2015-11-12T14:36:48-06:00 2014-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2014-01-01 344428206 BLANCHARD VALLEY HEALTH SYSTEM % DAVID M CYTLAK BLAN 4194235497 1900 SOUTH MAIN STREET FINDLAY OH 45840 DAVID M CYTLAK CFO 4194235497 2015-11-16 true Joyce A Dulworth P00151125 2604604000 2014 2016-02-25 16:41:14Z DAVID M CYTLAK 1900 SOUTH MAIN STREET FINDLAY OH 45840 33674017 false X WWW.BVHEALTHSYSTEM.ORG X 1951 OH WE PROVIDE MANAGEMENT OVERSIGHT AND GOVERNANCE OF ALL HEALTH SYSTEM ACTIVITIES. WE ALSO OPERATE FAMILY PRACTICES, AN URGENT CARE CENTER, AND A CANCER CENTER. 18 17 515 165 26633 9240 0 0 19074699 28475535 333799 1988717 1081218 650798 20489716 31115050 0 0 0 0 16307754 22275801 0 0 0 8637345 10745462 24945099 33021263 -4455383 -1906213 80822187 88909940 54918624 67329193 25903563 21580747 OUR MISSION: OUR EXTRAORDINARY PEOPLE PROVIDE CARING FOR A LIFETIME THROUGH A BROAD CONTINUUM OF EXCEPTIONAL HEALTH-RELATED SERVICES IN NORTHWEST OHIO. false false 25161713 28475535 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 OFFICES, SPECIALTY PHYSICIAN OFFICES, RADIATION THERAPY SERVICES, AND AN URGENT CARE CENTER. BVMP IS COMMITTED TO PROVIDING EASILY ACCESSIBLE HEALTH CARE SERVICES TO ALL MEMBERS OF THE SURROUNDING COMMUNITIES THROUGH THEIR FAMILY PRACTICES AND URGENT CARE CENTER. SPECIALIZED SERVICES ARE ALSO AVAILABLE, INCLUDING NEUROLOGICAL SERVICES, CANCER TREATMENT, CARDIAC CARE, AND DIAGNOSTIC SERVICES. HANCO PROVIDES PROFESSIONAL AND EXPEDIENT AMBULANCE SERVICES AND PRE-HOSPITAL EMERGENCY MEDICAL CARE. 25161713 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 515 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 X DAVID M CYTLAK 4194235497 1900 SOUTH MAIN STREET FINDLAY OH 45840 SCOTT MALANEY CHIEF EXECUTIVE OFFICER 2.0 38.0 X X 856896 0 24088 DUANE JEBBETT CHAIR 0.5 1.0 X 0 0 0 PAUL WORSTELL VICE CHAIR 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 GARRY PEIFFER 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 BRADLEY HUGHES 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 KAREN KLASSEN HARDER SECRETARY 0.5 1.0 X 0 0 0 ERIC BOSTICK MD TRUSTEE 0.5 1.0 X 0 0 0 RICHARD POLDER MD TRUSTEE 0.5 1.0 X 0 0 0 DAVE CYTLAK CHIEF FINANCIAL OFFICER 2.0 38.0 X 392875 0 21888 WILLIAM KOSE CHIEF QUALITY OFFICER 4.0 36.0 X 406724 0 25200 WILLIAM WATKINS CHIEF ADMINISTRATIVE OFFICER 36.0 4.0 X 204004 0 13735 CHRISTOPHER PRESS PRESIDENT BVRHC 2.0 38.0 X 484768 0 2055 DR MICHAEL DENIKE PHYSICIAN 40.0 0.0 X 498386 0 21588 DR GARY PARENTEAU PHYSICIAN 40.0 0.0 X 449919 0 19013 DR SEAN LOGAN PHYSICIAN 40.0 0.0 X 923168 0 9180 DR ROBERT HOLLIS PHYSICIAN 40.0 0.0 X 703347 0 13323 DR MOHAMMAD MOBAYED PHYSICIAN 40.0 0.0 X 505507 0 20674 5425594 0 170744 52 false true false CARETECH SOLUTIONS INC PO BOX 674271 DETROIT MI 48267 HEALTHCARE IT 633808 BKD LLP 200 EAST MAIN STREET SUITE 700 FT WAYNE IN 46802 AUDIT & TAX SERVICES 220377 SCHNEIDER AND WUEST INC 26302 THOMPSON RD PERRYSBURG OH 43351 PHYSICIST SERVICES 162720 RCM ARCHITECTS INC 322 SOUTH MAIN ST FINDLAY OH 45840 ARCHITECTS 188916 SEI INVESTMENTS COMPANY PO BOX 945794 ATLANTA GA 30394 INVESTMENT SERVICES 1083781 6 0 NET PATIENT SERVICE REVENUE 621110 22574675 22574675 MANAGEMENT ALLOCATIONS TO RELATED ENTITIES 900099 5900860 5900860 28475535 1051758 26633 1025125 0 0 332107 332107 0 332107 332107 3495926 2558967 936959 936959 936959 0 0 0 MISCELLANEOUS REVENUE 900099 318691 318691 318691 31115050 28475535 26633 2612882 0 0 0 0 5103527 4082822 1020705 0 14015038 11212030 2803008 545121 436097 109024 1583156 1266525 316631 1028959 823167 205792 0 444811 444811 1109982 554991 554991 0 0 1089781 1089781 880071 792064 88007 16297 1630 14667 1926876 1926876 372309 279232 93077 0 804360 643488 160872 165546 82773 82773 0 0 77186 77186 0 1095102 985592 109510 96650 77320 19330 PROVISION FOR BAD DEBTS 1443252 1443252 MEDICAL & PRO. FEES 311470 280323 31147 OTHER 911769 273531 638238 33021263 25161713 7859550 0 375 3105 9175 31072 0 0 2361571 2611942 0 0 0 0 0 0 300 36136 338567 1380491 49427091 24398310 19987083 25028781 51807745 53595267 6071098 6080374 0 0 0 0 246273 142772 80822187 88909940 6935190 5070771 0 0 0 0 0 0 0 0 0 0 0 147454 0 0 47983434 62110968 54918624 67329193 X 12739469 7192665 436522 454158 12727572 13933924 25903563 21580747 80822187 88909940 X -1906213 -1224431 -1192172 X false true X true false X X 2 BLANCHARD VALLEY REGIONAL HEALTH CENTER 341369963 03 false 5330355 0 BLANCHARD VALLEY CONTINUING CARE SERVICES 346006904 09 false 628983 0 2 5959338 true false false false false false false false false false false false false false false true false 14152532 -420329 13732203 14424824 113872 386164 14152532 13034145 1720414 329735 14424824 13058307 -1125 23037 13034145 14801268 -1731242 11719 13058307 0.96690 0.03310 false true true 0 6701247 6701247 0 9725318 5378836 4346482 0 1893294 1492973 400321 0 23193050 15708708 7484342 0 7914183 1817794 6096389 25028781 VENTURES AND PARTNERSHIPS 264251 C CARE SERVICES 5816123 C 6080374 0 ADVANCES FROM AFFILIATES 62110968 62110968 28974486 -1224431 537234 -687197 29661683 1453367 1453367 31115050 31578011 31578011 1443252 1443252 33021263 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 $318,234 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS $219,000 TOTAL $537,234 PART XI, LINE 4B BAD DEBT RECLASS $1,443,252 INVESTMENT INCOME TIMING DIFFERENCE $10,115 TOTAL $1,453,367 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 CHIEF EXECUTIVE OFFICER 515637 0 180132 0 161127 0 15600 0 8488 0 880984 0 0 0 DAVE CYTLAK CHIEF FINANCIAL OFFICER 297010 0 70281 0 25584 0 15600 0 6288 0 414763 0 0 0 WILLIAM KOSE CHIEF QUALITY OFFICER 298539 0 75943 0 32242 0 15600 0 9600 0 431924 0 0 0 DR MICHAEL DENIKE PHYSICIAN 495946 0 1900 0 540 0 15600 0 5988 0 519974 0 0 0 DR GARY PARENTEAU PHYSICIAN 429919 0 20000 0 0 0 15600 0 3413 0 468932 0 0 0 DR SEAN LOGAN PHYSICIAN 895893 0 0 0 27275 0 692 0 8488 0 932348 0 0 0 DR ROBERT HOLLIS PHYSICIAN 703347 0 0 0 0 0 7695 0 5628 0 716670 0 0 0 DR MOHAMMAD MOBAYED PHYSICIAN 491806 0 0 0 13701 0 10095 0 10579 0 526181 0 0 0 WILLIAM WATKINS CHIEF ADMINISTRATIVE OFFICER 162350 0 37507 0 4147 0 10114 0 3621 0 217739 0 0 0 CHRISTOPHER PRESS PRESIDENT BVRHC 251730 0 89436 0 143602 0 1769 0 286 0 486823 0 117744 0 PART I, LINE 4A CONSISTENT WITH HIS CONTRACT TERMS, SEVERANCE PAY OF $275,000 WAS GIVEN TO CHRISTOPHER PRESS. PART I, LINE 4B In 2014, Blanchard Valley Health System contributed on behalf of Scott Malaney $146,184 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 2014, Blanchard Valley Health System contributed on behalf of David Cytlak $21,149 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 President (Christopher Press) Provide 50% target income replacement for CFO (David Cytlak) **Employee contributions to the 457(f) account are not allowed. * Each participants 457(b) account will be credited up to the statutory limit ($17,500 in 2014), 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, QUESTION 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, QUESTION 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, QUESTION 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, QUESTION 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 EARLY 2014 BY SULLIVAN COTTER AND ASSOCIATES (AN EXTERNAL CONSULTANT) AND SHARED/DISCUSSED WITH THE BOARD IN APRIL 2014. FORM 990, PART VI, QUESTION 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: $219,000 INVESTMENT INCOME TIMING DIFFERENCE: ($10,115) TRANSFERS FROM AFFILIATES: $318,234 CHANGE IN UNRESTRICTED NET ASSETS ($1,719,292) TOTAL: $1,192,173 BLANCHARD VALLEY MEDICAL PRACTICES LLC 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFCS OH 19922819 6343577 BVHS BLANCHARD VALLEY HOME CARE SERVICES LLC 1900 SOUTH MAIN ST FINDLAY OH 45840 421565629 HOME HEALTH OH BVCCS CRNA OF BLANCHARD VALLEY LLC 1900 SOUTH MAIN ST FINDLAY OH 45840 061748552 CERT NURSE OH BVHS NEUROSURGICAL ASSOCIATES OF NW OHIO LLC 1900 SOUTH MAIN ST FINDLAY OH 45840 342052585 PHYS OFFICE OH BVMP SPECIALTY PHYSICIANS OF BLANCHARD VALLEY 1900 SOUTH MAIN ST FINDLAY OH 45840 262448601 PHYS OFFICE OH BVMP BLANCHARD VALLEY REGIONAL CANCER CENTER 1900 SOUTH MAIN ST FINDLAY OH 45840 050623393 PHYS OFFICE OH BVMP HANCO EMERGENCY MEDICAL SERVICES LLC 417 SIXTH ST FINDLAY OH 45840 463299390 AMBULANCE SER OH 3286065 1303208 BVHS BLANCHARD VALLEY CONTINUING CARE SERVICE 15100 BIRCHAVEN LN FINDLAY OH 45840 346006904 CONT. 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