2019-11-07T14:01:52-06:00 2018-12-31 351178661 BLUE & CO LLC 500 N MERIDIAN ST SUITE 200 INDIANAPOLIS IN 46204 990 2018-01-01 331031454 BERGER HEALTH FOUNDATION BERG 7404208209 600 NORTH PICKAWAY STREET CIRCLEVILLE OH 43113 LARRY HALM TREASURER 7404208089 2019-11-07 1 MARGOT BURKE P01588992 3176334705 2019-11-07 47.227.233.166 2019-11-07 13:49:41 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B19D0506B86ED19F1A0FD2AFEEB91090E576B51F 2018 2020-03-31 21:24:44Z NELSON EMBRY 600 NORTH PICKAWAY STREET CIRCLEVILLE OH 43113 724374 0 X WWW.BERGERFOUNDATION.ORG X 2002 OH 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. 13 13 9 100 0 0 897361 688171 0 0 82307 -6124 21923 21255 1001591 703302 1416266 1071816 0 0 221637 334329 0 0 0 296021 81961 1933924 1488106 -932333 -784804 3926569 2931813 251291 88121 3675278 2843692 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. 0 0 1116778 1071816 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. 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. 1116778 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 0 0 1 9 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 13 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X KARA MARQUARDT 7404208089 600 N PICKAWAY ST CIRCLEVILLE OH 43113 DIANE HILL PRESIDENT 2.00 0.00 X X 0 0 0 MIKE HESS VICE PRESIDENT 2.00 0.00 X X 0 0 0 BETHANY REID TREASURER 2.00 0.00 X X 0 0 0 SCOTT ALLEN DIRECTOR 2.00 0.00 X 0 0 0 RANDY BEACH DIRECTOR 2.00 0.00 X 0 0 0 LARRY ELLIOT DIRECTOR 2.00 0.00 X 0 0 0 NELSON EMBREY DIRECTOR 2.00 0.00 X 0 0 0 RICHARD FISHER DIRECTOR 2.00 0.00 X 0 0 0 PAM HILL DIRECTOR 2.00 0.00 X 0 0 0 STAN SUMMERS DIRECTOR 2.00 0.00 X 0 0 0 SUE HALEY DIRECTOR 2.00 0.00 X 0 0 0 RODNEY HEMMING DIRECTOR 2.00 0.00 X 0 0 0 JOHN HOFFMAN DIRECTOR 2.00 0.00 X 0 0 0 LARRY HALM EXECUTIVE DIRECTOR 40.00 0.00 X 115748 0 24739 115748 0 24739 1 0 0 0 0 3625 441286 243260 688171 -6124 -6124 1045 0 1045 1045 1045 41282 3625 21072 20210 20210 703302 0 0 15131 1071816 1071816 140487 10537 129950 83460 6260 77200 8196 615 7581 83717 6279 77438 18469 1385 17084 16825 16825 11152 11152 2486 2486 15554 15554 4837 4837 135 135 BAD DEBT 19526 19526 DUES AND SUBSCRIPTIONS 720 360 360 10726 10726 1488106 1116778 371328 0 1288 139 913580 915610 561136 282764 83474 2258 385967 385967 385967 517017 1981124 806783 0 21275 3926569 2931813 251291 88121 251291 88121 X 3289311 2457725 385967 385967 3675278 2843692 3926569 2931813 -784804 -46782 0 X X 0 1 X 1 0 X 1870939 1644075 516889 897361 684546 5613810 1870939 1644075 516889 897361 684546 5613810 911599 4702211 94578 3711 94144 82307 1045 275785 12559 15898 136352 21923 186732 6076327 0.77390 0.91900 X SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: OTHER INCOME - 2014 AMOUNT: $ 12,559. 2015 AMOUNT: $ 15,898. 2016 AMOUNT: $ 136,352. 2017 AMOUNT: $ 21,923. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 260916 10500 -6674 7006 257736 241049 26862 6000 995 260916 233675 2001 11514 5225 916 241049 232920 10005 -129 8215 906 233675 215054 215054 0.48950 0.51050 0 0 385967 385967 385967 OTHER INVESTMENTS 806783 F 806783 PART V, LINE 4: $131,566 OF THE ENDOWMENT IS PERMANENTLY RESTRICTED AND TO BE USED FOR NURSING EDUCATION. GOLF OUTING 44907 3625 41282 10094 10978 44907 3625 41282 10094 10978 21072 20210 1 BERGER HOSPITAL 600 N PICKAWAY ST CIRCLEVILLE OH 43113 316400103 GOVT 853163 HOSPICE, EXPENSE REIMBURSEMENT, OPERATIONAL NEEDS PICKAWAY COUNTY COMMUNITY FOUNDATION 770 N COURT ST CIRCLEVILLE OH 43113 311777036 501(C)(3) 96357 SUPPORT FOR COUNTY NEEDS-OPIOID ADDICTION SERVICES HEALTHWAYS SC LLC 255 E PACES FERRY RD ATLANTA GA 30305 813034459 N/A 50000 BLUE ZONES SPEAKING ENGAGEMENT HAVEN HOUSE PO BOX 366 CIRCLEVILLE OH 43113 311367577 501(C)(3) 16667 BATTERED WOMEN ASSISTANCE CIRCLEVILLE PUMPKIN SHOW FOUNDATION 159 E FRANKLIN ST CIRCLEVILLE OH 43113 473225414 501(C)(3) 15000 DEVELOPMENT OF DOWNTOWN PUMPKIN SHOW PARK FOUNDATIONS4YOUTH 457 E OHIO ST CIRCLEVILLE OH 43113 830980333 501(C)(3) 15000 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) 12096 PROVIDE FOR SURGERY EDUCATION, SALARY REIMBURSEMENT KB HEALTHCARE 1412 PINNACLE CLUB DRIVE GROVE CITY OH 43123 474935135 501(C)(3) 7756 SERVICES FOR OPIATE ADDICTION COMMITTEE TOUCHED BY CANCER 13587 WINCHESTER RD ASHVILLE OH 43103 473509191 501(C)(3) 5777 MASSAGES TO CANCER PATIENTS 8 1 SCHEDULE I, PART I, LINE 2: 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. 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. 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 BERGER HOSPITAL 1 BERGER HEALTH SYSTEM 600 N PICKAWAY ST CIRCLEVILLE OH 43113 262545110 INACTIVE ACUTE CARE HOSPITAL OH GOVERNMENTAL HOSPITA N/A N/A 0 PICKAWAY PROFESSIONAL SERVICES INC 600 N PICKAWAY ST CIRCLEVILLE OH 43113 641408162 ANESTHESIOLOGISTS OH N/A C 1 BERGER HEALTH FOUNDATION VENTURES 1204 N COURT ST CIRCLEVILLE OH 43113 412218009 MEDICAL SERVICES OH BERGER HEALTH FOUNDATION C 75342 107170 1.00000 1 0 1 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0