2020-11-13T07:32:57-06:00 2019-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2019-01-01 344428206 BLANCHARD VALLEY HEALTH SYSTEM % DAVID M CYTLAK BLAN 4194234500 1900 SOUTH MAIN STREET FINDLAY OH 45840 DAVID M CYTLAK CFO 4194234500 2020-11-16 true AARON D HERSHBERGER P00961884 2604604000 167.68.126.162 35027420203185000007 2020-11-13 P 4054C3EF14AA7DF352A59B9CFDC0CB34D463127C 98F48BC4268BBFECC27B79B2B9B20B6B3E311CC0 2019 2021-01-29 14:40:06Z DAVID M CYTLAK 1900 SOUTH MAIN STREET FINDLAY OH 45840 54618395 false X WWW.BVHEALTHSYSTEM.ORG X 1951 OH WE PROVIDE MANAGEMENT OVERSIGHT AND GOVERNANCE OF ALL HEALTH SYSTEM ACTIVITIES. WE ALSO OPERATE FAMILY PRACTICES, SPECIALTY PRACTICES, AND EMS AMBULANCE SERVICES. 17 15 359 193 -18756 115477 0 0 48169268 50802204 2422593 566458 146373 2979000 50738234 54347662 0 0 0 0 71301229 81792741 0 0 0 26797273 26934918 98098502 108727659 -47360268 -54379997 116113518 119267001 115643224 118701934 470294 565067 X OUR MISSION: OUR EXTRAORDINARY PEOPLE PROVIDE CARING FOR A LIFETIME THROUGH A BROAD CONTINUUM OF EXCEPTIONAL HEALTH-RELATED SERVICES IN NORTHWEST OHIO. false false 83294002 53932432 BLANCHARD VALLEY HEALTH SYSTEM'S PROGRAM SERVICE REVENUE IS GENERATED BY BLANCHARD VALLEY MEDICAL PRACTICES (BVMP), HANCO EMERGENCY MEDICAL SERVICES (HANCO), AND BEYOND MEDSPA (MEDSPA), WHICH ARE WHOLLY OWNED, DISREGARDED ENTITIES. BVMP CONSISTS OF FAMILY PRACTICE PHYSICIAN OFFICES, NEUROSURGICAL PHYSICIAN OFFICES, SPECIALTY PHYSICIAN OFFICES, AND AN URGENT CARE CENTER. BVMP IS COMMITTED TO PROVIDING EASILY ACCESSIBLE HEALTH CARE SERVICES TO ALL MEMBERS OF THE SURROUNDING COMMUNITIES THROUGH ITS FAMILY PRACTICES AND URGENT CARE CENTER. SPECIALIZED SERVICES ARE ALSO AVAILABLE, INCLUDING NEUROSURGICAL SERVICES, CANCER CARE, CARDIAC CARE, AND DIAGNOSTIC SERVICES. HANCO PROVIDES PROFESSIONAL AND EXPEDIENT AMBULANCE SERVICES AND PRE-HOSPITAL EMERGENCY MEDICAL CARE. MEDSPA PROVIDES COSMETIC MEDICAL TREATMENT CENTERS. 83294002 true false false false false false false false false true true false false false true false false true false false false false false false false false false false false true false false false false false false false false false false false false true true true true false false true 0 0 359 true true true false false false false false false false false false false false X 17 15 false false false false false false false true true false false true true true true true true true true true true OH X DAVID M CYTLAK 4194234500 1900 SOUTH MAIN STREET FINDLAY OH 45840 DR THOMAS KINDL PHYSICIAN 40.0 0.0 X 1685336 0 23365 SCOTT MALANEY CEO 38.0 2.0 X X 986338 0 24801 DR WILLIAM HOGAN PHYSICIAN 40.0 0.0 X 818528 0 0 JOHN OGDEN PHYSICIAN 40.0 0.0 X 787938 0 8186 DR AMBER PATTERSON PHYSICIAN 40.0 0.0 X 756394 0 24339 DOUGLAS YODER PHYSICIAN 40.0 0.0 X 768863 0 9885 DR MICHAEL DENIKE CHIEF MEDICAL OFFICER 40.0 0.0 X 530676 0 25125 DAVE CYTLAK CFO 38.0 2.0 X 475024 0 21006 RICHARD POLDER MD TRUSTEE 0.5 1.0 X 469453 0 11552 KELLEY SHROLL PRESIDENT OF BVMP 40.0 0.0 X 263132 0 21146 WILLIAM KOSE VP OF SPECIAL PROJECTS 36.0 4.0 X 190790 0 23731 JAMES WELLMAN CHIEF INFORMATION OFFICER 38.0 2.0 X 145296 0 3083 PAUL WORSTELL CHAIRMAN 0.5 1.0 X X 0 0 0 KAREN CLINE TRUSTEE 0.5 1.0 X 0 0 0 FRANK A COSIANO MD TRUSTEE 0.5 1.0 X 0 0 0 GINGER JONES TRUSTEE 0.5 1.0 X 0 0 0 DAVID EUBANKS TRUSTEE 0.5 1.0 X 0 0 0 RANDAL MYERS RPH TRUSTEE 0.5 1.0 X 0 0 0 JAMES DOWLING MD SECRETARY 0.5 1.0 X X 0 0 0 GARRY PEIFFER TREASURER 0.5 1.0 X X 0 0 0 WILLIAM REIST DMIN TRUSTEE 0.5 1.0 X 0 0 0 KIMBERLY STUMPP VICE CHAIRMAN 0.5 1.0 X X 0 0 0 JOSEPH LONGO TRUSTEE 0.5 1.0 X 0 0 0 KAREN KLASSEN HARDER TRUSTEE 0.5 1.0 X 0 0 0 ADELE WEBB PHD TRUSTEE 0.5 1.0 X 0 0 0 RICHARD STATES DHSC TRUSTEE 0.5 1.0 X 0 0 0 JOHN REINEKE TRUSTEE 0.5 1.0 X 0 0 0 7877768 0 196219 22 false true false BLANCHARD VALLEY MEDICAL ASSOCIATES 200 W PEARL STREET FINDLAY OH 45840 OUTSIDE REF LABS 383290 BLANCHARD VALLEY PATHOLOGY AND LAB 1900 SOUTH MAIN STREET FINDLAY OH 45840 PATHOLOGY SERVICES 780774 JDP VENTURES LLC 301 S MAIN STREET FINDLAY OH 45840 REAL ESTATE RENT 411268 TECHNICORE PO BOX 1210 FINDLAY OH 45839 MED EQUIP SERVICES 1475228 KAUFMAN HALL ASSOCIATES LLC 5202 OLD ORCHARD RD SUITE N700 SKOKIE IL 60077 SOFTWARE MAIN/SUBSC 417854 24 0 NET PATIENT SERVICE REVENUE 621110 49495000 49495000 MANAGEMENT ALLOCATIONS TO RELATED ENTITIES 900099 1307204 1307204 50802204 373038 -18756 391794 0 0 106000 106000 0 106000 106000 289925 174228 270733 19192 174228 193420 174228 19192 0 0 0 0 0 0 0 0 0 EQUITY INVESTMENTS 621400 -83000 -83000 MISCELLANEOUS 900099 2956000 2956000 2873000 54347662 53932432 -18756 433986 0 0 0 0 3793918 1517567 2276351 0 67418260 53934608 13483652 2486684 2486684 -3160021 -2528017 -632004 11253900 9003120 2250780 0 0 2022020 1011010 1011010 0 0 -605000 -605000 1262609 1136348 126261 56929 51236 5693 3255559 2278891 976668 1095963 821972 273991 0 1729814 1383851 345963 755680 377840 377840 0 0 0 0 7515721 6012577 1503144 795526 636421 159105 PROVISION FOR BAD DEBTS 2914652 2914652 MEDICAL SUPPLIES 3178198 3178198 DUES & SUBSCRIPTIONS 1018111 763583 254528 OTHER 1939136 800145 1138991 108727659 83294002 25433657 0 11001795 4169001 0 0 0 0 15476000 15225000 0 0 0 0 0 0 37116 37000 3809557 3297000 62900000 28625000 27394566 34275000 38273479 44993000 6014000 5951000 0 0 14107005 9363000 0 1957000 116113518 119267001 32480150 31842934 0 0 0 0 0 0 0 0 0 0 0 0 0 0 83163074 86859000 115643224 118701934 X -272 838 470566 564229 470294 565067 116113518 119267001 X -54379997 4078000 50396770 X false true X true false X X X 3 BLANCHARD VALLEY HEALTH FOUNDATION 341370522 7 true 5264 0 BLANCHARD VALLEY REGIONAL HEALTH CENTER 341369963 3 true 811839 0 BLANCHARD VALLEY CONTINUING CARE SERVICES 346006904 10 true 279538 0 3 1096641 true false false false false false false false false false false false false false false true false 470566 105698 1400 574864 492357 -9147 12644 470566 449878 61967 19488 492357 13031190 28650 12609962 449878 13732203 -381512 319501 13031190 0.75400 0.24600 false true true 8586863 8586863 21273615 5868831 15404784 1694639 1482682 211957 27426019 19507433 7918586 3918864 1766054 2152810 34275000 0 ADVANCES FROM AFFILIATES 74154000 OTHER LONG-TERM OBLIGATIONS 10671000 DEFERRED REVENUE 67000 LEASE LIABILITY 1967000 86859000 105907780 4078000 50396770 54474770 51433010 2914652 2914652 54347662 105813007 105813007 2914652 2914652 108727659 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ARE UTILIZED FOR DONOR DESIGNATED PURPOSES, INCLUDING CHARITY CARE, CAPITAL PROJECTS AND PURCHASES, AND CONTINUING EDUCATION FOR STAFF AND PHYSICIANS. PART XI, LINE 2D INVESTMENT INCOME TIMING DIFFERENCE $ 108,770 TRANSFERS FROM AFFILIATES $50,288,000 TOTAL $50,396,770 PART XI & PART XII, LINE 4B BAD DEBT RECLASS $2,914,652 ASC 740 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. X X X X X X false true false false false false false false false SCOTT MALANEY CEO 620473 0 174853 0 191012 0 16800 0 8001 0 1011139 0 DAVE CYTLAK CFO 363976 0 76818 0 34230 0 16800 0 4206 0 496030 0 WILLIAM KOSE VP OF SPECIAL PROJECTS 127646 0 34331 0 28813 0 10066 0 13665 0 214521 0 RICHARD POLDER MD TRUSTEE 466626 0 0 0 2827 0 0 0 11552 0 481005 0 DR THOMAS KINDL PHYSICIAN 573845 0 1091681 0 19810 0 11200 0 12165 0 1708701 0 DR AMBER PATTERSON PHYSICIAN 320556 0 416514 0 19324 0 11200 0 13139 0 780733 0 DR WILLIAM HOGAN PHYSICIAN 455860 0 332210 0 30458 0 0 0 0 0 818528 0 JOHN OGDEN PHYSICIAN 744705 0 42423 0 810 0 0 0 8186 0 796124 0 DOUGLAS YODER PHYSICIAN 754016 0 13701 0 1146 0 0 0 9885 0 778748 0 DR MICHAEL DENIKE CHIEF MEDICAL OFFICER 518686 0 11180 0 810 0 16800 0 8325 0 555801 0 KELLEY SHROLL PRESIDENT OF BVMP 212823 0 44681 0 5628 0 13490 0 7656 0 284278 0 SCHEDULE J, PART I, LINE 4C IN 2019, BLANCHARD VALLEY HEALTH SYSTEM CONTRIBUTED ON BEHALF OF SCOTT MALANEY $19,000 TO A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE SERP IS AN UNFUNDED, NONQUALIFIED DEFERRED COMPENSATION ARRANGEMENT CONSISTING OF TWO PLANS: AN ELIGIBLE PLAN SUBJECT TO INTERNAL REVENUE CODE SECTION 457(B) AND AN INELIGIBLE PLAN SUBJECT TO SECTION 457(F). THE 457(B) PLAN WAS ORIGINALLY IMPLEMENTED EFFECTIVE JANUARY 1, 2002. THE 457(F) PLAN WAS ORIGINALLY EFFECTIVE SEPTEMBER 1, 2000 AND WAS RESTATED ON JANUARY 1, 2002 FOR COORDINATION WITH THE 457(B) PLAN. IN 2010 AND 2011, THE 457(F) PLAN WAS FURTHER AMENDED AND RESTATED TO COMPLY WITH THE LATEST REGULATORY GUIDANCE AND PROVIDE FOR A NEW CONTRIBUTION MODEL AND VESTING SCHEDULE. ADDITIONAL EXECUTIVES WERE ALSO ADDED AND DEEMED ELIGIBLE FOR PLAN BENEFITS IN 2010, INCLUDING DAVID CYTLAK. IN 2019, BLANCHARD VALLEY HEALTH SYSTEM CONTRIBUTED ON BEHALF OF DAVID CYTLAK $25,673 TO THE SERP. KEY FEATURES OF THE SERP, AS AMENDED AND RESTATED IN 2010/2011, INCLUDE THE FOLLOWING: * ELIGIBILITY IS LIMITED TO CERTAIN MANAGEMENT OR HIGHLY-COMPENSATED EMPLOYEES OF BVHS (I.E., TOP HAT REFERENCE). FUTURE PARTICIPATION IS UPON NOMINATION BY THE CEO AND APPROVAL BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD. * EMPLOYER CONTRIBUTIONS ARE COMPRISED OF: ** DEFINED CONTRIBUTION TARGET INCOME REPLACEMENT PERCENTAGE CONTRIBUTION: - PROVIDE 60% TARGET INCOME REPLACEMENT FOR CEO (SCOTT MALANEY) - PROVIDE 50% TARGET INCOME REPLACEMENT FOR CFO (DAVID CYTLAK) **EMPLOYEE CONTRIBUTIONS TO THE SERP ACCOUNT ARE NOT ALLOWED. *EACH PARTICIPANT'S 457(B) ACCOUNT WILL BE CREDITED UP TO THE STATUTORY LIMIT ($19,000 IN 2019), WITH THE REMAINING AMOUNT BEING DEPOSITED INTO THE 457(F) ACCOUNT. *EMPLOYER CONTRIBUTIONS TO THE 457(F) PLAN ARE SUBJECT TO A CLASS YEAR VESTING SCHEDULE, WITH A WAITING PERIOD SET AT 2-5 YEARS, DEPENDING ON THE AGE OF THE PARTICIPANT AT THE TIME OF CONTRIBUTION. UPON VESTING, THE FULL VESTED BALANCE WILL BE DISTRIBUTED TO THE PARTICIPANT AND CONSIDERED TAXABLE INCOME. IN ADDITION TO THE VESTING SCHEDULE ABOVE, 100% AND IMMEDIATE VESTING OF THE BENEFIT ACCRUED UPON ATTAINMENT OF NORMAL RETIREMENT AGE, DEATH, DISABILITY, INVOLUNTARY TERMINATION WITHOUT CAUSE, PLAN TERMINATION, OR CHANGE OF CONTROL. *DISTRIBUTION OF THE VESTED PORTION OF THE 457(F) BENEFIT IS PAID AS A LUMP SUM AS SOON AS ADMINISTRATIVELY FEASIBLE FORM 990, PART VI, SECTION A, LINE 1B SCOTT MALANEY AND DR. RICHARD POLDER ARE BOARD MEMBERS AND ARE ALSO PAID EMPLOYEES OF BLANCHARD VALLEY HEALTH SYSTEM. DUE TO THEIR EMPLOYMENT, THEY ARE CONSIDERED NON INDEPENDENT VOTING MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B A DETAIL REVIEW OF THE FORM 990 IS PERFORMED BY THE ORGANIZATION'S COMPLIANCE & AUDIT COMMITTEE. THIS COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES, MEMBERS OF THE COMMUNITY, AND MEMBERS OF UPPER MANAGEMENT. THE COMPLIANCE & AUDIT COMMITTEE REPORTS TO THE BOARD OF TRUSTEES ANY AREAS OF CONCERN REGARDING THE FORM 990'S. ONCE THE FORM 990'S HAVE BEEN FINALIZED, REVIEWED AND APPROVED, THE MEMBERS OF BOARD OF TRUSTEES RECEIVE ELECTRONIC COMMUNICATION THAT THE FORM 990'S ARE COMPLETE AND AVAILABLE FOR REVIEW. ANY QUESTIONS ARISING FROM BOARD MEMBERS ARE ADDRESSED BY THE COMPLIANCE & AUDIT COMMITTEE, UPPER MANAGEMENT, THE ACCOUNTING DEPARTMENT, AND/OR EXTERNAL ACCOUNTANTS. FORM 990, PART VI, SECTION B, LINE 12C ANNUALLY, THE ORGANIZATION ASKS ITS BOARD MEMBERS, ITS CORPORATE OFFICERS, AND ITS KEY EMPLOYEES TO SIGN CONFLICT OF INTEREST LETTERS. THE ORGANIZATION ALSO ASKS THESE INDIVIDUALS TO REVIEW THEIR ACTIVITIES AND COMPLETE RELATIONSHIP QUESTIONNAIRES FOR THE FORM 990 FILING YEAR. BOARD MEMBERS ARE REQUIRED TO BRING TO THE ATTENTION OF EXECUTIVE MANAGEMENT ANY CONFLICTS AS THEY ARISE. THESE CONFLICTS ARE DOCUMENTED IN THE BOARD MINUTES. BOARD MEMBERS THAT HAVE CONFLICTS ARE TO EXCUSE THEMSELVES FROM DISCUSSIONS AND/OR VOTING ON ISSUES WITH WHICH CONFLICTS EXIST. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION REVIEWS EXECUTIVE COMPENSATION, BENEFITS, AND PERQUISITES ON A PERIODIC BASIS TO ENSURE CONSISTENCY WITH COMPENSATION PHILOSOPHY AND MARKET PRACTICE. A SUBSET OF MEMBERS FROM THE BOARD OF DIRECTORS SERVES AS THE EXECUTIVE COMPENSATION REVIEW COMMITTEE, AND THIS COMMITTEE MEETS TO APPROVE WAGE INCREASES AS WELL AS REVIEWS THE ORGANIZATION'S POSITION IN THE MARKET WHEN IT COMES TO EXECUTIVE COMPENSATION. IN ADDITION, THE EXECUTIVE COMPENSATION REVIEW COMMITTEE REGULARLY ENGAGES A HUMAN RESOURCES CONSULTING FIRM TO ASSESS THE REASONABLENESS OF THE COMPENSATION PROGRAM USED FOR ITS EXECUTIVES. THE ORGANIZATION IS COMMITTED TO A DECISION-MAKING PROCESS FOR EXECUTIVE COMPENSATION THAT IS CONSISTENT WITH INTERNAL REVENUE CODE SECTION 4958 REQUIREMENTS FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS". THE MEMBERS OF THE COMMITTEE APPROVING EXECUTIVE COMPENSATION DECISIONS ARE INDIVIDUALS WHO ARE DISINTERESTED (I.E., DO NOT HAVE A CONFLICT OF INTEREST WITH RESPECT TO THE ARRANGEMENTS). THE COMMITTEE REVIEWS OBJECTIVE DATA, INCLUDING SURVEY DATA PREPARED BY INDEPENDENT FIRMS, AS PART OF THE DECISION-MAKING PROCESS. THE MARKET DATA PROVIDED IN THE COMPENSATION REPORT FROM THE CONSULTING FIRM ASSISTS THE ORGANIZATION IN ESTABLISHING THE REBUTTABLE PRESUMPTION OF REASONABLENESS. THE ORGANIZATION CONSULTS WITH SULLIVAN COTTER AND ASSOCIATES (AN EXTERNAL CONSULTANT) ON AN ANNUAL BASIS TO REVIEW COMPENSATION MATTERS. ON A BIENNIAL BASIS, THE ORGANIZATION PERFORMS A FULL COMPENSATION AND BENEFIT ANALYSIS AND REVIEW. THE RESULTS OF THE REVIEW BY SULLIVAN COTTER AND ASSOCIATES ARE SHARED/DISCUSSED WITH THE BOARD. FORM 990, PART VI, SECTION B, LINE 15B THE SAME PROCESS APPLIES FOR ALL OTHER EXECUTIVE STEERING COMMITTEE MEMBERS AS DETAILED FOR THE CEO. FORM 990, PART VI, SECTION C, LINE 19 FINANCIAL STATEMENTS, REQUIRED TAX FORMS (I.E., FORM 990), AS WELL AS GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICIES ARE AVAILABLE UPON REQUEST THROUGH THE ADMINISTRATIVE AND FINANCE OFFICES. FORM 990, PART XI, LINE 9 INVESTMENT INCOME TIMING DIFFERENCE $ 108,770 TRANSFERS FROM AFFILIATES $50,288,000 TOTAL $50,396,770 BLANCHARD VALLEY MEDICAL PRACTICES LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 421659766 PHYS OFFICE OH 43223144 18458761 BVHS BLANCHARD VALLEY HOME CARE SERVICES LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 421565629 HOME HEALTH OH BVCCS CRNA OF BLANCHARD VALLEY LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 061748552 CERT NURSE OH 0 BVRHC NEUROSURGICAL ASSOCIATES OF NW OHIO LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 342052585 PHYS OFFICE OH 0 BVMP SPECIALTY PHYSICIANS OF BLANCHARD VALLEY 1900 SOUTH MAIN STREET FINDLAY OH 45840 262448601 PHYS OFFICE OH BVMP BLANCHARD VALLEY REGIONAL CANCER CENTER 1900 SOUTH MAIN STREET FINDLAY OH 45840 050623393 PHYS OFFICE OH BVMP HANCO EMERGENCY MEDICAL SERVICES LLC 417 SIXTH STREET FINDLAY OH 45840 463299390 AMBULANCE SER OH 3834203 505207 BVHS BEYOND MEDSPA LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 814440286 COSMETIC SPA OH 536288 880522 BVHS BIRCHAVEN ESTATES AT EASTERN WOODS LTD 15100 BIRCHAVEN LANE FINDLAY OH 45840 201494204 CONDOMINIUMS OH BVCCS BLANCHARD VALLEY CONTINUING CARE SERVICE 15100 BIRCHAVEN LANE FINDLAY OH 45840 346006904 CONT. 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