2018-11-09T14:40:00-06:00 2017-12-31 351178661 BLUE & CO LLC 9200 WORTHINGTON RD STE 200 WESTERVILLE OH 43082 990 2017-01-01 331031454 BERGER HEALTH FOUNDATION BERG 7404208209 600 NORTH PICKAWAY STREET CIRCLEVILLE OH 43113 LARRY HALM EXECUTIVE DIRECTOR 7404208089 2018-11-01 1 MATTHEW DASTA P00544683 6148852583 2018-11-01 38.109.186.2 2018-11-01 16:38:01 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 C2B4DDBB6522F83FE227DDBDCF2462E7B4C7121E 2017 2019-02-21 02:37:17Z LARRY HALM 600 N PICKAWAY ST CIRCLEVILLE OH 43113 1033347 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. 15 14 8 100 0 0 416613 897361 0 0 94144 82307 136352 21923 647109 1001591 1231080 1416266 0 0 131798 221637 0 0 0 83228 296021 1446106 1933924 -798997 -932333 4650994 3926569 43383 251291 4607611 3675278 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 1583613 1416266 1001591 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. 1583613 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 8 1 0 0 0 0 0 1 1 0 0 0 0 X 15 14 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X RICHARD FILLER 7404208089 600 N PICKAWAY ST CIRCLEVILLE OH 43113 DIANE HILL PRESIDENT 2.00 X X 0 0 0 SEREANA DRESBACH TREASURER 2.00 X X 0 0 0 MIKE HESS VICE PRESIDENT 2.00 X X 0 0 0 SCOTT ALLEN DIRECTOR 2.00 X 0 0 0 RANDY BEACH DIRECTOR 2.00 X 0 0 0 HILLAIRY BOLTENHOUSE RN DIRECTOR 2.00 38.00 X 0 79983 15701 JEAN DROSTE DIRECTOR 2.00 X 0 0 0 LARRY ELLIOT DIRECTOR 2.00 X 0 0 0 NELSON EMBREY DIRECTOR 2.00 X 0 0 0 RICHARD FISHER DIRECTOR 2.00 X 0 0 0 KRISTIN GARDNER DIRECTOR 2.00 38.00 X X 0 141061 23567 PAM HILL DIRECTOR 2.00 X 0 0 0 JOHN HOFFMAN DIRECTOR 2.00 X 0 0 0 BETHANY REID DIRECTOR 2.00 X 0 0 0 STAN SUMMERS DIRECTOR 2.00 X 0 0 0 SUE HALEY DIRECTOR 2.00 X 0 0 0 RODNEY HEMMING DIRECTOR 2.00 X 0 0 0 LARRY HALM EXECUTIVE DIRECTOR 40.00 X 127557 0 28778 127557 221044 68046 1 0 1 0 0 685126 212235 897361 82307 82307 1103 0 1103 1103 1103 52576 31756 20820 20820 1001591 0 0 104230 1416266 1416266 84441 6333 78108 92088 6907 85181 7282 546 6736 20878 1566 19312 16948 1271 15677 540 540 17259 17259 6681 6681 14360 14360 15796 15796 3518 3518 1575 1575 BAD DEBT 149432 149432 MISCELLANEOUS EXPENSE 83119 83119 DUES AND SUBSCRIPTIONS 2586 1292 1294 BANK FEES 1155 1155 1933924 1583613 350311 0 338917 1288 630329 913580 586083 561136 46575 83474 385967 385967 385967 2663123 1981124 4650994 3926569 43383 251291 43383 251291 X 4221644 3289311 385967 385967 0 0 4607611 3675278 4650994 3926569 -932333 0 X X 0 1 X 1 0 X 1423156 1870939 1644075 516889 897361 6352420 1423156 1870939 1644075 516889 897361 6352420 6352420 57259 94578 3711 94144 82307 331999 41520 12559 15898 136352 21923 228252 6912671 0.91900 0.91050 X 1 33708 33708 0 PART II-B, LINE 1: DONATION TO SUPPORT GRASS ROOTS EFFORT TO ALLOW BERGER HOSPITAL TO CHANGE FROM A GOVERNMENT OWNED HOSPITAL TO PRIVATE NONPROFIT HOSPITAL 241049 26862 6000 995 260916 233675 2001 11514 5225 916 241049 232920 10005 -129 8215 906 233675 215054 215054 123656 76451 25678 10731 215054 0.45020 0.54980 0.00000 0 0 385967 385967 385967 OTHER INVESTMENTS 1981124 F 1981124 PART V, LINE 4: $143,448 OF THE ENDOWMENT IS PERMANENTLY RESTRICTED AND TO BE USED FOR NURSING EDUCATION. GOLF OUTING 52576 52576 19828 11928 52576 52576 19828 11928 31756 20820 1 HAVEN HOUSE 1180 N COURT ST CIRCLEVILLE OH 43113 311367577 501(C)(3) 26667 BATTERED WOMEN ASSISTANCE COMMUNITY ASSISTANCE STRONGER BERGER STRONGER COMMUNITY 571 GARDEN PARKWAY CIRCLEVILLE OH 43113 304365787 501(C)(3) 33708 COMMUNITY ACTION COMMUNITY ASSISTANCE KB HEALTHCARE 1412 PINNACLE CLUB DRIVE GROVE CITY OH 43123 474935135 501(C)(3) 47540 SERVICES FOR OPIATE ADDICITON COMMITTEE DRUG ADDICTION COMMITTEE BERGER HOSPITAL 600 N PICKAWAY ST CIRCLEVILLE OH 43113 316400103 GOVT 1267147 HOSPITAL RENOVATION, HEALTHCARE SERVICES HOSPITAL RENOVATIONS, HEALTHCARE SERVICES 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. X X X X 0 0 0 0 0 0 0 0 0 KRISTIN GARDNER DIRECTOR 0 140987 0 0 0 74 0 21695 0 1872 0 164628 0 0 LARRY HALM EXECUTIVE DIRECTOR 115557 0 12000 0 0 0 24000 0 4778 0 156335 0 0 0 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 EXECUTIVE DIRECTOR AND CFO 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 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 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 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 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 501(C)(3) N/A 0 PICKAWAY PROFESSIONAL SERVICES INC 600 N PICKAWAY ST CIRCLEVILLE OH 43113 641408162 ANESTHESIOLOGISTS OH C 1 BERGER HEALTH FOUNDATION VENTURES 1204 N COURT ST CIRCLEVILLE OH 43113 412218009 MEDICAL SERVICES OH C 60354 1.00000 1 0 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0 BERGER HOSPITAL B 1267147 ACCOUNTS PAYABLE BERGER HOSPITAL O 175000