2019-11-07T14:31:48-06:00 2018-12-31 351178661 BLUE & CO LLC 9200 WORTHINGTON RD STE 200 WESTERVILLE OH 43082 990 2018-01-01 311438107 PICKAWAY HEALTH SERVICES PICK 7404742126 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 ASHTON COX EXECUTIVE DIRECTOR 7404742126 2019-11-07 1 MARGOT BURKE P01588992 6148852583 2019-11-07 47.227.233.166 2019-11-07 13:43:45 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 B19D0506B86ED19F1A0FD2AFEEB91090E576B51F 2018 2020-03-31 21:24:44Z BERGER HEALTH PARTNERS ASHTON COX 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 15073358 0 X WWW.PICKAWAYHEALTHSERVICES.COM X 1995 OH TO ATTRACT AND RETAIN QUALIFIED HEALTHCARE PROFESSIONALS TO MEET THE EXPANDING HEALTHCARE NEED OF PICKAWAY COUNTY IN A MANNER THAT IS COMPASSIONATE, EXCEEDS PATIENT SERVICE EXPECTATIONS, AND RESULTS IN A FINANCIALLY SELF-SUSTAINING ORGANIZATION. 9 6 126 6 0 0 5815080 6586751 7919381 7049473 0 0 1283667 1437134 15018128 15073358 0 0 0 0 9930476 10363155 0 0 0 4847107 4452858 14777583 14816013 240545 257345 1347777 1540896 957420 893194 390357 647702 X TO ATTRACT AND RETAIN QUALIFIED HEALTHCARE PROFESSIONALS TO MEET THE EXPANDING HEALTHCARE NEED OF PICKAWAY COUNTY IN A MANNER THAT IS COMPASSIONATE, EXCEEDS PATIENT SERVICE EXPECTATIONS, AND RESULTS IN A FINANCIALLY SELF-SUSTAINING ORGANIZATION. 0 0 13056404 8486607 THE FAMILY PRACTICE GROUP OFFERS A FULL RANGE OF MEDICAL SERVICE IN ADDITION TO COMMUNITY EDUCATION AND WELLNESS PROJECTS CONSISTENT WITH THE CHARITABLE PURPOSE OF A 501(C)(3) ENITY INTERNAL MEDICINE OFFERS A FULL RANGE OF SERVICES CONSISTENT WITH THE CHARITABLE PURPOSE OF A 501(C)(3) ENTITY. THE OB/GYN PRACTICE OFFERS A FULL RANGE OF SERVICES CONSISTENT WITH THE CHARITABLE PURPOSE OF A 501(C)(3) ENTITY. 13056404 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 14 0 1 126 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 6 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X X KARA MARQUARDT 7404208089 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 MADELINE SANDERS CHAIR 3.00 0.00 X X 0 0 0 TIM COLBURN SECRETARY 4.00 36.00 X X 0 304268 38490 ANDREW BINEGAR MEMBER 3.00 0.00 X 0 0 0 KRISTY BLUM MEMBER 40.00 0.00 X 195673 0 19497 FRANKLIN CHRISTMAN MEMBER - TERM ENDED 7/2018 3.00 0.00 X 0 0 0 JOY EWING MEMBER 3.00 0.00 X 0 0 0 ROBERT MABE MEMBER 3.00 0.00 X 0 0 0 JEREMY NEFF MEMBER 3.00 0.00 X 0 0 0 MATT TOOTLE MEMBER 3.00 0.00 X 0 0 0 CAROLYN YOST MEMBER 40.00 0.00 X 316632 0 25020 CHRISTY ALONZO VICE CHAIR - TERM ENDED 3/2018 3.00 0.00 X X 0 0 0 RICH FILLER CFO 5.00 35.00 X 185501 0 33590 ASHTON COX EXECUTIVE DIRECTOR 40.00 0.00 X 119994 0 19154 DAVID B GOLDFARB EMPLOYEE 40.00 0.00 X 453703 0 20400 YADWINDER SINGH EMPLOYEE 40.00 0.00 X 437645 0 9918 RAUL A ZAMORA EMPLOYEE 40.00 0.00 X 364354 0 14468 ROBERT G KLOOS EMPLOYEE 40.00 0.00 X 378484 0 7879 ARNOLD N PALMER JR EMPLOYEE 40.00 0.00 X 341649 0 25351 2793635 304268 213767 27 0 1 0 NTT DATA SERVICES PO BOX 677959 DALLAS TX 75267 BILLING SERVICES 887549 OHIOHEALTHWORKHEALTH DEPT L-3234 COLUMBUS OH 43260 CLINIC SERVICES CONTRACTING 348370 HEMATOLOGY ONCOLOGY CONSULTANTS INC 300 POLARIS PARKWAY WESTERVILLE OH 43082 ONCOLOGY CONTRACTING 178500 3 6586751 6586751 NET PATIENT SERVICE REVENUE 621110 7049473 7049473 7049473 PURCHASE DISCOUNTS 900099 4563 4563 1432571 1432571 1437134 15073358 8486607 0 0 X 915061 805254 109807 8065547 7081550 983997 161581 142191 19390 704716 620150 84566 516250 454300 61950 37110 37110 41712 41712 2112403 1858915 253488 144153 134451 9702 777285 722875 54410 1625 1511 114 43226 40200 3026 75461 75461 125741 116939 8802 DRUGS AND MEDICAL SUPPL 931697 931697 TUITION REIMBURSEMENT 94051 82765 11286 DUES AND SUBSCRIPTIONS 53134 49414 3720 15260 14192 1068 14816013 13056404 1759609 0 14199 86006 640959 416467 343839 728423 1733781 1423781 348780 310000 1347777 1540896 957420 893194 957420 893194 X 390357 647702 390357 647702 1347777 1540896 257345 0 X X 0 1 X 1 0 X X 1 BERGER HEALTH SYSTEM 316400103 6 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1597 1597 0 53047 32634 20413 1679130 1389550 289580 7 7 310000 X X X X 0 0 0 0 0 0 0 0 0 TIM COLBURN SECRETARY 0 304268 0 0 0 0 37800 0 690 0 38490 304268 0 0 KRISTY BLUM MEMBER 195673 0 0 0 0 0 5000 0 14497 0 215170 0 0 0 CAROLYN YOST MEMBER 294668 0 21964 0 0 0 5000 0 20020 0 341652 0 0 0 RICH FILLER CFO 178001 0 7500 0 0 0 24500 0 9090 0 219091 0 0 0 DAVID B GOLDFARB EMPLOYEE 440003 0 13700 0 0 0 5000 0 15400 0 474103 0 0 0 YADWINDER SINGH EMPLOYEE 437645 0 0 0 0 0 5000 0 4918 0 447563 0 0 0 RAUL A ZAMORA EMPLOYEE 335989 0 28365 0 0 0 5000 0 9468 0 378822 0 0 0 ROBERT G KLOOS EMPLOYEE 340999 0 37485 0 0 0 5000 0 2879 0 386363 0 0 0 ARNOLD N PALMER JR EMPLOYEE 341649 0 0 0 0 0 5000 0 20351 0 367000 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 PICKAWAY HEALTH SERVICES IS ORGANIZED AS A COMPONENT UNIT OF BERGER HEALTH SYSTEM, THE PARENT ORGANIZATION AND MEMBER OF THE CONSOLIDATED GROUP. PICKAWAY HEALTH SERVICES OPERATES INDEPENDENTLY OF THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7A PICKAWAY HEALTH SERVICES IS ORGANIZED AS A COMPONENT UNIT OF BERGER HEALTH SYSTEM, THE PARENT ORGANIZATION AND MEMBER OF THE CONSOLIDATED GROUP. PICKAWAY HEALTH SERVICES OPERATES INDEPENDENTLY OF THE HOSPITAL. PICKAWAY HEALTH SERVICES BOARD OF DIRECTORS ARE APPROVED BY THE BOARD OF DIRECTORS OF BERGER HOSPITAL. THE ONLY RELATED ENTITY MEMBER OF THE BOARD IS THE BERGER HEALTH SYSTEM PRESIDENT/CEO WHO SERVES AS THE SECRETARY. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED FOR COMPLETENESS AND ACCURACY BY BOTH THE EXECUTIVE DIRECTOR AND CFO. 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 PICKAWAY HEALTH SERVICES 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 QUESTONS 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 COMPENSATION COMMITTEE. DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATION AND DISCUSSIONS IS DONE 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 IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 539,213. MANAGEMENT AND GENERAL EXPENSES 73,529. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 612,742. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,319,702. MANAGEMENT AND GENERAL EXPENSES 179,959. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,499,661. FORM 990 PART XII, LINE 2C THE ORGANIZATION HAS NOT CHANGED ITS OVERSIGHT PROCESS FROM THE PREVIOUS YEAR. BERGER HOSPITAL 600 N PICKAWAY ST CIRCLEVILLE OH 43113 316400103 ACUTE CARE HOSPITAL OH GOVERNMENTAL HOSPITA N/A N/A 0 BERGER HEALTH FOUNDATION 1280 N COURT ST CIRCLEVILLE OH 43113 331031454 SUPPORT THE HOSPITAL AND COMMUNITY PROGRAMS 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 611408162 ANESTHESIOLOGISTS OH N/A C 0 BERGER HEALTH FOUNDATION VENTURES 1204 N COURT STREET CIRCLEVILLE OH 43113 412218009 MEDICAL SERVICES OH N/A C 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0