BLANCHARD VALLEY HEALTH SYSTEM: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
BLANCHARD VALLEY HEALTH SYSTEM (EIN 34-4428206)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-11-07
IRS object ID
201813119349302511
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-11-07T15:31:15-06:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1200 E Main St Suite 700AddressLine1Txt
CityFort WayneCityNm
State AbbreviationINStateAbbreviationCd
ZIP46802ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN344428206EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1BLANCHARD VALLEY HEALTH SYSTEMBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% DAVID M CYTLAKInCareOfNm
Business Name ControlBLANBusinessNameControlTxt
Phone4194234500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 SOUTH MAIN STREETAddressLine1Txt
CityFINDLAYCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45840ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID M CYTLAKPersonNm
Person TitleCFOPersonTitleTxt
Phone4194234500PhoneNum
Signature2018-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAaron D HershbergerPreparerPersonNm
PTINP00961884PTIN
Phone2604604000PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address167.68.126.162IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id35027420183115000002FederalOriginalSubmissionId
Federal Original Submission Id2018-11-07FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdFD17B16453602DE2B5C268902672A980DDBA3821AtSubmissionCreationDeviceId
At Submission Filing Device IdB6216CF12129628A7FE598526BDE6CBBE5F2D5F5AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID M CYTLAKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 SOUTH MAIN STREETAddressLine1Txt
CityFINDLAYCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45840ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$59,273,922GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BVHEALTHSYSTEM.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1951FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionWE PROVIDE MANAGEMENT OVERSIGHT AND GOVERNANCE OF ALL HEALTH SYSTEM ACTIVITIES. WE ALSO OPERATE FAMILY PRACTICES, SPECIALTY PRACTICES, AND EMS AMBULANCE SERVICES.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent15VotingMembersIndependentCnt
Total Employee293TotalEmployeeCnt
Total Volunteers166TotalVolunteersCnt
Total Gross UBI$40,238TotalGrossUBIAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$0CYContributionsGrantsAmt
PY Program Service Revenue$39,418,288PYProgramServiceRevenueAmt
CY Program Service Revenue$41,566,444CYProgramServiceRevenueAmt
PY Investment Income$2,637,640PYInvestmentIncomeAmt
CY Investment Income$3,206,421CYInvestmentIncomeAmt
PY Other Revenue$122,059PYOtherRevenueAmt
CY Other Revenue$152,104CYOtherRevenueAmt
PY Total Revenue$42,177,987PYTotalRevenueAmt
CY Total Revenue$44,924,969CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$57,887,539PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$64,332,935CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$29,706,442PYOtherExpensesAmt
CY Other Expenses$25,184,131CYOtherExpensesAmt
PY Total Expenses$87,593,981PYTotalExpensesAmt
CY Total Expenses$89,517,066CYTotalExpensesAmt
PY Revenues Less Expenses-$45,415,994PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$44,592,097CYRevenuesLessExpensesAmt
Total Assets BOY$114,427,650TotalAssetsBOYAmt
Total Assets EOY$117,881,948TotalAssetsEOYAmt
Total Liabilities BOY$135,123,159TotalLiabilitiesBOYAmt
Total Liabilities EOY$180,767,859TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY-$20,695,509NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY-$62,885,911NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionOUR MISSION: OUR EXTRAORDINARY PEOPLE PROVIDE CARING FOR A LIFETIME THROUGH A BROAD CONTINUUM OF EXCEPTIONAL HEALTH-RELATED SERVICES IN NORTHWEST OHIO.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$67,314,037ExpenseAmt
Revenue$41,566,444RevenueAmt
DescBLANCHARD 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.Desc
Total Program Service Expenses$67,314,037TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredfalseScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalfalseOperateHospitalInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityYes (true)DisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee293EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
DAF Excess Business HoldingsfalseDAFExcessBusinessHoldingsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member15IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VentureYes (true)InvestmentInJointVentureInd
Written Policy Or ProcedureYes (true)WrittenPolicyOrProcedureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonDAVID M CYTLAKPersonNm
Phone4194234500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 SOUTH MAIN STREETAddressLine1Txt
CityFINDLAYCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45840ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
DUANE JEBBETT
CHAIR0.51.0Yes (X)Yes (X)$0$0$0
PAUL WORSTELL
VICE CHAIR0.51.0Yes (X)Yes (X)$0$0$0
KAREN CLINE
TRUSTEE0.51.0Yes (X)$0$0$0
FRANK A COSIANO MD
TRUSTEE0.51.0Yes (X)$0$0$0
GINGER JONES
TRUSTEE0.51.0Yes (X)$0$0$0
DAVID EUBANKS
TRUSTEE0.51.0Yes (X)$0$0$0
RANDAL MYERS RPH
TRUSTEE0.51.0Yes (X)$0$0$0
ROD NICHOLS
TRUSTEE0.51.0Yes (X)$0$0$0
DEBRA PARKER
TRUSTEE0.51.0Yes (X)$0$0$0
GARRY PEIFFER
TREASURER0.51.0Yes (X)Yes (X)$0$0$0
WILLIAM REIST DMIN
TRUSTEE0.51.0Yes (X)$0$0$0
KIMBERLY STUMPP
TRUSTEE0.51.0Yes (X)$0$0$0
JOSEPH LONGO
TRUSTEE0.51.0Yes (X)$0$0$0
KAREN KLASSEN HARDER
SECRETARY0.51.0Yes (X)Yes (X)$0$0$0
SCOTT MALANEY
CEO2.038.0Yes (X)Yes (X)$1,058,712$0$25,291
RICHARD POLDER MD
TRUSTEE0.51.0Yes (X)$0$0$0
DAVE CYTLAK
CFO2.038.0Yes (X)$417,451$0$21,939
WILLIAM KOSE
CHIEF MEDICAL OFFICER4.036.0Yes (X)$270,246$0$23,617
ROBERT WESTPHAL
PRESIDENT OF BVCCS0.040.0Yes (X)$263,869$0$23,489
DR ANAS BALAA
PHYSICIAN40.00.0$1,078,964$0$34,934Yes (X)
DR PANAGIOTIS BAKOS
PHYSICIAN40.00.0$983,889$0$23,012Yes (X)
DR THOMAS KINDL
PHYSICIAN40.00.0$1,176,297$0$21,525Yes (X)
DR ROBERT HOLLIS III
PHYSICIAN40.00.0$747,027$0$23,670Yes (X)
DR WILLIAM HOGAN
PHYSICIAN40.00.0$747,185$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$6,743,640TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$197,477TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K20IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HCTEC PARTNERS LLC
5106 MARYLAND WAYBRENTWOODTN37027CONSULTING SERVICES$537,427
CHRISTIAN MEDICAL ASSOCIATES PC
330 LONGVUE COURTJOHNS CREEKGA30097LOCUM SERVICES$744,016
BLANCHARD VALLEY PATHOLOGY AND LAB
1900 SOUTH MAIN STREETFINDLAYOH45840PATHOLOGY SERVICES$780,686
ALPHA IMAGING LLC
4455 GLENBROOK ROADWILLOUGHBYOH44094MED EQUIP SERVICES$1,072,516
TECHNICORE
PO BOX 1210FINDLAYOH45839MED EQUIP SERVICES$1,593,128
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K36CntrctRcvdGreaterThan100KCnt
Total Contributions$0TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE621110$39,872,185$39,872,185
MANAGEMENT ALLOCATIONS TO RELATED ENTITIES900099$1,694,259$1,694,259
FieldValueIRS element (for citing)
Total Program Service Revenue$41,566,444TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,866,357TotalRevenueColumnAmt
Unrelated Business Revenue$40,238UnrelatedBusinessRevenueAmt
Exclusion$1,826,119ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$152,104RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$152,104RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$152,104TotalRevenueColumnAmt
Exclusion$152,104ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$15,689,017SecuritiesAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$14,348,953SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$1,340,064SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,340,064TotalRevenueColumnAmt
Exclusion$1,340,064ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Other Revenue Total$0OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$44,924,969TotalRevenueColumnAmt
Related Or Exempt Func Income$41,566,444RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$40,238UnrelatedBusinessRevenueAmt
Exclusion$3,318,287ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$2,101,013TotalAmt
Program Services$630,304ProgramServicesAmt
Management And General$1,470,709ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$53,142,016TotalAmt
Program Services$42,513,613ProgramServicesAmt
Management And General$10,628,403ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$1,731,241TotalAmt
Management And General$1,731,241ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$4,364,263TotalAmt
Program Services$3,491,410ProgramServicesAmt
Management And General$872,853ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$2,994,402TotalAmt
Program Services$2,395,522ProgramServicesAmt
Management And General$598,880ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$2,427,518TotalAmt
Program Services$1,213,759ProgramServicesAmt
Management And General$1,213,759ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$684,513TotalAmt
Management And General$684,513ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,302,743TotalAmt
Program Services$1,172,469ProgramServicesAmt
Management And General$130,274ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$367,098TotalAmt
Program Services$36,710ProgramServicesAmt
Management And General$330,388ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$5,382,447TotalAmt
Program Services$5,382,447ProgramServicesAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$401,315TotalAmt
Program Services$300,986ProgramServicesAmt
Management And General$100,329ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,764,593TotalAmt
Program Services$1,411,674ProgramServicesAmt
Management And General$352,919ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$510,004TotalAmt
Program Services$255,002ProgramServicesAmt
Management And General$255,002ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$30,634TotalAmt
Management And General$30,634ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$7,273,504TotalAmt
Program Services$5,818,803ProgramServicesAmt
Management And General$1,454,701ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PROVISION FOR BAD DEBTS$1,952,968$1,952,968
MEDICAL & PRO. FEES$302,296$272,066$30,230
DUES & SUBSCRIPTIONS$1,154,626$1,154,626
OTHER$1,629,872$466,304$1,163,568

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$89,517,066TotalAmt
Program Services$67,314,037ProgramServicesAmt
Management And General$22,203,029ManagementAndGeneralAmt
Fundraising$0FundraisingAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XYes (X)InfoInScheduleOPartXInd

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$5,223,603BOYAmt
EOY$16,742,900EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$13,345,671BOYAmt
EOY$10,042,843EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$36,902BOYAmt
EOY$37,116EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$1,677,360BOYAmt
EOY$2,982,801EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$46,577,667LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$23,794,382LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$24,792,694BOYAmt
EOY$22,783,285EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$40,644,136BOYAmt
EOY$41,300,337EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$6,034,284BOYAmt
EOY$6,013,953EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$22,673,000BOYAmt
EOY$17,978,713EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$114,427,650BOYAmt
EOY$117,881,948EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$35,972,503BOYAmt
EOY$36,656,190EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$99,150,656BOYAmt
EOY$144,111,669EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$135,123,159BOYAmt
EOY$180,767,859EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY-$21,145,387BOYAmt
EOY-$63,378,268EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$449,878BOYAmt
EOY$492,357EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY-$20,695,509BOYAmt
EOY-$62,885,911EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$114,427,650BOYAmt
EOY$117,881,948EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$44,592,097ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$2,288,000NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$113,695OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations3SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp (3 entries)

EINEINOrganization TypeOrganizationTypeCdGoverning Document ListedGoverningDocumentListedIndSupportSupportAmtOther SupportOtherSupportAmt
BLANCHARD VALLEY REGIONAL HEALTH CENTER
3413699633Yes (true)$1,095,148$0
BLANCHARD VALLEY CONTINUING CARE SERVICES
34600690410Yes (true)$353,381$0
BLANCHARD VALLEY HEALTH FOUNDATION
3413705227Yes (true)$6,415$0
FieldValueIRS element (for citing)
Supported Organizations Total3SupportedOrganizationsTotalCnt
Support Sum$1,454,944SupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (true)ListedByNameGoverningDocInd
Suprt Org No IRS DeterminationfalseSuprtOrgNoIRSDeterminationInd
Supported Org Section C456falseSupportedOrgSectionC456Ind
Supported Org Not Organized USfalseSupportedOrgNotOrganizedUSInd
Organization Change Suprt OrgfalseOrganizationChangeSuprtOrgInd
Support Non Supported OrgfalseSupportNonSupportedOrgInd
Payment Substantial ContribtrfalsePaymentSubstantialContribtrInd
Loan Disqualified PersonfalseLoanDisqualifiedPersonInd
Controlled Disqualified PrsnfalseControlledDisqualifiedPrsnInd
Disqualified Prsn Controll IntfalseDisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr IntfalseDisqualifiedPrsnOwnrIntInd
Excess Business Holdings RulesfalseExcessBusinessHoldingsRulesInd
Contribution ControllerfalseContributionControllerInd
Contribution FamilyfalseContributionFamilyInd
Contribution35 ControlledfalseContribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (true)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt OrgfalseOperateBenefitNonSuprtOrgInd

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$449,878BeginningYearBalanceAmt
Investment Earnings Or Losses$61,967InvestmentEarningsOrLossesAmt
Other Expenditures$19,488OtherExpendituresAmt
End Year Balance$492,357EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$13,031,190BeginningYearBalanceAmt
Investment Earnings Or Losses$28,650InvestmentEarningsOrLossesAmt
Other Expenditures$12,609,962OtherExpendituresAmt
End Year Balance$449,878EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$13,732,203BeginningYearBalanceAmt
Investment Earnings Or Losses-$381,512InvestmentEarningsOrLossesAmt
Other Expenditures$319,501OtherExpendituresAmt
End Year Balance$13,031,190EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$14,152,532BeginningYearBalanceAmt
Investment Earnings Or Losses-$420,329InvestmentEarningsOrLossesAmt
End Year Balance$13,732,203EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$14,424,824BeginningYearBalanceAmt
Investment Earnings Or Losses$113,872InvestmentEarningsOrLossesAmt
Other Expenditures$386,164OtherExpendituresAmt
End Year Balance$14,152,532EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY0.83000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.17000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,919,930OtherCostOrOtherBasisAmt
Book Value$6,919,930BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,031,049OtherCostOrOtherBasisAmt
Depreciation$4,876,103DepreciationAmt
Book Value$6,154,946BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,643,235OtherCostOrOtherBasisAmt
Depreciation$1,610,623DepreciationAmt
Book Value$32,612BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$21,362,196OtherCostOrOtherBasisAmt
Depreciation$15,740,163DepreciationAmt
Book Value$5,622,033BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$5,621,257OtherCostOrOtherBasisAmt
Depreciation$1,567,493DepreciationAmt
Book Value$4,053,764BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$22,783,285TotalBookValueLandBuildingsAmt
Financial DerivativesFinancialDerivativesGrp
Closely Held Equity InterestsCloselyHeldEquityInterestsGrp

Other Securities OtherSecuritiesGrp (2 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
VENTURES AND PARTNERSHIPS$243,953F
CARE SERVICES$5,770,000F
FieldValueIRS element (for citing)
Total Book Value Securities$6,013,953TotalBookValueSecuritiesAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
ADVANCES FROM AFFILIATES$134,369,942
OTHER LONG-TERM OBLIGATIONS$9,634,120
DEFERRED REVENUE$107,607
FieldValueIRS element (for citing)
Total Liability$144,111,669TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$45,373,696TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst$2,288,000NetUnrealizedGainsInvstAmt
Other Revenue$113,695OtherRevenueAmt
Revenue Not Reported$2,401,695RevenueNotReportedAmt
Revenue Subtotal$42,972,001RevenueSubtotalAmt
Other Revenues Not Included$1,952,968OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$1,952,968RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$44,924,969TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$87,564,098TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$87,564,098ExpensesSubtotalAmt
Other Expenses Not Included$1,952,968OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,952,968ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$89,517,066TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART V, LINE 4ENDOWMENT FUNDS ARE UTILIZED FOR DONOR DESIGNATED PURPOSES, INCLUDING CHARITY CARE, CAPITAL PROJECTS AND PURCHASES, AND CONTINUING EDUCATION FOR STAFF AND PHYSICIANS.
PART XI, LINE 2DINVESTMENT INCOME TIMING DIFFERENCE $ 113,695
PART XI & PART XII, LINE 4BBAD DEBT RECLASS $1,952,968
ASC 740MANAGEMENT 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.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Form990 Of Other OrganizationsYes (X)Form990OfOtherOrganizationsInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt
SCOTT MALANEY
CEO$581,201$0$126,972$0$350,539$0$18,000$0$7,291$0$1,084,003$0$168,481
DAVE CYTLAK
CFO$342,169$0$47,737$0$27,545$0$18,000$0$3,939$0$439,390$0$3,776
WILLIAM KOSE
CHIEF MEDICAL OFFICER$193,591$0$51,184$0$25,471$0$13,507$0$10,110$0$293,863$0
ROBERT WESTPHAL
PRESIDENT OF BVCCS$204,350$0$45,357$0$14,162$0$13,136$0$10,353$0$287,358$0
DR ANAS BALAA
PHYSICIAN$564,308$514,176$480$16,200$18,734$1,113,898
DR PANAGIOTIS BAKOS
PHYSICIAN$577,124$387,512$19,253$10,800$12,212$1,006,901
DR THOMAS KINDL
PHYSICIAN$578,612$578,868$18,817$10,800$10,725$1,197,822
DR ROBERT HOLLIS III
PHYSICIAN$745,759$0$1,268$16,200$7,470$770,697
DR WILLIAM HOGAN
PHYSICIAN$454,802$266,607$25,776$0$0$747,185

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE J, PART I, LINE 4BFormAndLineReferenceDesc
ExplanationIN 2017, BLANCHARD VALLEY HEALTH SYSTEM CONTRIBUTED ON BEHALF OF SCOTT MALANEY $18,000 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 2017, BLANCHARD VALLEY HEALTH SYSTEM CONTRIBUTED ON BEHALF OF DAVID CYTLAK $18,000 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 ($18,000 IN 2017), 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.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, LINE 1BSCOTT MALANEY IS A BOARD MEMBER AND IS ALSO A PAID EMPLOYEE OF BLANCHARD VALLEY HEALTH SYSTEM. DUE TO HIS EMPLOYMENT, HE IS CONSIDERED A NON INDEPENDENT VOTING MEMBER 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. ONCE THE FORM 990 HAS BEEN FINALIZED, REVIEWED AND APPROVED, THE MEMBERS OF BOARD OF TRUSTEES RECEIVE ELECTRONIC COMMUNICATION THAT THE FORM 990 IS 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 12CANNUALLY, 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 15ATHE 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 15BTHE SAME PROCESS APPLIES FOR ALL OTHER EXECUTIVE STEERING COMMITTEE MEMBERS AS DETAILED FOR THE CEO.
FORM 990, PART VI, SECTION C, LINE 19FINANCIAL 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 X, LINES 10C & 14THE BEGINNING OF THE YEAR BALANCE FOR LINE 10C INCLUDED $22,673,000 OF INTANGIBLE ASSETS. THIS AMOUNT WAS RECLASSIFIED FROM LINE 10C TO LINE 14 TO MATCH THE AUDITED FINANCIAL STATEMENTS. FORM 990, PART XI, LINE 9 INVESTMENT INCOME TIMING DIFFERENCE: $ 113,695

Schedule R IRS990ScheduleR

Id Disregarded Entities IdDisregardedEntitiesGrp (9 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdTotal IncomeTotalIncomeAmtEnd Of Year AssetsEndOfYearAssetsAmtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
BLANCHARD VALLEY MEDICAL PRACTICES LLC
1900 SOUTH MAIN STREETFINDLAYOH45840421659766PHYS OFFICEOH$33,440,000$6,879,000BVHS
BLANCHARD VALLEY HOME CARE SERVICES LLC
1900 SOUTH MAIN STREETFINDLAYOH45840421565629HOME HEALTHOHBVCCS
CRNA OF BLANCHARD VALLEY LLC
1900 SOUTH MAIN STREETFINDLAYOH45840061748552CERT NURSEOHBVRHC
NEUROSURGICAL ASSOCIATES OF NW OHIO LLC
1900 SOUTH MAIN STREETFINDLAYOH45840342052585PHYS OFFICEOHBVMP
SPECIALTY PHYSICIANS OF BLANCHARD VALLEY
1900 SOUTH MAIN STREETFINDLAYOH45840262448601PHYS OFFICEOHBVMP
BLANCHARD VALLEY REGIONAL CANCER CENTER
1900 SOUTH MAIN STREETFINDLAYOH45840050623393PHYS OFFICEOHBVMP
HANCO EMERGENCY MEDICAL SERVICES LLC
417 SIXTH STREETFINDLAYOH45840463299390AMBULANCE SEROHBVHS
BEYOND MEDSPA LLC
1900 SOUTH MAIN STREETFINDLAYOH45840814440286COSMETIC SPAOHBVHS
BIRCHAVEN ESTATES AT EASTERN WOODS LTD
15100 BIRCHAVEN LANEFINDLAYOH45840201494204CONDOMINIUMSOHBVCCS

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
BLANCHARD VALLEY CONTINUING CARE SERVICE
15100 BIRCHAVEN LANEFINDLAYOH45840346006904CONT. CAREOH501(C)(3)10BVHSYes (true)
BLANCHARD VALLEY REGIONAL HEALTH CENTER
1900 SOUTH MAIN STREETFINDLAYOH45840341369963ACUTE CAREOH501(C)(3)3BVHSYes (true)
BLANCHARD VALLEY HEALTH FOUNDATION
1900 SOUTH MAIN STREETFINDLAYOH45840341370522FUNDRAISINGOH501(C)(3)7BVHSYes (true)
EC EDWARDS MEMORIAL TRUST FBO FINDLAY
1900 SOUTH MAIN STREETFINDLAYOH45840346953719INVESTMENTOH501(C)(3)PFBVHFYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxt
NORTHWEST OHIO MEDICAL EQUIPMENT
1900 SOUTH MAIN STFINDLAYOH45840341882390MED EQUIPMENTOHBVCCSRELATED
BLANCHARD VALLEY PAIN MANAGEMENT
1900 SOUTH MAIN STFINDLAYOH45840270095470PAIN MGMTOHBVRHCRELATED
TECHNICORE CLINICAL ENGINEERING
1900 SOUTH MAIN STFINDLAYOH45840421702910BIO-MED SUPPORTOHBVRHCRELATED
CREIGHTON DIALYSIS LLC
1900 SOUTH MAIN STFINDLAYOH45840274527592DIALYSIS SERVICESOHBVRHCRELATED

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1CITAS INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line11900 SOUTH MAIN STREETAddressLine1Txt
CityFINDLAYCityNm
State AbbreviationOHStateAbbreviationCd
ZIP45840ZIPCd
FieldValueIRS element (for citing)
EIN311369708EIN
Primary ActivitiesRECRUITINGPrimaryActivitiesTxt
Legal Domicile StateOHLegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BVHSBusinessNameLine1Txt
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Ownership1.00000OwnershipPct
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1BLANCHARD VALLEY REGIONAL HEALTH CENTERBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeDTransactionTypeTxt
Involved$97,725,000InvolvedAmt
Method Of Amount DeterminationFMVMethodOfAmountDeterminationTxt

Comments

Anonymous: no account or email. Up to 2,000 characters, at most one link. Comments are checked automatically; some wait for review.