Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf .... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 246,409 | 206,694 | 138,090 | 124,696 | 0 | 715,889 |
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | 48,479,000 | 47,252,000 | 32,194,000 | 33,476,000 | 35,033,700 | 196,434,700 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 48,725,409 | 47,458,694 | 32,332,090 | 33,600,696 | 35,033,700 | 197,150,589 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | 0 | 0 | 0 | 0 | 0 |
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public support. (Subtract line 7c from line 6.) | 197,150,589 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 48,725,409 | 47,458,694 | 32,332,090 | 33,600,696 | 35,033,700 | 197,150,589 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,984,453 | 1,819,809 | 1,850,374 | 1,032,584 | 876,177 | 7,563,397 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 129,566 | 146,482 | 276,048 | |||
| c | Add lines 10a and 10b. | 2,114,019 | 1,966,291 | 1,850,374 | 1,032,584 | 876,177 | 7,839,445 |
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 315,968 | 2,098,510 | 1,614,417 | 698,628 | 799,372 | 5,526,895 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 51,155,396 | 51,523,495 | 35,796,881 | 35,331,908 | 36,709,249 | 210,516,929 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part III, Line 12 Other Income | DESCRIPTION - GAIN/LOSS ON EQUITY INVESTMENT, COLUMN A - 99652.0, COLUMN B - 10000.0, COLUMN C - -191000.0, COLUMN D - -660000.0, COLUMN E - -1018000.0, COLUMN F - -1759348.0; DESCRIPTION - MISCELLANEOUS REVENUE, COLUMN A - 216316.0, COLUMN B - 2088510.0, COLUMN C - 1805417.0, COLUMN D - 1358628.0, COLUMN E - 1817372.0, COLUMN F - 7286243.0; |
| Software ID: | 23017437 |
| Software Version: | 2023v5.1 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 4a | BIRCHAVEN VILLAGE IN FINDLAY AND INDEPENDENCE HOUSE IN FOSTORIA, OUR SKILLED NURSING AND LONGTERM CARE FACILITIES, WORK WITH THE RESIDENTS TO CREATE A COMPREHENSIVE PLAN THAT FOCUSES ON THEIR SPECIFIC MEDICAL, SOCIAL AND SPIRITUAL GOALS. BOTH FACILITIES PROVIDE 24-HOUR MEDICAL AND CUSTODIAL CARE FOR INDIVIDUALS WITH SERIOUS ILLNESSES OR INJURIES. IN ADDITION, A MULTIDISCIPLINARY TEAM OF HEALTH CARE PROFESSIONALS PROVIDES PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY AND FOCUSES ON CLINICAL SERVICES AND ACTIVITIES DESIGNED FOR MENTAL AND PHYSICAL STIMULATION. STAYS AT BIRCHAVEN VILLAGE OR INDEPENDENCE HOUSE CAN RANGE FROM SHORT-TERM (FOR REHABILITATION AFTER SURGERY) TO LONG-TERM, DEPENDING ON EACH RESIDENT'S INDIVIDUAL NEEDS. FURTHERMORE, 24-HOUR MEDICAL AND CUSTODIAL CARE IS PROVIDED FOR RESIDENTS WHO NEED LONG-TERM ASSISTANCE WITH THEIR PHYSICAL OR EMOTIONAL NEEDS. EXAMPLES OF THIS SUPPORTIVE CARE INCLUDE ASSISTANCE WITH BATHING, DRESSING AND INCONTINENCE ISSUES, AS WELL AS ATTENTION PAID TO MEDICAL NEEDS, PAIN MANAGEMENT, AND PREVENTING UNSAFE BEHAVIOR. BRIDGE HOME HEALTH AND HOSPICE ENCOMPASSES A RANGE OF OUTPATIENT AND INPATIENT POST ACUTE SERVICES INCLUDING HOSPICE, PALLIATIVE CARE, SKILLED HOME NURSING AND RELATED THERAPIES AS WELL AS PRIVATE DUTY SERVICES. -HOSPICE AND PALLIATIVE CARE ARE PROVIDED FOR PATIENTS WITH LIFE-LIMITING ILLNESSES BY A TEAM OF PROVIDERS, PROFESSIONALS AND VOLUNTEERS IN THE SETTING MOST APPROPRIATE TO MEET THE NEEDS OF THE PATIENT AND FAMILY. SERVICES ARE PRIMARILY FOCUSED ON SYMPTOM MANAGEMENT AS WELL AS MEETING EMOTIONAL, SOCIAL AND SPIRITUAL NEEDS. - SKILLED HOME CARE AND RELATED THERAPIES ARE INTERMITTENT AND PROVIDED UNDER PHYSICIAN DIRECTION IN THE HOME. SERVICES INCLUDE NURSING ASSESSMENT, MEDICATION TEACHING, WOUND CARE, IV MEDICATION ADMINISTRATION AND CHRONIC DISEASE MANAGEMENT AS WELL AS PHYSICAL, OCCUPATIONAL AND SPEECH THERAPIES. - PRIVATE DUTY SERVICES PROVIDE SUPPORT FOR CLIENTS WISHING TO REMAIN IN THE HOME SETTING. COMPANIONS AND NURSE AIDS ARE SUPERVISED BY NURSES AND ASSIST WITH ACTIVITIES OF DAILY LIVING, HOUSEHOLD CHORES, SHOPPING SERVICES AND MEDICATION REMINDERS. |
| Form 990, Part VI, Line 1b | MYRON LEWIS AND DR. RICHARD POLDER ARE BOARD MEMBERS AND ARE PAID EMPLOYEES OF A REALATED ORGANIZATION. DUE TO THEIR EMPLOYMENT, THEY ARE CONSIDERED NON-INDEPENDENT VOTING MEMBERS OF THE BOARD. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | BLANCHARD VALLEY HEALTH SYSTEM, AN OHIO NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF BLANCHARD VALLEY CONTINUING CARE SERVICES. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | A DETAILED REVIEW OF THE FORM 990 IS PERFORMED BY 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 AND 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 THE BOARD OF TRUSTEES RECEIVE ELECTRONIC COMMUNICATION THAT THE FORM 990'S ARE COMPLETE AND AVAILABLE FOR REVIEW. ANY QUESTIONS ARISING FROM BOARD MEMBERS ARE ADDRESSED BY THE COMPLIANCE AND AUDIT COMMITTEE, UPPER MANAGEMENT, THE ACCOUNTING DEPARTMENT, AND/OR EXTERNAL ACCOUNTANTS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ANNUALLY, THE ORGANIZATION ASKS ITS BOARD MEMBERS, CORPORATE OFFICERS, UPPER MANAGEMENT, AND KEY EMPLOYEES TO COMPLETE CONFLICT OF INTEREST SURVEYS. THESE SURVEYS ALSO INCLUDE RELATIONSHIP & ACTIVITY QUESTIONS THAT THESE INDIVIDUALS ARE ASKED TO COMPLETE FOR THE FORM 990 FILING YEAR. BOARD MEMBERS ARE REQUIRED TO BRING TO THE ATTENTION OF EXECUTIVE MANAGEMENT ANY CONFLICTS AS THEY ARISE. THESE CONFLICTS ARE DOCUMENTED IN THE BOARD MINUTES. BOARD MEMBERS THAT HAVE CONFLICTS ARE TO EXCUSE THEMSELVES FROM DISCUSSIONS AND/OR VOTING ON ISSUES WITH WHICH A CONFLICT EXISTS. |
| Form 990, Part VI, Line 15a Process to establish compensation of top management official | THE ORGANIZATION REVIEWS EXECUTIVE COMPENSATION, BENEFITS, AND PREREQUISITES ON A PERIODIC BASIS TO ENSURE CONSISTENCY WITH COMPENSATION PHILOSOPHY AND MARKET PRACTICE. A SUBSET OF MEMBERS FROM THE BOARD OF DIRECTORS SERVES AS THE EXECUTIVE COMPENSATION 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 COMMITTEE ANNUALLY ENGAGES SULLIVAN COTTER AND ASSOCIATES, AN EXTERNAL COMPENSATION CONSULTING FIRM, TO ASSESS THE REASONABLENESS OF THE COMPENSATION PROGRAM USED FOR ITS EXECUTIVES. THE COMMITTEE PERIODICALLY ALSO PERFORMS A FULL BENEFIT ANALYSIS AND REVIEW WITH SULLIVAN COTTER AND ASSOCIATES AS PART OF THIS PROCESS. 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 EXECUTIVE COMPENSATION COMMITTEE'S WORK IS ALSO SHARED/DISCUSSED WITH THE BOARD. |
| Form 990, Part VI, Line 15b Process to establish compensation of other employees | THE SAME PROCESS APPLIES FOR ALL OTHER EXECUTIVE STEERING COMMITTEE MEMBERS AS DETAILED FOR THE CEO. |
| Form 990, Part VI, Line 19 Required documents available to the public | 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 XI, Line 9 Other changes in net assets or fund balances | OTHER CHANGES IN NET ASSETS - -102843; |
| FORM 990, PART VI, SECTION A, LINE 6 MEMBERS | BLANCHARD VALLEY HEALTH SYSTEM, AN OHIO NON-PROFIT CORPORATION, IS THE SOLE MEMBER OF BLANCHARD VALLEY CONTINUING CARE SERVICES. |
| Software ID: | 23017437 |
| Software Version: | 2023v5.1 |