Form 990 for tax year 2022

Revenue

Part VIII, the statement of revenue.

• 1f · All other contributions, gifts and grants

  $124,696

• 2a · Program service revenue: PATIENT SERVICES

  total $33,476,000 · related or exempt $33,476,000

• 3 · Investment income

  total $992,584 · excluded $992,584

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

  total $0

• 5 · Royalties

  total $0

• 6a · Gross rents

  real property $40,000

• 6b · Less rental expenses

  real property $0

• 6c · Rental income or loss

  real property $40,000 · personal property $0

• 6d · Net rental income or loss

  total $40,000 · excluded $40,000

• 7a · Gross sales of assets other than inventory

  securities $1,575,379

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

  securities $1,434,963

• 7c · Gain or loss

  securities $140,416

• 7d · Net gain or loss

  total $140,416 · excluded $140,416

• 8a · Fundraising events: gross income

  $0

• 8b · Fundraising events: direct expenses

  $0

• 8c · Net income from fundraising events

  total $0

• 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

• 11a · Other revenue: CATERING

  total $37,365 · unrelated business $37,365

• 11b · Other revenue: GAIN(LOSS) ON EQUITY INVESTMENT

  total -$660,000 · related or exempt -$660,000

• 11c · Other revenue: NORTHWEST OHIO MED EQUIPMENT

  total -$258,759 · unrelated business -$258,759

• 11d · All other revenue

  total $1,358,628 · excluded $1,358,628

• 11e · Other revenue, total

  $477,234

Functional expenses

Part IX, the statement of functional expenses.

• 1 · Grants to domestic organizations and governments

  total $0

• 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 $0

• 6 · Compensation of disqualified persons

  total $0

• 7 · Other salaries and wages

  total $23,049,352 · program services $18,439,482 · management and general $4,609,870 · fundraising $0

• 8 · Pension plan contributions

  total $647,878 · program services $518,302 · management and general $129,576

• 9 · Other employee benefits

  total $4,305,938 · program services $3,444,750 · management and general $861,188

• 10 · Payroll taxes

  total $1,436,465 · program services $1,149,172 · management and general $287,293

• 11a · Fees: management

  total $0

• 11b · Fees: legal

  total $0

• 11c · Fees: accounting

  total $286,831 · program services $229,465 · management and general $57,366

• 11d · Fees: lobbying

  total $0

• 11e · Fees: professional fundraising services

  total $0

• 11f · Fees: investment management

  total $0

• 11g · Fees: other

  total $310,726 · program services $248,581 · management and general $62,145

• 12 · Advertising and promotion

  total $106,894 · program services $85,515 · management and general $21,379

• 13 · Office expenses

  total $2,541,730 · program services $2,033,384 · management and general $508,346

• 14 · Information technology

  total $512,699 · program services $410,159 · management and general $102,540

• 15 · Royalties

  total $0

• 16 · Occupancy

  total $838,774 · program services $671,019 · management and general $167,755

• 17 · Travel

  total $492,741 · program services $394,193 · management and general $98,548

• 18 · Travel or entertainment for public officials

  total $0

• 19 · Conferences, conventions and meetings

  total $0

• 20 · Interest

  total $387,301 · program services $309,841 · management and general $77,460

• 21 · Payments to affiliates

  total $0

• 22 · Depreciation, depletion and amortization

  total $1,800,440 · program services $1,440,352 · management and general $360,088

• 23 · Insurance

  total $176,096 · program services $140,877 · management and general $35,219

• 24a · Other expenses: PROVISION FOR BAD DEBT

  total $454,973 · program services $454,973

• 24b · Other expenses: MEDICAL SUPPLIES

  total $2,131,067 · program services $2,131,067

• 24c · Other expenses: DUES & SUBSCRIPTIONS

  total $145,569 · program services $116,455 · management and general $29,114

• 24d · Other expenses: NET ASSETS RELEASED FROM RESTR

  total $160,131 · program services $160,131

• 24e · All other expenses

  total $1,329,369 · program services $1,063,495 · management and general $265,874

Balance sheet

Part X, book values.

• 1 · Cash, non-interest-bearing

  beginning of year $1,222 · end of year $1,222

• 2 · Savings and temporary cash investments

  beginning of year $24,147 · end of year $0

• 3 · Pledges and grants receivable

  beginning of year $0 · end of year $0

• 4 · Accounts receivable

  beginning of year $3,570,215 · end of year $3,337,664

• 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

  $60,198,134

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

  $31,558,034

• 10c · Land, buildings and equipment, net

  beginning of year $30,328,100 · end of year $28,640,100

• 11 · Investments: publicly traded securities

  beginning of year $24,501,347 · end of year $16,856,454

• 12 · Investments: other securities

  beginning of year $2,081,989 · end of year $1,453,592

• 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 $1,422,651 · end of year $916,250

• 17 · Accounts payable and accrued expenses

  beginning of year $0 · end of year $0

• 18 · Grants payable

  beginning of year $0 · end of year $0

• 19 · Deferred revenue

  beginning of year $362,225 · end of year $308,711

• 20 · Tax-exempt bond liabilities

  beginning of year $17,501,165 · end of year $15,323,873

• 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 $2,275,364 · end of year $2,177,292

• 24 · Unsecured notes and loans payable

  beginning of year $0 · end of year $0

• 25 · Other liabilities

  beginning of year $6,759,014 · end of year $7,077,004

• 27 · Net assets without donor restrictions

  beginning of year $34,915,160 · end of year $26,201,669

• 28 · Net assets with donor restrictions

  beginning of year $116,743 · end of year $116,733

The filer's explanations (Part III)

SCHEDULE J, PART I, LINE 4C

IN 2022, BLANCHARD VALLEY HEALTH SYSTEM CALCULATED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) PAYMENTS TO BE CONTRIBUTED IN 2023. $96,553 WILL BE CONTRIBUTED ON BEHALF OF MYRON LEWIS TO A 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.

Disregarded entities

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

• BIRCHAVEN ESTATES AT EASTERN WOODS LTD

  CONDOMINIUMS · OH

  Directly controlled by BVCCS

• BLANCHARD VALLEY MEDICAL PRACTICES LLC

  PHYS OFFICE · OH · assets $0

  Directly controlled by BVHS

• CRNA OF BLANCHARD VALLEY LLC

  CERT NURSE · OH

  Directly controlled by BVRHC

• NEUROSURGICAL ASSOCIATES OF NW OHIO LLC

  PHYS OFFICE · OH

  Directly controlled by BVMP

• SPECIALTY PHYSICIANS OF BLANCHARD VALLEY

  PHYS OFFICE · OH

  Directly controlled by BVMP

• BLANCHARD VALLEY REGIONAL CANCER CENTER

  PHYS OFFICE · OH

  Directly controlled by BVMP

• HANCO EMERGENCY MEDICAL SERVICES LLC

  HEALTHCARE · OH

  Directly controlled by BVHS

• BLANCHARD VALLEY HOME CARE SERVICES LLC

  HOME HEALTH · OH · income $14,425,640 · assets $16,156,876

  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 (NOME)

  RELATED · MED EQUIPMENT · OH · 73.333% owned · share of income -$597,596 · share of assets $1,921,922 · general or managing partner

  Directly controlled by BVCCS

• BLANCHARD VALLEY PAIN MANAGEMENT

  RELATED · PAIN MGMT · OH

  Directly controlled by BVRHC

• TECHNICORE CLINICAL ENGINEERING

  RELATED · 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