2012-11-14T12:59:59-06:00 2011-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2011-01-01 344428206 BLANCHARD VALLEY HEALTH SYSTEM % DAVID M CYTLAK BLAN 4194235497 1900 SOUTH MAIN STREET FINDLAY OH 45840 DAVID CYTLAK 2012-11-15 true Joyce A Dulworth 2604604000 2011 2016-02-24 21:20:13Z DAVID M CYTLAK 1900 SOUTH MAIN STREET FINDLAY OH 45840 21909919 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. 15 13 376 83 1318822 1249545 0 0 10240396 10410233 1704432 2165373 8523469 5296176 20468297 17871782 0 0 0 0 10659151 10591328 0 0 0 6274074 6388771 16933225 16980099 3535072 891683 67908350 65117312 40690681 40041029 27217669 25076283 OUR MISSION: OUR EXTRAORDINARY PEOPLE PROVIDE CARING FOR A LIFETIME THROUGH A BROAD CONTINUUM OF EXCEPTIONAL HEALTH-RELATED SERVICES IN NORTHWEST OHIO. false false 12230528 10408351 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 ITS FAMILY PRACTICES AND URGENT CARE CENTER. SPECIALIZED SERVICES ARE ALSO AVAILABLE, INCLUDING NEUROSURGICAL SERVICES, CARDIOLOGY SERVICES, DIAGNOSTIC SERVICES AND CANCER TREATMENT. 12230528 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 376 true false false false false false false false false false false false X 15 13 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 X SCOTT MALANEY 2.0 X X 571993 0 46322 G NORMAN NICHOLSON 1.0 X 0 0 0 JIM GEERS 1.0 X 0 0 0 GARRY PEIFFER 1.0 X 0 0 0 STEPHEN ORR MD 1.0 X 0 0 0 FRANK A COSIANO MD 1.0 X 0 0 0 ANDREA KOEPKE 1.0 X 0 0 0 FR MIKE HOHENBRINK 1.0 X 0 0 0 ROD NICHOLS 1.0 X 0 0 0 ERIC KURJAN 1.0 X 0 0 0 LEROY SCHROEDER MD 1.0 X 0 0 0 KAREN KLASSEN HARDER PHD 1.0 X 0 0 0 KIM STUMPP 1.0 X 0 0 0 DUANE JEBBETT 1.0 X 0 0 0 JOE LONGO 1.0 X 0 0 0 DAVE CYTLAK 2.0 X 318925 0 40073 WILLIAM KOSE 40.0 X 350527 0 30630 DR MICHAEL DENIKE 40.0 X 495489 0 25344 DR JEFFREY EIDEN 40.0 X 180547 0 22538 DR GARY PARENTEAU 40.0 X 410508 0 31697 DR JASON SCHROEDER 40.0 X 863479 0 40322 DR JACOB DAGANI 40.0 X 178262 0 27068 3369730 0 263994 33 false true false ALTA PARTNERS 902 WESTPOINT PKWY STE 320 WESTLAKE OH 44145 PHYSICIAN BILLING 1760373 SCHUMAKER LOOP KENDRICK LLP 41 SOUTH HIGH STREET STE 2400 COLUMBUS OH 43215 PROFESSIONAL SVCS 224852 BKD LLP 200 EAST MAIN STREET SUITE 700 FORT WAYNE IN 46802 AUDITING AND TAX 167863 SCHNEIDER AND WUEST INC 26302 THOMPSON RD PERRYSBURG OH 43351 PHYSICIST SERVICES 144000 GORDON FLESCH COMPANY INC 2675 RESEARCH PARK DR MADISON WI 53711 COPIER LEASING 296529 6 0 NET PATIENT SERVICE REVENUE 621110 10410233 10410233 10410233 2145823 1318822 827001 0 0 376285 376285 376285 376285 4057688 4036255 1882 21433 -1882 19550 -1882 21432 0 0 0 MISCELLANEOUS REVENUE 900099 359120 359120 EQUITY INVESTMENTS 621400 -17783 -17783 MANAGEMENT ALLOCATIONS TO RELATED ENTITIES 900099 4578554 4578554 4919891 17871782 10408351 1318822 6144609 0 0 0 0 1308646 368011 940635 0 889710 845313 44397 0 6853664 5409606 1444058 0 88287 88287 0 968802 751303 217499 0 482219 328517 153702 0 0 479045 479045 0 1037187 658725 378462 0 0 0 0 1032398 889731 142667 0 3104 473 2631 0 577759 577759 5776 4107 1669 0 0 507193 481884 25309 0 174827 88321 86506 0 0 0 0 0 470354 446883 23471 0 332208 314294 17914 0 PROVISION FOR BAD DEBTS 588530 588530 MEDICAL & PRO. FEES 177131 163173 13958 OTHER 989959 300598 689361 ASSETS RELEASED FROM RESTRICT 13300 13300 16980099 12230528 4749571 0 375 375 2705813 2546862 0 0 1264808 1071729 0 0 0 0 0 0 19437 21824 351701 228370 34969088 19753998 15883338 15215090 41520549 39871159 6146002 6128218 0 0 0 0 16327 33685 67908350 65117312 5022856 5244852 0 0 0 0 0 0 0 0 0 0 0 0 0 0 35667825 34796177 40690681 40041029 X 14159362 12042138 366235 346753 12692072 12687392 27217669 25076283 67908350 65117312 X 891683 -3033069 X false true true X false X X X false false false BVRHC 341369963 03 false false true 3970408 BVCCS 346006904 0 false false true 570132 2 4540540 13058307 -1125 23037 13034145 14801268 -1731242 11719 13058307 13540550 1260718 14801268 14281717 -732805 8362 13540550 0.97340 0.02660 true true true 6701247 6701247 9283678 4608168 4675510 1476876 1094893 381983 15394843 12639994 2754849 2692010 1410943 1281067 15794656 VENTURES AND PARTNERSHIPS 358218 C CARE SERVICES 5770000 C 6128218 0 ADVANCES FROM AFFILIATES 34796177 34796177 17871782 16980099 891683 -24011 -1690236 -1714247 -822564 19419713 -24011 2890764 2866753 16552960 1318822 1318822 17871782 12399099 -4581000 -4581000 16980099 16980099 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 8 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS: ($4,680) DEFINED BENEFIT PENSION PLAN: $2,895,444 OTHER CHANGES IN NET ASSETS: ($4,581,000) PART XII, LINE 2d CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS: ($4,680) DEFINED BENEFIT PENSION PLAN: $2,895,444 PART XII, LINE 4B INVESTMENT INCOME TIMING DIFFERENCE: $1,318,822 PART XIII, LINE 2d OTHER CHANGES IN NET ASSETS: ($4,581,000) FIN 48 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 DAVE CYTLAK 256705 0 38924 0 23296 0 14700 0 25373 0 358998 0 0 0 DR MICHAEL DENIKE 493103 0 1900 0 486 0 0 0 25344 0 520833 0 0 0 DR JEFFREY EIDEN 143033 0 37400 0 114 0 9498 0 13040 0 203085 0 0 0 WILLIAM KOSE 274380 0 49061 0 27086 0 14700 0 15930 0 381157 0 0 0 SCOTT MALANEY 429687 0 100628 0 41678 0 14700 0 31622 0 618315 0 0 0 DR GARY PARENTEAU 409512 0 0 0 996 0 14700 0 16997 0 442205 0 0 0 DR JASON SCHROEDER 742723 0 100000 0 20756 0 14700 0 25622 0 903801 0 0 0 DR JACOB DAGANI 160732 0 0 0 17530 0 10800 0 16268 0 205330 0 0 0 PART I, LINE 4b In 2011, Blanchard Valley Health System contributed on behalf of Scott Malaney $123,519 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 2011, Blanchard Valley Health System contributed on behalf of David Cytlak $18,385 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 are not allowed. * Each participants 457(b) account will be credited up to the statutory limit ($16,500 in 2011), 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. 0 DR JASON SCHROEDER SON- DR. LEROY SCHROEDER 863479 COMPENSATION false TERESA SCHROEDER WIFE- DR. LEROY SCHROEDER 26231 COMPENSATION false 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 THIS, HE IS 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 WHICH IS COMPRISED OF MEMBERS OF THE GOVERNING BODIES OF THE SYSTEM. THE BOARD CHAIR OF THE HEALTH FOUNDATION ALSO ATTENDS THIS REVIEW. THE COMPLIANCE COMMITTEE REPORTS TO THE PARENT BOARD ANY AREAS OF CONCERN REGARDING THE 990'S. THE PARENT BOARD HAS GRANTED AUTHORITY TO THE COMPLIANCE COMMITTEE TO REVIEW AND APPROVE THE 990'S. ONCE THE 990'S HAVE BEEN FINALIZED, REVIEWED AND APPROVED, THE MEMBERS OF THE PARENT AND HEALTH FOUNDATION BOARDS RECEIVE ELECTRONIC COMMUNICATION THAT THE 990S ARE COMPLETE AND AVAILABLE FOR THEIR REVIEW ON THE ELECTRONIC REPOSITORY. ANY QUESTIONS ARISING FROM BOARD MEMBERS ARE ADDRESSED BY THE COMPLIANCE AND AUDIT COMMITTEE, UPPER MANAGEMENT, THE ACCOUNTING DEPARTMENT, AND EXTERNAL ACCOUNTANTS. FORM 990, PART VI, QUESTION 12c ANNUALLY, THE ORGANIZATION ASKS THEIR BOARD AND EXECUTIVES TO SIGN CONFLICT OF INTEREST POLICIES. THE ORGANIZATION ALSO ASKS THEM TO REVIEW THEIR ACTIVITY AND COMPLETE RELATIONSHIP QUESTIONNAIRES FOR THE FORM 990 FILING YEAR. TRUSTEES ARE REQUIRED TO BRING TO THE ATTENTION OF MANAGEMENT ANY CONFLICTS AS THEY ARISE. THESE CONFLICTS ARE DOCUMENTED IN THE BOARD MINUTES. MEMBERS WITH CONFLICTS ARE TO EXCUSE THEMSELVES FROM DISCUSSION AND/OR VOTING ON ISSUES WITH WHICH A CONFLICT EXISTS. FORM 990, PART VI, QUESTION 15a THE ORGANIZATION PERFORMS AN INDEPTH REVIEW OF EXECUTIVE AND PHYSICIAN COMPENSATION, BENEFITS, AND PERQUISITES ON A BIENNIAL BASIS TO ENSURE CONSISTENCY WITH COMPENSATION PHILOSOPHY AND MARKET PRACTICE. AN ANNUAL REVIEW FOR COMPETITIVENESS IS ALSO PERFORMED. THE EXECUTIVE COMMITTEE FROM THE BOARD OF DIRECTORS SERVES AS THE EXECUTIVE COMPENSATION COMMITTEE, AND AS SUCH MAINTAINS SEPARATE MEETING MINUTES IN THEIR ROLE AS COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE MEETS TO APPROVE WAGE INCREASES AS WELL AS REVIEW THE ORGANIZATION'S POSITION IN THE MARKET WHEN IT COMES TO EXECUTIVE AND PHYSICIAN COMPENSATION. IN ADDITION, THE 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 REVIEW OF COMPENSATION, BENEFITS, AND PERQUISITES WAS COMPLETED IN EARLY 2011 BY SULLIVAN COTTER AND ASSOCIATES (AN EXTERNAL CONSULTANT) AND SHARED/DISCUSSED WITH THE BOARD IN APRIL 2011. PRIOR TO AWARDING WAGE INCREASES IN 2012, ANOTHER LESS EXTENSIVE REVIEW WAS COMPLETED OF EXECUTIVE COMPENSATION TO REFRESH MARKET DATA PROVIDED IN THE 2011 REPORT. THIS LESS EXTENSIVE REVIEW WAS ALSO SHARED WITH THE EXECUTIVE COMPENSATION COMMITTEE IN APRIL 2012, AND THEN WITH THE FULL BOARD IN JUNE 2012. 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 5 CHANGE IN BENEFICIAL INTEREST IN PERPETUAL TRUSTS: ($4,680) DEFINED BENEFIT PENSION PLAN: $2,895,444 OTHER CHANGES IN NET ASSETS: ($4,581,000) UNREALIZED LOSS: ($24,011) INVESTMENT INCOME TIMING DIFFERENCE: $1,318,822 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT MALANEY TITLE:PRESIDENT BVHS HOURS:38 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVE CYTLAK TITLE:CFO HOURS:38 BLANCHARD VALLEY MEDICAL PRACTICES 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFCS OH 10936408 2106995 NA 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 BVRHC BLANCHARD VALLEY CONTINUING CARE SVCS 15100 BIRCHAVEN LN FINDLAY OH 45840 346006904 CONT. CARE OH 501(C)3 9 NA false BLANCHARD VALLEY REGIONAL HEALTH CENTER 1900 SOUTH MAIN ST FINDLAY OH 45840 341369963 ACUTE CARE OH 501(C)3 3 NA false BLANCHARD VALLEY HEALTH FOUNDATION 1900 SOUTH MAIN ST FINDLAY OH 45840 341370522 FUNDRAISING OH 501(C)3 7 NA false NORTHWEST OHIO MEDICAL EQUIPMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 341882390 MED EQUIPMENT OH BVCCS N/A 0 0 BLANCHARD VALLEY PAIN MANAGEMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 270095470 PAIN MGMT OH BVRHC N/A 0 0 TECHNICORE PO BOX 1210 FINDLAY OH 45839 421702910 BIO-MED SUPPORT OH BVRHC N/A 0 0 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 CITAS INC 1900 SOUTH MAIN ST FINDLAY OH 45840 311369708 RECRUITING OH NA C CORP 56738 1998 1.00000 HANCO AMBULANCE INC 417 SIXTH STREET FINDLAY OH 45840 382048755 HEALTHCARE OH NA C CORP -1733696 964012 1.00000 false false true true false false false false true true false true true false false false false false BLANCHARD VALLEY REGIONAL HEALTH CENTER D 107675000 FMV BLANCHARD VALLEY REGIONAL HEALTH CENTER I 56004 FMV BLANCHARD VALLEY CONTINUING CARE SERVICES I 60000 FMV