2016-11-10T11:46:25-06:00 2015-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2015-01-01 344428206 BLANCHARD VALLEY HEALTH SYSTEM % DAVID M CYTLAK BLAN 4194234500 1900 SOUTH MAIN STREET FINDLAY OH 45840 DAVID M CYTLAK CFO 4194234500 2016-11-15 true Joyce A Dulworth P00151125 2604604000 2015 2017-02-10 21:41:12Z DAVID M CYTLAK 1900 SOUTH MAIN STREET FINDLAY OH 45840 33071373 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. 18 17 702 111 -43821 -61262 0 0 28475535 31651495 1988717 616292 650798 308725 31115050 32576512 0 0 0 0 22275801 26266610 0 0 0 10745462 12124406 33021263 38391016 -1906213 -5814504 88909940 99291697 67329193 84039815 21580747 15251882 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 27466118 31687093 BLANCHARD VALLEY HEALTH SYSTEM'S PROGRAM SERVICE REVENUE IS GENERATED BY BLANCHARD VALLEY MEDICAL PRACTICES (BVMP) AND HANCO EMERGENCY MEDICAL SERVICES (HANCO), 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. 27466118 true false false false false false false false false true true true 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 true 702 true true true false false false false false false false false false false X 18 17 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 4194235497 1900 SOUTH MAIN STREET FINDLAY OH 45840 SCOTT MALANEY CEO 2.0 38.0 X X 1135838 0 24845 DUANE JEBBETT CHAIR 0.5 1.0 X 0 0 0 PAUL WORSTELL VICE CHAIR 0.5 1.0 X 0 0 0 KAREN KLASSEN HARDER SECRETARY 0.5 1.0 X 0 0 0 GARRY PEIFFER TREASURER 0.5 1.0 X 0 0 0 CHERYL BUCKLAND TRUSTEE 0.5 1.0 X 0 0 0 KAREN CLINE TRUSTEE 0.5 1.0 X 0 0 0 DAVID EUBANKS TRUSTEE 0.5 1.0 X 0 0 0 RANDALL MYERS TRUSTEE 0.5 1.0 X 0 0 0 ROD NICHOLS TRUSTEE 0.5 1.0 X 0 0 0 ANDREA KOEPKE TRUSTEE 0.5 1.0 X 0 0 0 WILLIAM REIST DMIN TRUSTEE 0.5 1.0 X 0 0 0 LEROY SCHROEDER MD TRUSTEE 0.5 1.0 X 0 0 0 GINGER JONES TRUSTEE 0.5 1.0 X 0 0 0 KIMBERLY STUMPP TRUSTEE 0.5 1.0 X 0 0 0 JOSEPH LONGO TRUSTEE 0.5 1.0 X 0 0 0 RICHARD POLDER MD TRUSTEE 0.5 1.0 X 0 0 0 FRANK COSIANO MD TRUSTEE 0.5 1.0 X 0 0 0 DAVID CYTLAK CFO 2.0 38.0 X 431551 0 16866 WILLIAM KOSE CQO 4.0 36.0 X 440190 0 26129 WILLIAM WATKINS CAO 40.0 0.0 X 219090 0 14889 DR ANAS BALAA PHYSICIAN 40.0 0.0 X 721363 0 33164 DR PAMELA REED PHYSICIAN 40.0 0.0 X 640427 0 1922 DR SEAN LOGAN PHYSICIAN 40.0 0.0 X 963430 0 8005 DR ROBERT HOLLIS PHYSICIAN 40.0 0.0 X 777896 0 22345 DR JAMES DAVIDSON PHYSICIAN 40.0 0.0 X 672991 0 12442 6002776 0 160607 71 false true false LI MD CHAOYANG 8400 WEST WOODLAND TRAIL FINDLAY OH 45840 PHYSICIAN SERVICES 624000 BKD LLP 200 EAST MAIN STREET SUITE 700 FT WAYNE IN 46802 AUDIT & TAX SERVICES 205165 SHUMAKER LOOP KENDRICK LLP 41 SOUTH HIGH ST COLUMBUS OH 43215 LEGAL SERVICES 168274 CONCORDANCE HEALTHCARE SOLUTIONS LL 85 SHAFFER PARK DR TIFFIN OH 44883 MEDICAL SUPPLIES 139390 FINDLAY SPECTRUM PROPERTIES LLC 15840 MEDICAL DRIVE SOUTH FINDLAY OH 45840 RENTAL 107013 6 0 NET PATIENT SERVICE REVENUE 621110 23926486 23926486 MANAGEMENT ALLOCATIONS TO RELATED ENTITIES 900099 7725009 7725009 31651495 504906 -43821 549403 0 0 308725 308725 0 308725 308725 570649 494861 75788 35598 111386 35598 75788 0 0 0 0 32576512 31687093 -43821 933916 0 0 0 0 6163383 3853985 2309398 0 16261335 13009068 3252267 672427 672427 1995140 1596112 399028 1174325 939460 234865 0 424915 424915 1057600 528800 528800 0 0 1395053 1395053 605442 544898 60544 18283 1828 16455 2611350 2611350 517563 388172 129391 0 835154 668123 167031 223782 111891 111891 0 0 238 238 0 464026 417623 46403 339486 271589 67897 PROVISION FOR BAD DEBTS 1435761 1435761 MEDICAL & PRO. FEES 718216 646394 71822 OTHER 1477537 441064 1036473 38391016 27466118 10924898 0 3105 -788 31072 29530 0 0 2611942 2590078 0 0 0 0 0 0 36136 36136 1380491 1214581 57561936 19156180 25028781 38405756 53595267 50934679 6080374 6080374 0 0 0 0 142772 1351 88909940 99291697 5070771 3420032 0 0 0 0 0 0 0 0 0 0 147454 0 0 0 62110968 80619783 67329193 84039815 X 7192665 2220692 454158 433443 13933924 12597747 21580747 15251882 88909940 99291697 X -5814504 4000 -518361 X false true X true false X X 2 BLANCHARD VALLEY REGIONAL HEALTH CENTER 341369963 3 false 7114020 0 BLANCHARD VALLEY CONTINUING CARE SERVICES 346006904 9 false 639780 0 2 7753800 true false false false false false false false false false false false false false false true false 13732203 -381512 319501 13031190 14152532 -420329 13732203 14424824 113872 386164 14152532 13034145 1720414 329735 14424824 13058307 -1125 23037 13034145 0.96670 0.03330 false true true 6701247 6701247 6745770 4369987 2375782 1893294 1576863 316431 16092869 11786058 4306811 26128756 1423271 24705485 38405756 VENTURES AND PARTNERSHIPS 310374 C CARE SERVICES 5770000 C 6080374 0 ADVANCES FROM AFFILIATES 80619783 80619783 30626390 4000 817834 821834 29804556 2771956 2771956 32576512 36955255 36955255 1435761 1435761 38391016 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 TRANSFERS TO AFFILIATES $611,000 INVESTMENT INCOME TIMING DIFFERENCE $206,834 TOTAL $817,834 PART XI, LINE 4B BAD DEBT RECLASS $1,435,761 CHANGE IN BENEFICIAL INTEREST $1,336,195 TOTAL $2,771,956 PART XII, LINE 4B BAD DEBT RECLASS $1,435,761 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 true true false false false false false false false SCOTT MALANEY CEO 554774 0 188819 0 392245 0 0 0 0 0 1135838 0 357755 0 DAVID CYTLAK CFO 332467 0 73378 0 25706 0 0 0 0 0 431551 0 0 0 WILLIAM KOSE CQO 327881 0 78720 0 33589 0 0 0 0 0 440190 0 0 0 WILLIAM WATKINS CAO 173595 0 40546 0 4949 0 0 0 0 0 219090 0 0 0 DR ANAS BALAA PHYSICIAN 489764 0 231599 0 0 0 0 0 0 0 721363 0 0 0 DR PAMELA REED PHYSICIAN 624060 0 0 0 16367 0 0 0 0 0 640427 0 0 0 DR SEAN LOGAN PHYSICIAN 930066 0 0 0 33364 0 0 0 0 0 963430 0 0 0 DR ROBERT HOLLIS PHYSICIAN 776604 0 0 0 1292 0 0 0 0 0 777896 0 0 0 DR JAMES DAVIDSON PHYSICIAN 615257 0 38626 0 19108 0 0 0 0 0 672991 0 0 0 PART I, LINE 4B IN 2015, BLANCHARD VALLEY HEALTH SYSTEM CONTRIBUTED ON BEHALF OF SCOTT MALANEY $156,671 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 VESTING SCHEDULE. ADDITIONAL EXECUTIVES WERE ALSO ADDED AND DEEMED ELIGIBLE FOR PLAN BENEFITS IN 2010, INCLUDING DAVID CYTLAK. IN 2015, BLANCHARD VALLEY HEALTH SYSTEM CONTRIBUTED ON BEHALF OF DAVID CYTLAK $22,556 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 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 457(F) ACCOUNT ARE NOT ALLOWED. * EACH PARTICIPANT'S 457(B) ACCOUNT WILL BE CREDITED UP TO THE STATUTORY LIMIT ($18,000 IN 2015), 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, LINE 1B SCOTT 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, LINE 11B DETAIL REVIEWS OF THE FORM 990'S ARE PERFORMED BY AN INDEPENDENT CPA FIRM AND THE ORGANIZATION'S COMPLIANCE AND AUDIT COMMITTEE. THIS COMMITTEE IS COMPRISED OF MEMBERS OF THE BOARD OF TRUSTEES, MEMBERS OF THE COMMUNITY, AND MEMBERS OF UPPER MANAGEMENT. THE COMPLIANCE AND 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 ON BOARDNET. 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, 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 A CONFLICT EXISTS. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION REVIEWS EXECUTIVE COMPENSATION, BENEFITS, AND PERQUISITES ON A BI-ANNUAL 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 MOST RECENT FULL COMPENSATION AND BENEFIT ANALYSIS AND REVEIW WAS COMPLETED IN 2015 BY SULLIVAN COTTER AND ASSOCIATES (AN EXTERNAL CONSULTANT) AND THE RESULTS WERE 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, QUESTION 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 IX The amounts reported on 990 Part VIII Line 11a columns (b) and (d) represent management fee allocations out to other related organizations for management related services performed by individuals employed by Blanchard Valley Health System. The compensation, benefits, and other related costs for such individuals are recorded on 990 Part IX columns (b) and (c). FORM 990, PART XI, LINE 9 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS: $1,336,195 INVESTMENT INCOME TIMING DIFFERENCE: $(206,834) TRANSFERS FROM AFFILIATES: $611,000 TOTAL: $518,361 TOTAL: $1,192,173 BLANCHARD VALLEY MEDICAL PRACTICES LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 421659766 PHYS OFFICE OH 20665105 8095128 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 BVHS NEUROSURGICAL ASSOCIATES OF NW OHIO LLC 1900 SOUTH MAIN STREET FINDLAY OH 45840 342052585 PHYS OFFICE OH 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 3549933 1726093 BVHS BLANCHARD VALLEY CONTINUING CARE SERVICE 15100 BIRCHAVEN LANE FINDLAY OH 45840 346006904 CONT. 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