2018-11-12T09:24:29-06:00 2017-12-31 351178661 BLUE & CO LLC 9200 WORTHINGTON RD STE 200 WESTERVILLE OH 43082 990 2017-01-01 311438107 PICKAWAY HEALTH SERVICES PICK 7404742126 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 ASHTON COX EXECUTIVE DIRECTOR 7404742126 2018-11-07 1 MATTHEW DASTA P00544683 6148852583 2018-11-07 38.109.186.2 2018-11-07 12:20:49 ES P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 CBCE996F475CA3740CE88356C52AB1B9FF3D8150 2017 2019-02-21 02:37:17Z BERGER HEALTH PARTNERS ASHTON COX 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 15018128 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. 11 8 143 8 0 0 6234729 5815080 7456407 7919381 6967 0 452387 1283667 14150490 15018128 0 0 0 0 10002255 9930476 0 0 0 4278907 4847107 14281162 14777583 -130672 240545 1166423 1347777 1016611 957420 149812 390357 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 13021000 9203048 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. 13021000 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 1 143 1 0 0 0 0 0 0 0 0 0 0 X 11 8 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X X RICHARD FILLER 7404208089 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 MADELINE SANDERS CHAIR 3.00 X X 0 0 0 CHRISTY ALONZO VICE CHAIR 3.00 X X 0 0 0 TIM COLBURN SECRETARY 4.00 36.00 X X 0 354034 21523 JEREMY NEFF MEMBER 3.00 X 0 0 0 ANDREW BINEGAR MEMBER 3.00 X 0 0 0 CAROLYN YOST MEMBER 40.00 X 260396 0 25215 JOY EWING MEMBER 3.00 X 0 0 0 MATT TOOTLE MEMBER 3.00 X 0 0 0 KRISTY BLUM MEMBER 40.00 X 190559 0 22803 FRANKLIN CHRISTMAN MEMBER 3.00 X 0 0 0 ROBERT MABE MEMBER 3.00 X 0 0 0 RICH FILLER CFO 5.00 35.00 X 195607 0 20836 ASHTON COX EXECUTIVE DIRECTOR 40.00 X 101220 0 10108 KEVIN SELLERS EMPLOYEE 40.00 X 342148 0 12597 YADWINDER SINGH EMPLOYEE 40.00 X 352815 0 30879 RAUL ZAMORA EMPLOYEE 40.00 X 351273 0 19274 DAVID GOLDFARB EMPLOYEE 40.00 X 437037 0 21543 ROBERT KLOOS EMPLOYEE 40.00 X 290728 0 11598 2521783 354034 196376 26 0 1 0 NTT DATA SERVICES PO BOX 677959 DALLAS TX 75267 BILLING SERVICES 785221 HEMATOLOGY ONCOLOGY CONSULTANTS INC 300 POLARIS PARKWAY WESTERVILLE OH 43082 ONCOLOGY CONTRACTING 255000 WILLIAM EMLICH 4930 W BROAD ST COLUMBUS OH 43228 PHYSICIAN 187500 THERACOM INC PO BOX 640105 CINCINNATI OH 45264 PHARMACEUTICAL SUPPLIES 157453 4 5815080 5815080 PROG.SERV.REVENUE-RELATED-990 621110 7919381 7919381 7919381 PHS OTHER REVENUE MISCELLANEOUS R 900099 1280557 1280557 PHS OTHER REVENUE PURCHASE DISCOU 900099 3110 3110 1283667 15018128 9203048 0 0 X 826744 727535 99209 7709082 6768574 940508 159415 140285 19130 707828 622889 84939 527407 464118 63289 42974 42974 41712 41712 1871765 1647153 224612 134198 125166 9032 750920 698356 52564 8421 7832 589 49660 46184 3476 84406 84406 189490 176226 13264 DRUGS AND MEDICAL SUPPL 870770 870770 MISCELLANEOUS EXPENSES 431686 369739 61947 BAD DEBT 231458 231458 TUITION REIMBURSEMENT 103123 90748 12375 36524 33967 2557 14777583 13021000 1756583 0 14199 672825 640959 330800 343839 1697101 1348321 162798 348780 1166423 1347777 1016611 957420 1016611 957420 X 149812 390357 149812 390357 1166423 1347777 240545 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 1597 1597 0 33574 32634 940 1518281 1306400 211881 143649 7690 135959 348780 X X X X X 0 0 0 0 0 0 0 0 0 TIM COLBURN SECRETARY 0 309265 0 44769 0 0 0 21250 0 273 0 375557 0 0 CAROLYN YOST MEMBER 256963 0 0 0 3433 0 18000 0 7215 0 285611 0 0 0 KRISTY BLUM MEMBER 190095 0 0 0 464 0 18000 0 4803 0 213362 0 0 0 RICH FILLER CFO 164180 0 30746 0 681 0 16854 0 3982 0 216443 0 0 0 KEVIN SELLERS EMPLOYEE 342062 0 0 0 86 0 5000 0 7597 0 354745 0 0 0 YADWINDER SINGH EMPLOYEE 352815 0 0 0 0 0 24000 0 6879 0 383694 0 0 0 RAUL ZAMORA EMPLOYEE 338373 0 12900 0 0 0 17272 0 2002 0 370547 0 0 0 DAVID GOLDFARB EMPLOYEE 436037 0 1000 0 0 0 16500 0 5043 0 458580 0 0 0 ROBERT KLOOS EMPLOYEE 285958 0 4770 0 0 0 11338 0 260 0 302326 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 PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,647,153. MANAGEMENT AND GENERAL EXPENSES 224,612. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,871,765. 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 PICKAWAY PROFESSIONAL SERVICES INC 600 N PICKAWAY ST CIRCLEVILLE OH 43113 611408162 ANESTHESIOLOGISTS OH C 0 BERGER HEALTH FOUNDATION VENTURES 1204 N COURT STREET CIRCLEVILLE OH 43113 412218009 MEDICAL SERVICES OH C 0 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 0