 5719 -48566 -2394 -50960 -50960 EMR INCENTIVE PAMYNET 900099 1058413 1058413 CAFETERIA/CAFE 722514 276393 276393 GIFT SHOP 453220 53242 53242 127658 127658 1515706 48773710 48160975 7019 447734 X 95000 95000 15000 15000 863888 863888 15536021 13620777 1915244 555570 482279 73291 3409574 2989250 420324 1214777 1075857 138920 187104 187104 94350 94350 5090402 4462869 627533 255106 224492 30614 3124112 2811701 312411 911340 801979 109361 3641635 3102974 538661 17965 15809 2156 213093 186823 26270 3941369 3455486 485883 433982 430305 3677 UBI TAX 350 350 MEDICAL SUPPLIES 2765508 2765508 BAD DEBT EXPENSE 2727124 2727124 FRANCHISE FEE 674612 674612 286125 203252 82873 46054007 40141097 5912910 0 7375684 8081952 4750375 5823804 354787 399180 730171 896808 71611860 33510726 40863623 38101134 8834684 9423625 782924 1250078 1631191 1269670 65323439 65246251 6666220 6895094 20303979 19513824 3164173 2259540 2387546 1286127 32521918 29954585 X 32801521 35291666 32801521 35291666 65323439 65246251 X 2719703 256630 -486188 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 1 4085 4085 0 PART II-B, LINE 1: 3.4 PERCENT OF DUES TO THE OHIO HOSPITAL ASSOCIATION AND 22.8% OF THE AMERICAN HOSPITAL ASSOCIATION DUES WERE ALLOCATED TO LOBBYING ACTIVITIES BY THAT ORGANIZATION. 2161317 2161317 38214422 10757668 27456754 24847432 17074914 7772518 6388689 5678144 710545 38101134 THIRD PARTY SETTLEMENT 600858 DERIVATIVE LIABILITY 639229 DUE TO MEDICAL STAFF AND AUXILIARY 46040 1286127 X PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY THE IRS OR OTHER APPLICABLE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL AND HAS CONCLUDED THAT AS OF DECEMBER 31, 2014, THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS. WITH FEW EXCEPTIONS, THE HOSPITAL IS NO LONGER SUBJECT TO U.S. FEDERAL, STATE AND LOCAL, OR NON-U.S. INCOME TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. 1 1 X 1 X 1 X 1 1 0 1 1 755762 0 755762 0.01740 8853181 5705588 3147593 0.07260 9608943 5705588 3903355 0.09000 100285 46716 53569 0.00120 38396 0 38396 0.00090 31996 0 31996 0.00070 170677 46716 123961 0.00280 9779620 5752304 4027316 0.09280 30179 30179 0.00070 8775 8775 0.00020 50216 50216 0.00120 89170 89170 0.00210 1 2727124 812812 7808121 16909956 -9101835 X 1 1 1 1 THE BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 WWW.BELLEVUEHOSPITAL.COM 1261 X X X SWING BED - SNF HOME HEALTH THE BELLEVUE HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 1 1 1 X WWW.BELLEVUEHOSPITAL.COM X WWW.ALWAYSCHOOSEHEALTH.COM X X 1 13 1 WWW.BELLEVUEHOSPITAL.COM 0 0 1 X 100.000000000000 400.000000000000 1 1 X X X 1 X X X X X 1 X 0 X X X 1 X 0 0 THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 5: THE NEEDS OF THE POPULATION, ESPECIALLY THOSE WHO ARE MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS, WERE TAKEN INTO ACCOUNT THROUGH THE SAMPLE METHODOLOGY THAT SURVEYED THESE POPULATIONS AND OVER-SAMPLED MINORITY POPULATIONS. IN ADDITION, THE ORGANIZATIONS THAT SERVE THESE POPULATIONS PARTICIPATED IN THE HEALTH ASSESSMENT AND COMMUNITY PLANNING PROCESS, SUCH AS MENTAL HEALTH AND RECOVERY SERVICES BOARD, WSOS, AND SANDUSKY COUNTY HEALTH PARTNERS. PARTICIPANTS INCLUDED THE FOLLOWING GROUPS AND ORGANIZATIONS: (A (PH) AFTER THEIR NAME 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 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. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 16A WEBSITE: WWW.BELLEVUEHOSPITAL.COM THE BELLEVUE HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: WWW.BELLEVUEHOSPITAL.COM 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 $2,727,124. 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; AND CONTRIBUTED TO THE BELLEVUE CENTRAL PARK FUND TO TRANSFORM LAND OF THE FORMER BELLEVUE JUNIOR HIGH SCHOOL INTO A COMMUNITY PARK TO ENCOURAGE MORE ACTIVITY IN THE DOWNTOWN AREA. - ECONOMIC DEVELOPMENT: ACTIVE ROLE WITH SANDUSKY COUNTY ECONOMIC DEVELOPMENT ORGANIZATION AND BELLEVUE ECONOMIC DEVELOPMENT CORPORATION TO CREATE NEW EMPLOYMENT OPPORTUNITIES, INCLUDING HEALTHCARE COVERAGE, IN AN AREA EXPERIENCING HIGH JOBLESS RATES. - COMMUNITY SUPPORT: PROVIDE SUPPORT FOR LOCAL UNITED SELECTIVE FUND CAMPAIGN AND OTHER LOCAL NON-PROFIT ORGANIZATIONS; ORGANIZED DISASTER READINESS FOR EBOLA PREPAREDNESS DURING THE 2014 EBOLA OUTBREAK; PARTICIPATED IN NORTHWEST OHIO HEALTHCARE EMERGENCY MANAGEMENT COALITION. WORKFORCE DEVELOPMENT: PARTNERSHIP WITH COMMUNITY COLLEGE/VOCATIONAL SCHOOL TO ADDRESS THE HEALTH CARE WORK FORCE SHORTAGE AS WELL AS PARTICIPATION ON ADVISORY BOARDS OF SCHOOL-BASED PROGRAMS FOR HEALTH CARE CAREERS.PART III, LINE 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, 38.83% OF ACCOUNTS THAT WERE RETURNED FROM THE STATE COLLECTION IN 2014 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 $812,812 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 $9,101,836 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 2014, MEDICARE ACCOUNTED FOR APPROXIMATELY 28% 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 1,707.34 SQUARE MILES. THE FOUR COUNTY ESTIMATED POPULATION WAS 250,390 FOR 2014, A 1.6% 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 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 2014 WAS 6.4%, DOWN FROM 8.2% FOR 2013, AND SLIGHTLY HIGHER THAN OHIO'S STATEWIDE UNEMPLOYMENT RATE OF 4.8% AND THE NATIONWIDE UNEMPLOYMENT RATE OF 5.6% FOR DECEMBER 2014. HURON COUNTY RANKED 8TH IN THE STATE OF OHIO IN 2014 WITH AN ANNUAL AVERAGE UNEMPLOYMENT RATE OF 7.9%. MEDIAN HOUSEHOLD INCOMES RANGED FROM $43,764 IN SENECA COUNTY TO $49,404 IN HURON COUNTY. ACCORDING TO THE U.S. CENSUS BUREAU, 2013 POVERTY RATES, THE LATEST AVAILABLE, HAVE INCREASED IN THREE OF THE FOUR COUNTIES AND RANGED FROM 13.3% FOR ERIE COUNTY TO 15.5% FOR SENECA COUNTY. OHIO DEPARTMENT OF JOB & FAMILY SERVICES REPORTED THAT 60,569 RESIDENTS, OR 24.19% OF RESIDENTS IN THE FOUR COUNTY AREA WERE ENROLLED IN MEDICAID AT 12/31/14, AND 13.0% OF RESIDENTS IN THE FOUR COUNTY AREA RECEIVED FOOD ASSISTANCE DURING DECEMBER 2014 COMPARED TO 14.3% OF RESIDENTS DURING DECEMBER 2013. SANDUSKY COUNTY IS ALSO DESIGNATED AS BOTH A MEDICALLY UNDERSERVED AREA AND AS A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA. PART VI, LINE 5: MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. THE HOSPITAL BOARD OF DIRECTORS IS COMPRISED OF LOCAL MEDICAL AND BUSINESS PROFESSIONALS WHO VOLUNTEER COUNTLESS HOURS OF SERVICE TO THE HOSPITAL IN THEIR OVERSIGHT ROLE OF GENERAL STEWARDSHIP. THE HOSPITAL EXPANDS ACCESS POINTS OF CARE THROUGHOUT THE COMMUNITY BY PROVIDING FREE OR LOW-COST BLOOD PRESSURE, DIABETES, CHOLESTEROL, SKIN CANCER, PROSTATE CANCER AND OTHER SCREENINGS. EDUCATIONAL PROGRAMS AND SUPPORT GROUPS ARE HELD TO PROVIDE INFORMATION ON SUCH TOPICS AS TOBACCO CESSATION, WEIGHT MAINTENANCE, DIABETES, CHILDBIRTH, INFANT CARE, AND MORE. HOSPITAL EMPLOYEES SERVE ON THE BOARDS OF MANY COMMUNITY AND HEALTH-ORIENTED ORGANIZATIONS. THE HOSPITAL ALSO PARTICIPATES IN COMMUNITY-WIDE AND REGIONAL-WIDE MASS CASUALTY AND DISASTER PREPAREDNESS WITH 33 OTHER REGIONAL HOSPITALS AS A MEMBER OF THE HOSPITAL COUNCIL OF NORTHWEST OHIO, TO ASSURE THE SAFETY AND HEALTH OF COMMUNITY RESIDENTS IN THE EVENT OF A NATURAL DISASTER, INDUSTRIAL ACCIDENT, BIOTERRORISM OR OTHER LARGE SCALE EMERGENCY. MEMBERSHIP BENEFITS INCLUDE INCREASED PURCHASING POWER FOR DISASTER SUPPLIES, EMERGENCY RESPONSE TRAINING, INCIDENT COMMAND, AND INFORMATION SHARING TO KEEP COMPLIANT WITH HOMELAND SECURITY REGULATIONS. PART VI, LINE 6: THE BELLEVUE HOSPITAL IS A GENERAL ACUTE CARE PROVIDER AT ONE FACILITY IN THE BELLEVUE, OHIO AREA. THE BELLEVUE HOSPITAL IS THE PARENT ORGANIZATION OF BELLEVUE PROFESSIONAL SERVICES, INC. AND THE SOLE BENEFICIARY OF THE BELLEVUE HOSPITAL FOUNDATION. THE BELLEVUE HOSPITAL ASSOCIATION IS THE PARENT ORGANIZATION OF THE BELLEVUE HOSPITAL. THE BELLEVUE HOSPITAL ASSOCIATION MEETS ANNUALLY IN FEBRUARY TO ELECT THE BELLEVUE HOSPITAL BOARD OF TRUSTEES AND TO CONDUCT ANY NECESSARY BUSINESS. BELLEVUE PROFESSIONAL SERVICES, INC. PROVIDES CLINICAL AND MEDICAL PROFESSIONAL SERVICES TO RESIDENTS OF BELLEVUE AND CLYDE, OHIO AND THE SURROUNDING AREA. THE BELLEVUE HOSPITAL FOUNDATION SUPPORTS THE BELLEVUE HOSPITAL WITH FINANCIAL TRANSFERS IN THE FORM OF BOTH CASH AND NON-CASH TRANSFERS. 1 THE UNIVERSITY OF TOLEDO 2801 W BANCROFT AVE TOLEDO OH 43606 346555110 501(C)(3) 25000 UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE SCHOLARSHIP FUND BELLEVUE REDMEN ATHLETIC BOOSTERS INC 200 OAKLAND AVE BELLEVUE OH 44811 341469153 501(C)(3) 10000 TURF PROJECT MARCH OF DIMES 3450 W CENTRAL AVE SUITE 352 TOLEDO OH 43606 131846366 501(C)(3) 5000 MARCH FOR BABIES PLATINUM SPONSOR BELLEVUE FISH & LOAVES 203 MAPLE ST BELLEVUE OH 44811 341397123 501(C)(3) 15000 AREA FOOD BANK FOR THE NEEDY SANDUSKY COUNTY PARK DISTRICT 1970 COUNTRYSIDE PLACE FREMONT OH 43420 346401312 STATE 10000 1ST OF 5 ANNUAL PLEDGE PMTS BELLEVUE CENTRAL PARK 3000 SENECA IND PKWY BELLEVUE OH 44811 346400096 CITY 15000 CONVERT FORMER JR HIGH SITE TO COMMUNITY PARK TO ENCOURAGE MORE ACTIVITY IN DOWNTOWN AREA AMERICAN CANCER SOCIETY 740 COMMERCE DR SUITE B PERRYSBURG OH 43551 131788491 501(C)(3) 5000 LEADERS OF RELAY SPONSOR BELLEVUE DEVELOPMENT CORPORATION 110 W MAIN ST BELLEVUE OH 44811 341397769 501(C)(3) 5000 ANNUAL DONATION, ECONOMIC DEVELOPMENT CLYDESCOPE EDC 222 NORTH MAIN ST CLYDE OH 43410 341811627 501(C)(6) 5000 ANNUAL DONATION, ECONOMIC DEVELOPMENT 5 3 EMPLOYEE CHILDREN'S SCHOLARSHIPS 10 15000 PART I, LINE 2: THE HOSPITAL MADE ANNUAL PLEDGES TO THE UNIVERSITY OF TOLEDO FOUNDATION, BELLEVUE ATHLETIC BOOSTERS, SANDUSKY COUNTY PARK DISTRICT, BELLEVUE CENTRAL PARK, AND CLYDESCOPE ECONOMIC DEVELOPMENT CORP. REPRESENTING OUR CONTINUED COMMITMENT FOR THE COMMUNITY. THE UNIVERSITY OF TOLEDO FOUNDATION IS A 501(C)(3) ORGANANIZATION FOUNDATION WHICH HAS SET UP SCHOLARSHIP FUNDS TO ASSIST WITH STUDENTS' FINANCIAL AID TOWARDS ATTENDANCE AT THE UNIVERSITY OF TOLEDO. THE BELLEVUE REDMEN ATHLETIC BOOSTERS IS ALSO 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 DONATION TO BELLEVUE CENTRAL PARK IS FOR A LONG-TERM PROJECT TO TRANSFORM THE SITE OF THE FORMER BELLEVUE JUNIOR HIGH SCHOOL INTO "BELLEVUE CENTRAL PARK" TO BE USED FOR COMMUNITY EVENTS AND ENCOURAGE MORE ACTIVITY IN THE DOWNTOWN AREA. 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. PART III: THE HOSPITAL HAS A COMMITTEE COMPOSED OF FOUR MEMBERS (AN HOURLY EMPLOYEE, A MEMBER OF THE MEDICAL STAFF, A MEMBER OF THE BOARD OF TRUSTEES AND A MEMBER OF THE COMMUNITY RELATIONS COMMITTEE OF THE FOUNDATION BOARD). ALL ELIGIBLE APPLICATIONS ARE REVIEWED BY THE COMMITTEE. EACH CANDIDATE IS SCORED BASED UPON THE INFORMATION PROVIDED IN THEIR APPLICATION. UPON THE DISCRETION OF THE COMMITTEE, INTERVIEWS OF THE APPLICANTS CAN TAKE PLACE. UP TO 10 CANDIDATES WILL BE SELECTED TO RECEIVE A $1,500.00 SCHOLARSHIP. THE HOSPITAL AWARDS THE SCHOLARSHIP PAYMENTS DIRECTLY TO THE COLLEGES TO OFFSET TUITION ONCE THE STUDENT PROVIDES THE HOSPITAL WITH PROOF OF ENROLLMENT FEES. X 1 1 X X X X 0 0 0 0 0 0 0 0 0 MICHAEL K WINTHROP PRESIDENT 397816 0 74040 0 11550 0 15526 0 13839 0 512771 0 0 0 TIMOTHY BUIT EXEC VP, CFO 261625 0 49552 0 11007 0 9799 0 19134 0 351117 0 0 0 PATRICIA SEMER VICE PRESIDENT, ADMINISTRATION 162510 0 23399 0 0 0 8789 0 18853 0 213551 0 0 0 SARA BROKAW VICE PRESIDENT, PATIENT CARE 176704 0 9527 0 0 0 0 0 686 0 186917 0 0 0 LISA SARTAIN VICE PRESIDENT, HUMAN RESOURCES 139778 0 20618 0 0 0 0 0 7212 0 167608 0 0 0 PART I, LINE 1A 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. A VILLAGE OF PORT JEFFERSON OHIO 341175548 NONEAVAIL 2012-08-28 9992500 SEE PART VI 0 0 0 B CITY OF BELLEVUE OHIO 346400096 NONEAVAIL 2012-09-12 8500000 SEE PART VI 0 0 0 C COUNTY OF SANDUSKY OHIO 346401312 NONEAVAIL 2012-10-03 2569153 SEE PART VI 0 0 0 A 363172 9992500 60000 12000 9920500 2005 1 0 1 1 B 308697 8500000 43398 8456602 2004 1 0 1 1 C 93305 2569153 30573 2538580 2004 1 0 1 1 A 0 0 0 0 0 0 0 B 0 0 0 0 0 0 0 C 0 0 0 0 0 0 0 A 0 0 1 0 1 0 0 0 1 B 0 0 1 0 1 0 0 0 1 C 0 0 1 0 1 0 0 0 1 A 1 B 1 C 1 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: HASSELBACH PAUL AGENCY INC TOM BARTH IS OWNER OF HASSELBACH & PAUL AGENCY, INC 311668 INSURANCE: DIRECTOR AND OFFICERS; PROFESSIONAL LIABILITY 0 FORM 990, PART III, LINE 3 WE CLOSED OUR HOME HEALTH PROGRAM EFFECTIVE DECEMBER 31, 2014. FORM 990, PART VI, SECTION A, LINE 2 PRESIDENT MICHAEL WINTHROP AND TRUSTEE DEAN MILLER HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE BELLEVUE HOSPITAL ENTERED INTO AN AGREEMENT WITH NORWALK AREA HEALTH SYSTEMS AND FIRELANDS REGIONAL HEALTH SYSTEM. NAHS AND FIRELANDS EACH HAVE TWENTY PERCENT MEMBERSHIP INTEREST IN THE HOSPITAL AND REPRESENTATION ON THE BOARD OF TRUSTEES. FORM 990, PART VI, SECTION A, LINE 7A NORWALK AREA HEALTH SYSTEMS AND FIRELANDS REGIONAL HEALTH SYSTEM CAN EACH APPOINT 2 MEMBERS TO THE BOARD OF DIRECTORS. 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 2014. 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 CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 4,462,869. MANAGEMENT AND GENERAL EXPENSES 627,533. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,090,402. FORM 990, PART XI, LINE 9: CHANGE IN FMV OF INTEREST RATE SWAP AGREEMENTS -86,304. CONTRIBUTION OF CAPITAL TO BELLEVUE PROFESSIONAL SERVICES, INC. -250,000. BOOK TO TAX DIFFERENCE IN FLOW THROUGH INCOME -98,884. CONTRIBUTION OF CAPITAL TO BELLEVUE PAIN MANAGEMENT, LLC -51,000. FORM 990, PART XII, LINE 2C THE PROCESS FOR OVERSIGHT OF THE AUDIT AS WELL AS SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. THE BELLEVUE HOSPITAL FOUNDATION 1400 WEST MAIN STREET BELLEVUE OH 44811 341745374 SUPPORT OH 501(C)(3) LINE 11A, 1 THE BELLEVUE HOSPITAL 1 THE BELLEVUE HOSPITAL ASSOCIATION 1400 WEST MAIN STREET BELLEVUE OH 44811 753102199 ADMINISTRATIVE SUPPORT OH 501(C)(3) LINE 11A, 1 N/A 0 BELLEVUE HEALTH NETWORK LLC 1400 WEST MAIN STREET BELLEVUE OH 44811 341870470 INSURANCE CONTRACTS OH THE BELLEVUE HOSPITAL RELATED -2107 349 0 1 0.55560 BELLEVUE HOSPITAL PAIN MANAGEMENT LLC 1400 WEST MAIN STREET BELLEVUE OH 44811 464660177 HEALTH CARE OH THE BELLEVUE HOSPITAL RELATED 97337 228023 0 1 0.51000 BELLEVUE PROFESSIONAL SERVICES INC 1400 WEST MAIN STREET BELLEVUE OH 44811 341828724 PHYSICIAN SERVICES OH THE BELLEVUE HOSPITAL C 1566376 398593 1.00000 1 1 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 0 0 0 BELLEVUE PROFESSIONAL SERVICES INC A 51219 LEASE AGREEMENT PAYMENT BELLEVUE PROFESSIONAL SERVICES INC B 250000 CASH CAPITAL CONTRIBUTION BELLEVUE HOSPITAL FOUNDATION C 105871 CHECKS BELLEVUE PAIN MANAGEMENT LLC B 51000 CASH CAPITAL CONTRIBUTION