2025-11-17T15:17:12-06:00 2024-12-31 331498605 PLANTE & MORAN PLLC 250 S HIGH ST SUITE 100 COLUMBUS OH 43215 990 2024-01-01 341745374 BELLEVUE HOSPITAL FOUNDATION THE BELL 4194834040 1400 WEST MAIN STREET BELLEVUE OH 44811 CHRIS CAPUTO CHAIRPERSON 4194834040 2025-11-17 1 1 AMY CIMINELLO P00796388 6148493000 2025-11-12 2024 2025-03-06 01:10:19Z CHRIS CAPUTO 1400 WEST MAIN STREET BELLEVUE OH 44811 851980 0 X HTTPS://WWW.BELLEVUEHOSPITAL.COM/DEPARTMENTS/FOUN X 1993 OH THE BELLEVUE HOSPITAL FOUNDATION CONTINUES TO SPONSOR PROGRAMS, PROJECTS AND SERVICES WITH BENEFIT TO THE BELLEVUE HOSPITAL. 18 15 0 40 0 0 59824 41763 0 0 53787 426567 215504 120474 329115 588804 22801 48254 0 0 0 0 0 0 0 181206 185993 204007 234247 125108 354557 2807831 2494279 318079 -162609 2489752 2656888 TO ASSIST THE HOSPITAL IN THE EXPANSION OF COMMUNITY HEALTH THROUGH EDUCATION AND COMMUNITY PARTICIPATION. 0 0 182257 48254 0 RELATED PARTY GENERAL SUPPORT TO THE BELLEVUE HOSPITAL. 182257 1 1 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 2 1 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 18 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 0 0 0 0 0 X SARAH BROKAW 4194834040 1400 W MAIN STREET BELLEVUE OH 44811 TIMOTHY BUIT TRUSTEE (HOSPITAL CEO & VP OF FINANCE) 1.00 45.00 X X 0 369819 29364 SARA BROKAW TRUSTEE (HOSPITAL PRESIDENT) 1.00 45.00 X X 0 381410 14501 DENNIS SABO FOUNDATION DIRECTOR 40.00 0.00 X X 0 92382 33573 CHRIS CAPUTO CHAIR 1.00 0.00 X X 0 0 0 GARY STEINLE VICE CHAIR 1.00 0.00 X X 0 0 0 DONNA HALL SECRETARY 1.00 0.00 X X 0 0 0 LAUREN BURKHART TREASURER 1.00 0.00 X X 0 0 0 NATHAN SAMSA TRUSTEE 1.00 45.00 X 0 304405 12821 ANGELA MOUGEY TRUSTEE 1.00 0.00 X 0 0 0 JIM DAVIS TRUSTEE 1.00 0.00 X 0 0 0 MICHAEL K WINTHROP TRUSTEE 1.00 0.00 X 0 0 0 DAN HIGGINS TRUSTEE 1.00 0.00 X 0 0 0 DAVE JARVIS TRUSTEE 1.00 0.00 X 0 0 0 BILL BRUGNONE TRUSTEE 1.00 0.00 X 0 0 0 ERIC SECKEL TRUSTEE 1.00 0.00 X 0 0 0 SHERRI WILHELM TRUSTEE 1.00 0.00 X 0 0 0 BRETT BARTH TRUSTEE 1.00 0.00 X 0 0 0 CALEB WYNBISSINGER TRUSTEE 1.00 0.00 X 0 0 0 0 1148016 90259 0 0 1 0 0 36497 5266 41763 56690 56690 369877 0 369877 369877 369877 9225 36497 29078 -19853 -19853 374425 234098 140327 140327 588804 0 0 547041 X 37754 37754 10500 10500 3950 3950 6678 6678 131672 131672 2205 2205 23241 23241 ADMINISTRATION EXPENSES 18121 18121 SPECIAL PROJECTS 126 126 234247 182257 51990 0 55842 245695 852560 705929 6565 600 10106 10106 0 0 1892864 1542055 2807831 2494279 227526 -162609 90553 0 318079 -162609 X 2061527 2267208 428225 389680 2489752 2656888 2807831 2494279 X 354557 -285027 90553 7053 X X 0 0 0 X X 1 THE BELLEVUE HOSPITAL 344428205 3 1 0 37754 1 0 37754 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 371172 371172 368672 2500 371172 368672 368672 368672 368672 368672 368672 0.00000 1.00000 0.00000 0 0 10106 10106 0 0 PART V, LINE 4: THE ENDOWMENT FUND INVESTMENTS ARE TO BE HELD IN PERPETUITY, THE INCOME FROM WHICH IS UNRESTRICTED. GOLF OUTING 45722 36497 9225 2160 8308 12677 3437 2496 45722 36497 9225 2160 8308 12677 3437 2496 29078 -19853 374425 170766 63332 0 374425 170766 63332 234098 140327 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 SARA BROKAW 1400 WEST MAIN STREET BELLEVUE OH 44811 0 DENNIS SABO 91043 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) 0 37754 COST EMPLOYEE BREAK ROOM ENHANCEMENT GENERAL SUPPORT 1 0 SCHOLARSHIPS 10 10500 N/A N/A PART I, LINE 2: THE FOUNDATION IS A SUPPORTING ORGANIZATION TO THE BELLEVUE HOSPITAL. THE FOUNDATION MONITORS SCHOLARSHIPS TO INDIVIDUALS TO ENSURE USED FOR EDUCATION EXPENSES. 0 0 0 0 0 0 0 0 0 TIMOTHY BUIT TRUSTEE (HOSPITAL CEO & VP OF FINANC 0 313999 0 0 0 55820 0 13800 0 15564 0 399183 0 0 SARA BROKAW TRUSTEE (HOSPITAL PRESIDENT) 0 356410 0 25000 0 0 0 13800 0 701 0 395911 0 0 NATHAN SAMSA TRUSTEE 0 303505 0 0 0 900 0 12101 0 720 0 317226 0 0 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 COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART II NATHAN SAMSA RECEIVED COMPENSATION FOR THE ROLE AS EX-OFFICIO AS MEDICAL STAFF OF THE BELLEVUE HOSPITAL ORGANIZATION AND NOT FOR A ROLE ON THE BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE BELLEVUE HOSPITAL FOUNDATION IS ORGANIZED AS A SUBSIDIARY OF THE BELLEVUE HOSPITAL, THE PARENT ORGANIZATION AND SOLE VOTING MEMBER FOR THE CONSOLIDATED GROUP. FORM 990, PART VI, SECTION A, LINE 7A BELLEVUE HOSPITAL HAS THE POWER TO ELECT OR APPOINT MEMBERS OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS MADE BY THE BELLEVUE HOSPITAL FOUNDATION'S BOARD OF DIRECTORS CAN BE OVERRULED BY THE BELLEVUE HOSPITAL'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS MADE AVAILABLE TO THE BELLEVUE HOSPITAL'S PRESIDENT & EXECUTIVE VICE PRESIDENT/CFO AT THE FINANCE MEETING FOR REVIEW AS WELL AS PRESENTATION TO THE BOARD OF DIRECTORS. IN ADDITION, EACH BOARD MEMBER RECEIVES A COPY OF FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION DOES NOT HAVE ITS OWN CONFLICT OF INTEREST POLICY. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICY WHEN APPLICABLE AS DESCRIBED BELOW. ON AN ANNUAL BASIS, THE PRESIDENT SHALL SEND TO ALL EXECUTIVE STAFF AND SELECTED EMPLOYEES, A COPY OF THE BOARD OF TRUSTEES CONFLICT OF INTEREST POLICY TO BE COMPLETED AND RETURNED. IN ADDITION, NEW BOARD MEMBERS THAT JOIN DURING THE YEAR FILL OUT AND COMPLETE THE CONFLICT OF INTEREST POLICY WHEN THEY FIRST JOIN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE BOARD OF TRUSTEES CONCERNING ANY INTERESTS TO BE DISCLOSED. IF ANY CONFLICTS DO ARISE, THAT TRUSTEE WILL ABSTAIN FROM VOTING ON THE ISSUE. PERIODIC REVIEWS ARE ALSO CONDUCTED TO ENSURE THAT THE CORPORATION OPERATES IN A MANNER CONSISTENT WITH ITS CHARITABLE PURPOSES, AND THAT IT DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS STATUS AS AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAX. THE BOARD OF DIRECTORS REVIEW THE COMPLETED CONFLICT OF INTEREST POLICIES INCLUDING THE PRESIDENT'S. THE BOARD OF DIRECTORS REVIEW THE PRESIDENT'S COMPLETED CONFLICT OF INTEREST POLICY ONCE THE PRESIDENT LEAVES THE ROOM. FORM 990, PART VI, SECTION B, LINE 15 THE FOUNDATION DOES NOT HAVE ITS OWN COMPENSATION POLICY. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICIES WHEN APPLICABLE, AS DESCRIBED BELOW. THE BOARD HAS A COMPENSATION COMMITTEE COMPRISED OF INDEPENDENT DIRECTORS. THE COMMITTEE UTILIZES AN OUTSIDE HEALTHCARE COMPENSATION CONSULTING COMPANY COMPARING COMPARABLE SIZED ORGANIZATIONS CONSISTENT WITH THE BOARD OF TRUSTEE COMPENSATION PHILOSOPHY STATEMENT. RECOMMENDATIONS ARE MADE FROM THE COMPENSATION COMMITTEE TO THE BOARD OF TRUSTEES. ANY COMPENSATION DECISIONS THAT ARE MADE ARE DOCUMENTED IN THE MINUTES OF THE EXECUTIVE COMPENSATION COMMITTEE AND EXECUTIVE SESSION MINUTES. THIS PROCESS WAS LAST UNDERTAKEN IN 2024. FORM 990, PART VI, SECTION C, LINE 19 THE FOUNDATION MAKES ITS FINANCIAL STATEMENTS AND CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINES 13 AND 14 THE FOUNDATION DOES NOT HAVE ITS OWN WHISTLEBLOWER OR DOCUMENT RETENTION POLICIES. HOWEVER, THE FOUNDATION FOLLOWS THE BELLEVUE HOSPITAL'S POLICIES WHEN APPLICABLE. FORM 990, PART IX, LINE 11G STAFFING & MEAL FEES: PROGRAM SERVICE EXPENSES 131,672. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 131,672. FORM 990, PART XI, LINE 9: TEMPORARILY RESTRICTED CONTRIBUTIONS 7,053. 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 12B, II N/A 0 BELLEVUE HOSPITAL PAIN MANAGEMENT LLC 1400 W MAIN STREET BELLEVUE OH 44811 464660177 HEALTH CARE OH N/A 0 1 BELLEVUE PROFESSIONAL SERVICES INC 1400 W MAIN STREET BELLEVUE OH 44811 341828724 PHYSICIAN SERVICES OH N/A C 1 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 1 0