2013-11-14T18:04:33-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2012-01-01 341745374 BELLEVUE HOSPITAL FOUNDATION THE BELL 4194834040 1400 WEST MAIN STREET BELLEVUE OH 44811 GARY STEINLE 4194834040 2013-11-07 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-03-07 17:11:31Z GARY STEINLE 1400 WEST MAIN STREET BELLEVUE OH 44811 271430 0 X N/A X 1993 OH THE BELLEVUE HOSPITAL FOUNDATION CONTINUES TO SPONSOR PROGRAMS, PROJECTS AND SERVICES WITH BENEFIT TO THE BELLEVUE HOSPITAL. 20 18 0 18 0 0 298652 66471 0 0 244255 32499 61214 55402 604121 154372 120807 16129 0 0 60179 66210 0 0 36784 72441 28156 253427 110495 350694 43877 1607037 1624667 363850 308605 1243187 1316062 X NONE 0 0 7500 7500 0 RELATED PARTY GENERAL SUPPORT FOR HOSPITAL SCHOLARSHIP PROGRAM. 809 809 0 RELATED PARTY MEDICAL SUPPORT FOR PURCHASES OF BARIATRIC BED RENTAL FOR HOSPITAL. 7820 7820 0 RELATED PARTY GENERAL SUPPORT FOR K-MOTION INTERACTIVE HARDWARD AND SOFTWARE FOR HOSPITAL. 13242 0 0 OTHER 13242 29371 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 1 1 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 18 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X TIMOTHY BUIT 4194834040 1400 W MAIN STREET BELLEVUE OH 44811 GARY STEINLE 1.00 X X 0 0 0 CAROLYN FARRAR 1.00 X X 0 0 0 CHRIS CAPUTO 1.00 X X 0 0 0 MARIE ARCHER 1.00 X X 0 0 0 KATE HERRING 12.00 X X 0 47473 2465 MARCIA BRAUN MD 1.00 X 0 0 0 PETE CALLAGHAN 1.00 X 0 0 0 RODNEY COOK 1.00 X 0 0 0 ALICIA CROCKETT 1.00 X 0 0 0 DINAH DWYER 1.00 X 0 0 0 GREGG ELCHERT 1.00 X 0 0 0 MARY BETH FISER 1.00 X 0 0 0 CHRISTINE GREILICH 1.00 X 0 0 0 DAN HIGGINS 1.00 X 0 0 0 ROSEANN HOPKINS 1.00 X 0 0 0 REV NANCY HULL 1.00 X 0 0 0 DAVE JARVIS 1.00 X 0 0 0 BRAD SMITH 1.00 X 0 0 0 BETTE WOODS 1.00 X 0 0 0 MICHAEL WINTHROP 1.00 45.00 X 0 424310 27120 0 471783 29585 0 0 1 0 0 26596 39875 66471 32499 32499 16228 26596 23690 -7462 -7462 156232 93368 62864 62864 154372 0 0 87901 16129 16129 66210 13242 19863 33105 3700 3700 2947 2947 1303 1201 102 11690 11690 932 932 2577 2577 581 581 849 849 FUNDRAISING 1820 1820 SPONSORSHIP 1757 1757 110495 29371 44340 36784 161512 123488 233671 237914 3349 500 3125 1353 6356 6356 0 0 1205380 1251935 0 9477 1607037 1624667 214 210 363636 308395 363850 308605 X 205507 269709 676258 684181 361422 362172 1243187 1316062 1607037 1624667 43877 28998 0 X X 0 1 X 1 0 X X X 0 0 0 THE BELLEVUE HOSPITAL 344428205 3 1 1 1 8309 1 8309 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: NONCASH SUPPORT WAS PROVIDED TO THE BELLEVUE HOSPITAL IN THE FORM OF K-MOTION INTERACTIVE HARDWARE & SOFTWARE TOTALING $7,820. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 361422 750 362172 181484 179938 361422 178664 2820 181484 177564 1100 178664 177564 177564 0.00000 1.00000 0.00000 0 0 6356 6356 0 0 MUTUAL FUNDS 1140025 F CASH & CASH EQUIVALENTS 26815 F REAL ESTATE INSURANCE TRUSTS 42731 F OTHER INVESTMENTS 2715 F CORPORATE STOCK 39649 F 1251935 INTERCOMPANY PAYABLES 217842 INTERCOMPANY PLEDGES PAYABLE 90553 308395 X DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUND INVESTMENTS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS UNRESTRICTED. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: ACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE FOUNDATION AND RECOGNIZE A TAX LIABILITY IF THE FOUNDATION 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, 2012, 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 2009. GOLF OUTING 36411 26596 9815 3648 4696 9189 36411 26596 9815 3648 4696 9189 17533 -7718 156232 45125 48243 1 0.05000 156232 45125 48243 93368 62864 OH 0 IN THE STATE OF OHIO, A CHARITABLE ORGANIZATION THAT IS EXEMPT FROM FEDERAL INCOME TAXATION UNDER SUBSECTION 501(A) AND IS DESCRIBED IN SUBSECTION 501(C)(3) IS NOT REQUIRED TO OBTAIN A GAMING LICENSE TO CONDUCT A RAFFLE TO RAISE MONEY FOR THE ORGANIZATION. OHIO REVISED CODE 2915.092. 0 1 0 0.67000 0.33000 TIMOTHY BUIT 1400 WEST MAIN STREET BELLEVUE OH 44811 0 KATE HERRING 15358 COORDINATION OF ALL ACTIVITIES, SUCH AS, ADVERTISING, MAILINGS, TICKET PURCHASES, TICKET SALES, DRAWINGS, AND WORKING WITH THE BOARD MEMBERS TO HOLD A CORVETTE FOR THE WINNER. X 0 1 THE BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 344428205 501(C)(3) 7500 RELATED PARTY GENERAL SUPPORT FOR HOSPITAL SCHOLARSHIP PROGRAM. THE BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 344428205 501(C)(3) 809 RELATED PARTY MEDICAL SUPPORT FOR PURCHASES OF BARIATRIC BED RENTAL. THE BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 344428205 501(C)(3) 7820 BOOK K-MOTION INTERACTIVE HARDWARE AND SOFTWARE RELATED PARTY GENERAL SUPPORT FOR K-MOTION INTERACTIVE HARDWARE AND SOFTWARE. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: THE FOUNDATION IS A SUPPORTING ORGANIZATION TO THE BELLEVUE HOSPITAL. IT REGULARLY TRANSFERS FUNDS TO FURTHER THE HOSPITAL'S EXEMPT PURPOSES. 0 0 0 0 0 0 0 0 0 MICHAEL WINTHROP 0 414025 0 0 0 10285 0 14313 0 12807 0 451430 0 0 SUPPLEMENTAL INFORMATION PART III PART I, LINE 3: COMPENSATION PAID TO THE ORGANIZATION'S PRESIDENT IS ESTABLISHED BY A RELATED ORGANIZATION AND INCLUDES USE OF A COMPENSATION COMMITTEE, AN INDEPENDENT COMPENSATION CONSULTANT, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION A, LINE 6 THE BELLEVUE HOSPITAL FOUNDATION IS ORGANIZED AS A SUBSIDIARY OF THE BELLEVUE HOSPITAL, THE PARENT ORGANIZATION AND SOLE VOTING MEMBER FOR THE CONSOLIDATED GROUP. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS MADE BY THE BELLEVUE HOSPITAL FOUNDATION'S BOARD OF DIRECTORS CAN BE OVERRULED BY THE BELLEVUE HOSPITAL'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11 A COPY OF FORM 990 IS MADE AVAILABLE TO THE BELLEVUE HOSPITAL'S PRESIDENT & EXECUTIVE VICE PRESIDENT/CFO AT THE FINANCE MEETING FOR REVIEW AS WELL AS PRESENTATION TO THE BOARD OF DIRECTORS. IN ADDITION, EACH BOARD MEMBER RECEIVES A COPY OF FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICY WHEN APPLICABLE AS DESCRIBED BELOW. ON AN ANNUAL BASIS, THE PRESIDENT SHALL SEND TO ALL EXECUTIVE STAFF AND SELECTED EMPLOYEES, A COPY OF THE BOARD OF TRUSTEES CONFLICT OF INTEREST POLICY TO BE COMPLETED AND RETURNED. IN ADDITION, NEW BOARD MEMBERS THAT JOIN DURING THE YEAR FILL OUT AND COMPLETE THE CONFLICT OF INTEREST POLICY WHEN THEY FIRST JOIN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE BOARD OF TRUSTEES CONCERNING ANY INTERESTS TO BE DISCLOSED. IF ANY CONFLICTS DO ARISE, THAT TRUSTEE WILL ABSTAIN FROM VOTING ON THE ISSUE. PERIODIC REVIEWS ARE ALSO CONDUCTED TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES, AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. THE BOARD OF DIRECTORS REVIEW THE COMPLETED CONFLICT OF INTEREST POLICIES INCLUDING THE PRESIDENT'S. THE BOARD OF DIRECTORS REVIEW THE PRESIDENT'S COMPLETED CONFLICT OF INTEREST POLICY ONCE THE PRESIDENT LEAVES THE ROOM. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION DOES NOT HAVE ITS OWN COMPENSATION, WHISTLEBLOWER, OR DOCUMENT RETENTION POLICIES. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICIES WHEN APPLICABLE AS DESCRIBED BELOW. THE BOARD HAS A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT DIRECTORS. THE COMMITTEE UTILIZES AN OUTSIDE HEALTHCARE COMPENSATION CONSULTING COMPANY COMPARING COMPARABLE SIZED ORGANIZATIONS CONSISTENT WITH THE BOARD OF TRUSTEE COMPENSATION PHILOSOPHY STATEMENT. RECOMMENDATIONS ARE MADE FROM THE COMPENSATION COMMITTEE TO THE BOARD OF TRUSTEES. ANY COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMPENSATION COMMITTEE AND EXECUTIVE SESSION MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN NOVEMBER 2012. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PAGE 6, PART VI, LINE 7A: THE BELLEVUE HOSPITAL FOUNDATION'S BOARD OF DIRECTORS ARE NOT ELECTED BY THE BELLEVUE HOSPITAL'S BOARD OF DIRECTORS, HOWEVER THE BELLEVUE HOSPITAL'S BOARD OF DIRECTORS RATIFY THE ELECTED TRUSTEES AT THEIR ANNUAL MEETING. FORM 990, PAGE 12, PART XII, LINE 2C THE BELLEVUE HOSPITAL HAS A COMMITTEE RESPONSIBLE FOR SELECTION OF THE INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT. THE PROCESS FOR OVERSIGHT OF THE AUDIT AS WELL AS SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 344428205 HEALTH CARE OH 501(C)3 LINE 3 THE BELLEVUE HOSPITAL ASSOCIATION 1 THE BELLEVUE HOSPITAL ASSOCIATION 1400 WEST MAIN STREET BELLEVUE OH 44811 753102199 ADMINISTRATIVE SUPPORT OH 501(C)3 LINE 11A, I N/A 0 BELLEVUE HEALTH NETWORK 1400 W MAIN STREET BELLEVUE OH 44811 341870470 INSURANCE CONTRACTS OH N/A BELLEVUE PROFESSIONAL SERVICES INC 1400 W MAIN STREET BELLEVUE OH 44811 341828724 PHYSICIAN SERVICES OH N/A C 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 BELLEVUE HOSPITAL M 57967 TIME SHEET COST ALLOCATION