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← BLANCHARD VALLEY HEALTH FOUNDATION

Form 990 for tax year 2022

Filed by BLANCHARD VALLEY HEALTH FOUNDATION.

Totals

Total revenue
$4,154,361
Total expenses
$2,435,936
Contributions and grants received
$3,296,766
Grants paid
$1,505,000
Program service revenue
$0
Investment income
$914,000
Other revenue
-$56,405
Total assets, end of year
$26,015,329
Total liabilities, end of year
$11,944,000
Net assets or fund balances, end of year
$14,071,329
Program services expenses (Part IX)
$1,505,000
Management and general expenses
$212,190
Fundraising expenses
$718,746
Program service expenses (Part III)
$1,505,000

Program services were 61.8% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1c · Fundraising events

    $247,636

  • 1f · All other contributions, gifts and grants

    $3,049,130

  • 3 · Investment income

    total $825,140 · excluded $825,140

  • 4 · Income from investment of tax-exempt bond proceeds

    total $0

  • 5 · Royalties

    total $0

  • 6c · Rental income or loss

    real property $0 · personal property $0

  • 6d · Net rental income or loss

    total $0

  • 7a · Gross sales of assets other than inventory

    securities $3,117,103

  • 7b · Less cost or other basis and sales expenses

    securities $3,028,243

  • 7c · Gain or loss

    securities $88,860

  • 7d · Net gain or loss

    total $88,860 · excluded $88,860

  • 8a · Fundraising events: gross income

    $75,643

  • 8a · Fundraising events: contributions included on line 1c

    $247,636

  • 8b · Fundraising events: direct expenses

    $132,048

  • 8c · Net income from fundraising events

    total -$56,405 · excluded -$56,405

  • 9a · Gaming: gross income

    $0

  • 9b · Gaming: direct expenses

    $0

  • 9c · Net income from gaming

    total $0

  • 10a · Gross sales of inventory

    $0

  • 10b · Cost of goods sold

    $0

  • 10c · Net income from sales of inventory

    total $0

  • 11e · Other revenue, total

    $0

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $1,505,000 · program services $1,505,000

  • 2 · Grants to domestic individuals

    total $0

  • 3 · Grants to foreign organizations and individuals

    total $0

  • 4 · Benefits paid to or for members

    total $0

  • 5 · Compensation of officers, directors and key employees

    total $121,115 · management and general $30,279 · fundraising $90,836

  • 6 · Compensation of disqualified persons

    total $0

  • 7 · Other salaries and wages

    total $256,599 · management and general $64,150 · fundraising $192,449

  • 8 · Pension plan contributions

    total $11,673 · management and general $2,918 · fundraising $8,755

  • 9 · Other employee benefits

    total $69,767 · management and general $17,442 · fundraising $52,325

  • 10 · Payroll taxes

    total $0

  • 11a · Fees: management

    total $0

  • 11b · Fees: legal

    total $0

  • 11c · Fees: accounting

    total $1,425 · management and general $356 · fundraising $1,069

  • 11d · Fees: lobbying

    total $0

  • 11e · Fees: professional fundraising services

    total $0

  • 11f · Fees: investment management

    total $0

  • 11g · Fees: other

    total $0

  • 12 · Advertising and promotion

    total $31,753 · management and general $7,938 · fundraising $23,815

  • 13 · Office expenses

    total $6,288 · management and general $1,572 · fundraising $4,716

  • 14 · Information technology

    total $12,948 · management and general $3,237 · fundraising $9,711

  • 15 · Royalties

    total $0

  • 16 · Occupancy

    total $0

  • 17 · Travel

    total $3,704 · fundraising $3,704

  • 18 · Travel or entertainment for public officials

    total $0

  • 19 · Conferences, conventions and meetings

    total $0

  • 20 · Interest

    total $0

  • 21 · Payments to affiliates

    total $0

  • 22 · Depreciation, depletion and amortization

    total $343 · management and general $86 · fundraising $257

  • 23 · Insurance

    total $2,019 · management and general $505 · fundraising $1,514

  • 24a · Other expenses: DUES & SUBSCRIPTIONS

    total $6,840 · management and general $1,710 · fundraising $5,130

  • 24b · Other expenses: PROVISION FOR BAD DEBTS

    total $78,472 · fundraising $78,472

  • 24c · Other expenses: OTHER EXPENSES

    total $327,990 · management and general $81,997 · fundraising $245,993

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $0 · end of year $0

  • 2 · Savings and temporary cash investments

    beginning of year $1,132,864 · end of year $367,375

  • 3 · Pledges and grants receivable

    beginning of year $785,339 · end of year $2,033,000

  • 4 · Accounts receivable

    beginning of year $0 · end of year $0

  • 5 · Loans and receivables from officers and key people

    beginning of year $0 · end of year $0

  • 6 · Loans and receivables from disqualified persons

    beginning of year $0 · end of year $0

  • 7 · Other notes and loans receivable

    beginning of year $0 · end of year $0

  • 8 · Inventories for sale or use

    beginning of year $0 · end of year $0

  • 9 · Prepaid expenses and deferred charges

    beginning of year $0 · end of year $0

  • 10a · Land, buildings and equipment: cost or other basis

    $40,268

  • 10b · Land, buildings and equipment: accumulated depreciation

    $40,251

  • 10c · Land, buildings and equipment, net

    beginning of year $360 · end of year $17

  • 11 · Investments: publicly traded securities

    beginning of year $24,554,310 · end of year $23,614,937

  • 12 · Investments: other securities

    beginning of year $0 · end of year $0

  • 13 · Investments: program-related

    beginning of year $0 · end of year $0

  • 14 · Intangible assets

    beginning of year $0 · end of year $0

  • 15 · Other assets

    beginning of year $0 · end of year $0

  • 17 · Accounts payable and accrued expenses

    beginning of year $744 · end of year $0

  • 18 · Grants payable

    beginning of year $0 · end of year $0

  • 19 · Deferred revenue

    beginning of year $0 · end of year $0

  • 20 · Tax-exempt bond liabilities

    beginning of year $0 · end of year $0

  • 21 · Escrow or custodial account liability

    beginning of year $0 · end of year $0

  • 22 · Loans and payables to officers and key people

    beginning of year $0 · end of year $0

  • 23 · Secured mortgages and notes payable

    beginning of year $0 · end of year $0

  • 24 · Unsecured notes and loans payable

    beginning of year $0 · end of year $0

  • 25 · Other liabilities

    beginning of year $11,284,336 · end of year $11,944,000

  • 27 · Net assets without donor restrictions

    beginning of year $1,086,069 · end of year -$471,671

  • 28 · Net assets with donor restrictions

    beginning of year $14,101,724 · end of year $14,543,000

Mission and programs · 2022

Mission

BLANCHARD VALLEY HEALTH FOUNDATION WILL DEVELOP, MANAGE, AND STEWARD RELATIONSHIPS THAT RESULT IN PHILANTHROPIC GIVING TO BENEFIT THE HEALTH AND WELL-BEING OF THOSE PEOPLE SERVED BY BLANCHARD VALLEY HEALTH SYSTEM. BLANCHARD VALLEY HEALTH SYSTEM - CARING FOR A LIFETIME.

Activities or mission (Part I)

BLANCHARD VALLEY HEALTH FOUNDATION DEVELOPS RELATIONSHIPS THAT RESULT IN PHILANTHROPIC GIVING TO BENEFIT THE HEALTH OF THOSE SERVED BY BLANCHARD VALLEY HEALTH SYSTEM.

  • AS A SEPARATE 501(C)(3) ORGANIZATION, BVHF MANAGES UNRESTRICTED, TEMPORARILY RESTRICTED, AND PERMANENTLY RESTRICTED GIFTS TO FUND: 1) DIRECT PATIENT CARE, 2) CONTINUING HEALTH EDUCATION FOR BLANCHARD VALLEY HEALTH SYSTEM STAFF AND COMMUNITY MEMBERS, 3) FACILITIES AND EQUIPMENT, AND 4) OTHER MAJOR INNOVATIVE HEALTH INITIATIVES.

    Expenses $1,505,000 · Grants $1,505,000

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Myron Lewis

    CHIEF EXECUTIVE OFFICER

    Total calculated
    $806,180
    From this org
    $0
    From related orgs
    $779,794
    Other
    $26,386
    Hours/week
    2 + 38 related

    Schedule J breakdown matched by us

    Base
    $0 + $608,452 related
    Bonus
    $0 + $149,600 related
    Other
    $0 + $21,742 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $14,186 related
    Filer's total
    $0 + $806,180 related

  • Dave Cytlak

    CHIEF FINANCIAL OFFICER

    Total calculated
    $516,042
    From this org
    $0
    From related orgs
    $491,422
    Other
    $24,620
    Hours/week
    2 + 38 related

    Schedule J breakdown matched by us

    Base
    $0 + $387,651 related
    Bonus
    $0 + $67,316 related
    Other
    $0 + $36,455 related
    Deferred
    $0 + $18,300 related
    Nontaxable benefits
    $0 + $6,320 related
    Filer's total
    $0 + $516,042 related

  • Richard Polder MD

    TRUSTEE

    Total calculated
    $405,600
    From this org
    $0
    From related orgs
    $381,109
    Other
    $24,491
    Hours/week
    1 + 39 related

    Schedule J breakdown matched by us

    Base
    $0 + $358,047 related
    Bonus
    $0 + $19,084 related
    Other
    $0 + $3,978 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $12,291 related
    Filer's total
    $0 + $405,600 related

  • Karen George

    CHIEF DEVELOPMENT OFFICER

    Total calculated
    $123,227
    From this org
    $121,115
    From related orgs
    $0
    Other
    $2,112
    Hours/week
    40

  • Amy Ballinger

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Barbara Plaugher

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Sarah Palmer

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • John Quaid

    TREASURER

    Total calculated
    $0
    Hours/week
    1

  • John Reineke

    CHAIRMAN

    Total calculated
    $0
    Hours/week
    1

  • Fred Rodabaugh

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Paul Schmelzer

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Suzanne Gagle

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Katie Peterkoski

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Roger Miller

    SECRETARY

    Total calculated
    $0
    Hours/week
    1

  • Emil Ziegler MD

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

  • Beverly Dowling

    VICE CHAIR

    Total calculated
    $0
    Hours/week
    1

  • Karen Jones

    TRUSTEE

    Total calculated
    $0
    Hours/week
    1

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

  • 3 · Independent compensation consultant
  • 3 · Compensation survey or study
  • 4b · Supplemental nonqualified retirement plan

Answered no

  • 4a · Severance or change-of-control payment
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

The filer's explanations (Part III)

SCHEDULE J, PART I, LINE 4C
IN 2022, BLANCHARD VALLEY HEALTH SYSTEM CALCULATED SERP PAYMENTS TO BE CONTRIBUTED IN 2023. $96,553 WILL BE CONTRIBUTED ON BEHALF OF MYRON LEWIS TO A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2023. SERP CONTRIBUTIONS IN THE AMOUNT OF $90,461 WERE MADE FOR THE BENEFIT OF MYRON LEWIS IN 2022. 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 2022, BLANCHARD VALLEY HEALTH SYSTEM CACLULATED SERP PAYMENTS TO BE CONTRIBUTED IN 2023. $27,474 WILL BE CONTRIBUTED ON BEHALF OF DAVID CYTLAK TO THE SERP IN 2023. SERP CONTRIBUTIONS IN THE AMOUNT OF $26,713 WERE MADE FOR THE BENEFIT OF DAVID CYTLAK IN 2022. 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. **EMPLOYEE CONTRIBUTIONS TO THE SERP ACCOUNT ARE NOT ALLOWED. *EACH PARTICIPANT'S 457(B) ACCOUNT WILL BE CREDITED UP TO THE STATUTORY LIMIT ($20,500 IN 2022), 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 0-5 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.

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

  • BLANCHARD VALLEY MEDICAL PRACTICES

    PHYS OFFICE · OH

    Directly controlled by BVHS

  • BLANCHARD VALLEY HOME CARE SERVICES

    HOME HEALTH · OH

    Directly controlled by BVCCS

  • CRNA OF BLANCHARD VALLEY LLC

    CERT NURSE · OH

    Directly controlled by BVRHC

  • SPECIALTY PHYSICIANS OF BLANCHARD VALLEY

    PHYS OFFICE · OH

    Directly controlled by BVMP

  • NEUROSURGICAL ASSOCIATES OF NORTHWEST OH

    PHYS OFFICE · OH

    Directly controlled by BVMP

  • BLANCHARD VALLEY REGIONAL CANCER CENTER

    CANCER CARE · OH

    Directly controlled by BVMP

  • HANCO EMERGENCY MEDICAL SERVICES

    AMBULANCE · OH

    Directly controlled by BVHS

  • BIRCHAVEN ESTATES AT EASTERN WOODS LTD

    CONDOMINIUMS · OH

    Directly controlled by BVCCS

  • BEYOND MEDSPA LLC

    COSMETIC SPA · OH

    Directly controlled by BVHS

  • FINDLAY SURGERY CENTER LTD

    SURGERY CENT · OH

    Directly controlled by BVRHC

Related partnerships

Part III: related organizations taxable as a partnership, with the filer's share.

  • NORTHWEST OHIO MEDICAL EQUIPMENT

    N/A · MED EQUIPMENT · OH

    Directly controlled by BVCCS

  • BLANCHARD VALLEY PAIN MANAGEMENT

    N/A · PAIN MGMT · OH

    Directly controlled by BVRHC

  • TECHNICORE CLINICAL ENGINEERING

    N/A · BIO-MED SUPPO · OH

    Directly controlled by BVRHC

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • CITAS INC

    C CORP · RECRUITING · OH

    Directly controlled by BVHS

Provenance

Return type
form_990
Tax year
2022
Filed
15 May 2023
IRS schema version
2022v5.0
Source object
202323189349303457

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