2013-10-29T06:18:38-05:00 2012-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2012-01-01 341369963 BLANCHARD VALLEY REGIONAL HEALTH CENTER % 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 2016-03-07 17:11:31Z DAVID M CYTLAK 1900 SOUTH MAIN STREET FINDLAY OH 45840 238425735 false X WWW.BVHEALTHSYSTEM.ORG X 1982 OH BLANCHARD VALLEY REGIONAL HEALTH CENTER OPERATES TWO HOSPITALS OFFERING INPATIENT, EMERGENCY, MATERNITY AND OUTPATIENT SERVICES; OUTPATIENT CENTERS, AND A HOSPITAL-SUBSIDIZED PRIMARY CARE CLINIC. 21 18 1654 459 1653556 1068824 0 0 201649018 214115860 6893753 7392278 5912853 6408953 214455624 227917091 10000 0 0 0 93062061 98794796 0 0 0 95160072 100273844 188232133 199068640 26223491 28848451 365224455 396025373 231143785 227053543 134080670 168971830 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 32697262 41902180 Cardiovascular Services: Blanchard Valley Heartcare Center offers a complete range of services for comprehensive cardiac care. Services for diagnosis and treatment include coronary artery bypass surgery, valve replacements, cardiac and pulmonary rehabilitation, and diagnostic testing including ekgs, stress tests, holter monitoring, and echocardiograms. the cardiac and pulmonary rehab programs are nationally certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AAC[VR). In addition, education is provided to patients and their family, as well as community members, on a variety of heart-related topics throughout the year. The emergency departments at Blanchard Valley Hospital and Bluffton Hospital adhere to the national "gold standard" of heart care that includes the administration of "clot busters" and other drug therapy. All emergency department physicians and nurses have received extensive education in critical cardiac care, which includes advanced cardiac life support. Thanks to teamwork, the BVH emergency department and the Blanchard Valley Heartcare Center consistently beat the 90-minute national benchmark for "door to balloon time," established by the American College of Cardiology (ACC). In 2012, our median "door to balloon time" was 49.5 minutes. Also, Blanchard Valley Hospitals Cardiovascular Program, part of the Jane & Gary Heminger HeartCare Center, was named one of the nations 50 Top Cardiovascular Hospitals for 2013 by Truven Health Analytics, formerly Thomson Reuters. 25505185 32685394 General Surgery: Blanchard Valley Hospital's general surgery group is responsible for a full spectrum of care, from scheduled, elective procedures to the treatment of advanced stages of cancer. Procedures performed by this group include but are not limited to appendectomy (removal of the appendix), cholecystecomy (removal of the gallbladder), non-cosmetic breast surgery (from lumpectomy to mastectomy), orthopedic procedures (joint replacement), and lung and vascular procedures. Blanchard Valley Hospital is a level 3 trauma center, so our surgeons are trained and available to respond to a wide range of trauma needs and most surgical emergencies that come into our emergency department. 20051617 25696539 ORTHOPEDIC SERVICES: ORTHOPEDIC SERVICES AT BLANCHARD VALLEY HOSPITAL INCLUDE: HIP FRACTURE REPAIR AND REPLACEMENT, KNEE SURGERY, JOINT REPLACEMENT, TOTAL KNEE REPLACEMENT, AND MANY OTHER PROCEDURES. WE HAVE PERFORMED MORE THAN 1,000 JOINT REPLACEMENTS SINCE 2008 WITH SOME OF THE MOST ADVANCED TECHNOLOGY IN THE U.S., INCLUDING MINIMALLY INVASIVE AND GENDER-SPECIFIC PROCEDURES. OUR ORTHOPEDIC PROGRAM WAS DEVELOPED THROUGH THE COLLABORATION OF OUR SPECIALTY ORTHOPEDIC SURGEONS AND HOSPITAL ASSOCIATES. WE WORK DIRECTLY WITH OUR PATIENTS TO CREATE A HEALTH CARE PLAN TO FIT THEIR NEEDS. IN 2012, HEALTHGRADES - THE LEADING INDEPENDENT HEALTH CARE RATINGS COMPANY - AWARDED SEVERAL HONORS TO THE BVH TOTAL JOINT REPLACEMENT PROGRAM INCLUDING: 2012 HEALTHGRADES ORTHOPEDIC SURGERY EXCELLENCE AWARD #1 IN OHIO FOR OVERALL ORTHOPEDICS; 5-STAR RATING FOR OVERALL ORTHOPEDICS, 5-STAR RATING FOR TOTAL JOINT REPLACEMENT; 5-STAR RATING FOR TOTAL KNEE REPLACEMENT; 5-STAR RATING FOR TOTAL HIP REPLACEMENT. 88397963 113344902 166652027 true false false false false false false false false true true false false true true false false true false false false false false false false false true true false false true true false false false false false false false false true true false false false false true true true true false false true 420 0 true 1654 true true true false false false false false false false false false X 21 18 false false true 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 0 609373 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 0 354303 40264 CHRISTOPHER PRESS 38.0 2.0 X 310390 0 30815 DR WILLIAM KOSE 4.0 36.0 X 0 358444 31813 ROBERT WESTPHAL 2.0 38.0 X 0 221596 38361 BARBARA PASZTOR RN 40.0 X 233017 0 34345 CHRISTINE KELLER 40.0 X 188938 0 24403 WILLIAM WATKINS 4.0 36.0 X 0 170664 26854 DR CHIRANJI AGRAWAL 40.0 X 485684 0 29700 DR ANGELA HOLT 40.0 X 429789 0 28588 DR MIGUEL JORDAN 40.0 X 382702 0 22565 DR GEORGE ABATE 40.0 X 353426 0 27480 DR MICHAEL MANUAL 40.0 X 317364 0 38760 2701310 1714380 418708 54 false true false Caretech Solutions Inc 901 Wilshire Dr Suite 250 TROY MI 48084 IT & COMMUNICATION 5851061 Sodexo Inc 9001 Washington Blvd GAITHERSBURG MD 20878 Dietary Services 1451179 Hylant Group Inc 811 MADISON AVE TOLEDO OH 43604 INSURANCE 1146746 Technicore PO Box 1210 FINDLAY OH 45839 Bio-Med Support 1095835 Delta Dental Plan Of Ohio PO Box 633198 CINCINNATI OH 45263 Dental Plan 889562 45 0 PATIENT SERVICE 900099 209815119 209815119 OUTPATIENT PHARMACY 446110 1423309 869041 554268 INVESTMENT IN TECHNICORE 541900 1872001 1918836 -46835 MEDICAL SERVICES 900099 119033 119033 CHARITY SERVICES 900099 236669 236669 649729 649729 214115860 7281774 7281774 0 0 310364 310364 0 310364 310364 10407762 20588 10317846 89916 20588 110504 20588 89916 0 0 203866 190798 13068 13068 FINDLAY SURGERY CENTER 621300 1146123 1146123 CAFETERIA 900099 164340 164340 MEAL TICKETS 900099 811899 811899 3963159 3963159 6085521 227917091 213629015 1653556 12634520 0 0 0 0 3006652 2059450 947202 0 0 74081366 58953701 15127665 0 3130550 2491455 639095 0 13476579 10725363 2751216 0 5099649 4058566 1041083 0 0 72287 0 72287 0 984598 0 984598 0 0 0 0 8861053 7052087 1808966 0 689992 549132 140860 0 5980838 5813081 167757 0 3331709 2242268 1089441 0 0 3941118 3136547 804571 0 698105 555588 142517 0 0 0 8254130 6587241 1666889 0 0 11487588 9142420 2345168 0 662037 0 662037 0 PROVISION FOR BAD DEBTS 9319402 9319402 0 0 MEDICAL & PROFESSIONAL FEES 4155953 3307524 848429 0 DUES & SUBSCRIPTIONS 584929 465517 119412 0 MEDICAL SUPPLIES 36054089 36054089 0 0 5196016 4138596 1057420 199068640 166652027 32416613 0 0 0 26832431 28334610 0 0 23017139 23346014 0 0 0 0 0 0 5227897 5086555 833193 1161349 226461222 95244489 132613833 131216733 134440337 158100470 46968 377806 0 0 0 0 42212657 48401836 365224455 396025373 16216567 17154597 0 0 183287 161044 118879980 125004414 0 0 0 0 6878336 6349826 0 0 88985615 78383662 231143785 227053543 X 127746483 162156891 628340 722525 5705847 6092414 134080670 168971830 365224455 396025373 X 28848451 14717930 -8675221 X false true X true false X 6334186 752562 271810 6814938 6518959 -168872 15901 6334186 6136329 389430 6800 6518959 5459960 677759 1390 6136329 7587291 -2022743 104588 5459960 0.89400 0.10600 true true true 3084517 3084517 132072631 35850354 96222277 1526998 1246186 280812 78183445 54637138 23546307 11592103 3510811 8081292 131215205 ADVANCES TO AFFILIATES 46451035 DEFERRED BOND ISSUANCE COSTS 1950801 48401836 0 PENSION LIABILITY 47275798 THIRD PARTY SETTLEMENTS 2301238 INTEREST RATE SWAP OBLIGATION 28265661 MINORITY INTEREST IN PAIN MANA 540965 78383662 233959800 14717930 -8675221 6042709 227917091 227917091 199068640 199068640 199068640 SCHEDULE D PART V QUESTION 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 & PART XII, LINE 2D CHANGE IN INTEREST RATE SWAP AGREEMENT $(129,062) DEFINED BENEFIT PENSION PLAN (1,603,834) OTHER CHANGES IN NONCONTROLLING INTEREST (6,830,892) CHANGE IN PERPETUAL TRUST 387,567 TRANSFERS TO AFFILIATES (499,000) TOTAL (8,675,221) ASC 740 FOOTNOTE 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. true true X true X true X true true true false false 7023137 7023137 0.03700 17919706 12056308 5863398 0.03090 4073710 2845975 1227735 0.00650 29016553 14902283 14114270 0.07440 248173 4418 243755 0.00130 97780 97780 0.00050 69582 69582 0.00040 415535 4418 411117 0.00220 29432088 14906701 14525387 0.07660 5945 5945 0.00010 75307 3000 72307 0.00040 38455 38455 0.00020 9297 9297 0.00010 129004 3000 126004 0.00080 false 9319402 3075403 39927365 49513168 -9585803 X true false 2 1 BLANCHARD VALLEY HOSPITAL

1900 SOUTH MAIN STREET FINDLAY OH 45840

X X X 2 BLUFFTON HOSPITAL

139 GARAU STREET BLUFFTON OH 45817

X X X X BLANCHARD VALLEY HOSPITAL 1 true true 150. true 250. true X X X X X X true true X X X true true X X X X X true X false false BLUFFTON HOSPITAL 2 true true 150. true 250. true X X X X X X true true X X X true true X X X X X true X false false 2 CAUGHMAN HEALTH CENTER

1800 NORTH BLANCHARD STREET SUITE FINDLAY OH 45840

OUTPATIENT CLINIC CREIGHTON DIALYSIS LLC

100 EAST MAIN CROSS STREET FINDLAY OH 45840

DIALYSIS CENTER PART I, LINE 7 The costing methodology that is used to calculate the amounts in 7a through 7d is the same methodology that is used to prepare our 2012 Medicaid AND MEDICARE Cost Reports. We pull information from Schedule F and Schedule H for costs, payments, and charges as they are presented in the 2012 MedicaID Cost Report. PART I, LINE 7F Bad debt expense of $9,319,402 was removed from total expenses prior to calculating the percentage of total expense. PART III, LINE 4 WE DO NOT HAVE A BAD DEBT FOOTNOTE. Our bad debt expense is comprised of three components. First, accounts that have been transferred to collection agencies are recorded as an increase to bad debt expense. Second, changes in our allowance for uncollectible accounts based on changes in our accounts receivable aging buckets are recorded as an increase or decrease to bad debt expense. Finally, any recoveries that are received from collection agencies are recorded as a decrease to bad debt expense. These three components are the net bad debt expense amounts that are presented in our financial statements. Bad Debt at Cost (Part III line 2) is calculated by multiplying total bad debt expense for the year by the average cost-to-charge ratio per the Medicare Cost Report. The amount of that number attributable to patients eligible under charity care policies (Part III line 3) is estimated based upon past experiences. Bad debt should be treated as community benefit. We perform services to all patients, regardless of ability to pay. We consciously know that the some of these individuals will not be able to pay some or all of the costs associated with providing services to these individuals. Thus, this is a benefit to the community as they know that they always be treated and will not be turned away. PART III, LINE 8A ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. WE PERFORM SERVICES TO MEDICARE PATIENTS AND CONSCIOUSLY KNOW THAT THE COSTS TO PERFORM SUCH SERVICES ARE HIGHER THAN THE REIMBURSEMENT WE RECEIVE. THUS, WE FEEL THAT THIS IS A BENEFIT TO THE COMMUNITY BY BEING A CONVENIENT AND REPUTABLE SOURCE WITHIN THE COMMUNITY TO RECEIVE SUCH SERVICES. THE SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS OUR 2012 MEDICARE COST REPORTS AND OUR 2012 PSR REPORTS. PART III, LINE 9B Blanchard Valley Health System educates patients with Financial Assistance in several ways. The financial assistance guidelines are on the back of each statement. When patients are called or call the Business Office, associates in the Credit and Collection Department pre-screen patients to determine if they may be eligible for any type of financial assistance. If the patient is determined to potentially be eligible, we discuss with the patient their options and what financial assistance consists of. We then send an application to the patients via mail. Our applications and process is also on our website. In addition, if we have an outpatient or inpatient that may qualify, we talk to those patients and even assist with the application. Applications are then processed and a letter of award or denial is sent to the patient. They are instructed to call the Financial Advocates if they have further questions or concerns. NOTE: All points of service are equipped to discuss the financial application as well as distribute. PART V, LINE 13G The Ohio Revised Code is posted throughout the hospital facility, finanical assistance information is included on the back of a patient's monthly statement, literature (i.e. brochures, packets, etc.) is available, and Financial Couselors are available and make room visits. available, and Financial Couselors are available and make room visits. Part vi, line 2 needs assessment Blanchard Valley Regional Health Center (BVRHC) has a long-standing commitment to the health care needs of the communities it serves. Through participation in and sponsorship of health fairs, health screenings, awareness campaigns, and educational events; as well as active and ongoing dialogue with the Findlay City and Hancock County Health Departments, BVRHC seeks not only to assess the needs of local communities, but also to encourage community members of all ages to take charge of their health care needs. We confer with the local city and county schools, and cooperate with agencies in the community that may, from time to time, conduct health assessments. The Bluffton Hospital collaborates with the local schools to provide a school nurse program that not only evaluates the population for health issues, but provides education as well. BVRHC periodically conducts physician needs assessments. Our multiple boards and committees are formed with members and physicians who live within the community. We also monitor diseases and conditions that present in our emergency department at Caughman Health Center. BVRHC HELPED LEAD THE DEVELOPMENT OF THE 2011 HANCOCK COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL'S CONTRIBUTIONS INCLUDED SENIOR EXECUTIVE TIME AND FINANCIAL SUPPORT. BVRHC SUCCESSFULLY SOUGHT EXECUTIVE AND FINANCIAL SUPPORT FROM OTHER HANCOCK COUNTY PRIVATE AND PUBLIC AGENCIES WHO ARE STAKEHOLDERS IN ANY HEALTH NEEDS ASSESSMENT. DURING 2011, THE HOSPITAL HELPED A STEERING COMMITTEE ADMINISTER ASSESSMENTS OF ADULTS, YOUTH, AND CHILDREN. THE REPORT WAS COMPLETED IN LATE 2011. THE HOSPITAL REMAINS INVOLVED WITH THE COMMITTEE AS IT CONTINUES FORWARD TO devise action plans to address selected health problems. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE Blanchard Valley Regional Health Center educates patients about our options for financial assistance in several ways. The financial assistance guidelines are on the back of each statement. When patients are called or call the Business Office, associates in the Credit and Collection Department pre-screen patients to determine if they may be eligible for any type of financial assistance. If the patient is determined to potentially be eligible, we discuss with the patient their options for obtaining financial assistance. We then send an application to the patients via mail. The process is also defined and our application IS available on our website. In addition, if we have an outpatient or inpatient that may qualify, we talk to those patients and even assist with completing the application. Applications are then processed and a letter or award or denial is sent to the patient. They are instructed to call the Financial Advocates if they have further questions or concerns. NOTE: All points of service are equipped to discuss and distribute the financial assistance application. PART VI, LINE 4 COMMUNITY INFORMATION Blanchard Valley Health System serves an eight-county area that includes Hancock, Allen, Putnam, Henry, Wood, Seneca, Wyandot, and Hardin Counties. Hancock (our primary service area) and Seneca counties can be described as micropolitan; Allen and Wood counties as metropolitan; and the surrounding four counties as rural. The Findlay/Hancock County area has placed in the top 20 for the past 11 consecutive years of Site Selection magazine's listing of best micropoliton communities in the U.S. The population of Hancock county is approximately 75,000, with Findlay comprising about half of that total. Median income is moderate; ranging from $40,000 to $60,000 depending on location. Findlay supports a large university, as well as several large corporations including Cooper Tire & RUBBER COMPANY, Marathon PETROLEUM COMPANY, and Whirlpool CORPORATION. The surrounding areas are heavily agricultural. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH By reaching out to the community though health fairs, serving on the boards of local organizations, and providing health education, we are given the opportunity to further the knowledge of the community about the importance of wellness. We are also presented with the opportunity to interact with our community and listen to and identify their needs. Our hospitals are major sponsors of and participate in many community health fairs that provide free or low-cost health screens, educational materials on various health topics, and overall help to increase awareness throughout the community of healthier lifestyles and of local resources for health and healthcare services and products. The organization also contributes monetarily to local charities such as United Way, March of Dimes and the American Cancer Society. PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM CAUGHMAN HEALTH CENTER PROVIDES HEALTH CARE TO HANCOCK COUNTY FAMILIES, REGARDLESS OF THEIR ABILITY TO PAY. FAMILY PRACTICE, PEDIATRIC, OB/GYN, AND PREVENTATIVE SERVICES ARE OFFERED AT CAUGHMAN. CAUGHMAN ALSO PARTICIPATES IN A PROGRAM THAT CONNECTS PATIENTS WITH PHARMACEUTICAL COMPANIES' INDIGENT CARE PROGRAMS TO PROVIDE MEDICATIONS AT NO CHARGE TO PATIENTS. A LICENSED INDEPENDENT SOCIAL WORKER IS EMPLOYED AT CAUGHMAN, AND SHE FACILITATES CLASSES FOR TEEN MOMS, PROVIDES COUNSELING TO PATIENTS, MAKES HOME VISITS FOR PATIENTS, AND PROVIDES ADDITIONAL SUPPORT FOR PATIENTS. BLANCHARD VALLEY REGIONAL HEALTH CENTER, ALONG WITH ITS AFFILIATES, PROVIDES UNRESTRICTED ACCESS TO CARE THROUGH THE ABOVE MENTIONED CAUGHMAN HEALTH CENTER, PHYSICIAN'S PLUS URGENT CARE FACILITY, AND ALL OF THEIR RELATED MEDICAL PRACTICES. WE ARE A SPONSORING AND PARTICIPATING MEMBER OF THE NORTHWEST OHIO FLOOD MITIGATION PARTNERSHIP WHICH IS WORKING TOWARDS RESOLVING THE FLOODING ISSUES IN OUR COMMUNITY. IN 2010 WE JOINED WITH OUR COMMUNITY IN THE HABITAT FOR HUMANITY BUILDING PROJECTS. X X X X X false true false false false false false false false BARBARA PASZTOR RN 185793 0 29417 0 17808 0 10547 0 23798 0 267362 0 CHRISTINE KELLER 168475 0 20320 0 144 0 11408 0 12995 0 213341 0 WILLIAM WATKINS 0 148477 0 18171 0 4016 0 10320 0 16534 0 197518 0 SCOTT MALANEY 0 479574 0 105145 0 24654 0 134697 0 29760 0 773830 DAVE CYTLAK 0 283140 0 47118 0 24045 0 18164 0 25264 0 397731 CHRISTOPHER PRESS 243708 0 48656 0 18026 0 41749 0 16128 0 368267 0 DR WILLIAM KOSE 0 292662 0 35847 0 29935 0 15000 0 16813 0 390257 DR CHIRANJI AGRAWAL 483290 0 0 0 2394 0 12722 0 16978 0 515384 0 DR ANGELA HOLT 411102 0 0 0 18687 0 15000 0 13588 0 458377 0 DR MIGUEL JORDAN 300303 0 58662 0 23737 0 15000 0 7565 0 405267 0 DR GEORGE ABATE 277348 0 57391 0 18687 0 4089 0 23391 0 380906 0 DR MICHAEL MANUAL 204517 0 95673 0 17174 0 15000 0 23760 0 356124 0 ROBERT WESTPHAL 0 180208 0 33152 0 8236 0 13561 0 24800 0 259957 0 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. A VILLAGE OF BLUFFTON OHIO 346400139 2010-12-31 11293759 SEE PART VI false false false B COUNTY OF HANCOCK OHIO 346400608 410040BY4 2011-04-14 108706899 REFUND ISSUE DATED 11/4/2004 false false false C VILLAGE OF ANNA OHIO 340894539 2012-06-13 9700000 BUILDING & EQUIPMENT FINANCING false false false A 4213142 0 11293759 0 0 0 0 0 0 0 11293759 0 true false true true B 2000000 0 108706899 0 0 0 1874847 0 0 0 106832052 0 true false true true C 350000 0 9700000 0 0 0 0 0 0 0 9700000 0 false false true true A false false true true false 0 true false false false B false false true true false 0 true false false false C false false true true false 0 true false false false A false false false false true false 0 false 0 false false B false false false false false false 0 false 0 false false C false false false false true false 0 false 0 false false A false B false C false PART I, COL. B, F: 0 THE ISSUE REFUNDED LEASE OBLIGATIONS DATED 11/15/2002, 12/21/2005, 12/20/2006, AND 10/23/2009. PART 2, COL. A, B, & C, LINE 11: 0 THE PROCEEDS LISTED WERE USED TO CURRENTLY REFUND THE PRIOR OBLIGATIONS LISTED IN PART I. LOUISE WATKINS WIFE OF WILLIAM WATKINS 19952 COMPENSATION false BUCKMAN LTD >35% OWNED SEE SUPPLEMENTAL INFORMATION false DR JASON SCHROEDER SON OF DR. LEROY 589827 COMPENSATION false TERESA SCHROEDER WIFE OF DR. LEROY 25128 COMPENSATION false PART IV CHERYL BUCKLAND IS A TRUSTEE ON THE ORGANIZATION'S BOARD. SHE IS A 50% OWNER IN BUCKMAN LIMITED. BLANCHARD VALLEY CONTINUING CARE SERVICES, A RELATED ENTITY, HAS AN OUTSTANDING LOAN TO BUCKMAN LIMITED FOR THE 2008 PURCHASE OF INDEPENDENCE HOUSE. PART III QUESTION 4D Other services provided at BVRHC include: Women's and Children's Services * Gynecology * Obstetrics * Breast Health * Pediatric Hospitalists * Level 2 Special Care Nursery Oncology/Hematology Services Urology/Nephrology Services Sleep Disorders Pain Management Wound Care Dialysis 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 PAID EMPLOYEE OF A RELATED ORGANIZATION. DUE TO HIS EMPLOYMENT, HE IS CONSIDERED A NON INDEPENDENT VOTING MEMBER OF THE BOARD. DR. LEROY SCHROEDER IS RELATED TO TWO PAID EMPLOYEES OF BVRHC. DUE TO THESE RELATIONSHIPS, HE IS CONSIDERED A NON INDEPENDENT VOTING MEMBER OF THE BOARD. 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 & 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. 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. QUESTION 15A & 15B 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. 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. PART XII QUESTION 2 During 2012, the organization changed its governance structure so that it could address health system needs over the entire continuum of care provided by the organization. Prior to 2012, the organization had a separate compliance committee and a separate audit committee. Also, the form 990's were reviewed by a subcommittee of the audit committee. In 2012, these two separate committees and one subcommittee were combined into one Compliance & Audit Committee. All of the duties of these prior committees were transferred to the new committee. Thus, the Compliance & Audit Committee is responsible for reviews of compliance, reviews of the audited financial statements, reviews of the form 990's, and reviews of other areas as described in the committee's charter. RECONCILIATION OF NET ASSETS PART XI LINE 9 CHANGE IN INTEREST RATE SWAP AGREEMENT $(129,062) DEFINED BENEFIT PENSION PLAN (1,603,834) OTHER CHANGES IN NONCONTROLLING INTEREST (6,830,892) TRANSFERS TO AFFILIATES (499,000) CHANGE IN PERPETUAL TRUST 387,567 TOTAL (8,675,221) CRNA OF BLANCHARD VALLEY LLC 1900 SOUTH MAIN ST FINDLAY OH 45840 061748552 CERT NURSE OH 3054550 NA BLANCHARD VALLEY MEDICAL PRACTICES 1900 SOUTH MAIN ST FINDLAY OH 45840 421659766 PHYS OFCS OH BVHS BLANCHARD VALLEY HOME CARE SERVICES 1900 SOUTH MAIN ST FINDLAY OH 45840 421565629 HOME HEALTH OH BVCCS BLANCHARD VALLEY HEALTH SYSTEM 1900 SOUTH MAIN ST FINDLAY OH 45840 344428206 HEALTHCARE OH 501(C)(3) 11A NA true BLANCHARD VALLEY CONTINUING CARE SVCS 15100 BIRCHAVEN LN FINDLAY OH 45840 346006904 CONT. CARE OH 501(C)(3) 9 BVHS true BLANCHARD VALLEY HEALTH FOUNDATION 1900 SOUTH MAIN ST FINDLAY OH 45840 341369963 FUNDRAISING OH 501(C)(3) 7 BVHS false BLANCHARD VALLEY PAIN MANAGEMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 270095470 PAIN MGMT OH BVRHC RELATED 9841980 2996760 false false 0.51000 TECHNICORE PO BOX 1210 FINDLAY OH 45839 421702910 BIO-MED SUPPO OH BVRHC RELATED 1248000 288667 false true 0.67000 CREIGHTON DIALYSIS 1900 SOUTH MAIN ST FINDLAY OH 45840 274527592 DIALYSIS SERV OH NA RELATED 2389000 3270000 false true 1.00000 NORTHWEST OHIO MEDICAL EQUIPMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 341882390 MEDICAL EQUIP OH BVCCS RELATED false CITAS INC 1900 SOUTH MAIN STREET FINDLAY OH 45840 341369708 RECRUITING OH BVHS C CORP false HANCO AMBULANCE INC 417 SIXTH STREET FINDLAY OH 45840 382048755 HEALTHCARE OH BVHS C CORP false BIRCHAVEN ESTATES AT EASTERN WOODS LTD 15100 BIRCHAVEN LANE FINDLAY OH 45870 346006904 CONDOMINIUM OH BVCCS C CORP false true false true false true false false false false false true false true true false false false false false BLANCHARD VALLEY PAIN MANAGEMENT A 290010 FMV TECHNICORE M 1095835 FMV