2011-11-10T11:52:23-06:00 2010-12-31 PLANTE & MORAN PLLC 65 EAST STATE ST STE 600 COLUMBUS OH 43215 990 2010-01-01 341745374 BELLEVUE HOSPITAL FOUNDATION THE BELL 4194834040 1400 WEST MAIN STREET BELLEVUE OH 44811 GARY STEINLE 4194834040 2011-10-26 1 BERNIE OSTROWSKI 6148493000 2010 2016-03-07 17:11:31Z GARY STEINLE 1400 WEST MAIN STREET BELLEVUE OH 44811 232745 0 X N/A X 1993 OH THE BELLEVUE HOSPITAL FOUNDATION CONTINUES TO SPONSOR PROGRAMS, PROJECTS AND SERVICES WITH BENEFIT TO THE BELLEVUE HOSPITAL. 25 23 0 23 0 0 335384 150207 0 0 17903 26553 3003 13331 356290 190091 504472 109463 0 0 0 0 0 0 553 118246 162696 622718 272159 -266428 -82068 1365935 1382223 192656 270350 1173279 1111873 X NONE 0 0 90600 90600 0 RELEASED FUNDS FROM CAPITAL CAMPAIGN FUND TO HOSPITAL. 18863 18863 0 WALKING TRAIL LANDSCAPING, VOLUNTEER GARDEN, AND DONOR PLAQUES/DISPLAY CASE TRANSFERRED TO HOSPITAL. 0 0 110951 OTHER 110951 220414 1 1 0 0 0 0 0 0 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 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 25 23 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X DEBORAH J FREEMAN 4194834040 1400 W MAIN STREET BELLEVUE OH 44811 X GARY STEINLE 1.00 X X 0 0 0 CAROLYN FARRAR 1.00 X X 0 0 0 JAMES AVERY 1.00 X X 0 0 0 CATHY PIFER 1.00 X X 0 0 0 KATE HERRING 12.00 X X 0 36654 535 MARIE ARCHER 1.00 X 0 0 0 HANNAH AUXTER 1.00 X 0 0 0 PETE CALLAGHAN 1.00 X 0 0 0 CHRIS CAPUTO 1.00 X 0 0 0 RODNEY COOK 1.00 X 0 0 0 DINAH DWYER 1.00 X 0 0 0 GREGG ELCHERT 1.00 X 0 0 0 KENDRA FULTZ 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 DOUG HOY MD 1.00 X 0 0 0 REV NANCY HULL 1.00 X 0 0 0 DAVE JARVIS 1.00 X 0 0 0 SHARON REEVES 1.00 X 0 0 0 BRAD SMITH 1.00 X 0 0 0 STEVE WASSERMAN 1.00 X 0 0 0 FRANK WEASNER 1.00 X 0 0 0 MICHAEL WINTHROP 1.00 X 0 572730 20953 BETTE WOODS 1.00 X 0 0 0 0 609384 21488 0 0 1 0 0 1000 149207 1000 150207 26553 26553 3428 1000 3433 -5 -5 52557 39221 13336 13336 190091 0 0 39884 109463 109463 2500 2500 7326 7326 1199 1199 2570 2570 3835 3835 93439 93439 3365 3365 1062 1062 849 849 1416 1416 ADMINISTRATION FEES 41366 41366 FUNDRAISING 553 553 3216 3216 272159 220414 51192 553 242948 312206 139905 51109 5091 3971 6356 5647 2125 709 975866 1014228 1365935 1382223 102103 2038 90553 268312 192656 270350 X 262979 264049 732736 670260 177564 177564 1173279 1111873 1365935 1382223 X -82068 20662 X X 0 1 1 X 0 X X X 0 0 0 THE BELLEVUE HOSPITAL 344428205 3 1 1 1 90600 1 90600 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: NONCASH SUPPORT WAS PROVIDED TO THE BELLEVUE HOSPITAL IN THE FORM OF LAND IMPROVEMENTS TOTALING $18,863. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 177564 2820 180384 177564 1100 178664 177564 177564 0.00000 1.00000 0.00000 0 0 6356 5647 709 709 MUTUAL FUNDS 788975 F CASH & CASH EQUIVALENTS 82923 F REAL ESTATE INSURANCE TRUSTS 139565 F OTHER INVESTMENTS 2765 F 1014228 INTERCOMPANY PAYABLES 177759 INTERCOMPANY PLEDGES PAYABLE 90553 268312 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUND INVESTMENTS THAT ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS UNRESTRICTED. 52557 39221 1 0.05000 52557 39221 39221 13336 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 DEB FREEMAN 1400 WEST MAIN STREET BELLEVUE OH 44811 0 KATE HERRING 37189 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) 90600 NEW HOSPITAL BUILDING THE BELLEVUE HOSPITAL 1400 WEST MAIN STREET BELLEVUE OH 44811 344428205 501(C)(3) 18863 BOOK LAND IMPROVEMENTS WALKING TRAIL LANDSCAPING AND VOLUNTEER GARDENING 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 545668 0 20000 0 7062 0 5513 0 15440 0 593683 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 & VP FINANCE AT THE FINANCE MEETING FOR REVIEW AS WELL AS PRESENTATION TO THE BOARD OF DIRECTORS AT THE OCTOBER MEETING. 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. 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 2010. FORM 990, PART VI, SECTION C, LINE 18 THE FOUNDATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. 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 7, PART VII: THE FOLLOWING TRUSTEE DEVOTED TIME TO BELLEVUE HOSPITAL: MICHAEL WINTHROP 40 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 20,662. 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 N/A 0 THE BELLEVUE HOSPITAL ASSOCIATION 1400 WEST MAIN STREET BELLEVUE OH 44811 753102199 ADMINISTRATIVE SUPPORT OH 501(C)3 LINE 11A, I THE BELLEVUE HOSPITAL 1 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 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 BELLEVUE HOSPITAL B 90600 FMV - CASH BELLEVUE HOSPITAL B 18863 FMV - BOOK