WELL-BEING FOUNDATION OF PICKAWAY COUNTY: Form 990, tax year 2018
View the entire original 990 at ProPublica ↗
- Organization
- WELL-BEING FOUNDATION OF PICKAWAY COUNTY (EIN 33-1031454)
- Tax period
- 2018-01-01 to 2018-12-31
- Filed
- 2019-11-07
- IRS object ID
- 201903119349302475
- Schema version
- 2018v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-11-07T14:01:52-06:00 | ReturnTs |
| Tax Period End | 2018-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 351178661 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BLUE & CO LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 500 N MERIDIAN ST SUITE 200 | AddressLine1Txt |
| City | INDIANAPOLIS | CityNm |
| State Abbreviation | IN | StateAbbreviationCd |
| ZIP | 46204 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2018-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 331031454 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BERGER HEALTH FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BERG | BusinessNameControlTxt |
| Phone | 7404208209 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NORTH PICKAWAY STREET | AddressLine1Txt |
| City | CIRCLEVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43113 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LARRY HALM | PersonNm |
| Person Title | TREASURER | PersonTitleTxt |
| Phone | 7404208089 | PhoneNum |
| Signature | 2019-11-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARGOT BURKE | PreparerPersonNm |
| PTIN | P01588992 | PTIN |
| Phone | 3176334705 | PhoneNum |
| Preparation | 2019-11-07 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 47.227.233.166 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-11-07 | IPDt |
| IP Tm | 13:49:41 | IPTm |
| IP Timezone | ES | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | B19D0506B86ED19F1A0FD2AFEEB91090E576B51F | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2018 | TaxYr |
| Build TS | 2020-03-31 21:24:44Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | NELSON EMBRY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 NORTH PICKAWAY STREET | AddressLine1Txt |
| City | CIRCLEVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43113 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $724,374 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BERGERFOUNDATION.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2002 | FormationYr |
| Legal Domicile State | OH | LegalDomicileStateCd |
| Activity Or Mission | BERGER HEALTH FOUNDATION ACHIEVES ITS MISSION THROUGH A VARIETY OF ENDEAVORS. FUNDRAISING EFFORTS PROVIDE PROGRAM SUPPORT FOR BERGER HOSPICE AND CIRCLE OF CARING FAITH-IN-ACTION PROGRAMS; PROVIDE BUILDING AND EQUIPMENT UPGRADES FOR BERGER HEALTH SYSTEM; AND HEALTHCARE SCHOLARSHIPS AND OTHER PROGRAMS TO PROMOTE ENHANCED NURSING CARE AND QUALITY INITIATIVES THAT BENEFIT PATIENT CARE AND ENHANCE COMMUNITY RESOURCES. ALL FUNDS RAISED ARE USED TO ASSIST IN MEETING HEALTH RELATED NEEDS FOR THE COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 9 | TotalEmployeeCnt |
| Total Volunteers | 100 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $897,361 | PYContributionsGrantsAmt |
| CY Contributions Grants | $688,171 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $0 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $0 | CYProgramServiceRevenueAmt |
| PY Investment Income | $82,307 | PYInvestmentIncomeAmt |
| CY Investment Income | -$6,124 | CYInvestmentIncomeAmt |
| PY Other Revenue | $21,923 | PYOtherRevenueAmt |
| CY Other Revenue | $21,255 | CYOtherRevenueAmt |
| PY Total Revenue | $1,001,591 | PYTotalRevenueAmt |
| CY Total Revenue | $703,302 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,416,266 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,071,816 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $221,637 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $334,329 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $296,021 | PYOtherExpensesAmt |
| CY Other Expenses | $81,961 | CYOtherExpensesAmt |
| PY Total Expenses | $1,933,924 | PYTotalExpensesAmt |
| CY Total Expenses | $1,488,106 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$932,333 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$784,804 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,926,569 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,931,813 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $251,291 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $88,121 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,675,278 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,843,692 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF BERGER HEALTH FOUNDATION IS TO ENCOURAGE, RECEIVE AND BE RESPONSIBLE FOR CHARITABLE GIFTS THAT SUPPORT THE DEVELOPMENT OF HEALTH-RELATED SERVICES AT BERGER HEALTH SYSTEM FOR THE RESIDENTS OF PICKAWAY COUNTRY AND THE SURROUNDING AREA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $1,116,778 | ExpenseAmt |
| Grant | $1,071,816 | GrantAmt |
| Desc | RAINBOW FUND - BRADLEY CANCER CENTER PATIENT SUPPORT - HELPS THE BRADLEY CANCER PATIENTS WITH EXPENSES SUCH AS RENT, UTILITIES AND GROCERIES.TACKLING CANCER - FUNDS ARE SPLIT BETWEEN CHARITIES TO HELP CANCER PATIENTS.THE HOSPITAL - HANNAN FUND PROVIDES SUPPORT TO THE HEALTH SYSTEM AND COMMUNITY PROGRAMS THAT PROMOTE HEALTH. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EFFORTS PROVIDE PROGRAM SUPPORT FOR BERGER HOSPICE AND CIRCLE OF CARING FAITH-IN-ACTION PROGRAMS; PROVIDE SUPPORT FOR ACTIVITIES RELATED TO WOMEN'S HEALTH; PROVIDE SUPPORT FOR ONCOLOGY PROGRAMS; PROVIDE BUILDING AND EQUIPMENT UPGRADES FOR BERGER HEALTH SYSTEM: AND HEALTHCARE SCHOLARSHIPS AND OTHER PROGRAMS TO PROMOTE ENHANCED NURSING CARE AND QUALITY INITIATIVE THAT BENEFIT PATIENT CARE AND ENHANCE COMMUNITY RESOURCES. ALL FUNDS RAISED ARE USED TO ASSIST IN MEETING HEALTH RELATED NEEDS OF THE COMMUNITY. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $1,116,778 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | 0 | OperateHospitalInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 9 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (1) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (1) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | OH | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KARA MARQUARDT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7404208089 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 N PICKAWAY ST | AddressLine1Txt |
| City | CIRCLEVILLE | CityNm |
| State Abbreviation | OH | StateAbbreviationCd |
| ZIP | 43113 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt |
|---|---|---|---|---|---|---|---|
| DIANE HILL | |||||||
| PRESIDENT | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| MIKE HESS | |||||||
| VICE PRESIDENT | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| BETHANY REID | |||||||
| TREASURER | 2.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 |
| SCOTT ALLEN | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RANDY BEACH | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| LARRY ELLIOT | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| NELSON EMBREY | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RICHARD FISHER | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| PAM HILL | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| STAN SUMMERS | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| SUE HALEY | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| RODNEY HEMMING | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| JOHN HOFFMAN | |||||||
| DIRECTOR | 2.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |
| LARRY HALM | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 0.00 | Yes (X) | $115,748 | $0 | $24,739 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $115,748 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $24,739 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
| Cntrct Rcvd Greater Than100 K | 0 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $3,625 | FundraisingAmt |
| Related Organizations | $441,286 | RelatedOrganizationsAmt |
| All Other Contributions | $243,260 | AllOtherContributionsAmt |
| Total Contributions | $688,171 | TotalContributionsAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$6,124 | TotalRevenueColumnAmt |
| Exclusion | -$6,124 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,045 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,045 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,045 | TotalRevenueColumnAmt |
| Exclusion | $1,045 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $41,282 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $3,625 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $21,072 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,210 | TotalRevenueColumnAmt |
| Exclusion | $20,210 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $703,302 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $15,131 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,071,816 | TotalAmt |
| Program Services | $1,071,816 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,487 | TotalAmt |
| Program Services | $10,537 | ProgramServicesAmt |
| Management And General | $129,950 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,460 | TotalAmt |
| Program Services | $6,260 | ProgramServicesAmt |
| Management And General | $77,200 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,196 | TotalAmt |
| Program Services | $615 | ProgramServicesAmt |
| Management And General | $7,581 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,717 | TotalAmt |
| Program Services | $6,279 | ProgramServicesAmt |
| Management And General | $77,438 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,469 | TotalAmt |
| Program Services | $1,385 | ProgramServicesAmt |
| Management And General | $17,084 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,825 | TotalAmt |
| Management And General | $16,825 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,152 | TotalAmt |
| Management And General | $11,152 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,486 | TotalAmt |
| Management And General | $2,486 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,554 | TotalAmt |
| Management And General | $15,554 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,837 | TotalAmt |
| Management And General | $4,837 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $135 | TotalAmt |
| Management And General | $135 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (2 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT | $19,526 | $19,526 | |
| DUES AND SUBSCRIPTIONS | $720 | $360 | $360 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,726 | TotalAmt |
| Management And General | $10,726 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,488,106 | TotalAmt |
| Program Services | $1,116,778 | ProgramServicesAmt |
| Management And General | $371,328 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,288 | BOYAmt |
| EOY | $139 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $913,580 | BOYAmt |
| EOY | $915,610 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $561,136 | BOYAmt |
| EOY | $282,764 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $83,474 | BOYAmt |
| EOY | $2,258 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $385,967 | LandBldgEquipCostOrOtherBssAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $385,967 | BOYAmt |
| EOY | $385,967 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $517,017 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,981,124 | BOYAmt |
| EOY | $806,783 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $21,275 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,926,569 | BOYAmt |
| EOY | $2,931,813 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,291 | BOYAmt |
| EOY | $88,121 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $251,291 | BOYAmt |
| EOY | $88,121 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,289,311 | BOYAmt |
| EOY | $2,457,725 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $385,967 | BOYAmt |
| EOY | $385,967 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,675,278 | BOYAmt |
| EOY | $2,843,692 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,926,569 | BOYAmt |
| EOY | $2,931,813 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$784,804 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$46,782 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Organization170 | Yes (X) | PublicOrganization170Ind |
Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,870,939 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,644,075 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $516,889 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $897,361 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $684,546 | CurrentTaxYearAmt |
| Total | $5,613,810 | TotalAmt |
Total Calendar Year170 TotalCalendarYear170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $1,870,939 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $1,644,075 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $516,889 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $897,361 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $684,546 | CurrentTaxYearAmt |
| Total | $5,613,810 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantial Contributors Tot | $911,599 | SubstantialContributorsTotAmt |
| Public Support Total170 | $4,702,211 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $94,578 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $3,711 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $94,144 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $82,307 | CurrentTaxYearMinus1YearAmt |
| Current Tax Year | $1,045 | CurrentTaxYearAmt |
| Total | $275,785 | TotalAmt |
Other Income170 OtherIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | $12,559 | CurrentTaxYearMinus4YearsAmt |
| Current Tax Year Minus3 Years | $15,898 | CurrentTaxYearMinus3YearsAmt |
| Current Tax Year Minus2 Years | $136,352 | CurrentTaxYearMinus2YearsAmt |
| Current Tax Year Minus1 Year | $21,923 | CurrentTaxYearMinus1YearAmt |
| Total | $186,732 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | $6,076,327 | TotalSupportAmt |
| Public Support CY170 | 0.77390 | PublicSupportCY170Pct |
| Public Support PY170 | 0.91900 | PublicSupportPY170Pct |
| Thirty Thr Pct Suprt Tests CY170 | Yes (X) | ThirtyThrPctSuprtTestsCY170Ind |
Form990 Schedule A Part VI Form990ScheduleAPartVIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FormAndLineReferenceDesc |
| Explanation | OTHER INCOME - 2014 AMOUNT: $ 12,559. 2015 AMOUNT: $ 15,898. 2016 AMOUNT: $ 136,352. 2017 AMOUNT: $ 21,923. | ExplanationTxt |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $260,916 | BeginningYearBalanceAmt |
| Contributions | $10,500 | ContributionsAmt |
| Investment Earnings Or Losses | -$6,674 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $7,006 | GrantsOrScholarshipsAmt |
| End Year Balance | $257,736 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $241,049 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $26,862 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $6,000 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $995 | AdministrativeExpensesAmt |
| End Year Balance | $260,916 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $233,675 | BeginningYearBalanceAmt |
| Contributions | $2,001 | ContributionsAmt |
| Investment Earnings Or Losses | $11,514 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $5,225 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $916 | AdministrativeExpensesAmt |
| End Year Balance | $241,049 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $232,920 | BeginningYearBalanceAmt |
| Contributions | $10,005 | ContributionsAmt |
| Investment Earnings Or Losses | -$129 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $8,215 | GrantsOrScholarshipsAmt |
| Administrative Expenses | $906 | AdministrativeExpensesAmt |
| End Year Balance | $233,675 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $215,054 | BeginningYearBalanceAmt |
| End Year Balance | $215,054 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.48950 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.51050 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $385,967 | OtherCostOrOtherBasisAmt |
| Book Value | $385,967 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $385,967 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INVESTMENTS | Desc |
| Book Value | $806,783 | BookValueAmt |
| Method Valuation | F | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $806,783 | TotalBookValueProgramRltdAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART V, LINE 4: | FormAndLineReferenceDesc |
| Explanation | $131,566 OF THE ENDOWMENT IS PERMANENTLY RESTRICTED AND TO BE USED FOR NURSING EDUCATION. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF OUTING | Event1Nm |
| Gross Receipts Event1 | $44,907 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $3,625 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $41,282 | GrossRevenueEvent1Amt |
| Rent Facility Costs Event1 | $10,094 | RentFacilityCostsEvent1Amt |
| Other Direct Expenses Event1 | $10,978 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $44,907 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $3,625 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $41,282 | GrossRevenueTotalEventsAmt |
| Rent Fclty Costs Total Events | $10,094 | RentFcltyCostsTotalEventsAmt |
| Oth Direct Expnss Total Events | $10,978 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $21,072 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $20,210 | NetIncomeSummaryAmt |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| BERGER HOSPITAL | |||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 316400103 | GOVT | $853,163 | HOSPICE, EXPENSE REIMBURSEMENT, OPERATIONAL NEEDS |
| PICKAWAY COUNTY COMMUNITY FOUNDATION | |||||||
| 770 N COURT ST | CIRCLEVILLE | OH | 43113 | 311777036 | 501(C)(3) | $96,357 | SUPPORT FOR COUNTY NEEDS-OPIOID ADDICTION SERVICES |
| HEALTHWAYS SC LLC | |||||||
| 255 E PACES FERRY RD | ATLANTA | GA | 30305 | 813034459 | N/A | $50,000 | BLUE ZONES SPEAKING ENGAGEMENT |
| HAVEN HOUSE | |||||||
| PO BOX 366 | CIRCLEVILLE | OH | 43113 | 311367577 | 501(C)(3) | $16,667 | BATTERED WOMEN ASSISTANCE |
| CIRCLEVILLE PUMPKIN SHOW FOUNDATION | |||||||
| 159 E FRANKLIN ST | CIRCLEVILLE | OH | 43113 | 473225414 | 501(C)(3) | $15,000 | DEVELOPMENT OF DOWNTOWN PUMPKIN SHOW PARK |
| FOUNDATIONS4YOUTH | |||||||
| 457 E OHIO ST | CIRCLEVILLE | OH | 43113 | 830980333 | 501(C)(3) | $15,000 | ORGANIZATION ESTABLISHED TO GIVE TEENS A SAFE PLACE TO HANG OUT |
| PICKAWAY HEALTH SERVICES | |||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 311438107 | 501(C)(3) | $12,096 | PROVIDE FOR SURGERY EDUCATION, SALARY REIMBURSEMENT |
| KB HEALTHCARE | |||||||
| 1412 PINNACLE CLUB DRIVE | GROVE CITY | OH | 43123 | 474935135 | 501(C)(3) | $7,756 | SERVICES FOR OPIATE ADDICTION COMMITTEE |
| TOUCHED BY CANCER | |||||||
| 13587 WINCHESTER RD | ASHVILLE | OH | 43103 | 473509191 | 501(C)(3) | $5,777 | MASSAGES TO CANCER PATIENTS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 8 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE BOARD OF DIRECTORS ROUTINELY APPROVES TRANSFERS TO BERGER HOSPITAL FOR PURCHASES OF MEDICAL SUPPLIES/EQUIPMENT THAT ARE MADE THROUGHOUT THE YEAR. IN ADDITION, THE BOARD OF DIRECTORS APPROVES THE DISTRIBUTION OF FUNDS TO ORGANIZATIONS IN THE COMMUNITY IN ORDER TO HELP PROMOTE AND ENHANCE THE SURROUNDING AREA. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | BERGER HEALTH FOUNDATION IS ORGANIZED AS A COMPONENT UNIT OF BERGER HEALTH SYSTEM, THE PARENT ORGANIZATION AND SOLE VOTING MEMBER FOR THE CONSOLIDATED GROUP. |
| FORM 990, PART VI, SECTION A, LINE 7A | BERGER HEALTH FOUNDATION BOARD OF DIRECTORS ARE CONFIRMED BY BERGER HEALTH SYSTEM'S BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED FOR COMPLETENESS AND ACCURACY BY BOTH THE PRESIDENT AND TREASURER OF BERGER HEALTH FOUNDATION. THE FORM 990 IS PROVIDED TO AND REVIEWED BY THE BOARD PRIOR TO FILING THE RETURN WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THEIR CONFLICT OF INTEREST POLICY BY DISTRIBUTING ANNUAL QUESTIONNAIRES TO THE BOARD MEMBERS, DIRECTORS AND OFFICERS. NEW BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE. ANNUALLY THE QUESTIONNAIRES MUST BE SIGNED AND RETURNED TO THE BERGER HEALTH FOUNDATION TO BE FILED FOR FURTHER REVIEW BY THE PRESIDENT/CEO OF BERGER HEALTH SYSTEM AND CORPORATE COMPLIANCE OFFICER. AT ANY TIME THAT AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED TO THE RESPECTIVE BOARD, WHETHER THROUGH THE VOLUNTARY SUBMISSION OF A CONFLICTS OF INTEREST STATEMENT BY A BOARD MEMBER, OR BY A DISCLOSURE BY A PERSON OTHER THAN THE BOARD MEMBER, THE BOARD SHALL REVIEW THE MATTER TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE CONFLICTED BOARD MEMBER SHALL NOT BE PRESENT DURING ANY MEETING IN WHICH THE BOARD CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED. BOARD MEMBERS SHALL MAKE A FINDING AS TO WHETHER A CONFLICT OF INTEREST INDEED EXISTS, AND SHALL FORWARD THAT FINDING TO THE RESPECTIVE BOARDS FOR DISCUSSION AND VOTE. THE CONFLICTED BOARD MEMBER MAY NOT BE PRESENT AND MUST ABSTAIN FROM VOTING WHEN THIS VOTE IS TAKEN. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER OFFICERS IS DETERMINED BASED ON THE RESULTS OF AN INDEPENDENT COMPENSATION CONSULTATION AND USE OF SALARY SURVEYS. THE EXECUTIVE DIRECTOR'S COMPENSATION IS REVIEWED AND APPROVED BY THE EXECUTIVE COMMITTEE OF THE BOARD. DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATION AND DISCUSSIONS IS KEPT CONTEMPORANEOUSLY IN THE CONTRACTS FOR THE OFFICERS AND IN THE MINUTES OF THE BOARD MEETINGS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | BERGER HEALTH SYSTEM ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| BERGER HOSPITAL | |||||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 316400103 | ACUTE CARE HOSPITAL | OH | GOVERNMENTAL HOSPITA | N/A | N/A | 0 | |
| PICKAWAY HEALTH SERVICES | |||||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 311438107 | PHYSICIAN GROUP | OH | 501(C)(3) | LINE 7 | Yes (1) | BERGER HOSPITAL | |
| BERGER HEALTH SYSTEM | |||||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 262545110 | INACTIVE ACUTE CARE HOSPITAL | OH | GOVERNMENTAL HOSPITA | N/A | N/A | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Share Of Total IncomeShareOfTotalIncomeAmt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PICKAWAY PROFESSIONAL SERVICES INC | |||||||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 641408162 | ANESTHESIOLOGISTS | OH | N/A | C | Yes (1) | ||||
| BERGER HEALTH FOUNDATION VENTURES | |||||||||||||
| 1204 N COURT ST | CIRCLEVILLE | OH | 43113 | 412218009 | MEDICAL SERVICES | OH | C | Yes (1) | BERGER HEALTH FOUNDATION | $75,342 | $107,170 | 1.00000 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | Yes (1) | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |