2013-10-29T06:19:23-05:00 2012-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2012-01-01 344428206 BLANCHARD VALLEY HEALTH SYSTEM % DAVID M CYTLAK BLAN 4194235497 1900 SOUTH MAIN STREET Suite FINDLAY OH 45840 DAVID M CYTLAK 4194235497 2013-11-15 true Joyce A Dulworth 2604604000 2012 2016-02-25 16:41:14Z SCOTT MALANEY 1900 SOUTH MAIN STREET FINDLAY OH 45840 19017722 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, AN URGENT CARE CENTER, AND A CANCER CENTER. 21 18 444 78 -187354 -219826 0 0 10410233 16351862 2165373 962492 5296176 671535 17871782 17985889 0 0 0 0 10591328 12172201 0 0 0 6388771 5747426 16980099 17919627 891683 66262 65117312 72566126 40041029 45342547 25076283 27223579 OUR MISSION: OUR EXTRAORDINARY PEOPLE PROVIDE CARING FOR A LIFETIME THROUGH A BROAD CONTINUUM OF EXCEPTIONAL HEALTH-RELATED SERVICES IN NORTHWEST OHIO. false false 11671077 16342791 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. 11671077 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 444 true true true false false false false false false false false false false X 21 18 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 2.0 38.0 X X 609374 0 44760 DR ERIC BOSTICK 0.5 1.0 X 0 0 0 CHERYL BUCKLAND RN 0.5 1.0 X 0 0 0 KAREN CLINE 0.5 1.0 X 0 0 0 KURT GEISHEIMER 0.5 1.0 X 0 0 0 DUANE JEBBETT 0.5 1.0 X 0 0 0 KAREN KLASSEN HARDER PHD 0.5 1.0 X 0 0 0 ANDREA KOEPKE DNS 0.5 1.0 X 0 0 0 JOE LONGO 0.5 1.0 X 0 0 0 DR STEVE MCCULLOUGH 0.5 1.0 X 0 0 0 DR RANDALL MYERS 0.5 1.0 X 0 0 0 ROD NICHOLS 0.5 1.0 X 0 0 0 DR NANCY OREL 0.5 1.0 X 0 0 0 DR RICHARD POLDER 0.5 1.0 X 0 0 0 REV WILLIAM REIST 0.5 1.0 X 0 0 0 DR LEROY SCHROEDER 0.5 1.0 X 0 0 0 KIMBERLY STUMP 0.5 1.0 X 0 0 0 DAVID EUBANKS 0.5 1.0 X 0 0 0 ERIC KURJAN 0.5 1.0 X 0 0 0 GARRY PEIFFER 0.5 1.0 X 0 0 0 PAUL WORSTELL 0.5 1.0 X 0 0 0 DAVE CYTLAK 2.0 38.0 X 354304 0 40264 DR WILLIAM KOSE 4.0 36.0 X 358444 0 31813 CHRISTOPHER PRESS 2.0 38.0 X 310390 0 30815 ROBERT WESTPHAL 2.0 38.0 X 0 221596 38361 WILLIAM WATKINS 4.0 36.0 X 170664 0 26854 DR JASON SCHROEDER 40.0 X 589827 0 37215 DR MICHAEL DENIKE 40.0 X 497235 0 38391 DR GARY PARENTEAU 40.0 X 485226 0 28747 DR JEFFERY SCHULTZ 40.0 X 414356 0 39798 DR BINH DINH 40.0 X 239643 0 29159 4029463 221596 386177 40 false true false ALTA PARTNERS 902 WESTPOINT PKWY STE 320 WESTLAKE OH 44145 PHYSICIAN BILLING 2025818 BKD LLP 200 EAST MAIN STREET SUITE 700 FORT WAYNE IN 46802 AUDITING AND TAX 216017 COMPREHENSIVE REIMBURSEMENT INC 947 EAST JOHNSTOWN ROAD SUITE 234 GAHANNA OH 43230 COST REPORT PREP 187643 GORDON FLESCH COMPANY INC 2675 RESEARCH PARK DRIVE MADISON WI 53701 EQUIPMENT LEASING 305511 SCHNEIDER AND WUEST INC 26302 THOMPSON ROAD PERRYSBURG OH 43351 PHYSICIST SERVICES 156500 9 0 NET PATIENT SERVICE REVENUE 621110 11350382 11350382 MANAGEMENT ALLOCATIONS TO RELATED ENTITIES 900099 5001480 5001480 16351862 951034 -187354 1138388 0 0 346966 346966 0 346966 346966 1043292 1022762 9071 20530 -9071 11458 -9071 20529 0 0 0 MISCELLANEOUS REVENUE 900099 324569 324569 324569 17985889 16342791 -187354 1830452 0 0 0 0 3698212 1039992 2658220 0 614955 496401 118554 0 6067405 4901565 1165840 0 340781 0 340781 0 913751 708611 205140 0 537097 365903 171194 0 0 331959 0 331959 0 975476 619532 355944 0 0 0 0 651068 561097 89971 0 19118 2912 16206 0 703178 703178 206527 146852 59675 0 0 528330 501967 26363 0 108364 54744 53620 0 0 0 0 0 426332 405058 21274 0 384278 363557 20721 0 PROVISION FOR BAD DEBTS 523932 523932 0 0 MEDICAL & PRO. FEES 9514 8764 750 0 OTHER 879350 267012 612338 0 17919627 11671077 6248550 0 375 375 2546862 2357954 0 0 1071729 1841604 0 0 0 0 0 0 21824 300 228370 249404 37175213 21060947 15215090 16114266 39871159 45587734 6128218 6120516 0 0 0 0 33685 293973 65117312 72566126 5244852 4848033 0 0 0 0 0 0 0 0 0 0 0 0 0 0 34796177 40494514 40041029 45342547 X 12042138 12798754 346753 386749 12687392 14038076 25076283 27223579 65117312 72566126 X 66262 3910 2077124 X false true X true false X X X false false false BVRHC 341369963 03 false false true 4833576 BVCCS 346006904 0 false false true 339156 2 5172732 13034145 1720414 329735 14424824 13058307 -1125 23037 13034145 14801268 -1731242 11719 13058307 13540550 1260718 14801268 14281717 -732805 8362 13540550 0.97320 0.02680 true true true 6701247 6701247 9293380 3916319 5377061 1480576 1175063 305513 15892619 14407306 1485313 3807392 1562260 2245132 16114266 VENTURES AND PARTNERSHIPS 350516 C CARE SERVICES 5770000 C 6120516 0 ADVANCES FROM AFFILIATES 40494514 40494514 20066923 3910 2077124 2081034 17985889 17985889 17919627 17919627 17919627 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 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS: $1,350,684 TRANSFERS TO AFFILIATES: $539,086 INVESTMENT INCOME TIMING DIFFERENCE: $187,354 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 false true false false false false false false false SCOTT MALANEY 479574 0 105145 0 24654 0 134697 0 29760 0 773831 0 DAVE CYTLAK 283140 0 47118 0 24045 0 18164 0 25264 0 397732 0 DR WILLIAM KOSE 292662 0 35847 0 29935 0 15000 0 16813 0 390257 0 WILLIAM WATKINS 148477 0 18171 0 4016 0 10320 0 16534 0 197518 0 CHRISTOPHER PRESS 243708 0 48656 0 18026 0 41749 0 16128 0 368267 0 DR JASON SCHROEDER 498790 0 75000 0 16036 0 14850 0 22365 0 627042 0 DR MICHAEL DENIKE 496749 0 0 0 486 0 15000 0 23391 0 535626 0 DR GARY PARENTEAU 427510 0 56666 0 1049 0 15000 0 13747 0 513973 0 DR JEFFERY SCHULTZ 307314 0 106871 0 171 0 15000 0 24798 0 454154 0 DR BINH DINH 207401 0 20000 0 12242 0 5604 0 23555 0 268802 0 ROBERT WESTPHAL 0 180208 0 33152 0 8236 0 13561 0 24800 0 259957 0 PART I, LINE 4b In 2012, Blanchard Valley Health System contributed on behalf of Scott Malaney $136,697 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 2012, Blanchard Valley Health System contributed on behalf of Christopher Press $44,062 and contributed on behalf of David Cytlak $20,164 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 SERP are not allowed. * Each participants 457(b) account will be credited up to the statutory limit ($17,000 in 2012), 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. DR JASON SCHROEDER SON- DR. LEROY SCHROEDER 589827 COMPENSATION false TERESA SCHROEDER WIFE- DR. LEROY SCHROEDER 25128 COMPENSATION false BUCKMAN LTD >35% OWNED BOARD 0 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 SCOTT MALANEY IS A BOARD MEMBER AND IS ALSO A PAID EMPLOYEE OF BLANCHARD VALLEY HEALTH SYSTEM. DR. LEROY SCHROEDER IS A BOARD MEMBER AND IS RELATED TO TWO PAID EMPLOYEES OF BVHS. DUE TO THESE RELATIONSHIPS, THESE INDIVIDUALS ARE CONSIDERED NON-INDEPENDENT. 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 REVEIW WAS COMPLETED IN EARLY 2011 BY SULLIVAN COTTER AND ASSOCIATES (AN EXTERNAL CONSULTANT) AND SHARED/DISCUSSED WITH THE BOARD IN APRIL 2011. 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: $1,350,684 INVESTMENT INCOME TIMING DIFFERENCE: $187,354 TRANSFERS FROM AFFILIATES: $539,086 Total: $2,077,124 BLANCHARD VALLEY MEDICAL PRACTICES 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFCS OH 11240000 3334000 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 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 false 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 346006904 CONDOMINIUMS OH BVCCS C CORP 0 0 1.00000 false CITAS INC 1900 SOUTH MAIN ST FINDLAY OH 45840 311369708 RECRUITING OH BVHS C CORP 0 0 1.00000 false HANCO AMBULANCE INC 417 SIXTH STREET FINDLAY OH 45840 382048755 HEALTHCARE OH BVHS C CORP 2219000 1053000 1.00000 false false false false true false false false false true true false true true false false false false false BLANCHARD VALLEY REGIONAL HEALTH CENTER D 106675000 FMV BLANCHARD VALLEY REGIONAL HEALTH CENTER I 56004 FMV BLANCHARD VALLEY CONTINUING CARE SERVICES I 60000 FMV