2017-11-14T13:33:15-06:00 2016-12-31 351178661 Blue & Co LLC 8800 Lyra Drive Suite 450 Columbus OH 43240 990 2016-01-01 311438107 Pickaway Health Services PICK 7404742126 600 N Pickaway Street Circleville OH 43113 Ashton Cox Executive Director 7404742126 2017-11-14 1 Matthew Dasta P00544683 6148852583 2017-11-14 38.109.186.2 2017-11-14 08:11:00 ES P CBCE996F475CA3740CE88356C52AB1B9FF3D8150 CBCE996F475CA3740CE88356C52AB1B9FF3D8150 2016 2017-02-10 21:41:12Z Berger Health Partners Ashton Cox 600 N Pickaway Street Circleville OH 43113 14150490 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 8 136 8 0 0 5270588 6234729 7145373 7456407 28931 6967 646852 452387 13091744 14150490 0 0 0 0 8682939 10002255 0 0 0 4575435 4278907 13258374 14281162 -166630 -130672 1305383 1166423 1024899 1016611 280484 149812 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 2602457 1916734 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 2161742 1666001 Internal Medicine offers a full range of services consistent with the charitable purpose ofa 501(c)(3) entity. 1322544 1025429 The OB/GYN practice offers a full range of services consistent with the charitable purpose of a 501(c)(3) entity. 6577436 3300630 Other 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. 6577436 3300630 12664179 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 1 136 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 309287 18252 Jeremy Neff member 3.00 X 0 0 0 Andrew Bingar member 3.00 X 0 0 0 Farooq Sattar member 40.00 X 349680 0 22608 Joy Ewing member 3.00 X 0 0 0 Matt Tootle member 3.00 X 0 0 0 Kristy Blum member 40.00 X 169876 0 25444 Franklin Christman member 3.00 X 0 0 0 Rober Mabe member 3.00 X 0 0 0 Wendy Elliott executive director 40.00 X 171812 0 25448 RICH FILLER CFO 5.00 35.00 X 0 177152 3268 ASHTON COX EXECUTIVE DIRECTOR 12/1 40.00 X 9731 0 0 Kevin Sellers employee 40.00 X 309446 0 10692 Yadwinder Singh employee 40.00 X 292606 0 31242 Raul Zamora employee 40.00 X 325674 0 15448 David Goldfarb employee 40.00 X 422366 0 25992 Robert Kloos employee 40.00 X 245162 0 10052 2296353 486439 188446 26 0 1 0 Hematology Oncology Consultants Inc 300 Polaris Parkway westerville OH 43082 Oncology contracting 275000 william emlich 4930 w broad st columbus OH 43228 physician 187500 NTT data services po box 677959 dallas TX 75267 billing services 157711 3 6234729 6234729 Prog.serv.revenue-Related-990 621110 7456407 7456407 7456407 6967 0 6967 6967 6967 MEANINGFUL USE 621110 428844 428844 MISCELLANEOUS 621110 15883 15883 PURCHASE DISCOUNTS 621110 7660 7660 452387 14150490 7908794 0 6967 X 197260 197260 8230466 7226314 1004152 135669 119389 16280 938898 826230 112668 499962 439967 59995 14688 14688 1755452 1755452 1033619 964056 69563 9621 8948 673 77006 71616 5390 107840 107840 271076 252101 18975 Drugs and Medical Suppl 835029 835029 Bad Debt 108378 108378 Miscellaneous 66198 56699 9499 14281162 12664179 1616983 0 64218 0 615076 672825 382056 330800 1410799 1248001 244033 162798 1305383 1166423 1024899 1016611 1024899 1016611 X 280484 149812 280484 149812 1305383 1166423 -130672 0 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 27716 27421 295 1367157 1206190 160967 14329 12793 1536 162798 X X X X X 0 0 0 0 0 0 0 0 0 Tim Colburn Secretary 0 309287 0 0 0 0 0 18000 0 252 0 327539 0 0 Farooq Sattar member 349680 0 0 0 0 0 18000 0 4608 0 372288 0 0 0 Kristy Blum member 169876 0 0 0 0 0 18000 0 7444 0 195320 0 0 0 Wendy Elliott executive director 171812 0 0 0 0 0 24000 0 1448 0 197260 0 0 0 RICH FILLER CFO 0 177152 0 0 0 0 0 0 0 3268 0 180420 0 0 Kevin Sellers employee 309446 0 0 0 0 0 5000 0 5692 0 320138 0 0 0 Yadwinder Singh employee 292606 0 0 0 0 0 24000 0 7242 0 323848 0 0 0 Raul Zamora employee 325674 0 0 0 0 0 13600 0 1848 0 341122 0 0 0 David Goldfarb employee 422366 0 0 0 0 0 16500 0 9492 0 448358 0 0 0 Robert Kloos employee 245162 0 0 0 0 0 10052 0 0 0 255214 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 1,755,452. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,755,452. 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