2012-11-08T15:02:33-06:00 2011-12-31 BKD LLP 200 E Main St Suite 700 Fort Wayne IN 46802 990 2011-01-01 341369963 BLANCHARD VALLEY REGIONAL HEALTH CENTER % DAVID M CYTLAK BLAN 4194235497 1900 SOUTH MAIN STREET FINDLAY OH 45840 DAVID M 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 245767234 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. 15 12 1634 340 1528620 1022049 0 0 188651594 201649018 4283584 6893753 3713456 5912853 196648634 214455624 10000 10000 0 0 85445958 93062061 0 0 0 93116587 95160072 178572545 188232133 18076089 26223491 357376493 365224455 188820476 231143785 168556017 134080670 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 31204338 39905605 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 (AACPVR). 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 2011, OUR MEDIAN "DOOR TO BALLOON TIME" WAS 51.5 MINUTES. 24340644 31127985 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. 19136080 24472138 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 2010, HEALTHGRADES - THE LEADING INDEPENDENT HEALTH CARE RATINGS COMPANY - AWARDED SEVERAL HONORS TO THE BVH TOTAL JOINT REPLACEMENT PROGRAM INCLUDING: 2010 JOINT REPLACEMENT EXCELLENCE AWARD TM; 5-STAR RATING FOR TOTAL JOINT REPLACEMENT; 5-STAR RATING FOR TOTAL KNEE REPLACEMENT; 5-STAR RATING FOR TOTAL HIP REPLACEMENT; AND 5-STAR RATING FOR BACK AND NECK SURGERY (SPINAL FUSION). IN 2011, BLANCHARD VALLEY HOSPITAL ALSO RECEIVED THE ORTHOPEDIC SURGERY EXCELLENCE AWARD FROM HEALTHGRADES. 84361800 107944190 159042862 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 true true true false false false false false false false false true true false false false false true true true true false false true 340 0 true 1634 true true true false false false false false false false false false X 15 12 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 CHRISTOPHER PRESS 40.0 X X 0 318844 29750 KURT GEISHEIMER 1.0 X 0 0 0 STEVE DANDURAND 1.0 X 0 0 0 STEVEN MCCULLOUGH DO 1.0 X 0 0 0 PAUL WORSTELL 1.0 X 0 0 0 DUANE JEBBETT 1.0 X 0 0 0 MARK FOX MD 1.0 X 0 16000 0 CHERYL BUCKLAND 1.0 X 0 0 0 KAREN CLINE 1.0 X 0 0 0 KATHLEEN CRATES PHD 1.0 X 0 0 0 RANDALL MYERS 1.0 X 0 0 0 ROBERT HEACOCK MD 1.0 X 77990 0 0 KAREN EUBANKS 1.0 X 0 0 0 ROBERT SUTER 1.0 X 0 0 0 RODNEY WINKLE 1.0 X 0 0 0 SCOTT MALANEY 32.0 X 0 571993 46322 DAVE CYTLAK 32.0 X 0 318925 40073 BARBARA PASZTOR 40.0 X 197596 0 16567 CHRISTINE SWANSON 40.0 X 192151 0 22300 WILLIAM WATKINS 40.0 X 173889 0 30634 DR CHIRANJI AGRAWAL 40.0 X 479015 0 18847 DR ANGELA HOLT 40.0 X 390711 0 23639 DR MIGUEL JORDAN 40.0 X 385675 0 21957 DR JEFFREY SCHULTZ 40.0 X 345113 0 41860 DR MICHAEL MANUEL 40.0 X 306179 0 39973 2548319 1225762 331922 64 false true false Caretech Solutions 901 Wilshire Dr Ste 250 TROY MI 48084 IT & COMMUNICATION 6213722 Charles Construction Services Inc 811 East Bigelow Ave FINDLAY OH 45839 CONTRACTORS 4010693 Hylant GroupInc 811 MADISON AVE TOLEDO OH 43604 CONSULTING SERVICES 1111540 Sodexo Inc 9001 WASHINGTON BLVD GAITHERSBURG MD 20878 DIETARY SERVICES 1233185 Technicore PO Box 1210 FINDLAY OH 45839 BIO-MED SUPPORT 1010497 38 0 PATIENT SERVICE 900099 200486892 200486892 OUTPATIENT PHARMACY 446110 1162126 745991 416135 201649018 6551161 6551161 0 0 305434 305434 305434 305434 31495886 4051 31080023 77322 415863 -73271 342592 -73271 415863 0 0 257565 154265 103300 103300 FINDLAY SURGERY CENTER 621300 1129817 1129817 CAFETERIA 900099 170784 170784 MEAL TICKETS 900099 785136 785136 3418382 2290306 -17332 1145409 5504119 214455624 203449918 1528620 9477087 0 10000 10000 0 0 590687 404600 186087 20070 20070 73933132 58835737 15097395 2417465 1923944 493521 11088190 8824559 2263631 5012517 3989222 1023295 0 62195 62195 213741 213741 0 0 0 8000223 6366994 1633229 760430 605190 155240 39089771 37993333 1096438 2856258 1922286 933972 0 3664369 2916296 748073 633039 503805 129234 0 0 8364774 6657123 1707651 0 11312534 9003103 2309431 -685950 -685950 PROVISION FOR BAD DEBTS 11948144 11948144 MEDICAL & PROFESSIONAL FEES 3555164 2829384 725780 DUES & SUBSCRIPTIONS 546817 435185 111632 OTHER EXPENSES 4838563 3853887 984676 188232133 159042862 29189271 0 0 0 22002052 26832431 0 0 22551614 23017139 0 0 0 0 0 0 3567127 5227897 838966 833193 218824430 86210597 134781574 132613833 130006555 134440337 583783 46968 0 0 0 0 43044822 42212657 357376493 365224455 16575795 16216567 0 0 678128 183287 121971600 118879980 0 0 0 0 8241008 6878336 0 0 41353945 88985615 188820476 231143785 X 162037058 127746483 647711 628340 5871248 5705847 168556017 134080670 357376493 365224455 X 26223491 -60698838 X false true true X false X 6518959 -168872 15901 6334186 6136329 389430 6800 6518959 5459960 677759 1390 6136329 7587291 -2022743 104588 5459960 0.90080 0.09920 true true true 3189752 3189752 132743308 31572924 101170384 1513718 1218724 294994 71720461 50297344 21423117 9657191 3121605 6535586 132613833 ADVANCES TO AFFILIATES 40161408 DEFERRED BOND ISSUANCE COSTS 2051249 42212657 0 PENSION LIABILITY 49920349 THIRD PARTY SETTLEMENTS 4425728 INTEREST RATE SWAP OBLIGATION 33948599 MINORITY INTEREST IN PAIN MANA 690939 88985615 214455624 188232133 26223491 -11090527 -49608311 -60698838 -34475347 153756786 -11090527 -49608311 -60698838 214455624 214455624 188232133 188232133 188232133 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 $(13,977,414) DEFINED BENEFIT PENSION PLAN (30,495,101) DEBT EXTINGUISHMENT (8,709,179) OTHER CHANGES IN NONCONTROLLING INTEREST 229,426 BUILDING IMPAIRMENT (1,590,080) CHANGE IN PERPETUAL TRUST (165,401) OTHER CHANGES IN NET ASSETS 4,581,000 FSC TAX DIFFERENCE (366,767) NET ASSETS RELEASED 885,205 TOTAL ($49,608,311) FIN 48 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 true true 5366853 5366853 0.03040 18097052 11713418 6383634 0.03620 3895262 3381416 513846 0.00290 27359167 15094834 12264333 0.06950 218925 300 218625 0.00120 61038 61038 0.00030 81833 81833 0.00050 361796 300 361496 0.00200 27720963 15095134 12625829 0.07150 3589 3589 63187 63187 0.00040 9215 9215 0.00010 75991 75991 0.00050 false 5589178 1863059 40586543 48570244 -7983701 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 false 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 false true X false false 1 CAUGHMAN HEALTH CENTER

1800 NORTH BLANCHARD STREET STE 121 FINDLAY OH 45840

OUTPATIENT CLINIC 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 2011 Medicaid Cost Reports. We pull information from Schedule F and Schedule H for costs, payments, and charges as they are presented in the 2011 Medicaid Cost Report. PART I, LINE 7F $11,948,144 of bad debt expense was removed from total expenses prior to calculating the percentage of total expense. PART III, LINE 4A WE DO NOT HAVE A BAD DEBT FOOTNOTE. PART III, LINE 4B We record bad debt expense based on three components. First, we record accounts that have been transferred to collection agencies to bad debt expense. Second, we record changes in our allowance for uncollectible accounts based on changes in our accounts receivable aging buckets to bad debt expense. Finally, we record any recoveries that are received from collection agencies as a reduction 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 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 because members of the community will 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, 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 2011 Medicare Cost Reports and our 2011 Provider statistical and reimbursement reports provided by Medicare. 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. brochure, packets, etc.) is available, and Financial Counselors 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, form 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 hospitals 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 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 micropolitAn 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, Marathon Petroleum Corporation and Whirlpool. The surrounding areas are heavily agricultural. PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH By reaching out to the community through 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. $1.7 million in medications were provided at no charge to patients in 2011, thanks to a program that connects patients with pharmaceutical companies' indigent care programs. A Licensed Independent Social Worker was also hired in 2009. She has facilitated classes for teen moms and does counseling, home visits 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. Blanchard Valley Hospital and Bluffton Hospital are part of Spirit of Women, a network of hospitals and health care providers across the United States that ascribe to the highest standards of excellence in women's health, education, and community outreach. This network affiliation allows Blanchard Valley Hospital and Bluffton Hospital to reach women and their families in our community through innovative and inspiring educational events, e-mail newsletters, and other health information venues. In its first two years of membership, more than 750 women in Findlay and the surrounding communities have become local BVHS Spirit of Women Members. true EDUCATIONAL SCHOLARSHIPS 10 10000 SCHEDULE I PART I, LINE 2 SCHOLARSHIP RECIPIENTS MUST MEET ELIGIBILITY CRITERIA PRIOR TO BEING AWARDED THE SCHOLARSHIP. THE SCHOLARSHIP IS EITHER PAID DIRECTLY TO THE RECEIPIENT'S SCHOOL OR IS PAID TO THE RECIPIENT AFTER PROOF OF PAYMENT OF ELIGIBLE EXPENSES (I.E. BOOK AND/OR TUITION INVOICE FROM THE SCHOOL) IS PROVIDED. false true false false false false false false false BARBARA PASZTOR 166941 0 0 0 30655 0 0 0 16567 0 214163 0 0 0 CHRISTINE SWANSON 163048 0 28973 0 130 0 9860 0 12440 0 214451 0 0 0 WILLIAM WATKINS 143779 0 26199 0 3911 0 8990 0 21644 0 204523 0 0 0 DR CHIRANJI AGRAWAL 476894 0 0 0 2121 0 489 0 18358 0 497862 0 0 0 DR ANGELA HOLT 373452 0 0 0 17259 0 8462 0 15177 0 414350 0 0 0 DR MIGUEL JORDAN 316180 0 25758 0 43737 0 14700 0 7257 0 407632 0 0 0 DR JEFFREY SCHULTZ 258936 0 86013 0 164 0 14700 0 27160 0 386973 0 0 0 DR MICHAEL MANUEL 215193 0 74312 0 16674 0 14700 0 25273 0 346152 0 0 0 SCOTT MALANEY 0 429687 0 100628 0 41678 0 14700 0 31622 0 618315 0 0 DAVE CYTLAK 0 256705 0 38924 0 23296 0 14352 0 25373 0 358650 0 0 CHRISTOPHER PRESS 0 237929 0 63439 0 17476 0 14352 0 15398 0 348594 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 Christopher Press and David Cytlak. In 2011, Blanchard Valley Health System contributed on behalf of David Cytlak $18,385 to the SERP. In 2011, Blanchard Valley Health System contributed on behalf of Christopher Press $43,056 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 President, BVRHC and CFO (Christopher Press and David Cytlak, respectively) **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. VILLAGE OF BLUFFTON OHIO 346400139 2010-12-30 11293759 SEE PART VI false false false COUNTY OF HANCOCK OHIO 346400608 410040BY4 2011-04-14 108706899 REFUND ISSUE DATED 11/4/2004 false false false 1026525 0 11293759 0 0 0 0 0 0 0 11293759 0 true false true true 1000000 0 108706899 0 0 0 1874847 0 0 0 106832053 0 2007 true false true true false false true true false 0.00000 0.00000 0.00000 true false false true true false 0 true false true false 0 false 0 false false false true false 0 false 0 false 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, LINE 11: 0 THE PROCEEDS LISTED WERE USED TO CURRENTLY REFUND THE PRIOR OBLIGATIONS LISTED IN PART I. BUCKMAN LTD >35% OWNED 0 SEE SUPPLEMENTAL INFORMATION false LOUISE WATKINS WIFE OF WILLIAM WATKINS 20070 COMPENSATION false PART IV CHERYL BUCKLAND IS A TRUSTEE ON THE ORGANIZATION'S BOARD. SHE IS A 50% OWNER IN BUCKMAN LIMITED, LLC. BLANCHARD VALLEY CONTINUING CARE SERVICES, A RELATED ENTITY, HAS AN OUTSTANDING LOAN TO BUCKMAN LIMITED, LLC FOR THE 2008 PURCHASE OF INDEPENDENCE HOUSE. PART III QUESTION 4D OTHER SERVICES PROVIDED AT BVRHC INCLUDE WOMEN'S AND CHILDRENS 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 CHRISTOPHER PRESS, DR. ROBERT HEACOCK, AND DR. MARK FOX ARE BOARD MEMBERS AND PAID EMPLOYEES OF A RELATED ORGANIZATION. DUE TO THEIR EMPLOYMENT, THEY ARE CONSIDERED NON INDEPENDENT VOTING MEMBERS 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 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. 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 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. 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. RECONCILIATION OF NET ASSETS PART XI LINE 5 CHANGE IN INTEREST RATE SWAP AGREEMENT $(13,977,414) DEFINED BENEFIT PENSION PLAN (30,495,101) DEBT EXTINGUISHMENT (8,709,179) OTHER CHANGES IN NONCONTROLLING INTEREST 229,426 UNREALIZED LOSS (11,090,527) BUILDING IMPAIRMENT (1,590,080) CHANGE IN PERPETUAL TRUST (165,401) OTHER CHANGES IN NET ASSETS 4,581,000 FSC TAX DIFFERENCE (366,767) NET ASSETS RELEASED 885,205 TOTAL (60,698,838) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SCOTT MALANEY TITLE:PRESIDENT BVHS HOURS:8 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVE CYTLAK TITLE:CFO HOURS:8 CRNA OF BLANCHARD VALLEY LLC 1900 SOUTH MAIN ST FINDLAY OH 45840 061748552 CERT NURSE OH 3055757 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 0 0 BVCCS BLANCHARD VALLEY HEALTH SYSTEM 1900 SOUTH MAIN ST FINDLAY OH 45840 344428206 HEALTHCARE OH 501(C)(3) 11A NA false BLANCHARD VALLEY CONTINUING CARE SVCS 15100 BIRCHAVEN LN FINDLAY OH 45840 346006904 CONT. CARE OH 501(C)(3) 9 BVHS false 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 6171890 2671530 false false 0.51000 TECHNICORE PO BOX 1210 FINDLAY OH 45839 421702910 BIO-MED SUPPORT OH BVRHC RELATED -110714 329419 false true 0.67000 CREIGHTON DIALYSIS 1900 SOUTH MAIN ST FINDLAY OH 45840 274527592 DIALYSIS SERVICES OH NA RELATED 91439 1369655 false true 0.99000 NORTHWEST OHIO MEDICAL EQUIPMENT 1900 SOUTH MAIN ST FINDLAY OH 45840 341882390 MEDICAL EQUIPMENT OH BVCCS RELATED 0 0 false CITAS INC 1900 SOUTH MAIN STREET FINDLAY OH 45840 341369708 RECRUITING OH BVHS C CORP HANCO AMBULANCE INC 417 SIXTH STREET FINDLAY OH 45840 382048755 HEALTHCARE OH BVHS C CORP BIRCHAVEN ESTATES AT EASTERN WOODS LTD 15100 BIRCHAVEN LANE FINDLAY OH 45870 346006904 CONDOMINIUM OH BVCCS C CORP 0 0 true false true false true false false false false true false true true false false false false false BLANCHARD VALLEY PAIN MANAGEMENT A 260611 FMV TECHNICORE L 1010497 FMV