2014-10-12T08:53:36-05:00 2013-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2013-01-01 344428206 BLANCHARD VALLEY HEALTH SYSTEM % DAVID M CYTLAK BLAN 4194235497 1900 SOUTH MAIN STREET Suite FINDLAY OH 45840 DAVID M CYTLAK CFO 4194235497 2014-11-15 true Joyce A Dulworth P00151125 4194235497 2013 2015-11-30 17:44:51Z SCOTT MALANEY 1900 SOUTH MAIN STREET FINDLAY OH 45840 64701866 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. 21 19 514 88 38157 17541 0 0 16351862 19074699 962492 333799 671535 1081218 17985889 20489716 0 0 0 0 12172201 16307754 0 0 0 5747426 8637345 17919627 24945099 66262 -4455383 72566126 80822187 45342547 54918624 27223579 25903563 OUR MISSION: OUR EXTRAORDINARY PEOPLE PROVIDE CARING FOR A LIFETIME THROUGH A BROAD CONTINUUM OF EXCEPTIONAL HEALTH-RELATED SERVICES IN NORTHWEST OHIO. false false 16908019 19011577 BLANCHARD VALLEY HEALTH SYSTEM'S PROGRAM SERVICE REVENUE IS GENERATED BY BLANCHARD VALLEY MEDICAL PRACTICES (BVMP), A WHOLLY OWNED, DISREGARDED ENTITY. 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. 16908019 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 true false false false false false true true true true false false true 0 0 true 514 true true true false false false false false false false false false false X 21 19 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 691547 0 41028 Dr Eric Bostick Trustee 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 Kurt Geisheimer Treasurer 0.5 1.0 X 0 0 0 Duane Jebbett Chairman 0.5 1.0 X 0 0 0 Karen Klassen Harder Secretary 0.5 1.0 X 0 0 0 Andrea Koepke Trustee 0.5 1.0 X 0 0 0 Joe Longo Trustee 0.5 1.0 X 0 0 0 Dr Steve McCullough Trustee 0.5 1.0 X 0 0 0 Dr Randall Myers Trustee 0.5 1.0 X 0 0 0 Rod Nichols Trustee 0.5 1.0 X 0 0 0 Dr Nancy Orel Trustee 0.5 1.0 X 0 0 0 Dr Richard Polder Trustee 0.5 1.0 X 0 0 0 Dr LeRoy Schroeder Trustee 0.5 1.0 X 0 0 0 Kimberly Stump Trustee 0.5 1.0 X 0 0 0 David Eubanks Trustee 0.5 1.0 X 0 0 0 Garry Peiffer Trustee 0.5 1.0 X 0 0 0 Paul Worstell Vice Chairman 0.5 1.0 X 0 0 0 William Reist Dmin Trustee 0.5 1.0 X 0 0 0 Bradley Hughes Trustee 0.5 1.0 X 0 0 0 DAVE CYTLAK Chief Financial Officer 2.0 38.0 X 380705 0 37235 WILLIAM KOSE Chief Quality Officer 4.0 36.0 X 400326 0 32692 WILLIAM WATKINS President BVMP 36.0 4.0 X 18208 174044 28741 CHRISTOPHER PRESS President BVRHC 2.0 38.0 X 351526 0 16989 Dr Michael Denike Physician 40.0 X 502318 0 38528 Dr Gary Parenteau Physician 40.0 X 450124 0 28686 Dr Robert Hollis Physician 40.0 X 697184 0 21806 Dr Sean Logan Physician 40.0 X 931261 0 25728 Dr Martin Valdivia Physician 40.0 X 373268 0 39829 4796467 174044 311262 50 false true false BKD LLP 200 EAST MAIN STREET SUITE 700 FORT WAYNE IN 46802 AUDIT & TAX SERVICES 228988 COMPREHENSIVE REIMBURSEMENT INC 947 EAST JOHNSTOWN ROAD SUITE 234 GAHANNA OH 43230 COST REPORT PREP 242525 SEI INVESTMENTS COMPANY 1 FREEDOM VALLEY DRIVE OAKS PA 19456 INVESTMENT CONSULTNG 432262 CARETECH SOLUTIONS INC PO BOX 674271 DETROIT MI 48267 HEALTHCARE IT 415111 ALTA PARTNERS 902 WESTPOINT PARKWAY SUITE 320 WESTLAKE OH 44145 PHYSICIAN BILLING 718282 9 0 NET PATIENT SERVICE REVENUE 621110 14464407 14464407 MANAGEMENT ALLOCATIONS TO RELATED ENTITIES 900099 4610292 4610292 19074699 -1585154 38113 -1623267 0 0 351107 351107 0 351107 351107 46131103 44149028 63122 1982075 -63122 1918953 -63122 44 1982031 0 0 0 AFFILIATE EARNINGS 621400 334673 334673 MISCELLANEOUS REVENUE 900099 395438 395438 730111 20489716 19011577 38157 1439982 0 0 0 0 2892832 867850 2024982 0 11431500 9145200 2286300 398039 398039 810309 648247 162062 775074 620059 155015 0 868379 868379 289279 144640 144639 0 0 676608 676608 665926 599333 66593 11137 1114 10023 1162484 1162484 316152 237114 79038 0 719992 575994 143998 165450 82725 82725 0 0 0 0 679721 611749 67972 830901 664721 166180 PROVISION FOR BAD DEBTS 1025032 1025032 MEDICAL & PRO. FEES 256453 230808 25645 OTHER 969831 290949 678882 24945099 16908019 8037080 0 375 375 2357954 9175 0 0 1841604 2361571 0 0 0 0 0 0 300 300 249404 338567 41850212 21863129 16114266 19987083 45587734 51807745 6120516 6071098 0 0 0 0 293973 246273 72566126 80822187 4848033 6935190 0 0 0 0 0 0 0 0 0 0 0 0 0 0 40494514 47983434 45342547 54918624 X 12798754 12739469 386749 436522 14038076 12727572 27223579 25903563 72566126 80822187 X -4455383 1000 3134367 X false true X true false X X X false false false BVRHC 341369963 03 false false true 4706256 BVCCS 346006904 09 false false true 300078 2 5006334 14424824 113872 386164 14152532 13034145 1720414 329735 14424824 13058307 -1125 23037 13034145 14801268 -1731242 11719 13058307 13540550 1260718 14801268 0.96920 0.03080 true true true 6701247 6701247 9427222 4107607 5319615 1477794 1234373 243421 20688331 14816634 5871697 3561618 1704515 1851103 19987083 VENTURES AND PARTNERSHIPS 254875 C CARE SERVICES 5816223 C 6071098 0 ADVANCES FROM AFFILIATES 47983434 47983434 22600051 1000 3624857 3625857 18974194 1515522 1515522 20489716 23920067 23920067 1025032 1025032 24945099 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: $3,624,857 PART XI, LINE 4B CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS: $322,119 INVESTMENT INCOME TIMING DIFFERENCE: $168,371 BAD DEBT RECLASS $1,025,032 TOTAL: $1,515,522 PART XII, LINE 4B BAD DEBT RECLASS $1,025,032 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 true true X X X X X false true false false false false false false false SCOTT MALANEY Chief Executive Officer 482069 0 165208 0 44271 0 15300 0 25728 0 732575 0 0 0 DAVE CYTLAK Chief Financial Officer 273441 0 64986 0 42278 0 15300 0 21935 0 417940 0 0 0 WILLIAM KOSE Chief Quality Officer 282316 0 70494 0 47517 0 15300 0 17392 0 433018 0 0 0 WILLIAM WATKINS President BVMP 18108 136555 0 33914 100 3575 1107 8501 348 18784 19663 201329 0 0 CHRISTOPHER PRESS President BVRHC 232108 0 82837 0 36581 0 14981 0 2008 0 368515 0 0 0 Dr Michael Denike Physician 497219 0 4600 0 498 0 15300 0 23228 0 540846 0 0 0 Dr Gary Parenteau Physician 429076 0 20000 0 1049 0 15300 0 13386 0 478810 0 0 0 Dr Robert Hollis Physician 686144 0 0 0 11040 0 0 0 21806 0 718990 0 0 0 Dr Sean Logan Physician 892781 0 0 0 38480 0 0 0 25728 0 956989 0 0 0 Dr Martin Valdivia Physician 322317 0 37500 0 13451 0 15300 0 24529 0 413097 0 0 0 PART I, LINE 1B SCOTT MALANEY'S WIFE SERVED A BONA FIDE BUSINESS FUNCTION ON THE TRIP AND CLAIMED EXPENSES ARE PROPERLY SUBSTANTIATED UNDER THE RULES OF SECTION 274. PART I, LINE 4B In 2013, Blanchard Valley Health System contributed on behalf of Scott Malaney $140,807 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 Christopher Press and David Cytlak. In 2013, Blanchard Valley Health System contributed on behalf of Christopher Press $44,943 and contributed on behalf of David Cytlak $20,602 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 2013), 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. BUCKMAN LTD >35% OWNED BOARD SEE STATEMENT false PART IV, LINE 3 CHERYL BUCKLAND IS A TRUSTEE ON THE ORGANIZATION'S BOARD. SHE IS A 50% OWNER IN BUCKMAN LTD. BLANCHARD VALLEY CONTINUING CARE SERVICES, A RELATED ENTITY, HAS AN OUSTANDING LOAN TO BUCKMAN LTD FOR THE 2008 PURCHASE OF INDEPENDENCE HOUSE. FORM 990, PART VI, QUESTION 1b CHERYL BUCKLAND IS A 50% OWNER OF A COMPANY THAT HAS AN OUTSTANDING LOAN TO BLANCHARD VALLEY CONTINUING CARE SERVICES, A RELATED ORGANIZATION. DUE TO THIS RELATIONSHIP, SHE IS CONSIDERED A NON INDEPENDENT VOTING MEMBER OF THE BOARD. 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 2013 BY SULLIVAN COTTER AND ASSOCIATES (AN EXTERNAL CONSULTANT) AND SHARED/DISCUSSED WITH THE BOARD IN APRIL 2013. 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: ($322,119) INVESTMENT INCOME TIMING DIFFERENCE: ($168,371) TRANSFERS FROM AFFILIATES: 3,624,857 Total: $3,134,367 BLANCHARD VALLEY MEDICAL PRACTICES 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFCS OH 13892000 6855240 BVHS BLANCHARD VALLEY HOME CARE SERVICES 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 ASSOCIATION NORTHWEST OHIO 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFFICE OH BVMP SPECIALTY PHYSICIANS OF BLANCHARD VALLEY 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFFICE OH BVMP BLANCHARD VALLEY REGIONAL CANCER CENTER 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFFICE OH BVMP BLANCHARD VALLEY CONTINUING CARE SVCS 15100 BIRCHAVEN LN FINDLAY OH 45840 346006904 CONT. CARE OH 501(C)(3) 9 BVHS true BLANCHARD VALLEY REGIONAL HEALTH CENTER 1900 SOUTH MAIN ST FINDLAY OH 45840 341369963 ACUTE CARE OH 501(C)(3) 3 BVHS true BLANCHARD VALLEY HEALTH FOUNDATION 1900 SOUTH MAIN ST FINDLAY OH 45840 341370522 FUNDRAISING OH 501(C)(3) 7 BVHS true EC EDWARDS MEMORIAL TRUST FBO FINDLAY 1900 SOUTH MAIN ST FINDLAY OH 45840 346953719 INVESTMENT OH 501(C)(3) PF BVHF true NORTHWEST OHIO MEDICAL EQUIPMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 341882390 MED EQUIPMENT OH BVCCS N/A BLANCHARD VALLEY PAIN MANAGEMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 270095470 PAIN MGMT OH BVRHC N/A TECHNICORE PO BOX 1210 FINDLAY OH 45839 421702910 BIO-MED SUPPO OH BVRHC N/A CREIGHTON DIALYSIS 1900 SOUTH MAIN ST FINDLAY OH 45840 274527592 DIALYSIS SVCS OH BVRHC N/A BIRCHAVEN ESTATES AT EASTERN WOODS LTD 15100 BRIRCHAVEN LANE FINDLAY OH 45840 201494204 CONDOMINIUMS OH BVCCS C CORP 1.00000 false CITAS INC 1900 SOUTH MAIN ST FINDLAY OH 45840 311369708 RECRUITING OH BVHS C CORP 1.00000 true HANCO AMBULANCE INC 417 SIXTH STREET FINDLAY OH 45840 382048755 HEALTHCARE OH BVHS C CORP 2975000 1232000 1.00000 true false false false true false false false false false true true false true true false false false false false BLANCHARD VALLEY REGIONAL HEALTH CENTER D 105625000 FMV BLANCHARD VALLEY REGIONAL HEALTH CENTER I 56004 FMV BLANCHARD VALLEY CONTINUING CARE SERVICES I 60000 FMV