PICKAWAY HEALTH SERVICES: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
PICKAWAY HEALTH SERVICES (EIN 31-1438107)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-14
IRS object ID
201733189349306263
Schema version
2016v3.0
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

FieldValueIRS element (for citing)
Return2017-11-14T13:33:15-06:00ReturnTs
Tax Period End2016-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351178661PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Blue & Co LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line18800 Lyra Drive Suite 450AddressLine1Txt
CityColumbusCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43240ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN311438107EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pickaway Health ServicesBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPICKBusinessNameControlTxt
Phone7404742126PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 N Pickaway StreetAddressLine1Txt
CityCirclevilleCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43113ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAshton CoxPersonNm
Person TitleExecutive DirectorPersonTitleTxt
Phone7404742126PhoneNum
Signature2017-11-14SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMatthew DastaPreparerPersonNm
PTINP00544683PTIN
Phone6148852583PhoneNum
Preparation2017-11-14PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address38.109.186.2IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-14IPDt
IP Tm08:11:00IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdCBCE996F475CA3740CE88356C52AB1B9FF3D8150AtSubmissionCreationDeviceId
At Submission Filing Device IdCBCE996F475CA3740CE88356C52AB1B9FF3D8150AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2017-02-10 21:41:12ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Berger Health PartnersBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerAshton CoxPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 N Pickaway StreetAddressLine1Txt
CityCirclevilleCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43113ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$14,150,490GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.pickawayhealthservices.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1995FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionTo 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.ActivityOrMissionDesc
Voting Members Governing Body11VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee136TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$5,270,588PYContributionsGrantsAmt
CY Contributions Grants$6,234,729CYContributionsGrantsAmt
PY Program Service Revenue$7,145,373PYProgramServiceRevenueAmt
CY Program Service Revenue$7,456,407CYProgramServiceRevenueAmt
PY Investment Income$28,931PYInvestmentIncomeAmt
CY Investment Income$6,967CYInvestmentIncomeAmt
PY Other Revenue$646,852PYOtherRevenueAmt
CY Other Revenue$452,387CYOtherRevenueAmt
PY Total Revenue$13,091,744PYTotalRevenueAmt
CY Total Revenue$14,150,490CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,682,939PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,002,255CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$4,575,435PYOtherExpensesAmt
CY Other Expenses$4,278,907CYOtherExpensesAmt
PY Total Expenses$13,258,374PYTotalExpensesAmt
CY Total Expenses$14,281,162CYTotalExpensesAmt
PY Revenues Less Expenses-$166,630PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$130,672CYRevenuesLessExpensesAmt
Total Assets BOY$1,305,383TotalAssetsBOYAmt
Total Assets EOY$1,166,423TotalAssetsEOYAmt
Total Liabilities BOY$1,024,899TotalLiabilitiesBOYAmt
Total Liabilities EOY$1,016,611TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$280,484NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$149,812NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTo 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$2,602,457ExpenseAmt
Revenue$1,916,734RevenueAmt
DescThe 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) enityDesc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$2,161,742ExpenseAmt
Revenue$1,666,001RevenueAmt
DescInternal Medicine offers a full range of services consistent with the charitable purpose ofa 501(c)(3) entity.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,322,544ExpenseAmt
Revenue$1,025,429RevenueAmt
DescThe OB/GYN practice offers a full range of services consistent with the charitable purpose of a 501(c)(3) entity.Desc

Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp

FieldValueIRS element (for citing)
Expense$6,577,436ExpenseAmt
Revenue$3,300,630RevenueAmt
DescOther program services include Gasteroenterology, Pulmonology, Oncology, Dermatology, Occupational Health, Pediatrics, Surgery and the NP's. These speciality practice offer a full range of services within their area of specialty consistent with the charitable purpose of a 501(c)(3) entity.Desc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$6,577,436TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Revenue$3,300,630TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$12,664,179TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other Liabilities0ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document14IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee136EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members11GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldOHStatesWhereCopyOfReturnIsFldCd
Own WebsiteYes (X)OwnWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonRichard FillerPersonNm
Phone7404208089PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 N Pickaway StreetAddressLine1Txt
CityCirclevilleCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43113ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Madeline Sanders
Chair3.00Yes (X)Yes (X)$0$0$0
Christy Alonzo
Vice Chair3.00Yes (X)Yes (X)$0$0$0
Tim Colburn
Secretary4.00Yes (X)Yes (X)$0$309,287$18,25236.00
Jeremy Neff
member3.00Yes (X)$0$0$0
Andrew Bingar
member3.00Yes (X)$0$0$0
Farooq Sattar
member40.00Yes (X)$349,680$0$22,608
Joy Ewing
member3.00Yes (X)$0$0$0
Matt Tootle
member3.00Yes (X)$0$0$0
Kristy Blum
member40.00Yes (X)$169,876$0$25,444
Franklin Christman
member3.00Yes (X)$0$0$0
Rober Mabe
member3.00Yes (X)$0$0$0
Wendy Elliott
executive director40.00Yes (X)$171,812$0$25,448
RICH FILLER
CFO5.00Yes (X)$0$177,152$3,26835.00
ASHTON COX
EXECUTIVE DIRECTOR 12/140.00Yes (X)$9,731$0$0
Kevin Sellers
employee40.00$309,446$0$10,692Yes (X)
Yadwinder Singh
employee40.00$292,606$0$31,242Yes (X)
Raul Zamora
employee40.00$325,674$0$15,448Yes (X)
David Goldfarb
employee40.00$422,366$0$25,992Yes (X)
Robert Kloos
employee40.00$245,162$0$10,052Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,296,353TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$486,439TotReportableCompRltdOrgAmt
Total Other Compensation$188,446TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K26IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (3 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Hematology Oncology Consultants Inc
300 Polaris ParkwaywestervilleOH43082Oncology contracting$275,000
william emlich
4930 w broad stcolumbusOH43228physician$187,500
NTT data services
po box 677959dallasTX75267billing services$157,711
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K3CntrctRcvdGreaterThan100KCnt
Related Organizations$6,234,729RelatedOrganizationsAmt
Total Contributions$6,234,729TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescProg.serv.revenue-Related-990Desc
Business621110BusinessCd
Total Revenue Column$7,456,407TotalRevenueColumnAmt
Related Or Exempt Func Income$7,456,407RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$7,456,407TotalProgramServiceRevenueAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$6,967OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$6,967OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,967TotalRevenueColumnAmt
Exclusion$6,967ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
MEANINGFUL USE621110$428,844$428,844
MISCELLANEOUS621110$15,883$15,883
PURCHASE DISCOUNTS621110$7,660$7,660
FieldValueIRS element (for citing)
Other Revenue Total$452,387OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,150,490TotalRevenueColumnAmt
Related Or Exempt Func Income$7,908,794RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$6,967ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$197,260TotalAmt
Management And General$197,260ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$8,230,466TotalAmt
Program Services$7,226,314ProgramServicesAmt
Management And General$1,004,152ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$135,669TotalAmt
Program Services$119,389ProgramServicesAmt
Management And General$16,280ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$938,898TotalAmt
Program Services$826,230ProgramServicesAmt
Management And General$112,668ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$499,962TotalAmt
Program Services$439,967ProgramServicesAmt
Management And General$59,995ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$14,688TotalAmt
Management And General$14,688ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,755,452TotalAmt
Program Services$1,755,452ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,033,619TotalAmt
Program Services$964,056ProgramServicesAmt
Management And General$69,563ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$9,621TotalAmt
Program Services$8,948ProgramServicesAmt
Management And General$673ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$77,006TotalAmt
Program Services$71,616ProgramServicesAmt
Management And General$5,390ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$107,840TotalAmt
Management And General$107,840ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$271,076TotalAmt
Program Services$252,101ProgramServicesAmt
Management And General$18,975ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Drugs and Medical Suppl$835,029$835,029
Bad Debt$108,378$108,378
Miscellaneous$66,198$56,699$9,499

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$14,281,162TotalAmt
Program Services$12,664,179ProgramServicesAmt
Management And General$1,616,983ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$64,218BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$615,076BOYAmt
EOY$672,825EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$382,056BOYAmt
EOY$330,800EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,410,799LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$1,248,001LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$244,033BOYAmt
EOY$162,798EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,305,383BOYAmt
EOY$1,166,423EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,024,899BOYAmt
EOY$1,016,611EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,024,899BOYAmt
EOY$1,016,611EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$280,484BOYAmt
EOY$149,812EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$280,484BOYAmt
EOY$149,812EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,305,383BOYAmt
EOY$1,166,423EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$130,672ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3Yes (X)SupportingOrganization509a3Ind
Supporting Org Type1Yes (X)SupportingOrgType1Ind
Supported Organizations1SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1Berger Health SystemBusinessNameLine1Txt
FieldValueIRS element (for citing)
EIN316400103EIN
Organization Type6OrganizationTypeCd
Governing Document ListedYes (1)GoverningDocumentListedInd
Support$0SupportAmt
Other Support$0OtherSupportAmt
FieldValueIRS element (for citing)
Supported Organizations Total1SupportedOrganizationsTotalCnt
Support Sum$0SupportSumAmt
Other Support Sum$0OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

FieldValueIRS element (for citing)
Listed By Name Governing DocYes (1)ListedByNameGoverningDocInd
Suprt Org No IRS Determination0SuprtOrgNoIRSDeterminationInd
Supported Org Section C4560SupportedOrgSectionC456Ind
Supported Org Not Organized US0SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org0OrganizationChangeSuprtOrgInd
Support Non Supported Org0SupportNonSupportedOrgInd
Payment Substantial Contribtr0PaymentSubstantialContribtrInd
Loan Disqualified Person0LoanDisqualifiedPersonInd
Controlled Disqualified Prsn0ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int0DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int0DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules0ExcessBusinessHoldingsRulesInd
Contribution Controller0ContributionControllerInd
Contribution Family0ContributionFamilyInd
Contribution35 Controlled0Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

FieldValueIRS element (for citing)
Power Appoint Majority Dir TrstYes (1)PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org0OperateBenefitNonSuprtOrgInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule D IRS990ScheduleD

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,597OtherCostOrOtherBasisAmt
Depreciation$1,597DepreciationAmt
Book Value$0BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$27,716OtherCostOrOtherBasisAmt
Depreciation$27,421DepreciationAmt
Book Value$295BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,367,157OtherCostOrOtherBasisAmt
Depreciation$1,206,190DepreciationAmt
Book Value$160,967BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,329OtherCostOrOtherBasisAmt
Depreciation$12,793DepreciationAmt
Book Value$1,536BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$162,798TotalBookValueLandBuildingsAmt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Independent ConsultantYes (X)IndependentConsultantInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Tim Colburn
Secretary$0$309,287$0$0$0$0$0$18,000$0$252$0$327,539$0$0
Farooq Sattar
member$349,680$0$0$0$0$0$18,000$0$4,608$0$372,288$0$0$0
Kristy Blum
member$169,876$0$0$0$0$0$18,000$0$7,444$0$195,320$0$0$0
Wendy Elliott
executive director$171,812$0$0$0$0$0$24,000$0$1,448$0$197,260$0$0$0
RICH FILLER
CFO$0$177,152$0$0$0$0$0$0$0$3,268$0$180,420$0$0
Kevin Sellers
employee$309,446$0$0$0$0$0$5,000$0$5,692$0$320,138$0$0$0
Yadwinder Singh
employee$292,606$0$0$0$0$0$24,000$0$7,242$0$323,848$0$0$0
Raul Zamora
employee$325,674$0$0$0$0$0$13,600$0$1,848$0$341,122$0$0$0
David Goldfarb
employee$422,366$0$0$0$0$0$16,500$0$9,492$0$448,358$0$0$0
Robert Kloos
employee$245,162$0$0$0$0$0$10,052$0$0$0$255,214$0$0$0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6Pickaway 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 7aPickaway 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 11bTHE 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 12cTHE 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 15THE 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 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part IX, line 11gPurchased Services: Program service expenses 1,755,452. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,755,452.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
Berger Hospital
600 N Pickaway StCirclevilleOH43113316400103Acute Care HospitalOHGOVERNMENTAL HOSPITAN/AN/A0
Berger Health Foundation
1280 N Court StCirclevilleOH43113331031454Support the hospital and community programsOH501(c)(3)Line 7Yes (1)BERGER HOSPITAL

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
PICKAWAY PROFESSIONAL SERVICES INC
600 N PICKAWAY STCIRCLEVILLEOH43113611408162ANESTHESIOLOGISTSOHC0
BERGER HEALTH FOUNDATION VENTURES
1204 N COURT STREETCIRCLEVILLEOH43113412218009MEDICAL SERVICESOHC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd

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