FURP.ORG / PUBLIC DATA EXPLORER

WELL-BEING FOUNDATION OF PICKAWAY COUNTY: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
WELL-BEING FOUNDATION OF PICKAWAY COUNTY (EIN 33-1031454)
Tax period
2016-01-01 to 2016-12-31
Filed
2017-11-14
IRS object ID
201723189349306382
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)
Return2017-11-14T13:30:45-06:00ReturnTs
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)
EIN331031454EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Berger Health FoundationBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlBERGBusinessNameControlTxt
Phone7404208209PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11280 N Court StreetAddressLine1Txt
CityCirclevilleCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43113ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonLARRY HALMPersonNm
Person TitleExecutive DirectorPersonTitleTxt
Phone7404208089PhoneNum
Signature2017-11-13SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMatthew DastaPreparerPersonNm
PTINP00544683PTIN
Phone6148852583PhoneNum
Preparation2017-11-13PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address38.109.186.2IPv4AddressTxt
FieldValueIRS element (for citing)
IP2017-11-13IPDt
IP Tm10:01:36IPTm
IP TimezoneESIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdCBCE996F475CA3740CE88356C52AB1B9FF3D8150AtSubmissionCreationDeviceId
At Submission Filing Device IdCBCE996F475CA3740CE88356C52AB1B9FF3D8150AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerLarry HalmPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 N Pickaway StAddressLine1Txt
CityCirclevilleCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43113ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$684,992GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.bergerfoundation.orgWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2002FormationYr
Legal Domicile StateOHLegalDomicileStateCd
Activity Or MissionBerger Health Foundation achieves its mission through a variety of endeavors. Its 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.ActivityOrMissionDesc
Voting Members Governing Body15VotingMembersGoverningBodyCnt
Voting Members Independent13VotingMembersIndependentCnt
Total Employee8TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$1,644,075PYContributionsGrantsAmt
CY Contributions Grants$416,613CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$3,711PYInvestmentIncomeAmt
CY Investment Income$94,144CYInvestmentIncomeAmt
PY Other Revenue-$12,170PYOtherRevenueAmt
CY Other Revenue$136,352CYOtherRevenueAmt
PY Total Revenue$1,635,616PYTotalRevenueAmt
CY Total Revenue$647,109CYTotalRevenueAmt
PY Grants And Similar Paid$316,357PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$1,231,080CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$141,935PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$131,798CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$26,790PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$12,840CYTotalFundraisingExpenseAmt
PY Other Expenses$134,995PYOtherExpensesAmt
CY Other Expenses$83,228CYOtherExpensesAmt
PY Total Expenses$620,077PYTotalExpensesAmt
CY Total Expenses$1,446,106CYTotalExpensesAmt
PY Revenues Less Expenses$1,015,539PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$798,997CYRevenuesLessExpensesAmt
Total Assets BOY$5,425,673TotalAssetsBOYAmt
Total Assets EOY$4,650,994TotalAssetsEOYAmt
Total Liabilities BOY$19,065TotalLiabilitiesBOYAmt
Total Liabilities EOY$43,383TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$5,406,608NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$4,607,611NetAssetsOrFundBalancesEOYAmt
MissionThe 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.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$16,398ExpenseAmt
DescRAINBOW 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.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$1,236,213ExpenseAmt
Grant$1,231,080GrantAmt
Revenue$73,959RevenueAmt
DescEFFORTS 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.Desc
FieldValueIRS element (for citing)
Total Program Service Expenses$1,252,611TotalProgramServiceExpensesAmt
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 EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related InvstYes (1)ReportProgramRelatedInvstInd
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 ActivitiesYes (1)FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
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 EntYes (1)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee8EmployeeCnt
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 ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
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 Members15GoverningBodyVotingMembersCnt
Independent Voting Member13IndependentVotingMemberCnt
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
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Richard FillerBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7404208089PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1600 N Pickaway StAddressLine1Txt
CityCirclevilleCityNm
State AbbreviationOHStateAbbreviationCd
ZIP43113ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt
Diane Hill
President2.00Yes (X)Yes (X)$0$0$0
Sereana Dresbach
Treasurer2.00Yes (X)Yes (X)$0$0$0
Mike Hess
Vice President2.00Yes (X)Yes (X)$0$0$0
Scott Allen
Director2.00Yes (X)$0$0$0
Randy Beach
Director2.00Yes (X)$0$0$0
Hillairy Boltenhouse RN
Director2.00Yes (X)$0$59,575$2,35038.00
Jean Droste
Director2.00Yes (X)$0$0$0
Larry Elliot
Director2.00Yes (X)$0$0$0
Nelson Embrey
Director2.00Yes (X)$0$0$0
Richard Fisher
Director2.00Yes (X)$0$0$0
Kristin Gardner
Director2.00Yes (X)Yes (X)$0$119,087$6,90038.00
Pam Hill
Director2.00Yes (X)$0$0$0
John Hoffman
Director2.00Yes (X)$0$0$0
Bethany Reid
Director2.00Yes (X)$0$0$0
Stan Summers
Director2.00Yes (X)$0$0$0
Larry Halm
executive director40.00Yes (X)$107,957$0$18,0000.00
FieldValueIRS element (for citing)
Total Reportable Comp From Org$107,957TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$178,662TotReportableCompRltdOrgAmt
Total Other Compensation$27,250TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Related Organizations$177,177RelatedOrganizationsAmt
All Other Contributions$239,436AllOtherContributionsAmt
Total Contributions$416,613TotalContributionsAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$94,144TotalRevenueColumnAmt
Exclusion$94,144ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$100,276FundraisingGrossIncomeAmt
Fundraising Direct Expenses$37,883FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$62,393TotalRevenueColumnAmt
Exclusion$62,393ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
Descbad debt recoveryDesc
Business900099BusinessCd
Total Revenue Column$73,959TotalRevenueColumnAmt
Related Or Exempt Func Income$73,959RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$73,959OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$647,109TotalRevenueColumnAmt
Related Or Exempt Func Income$73,959RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$156,537ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$1,215,986TotalAmt
Program Services$1,215,986ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$15,094TotalAmt
Program Services$15,094ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$109,439TotalAmt
Management And General$109,439ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$22,359TotalAmt
Management And General$22,359ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$755TotalAmt
Management And General$755ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$20,518TotalAmt
Management And General$20,518ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$810TotalAmt
Fundraising$810FundraisingAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$19,220TotalAmt
Management And General$9,610ManagementAndGeneralAmt
Fundraising$9,610FundraisingAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$4,840TotalAmt
Management And General$2,420ManagementAndGeneralAmt
Fundraising$2,420FundraisingAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
miscellaneous$21,531$21,531
Leases & rentals$15,554$15,554

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$1,446,106TotalAmt
Program Services$1,252,611ProgramServicesAmt
Management And General$180,655ManagementAndGeneralAmt
Fundraising$12,840FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$913,055BOYAmt
EOY$338,917EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$385,521BOYAmt
EOY$630,329EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,248,699BOYAmt
EOY$586,083EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$69,015BOYAmt
EOY$46,575EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$385,967LandBldgEquipCostOrOtherBssAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$385,967BOYAmt
EOY$385,967EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$2,423,416BOYAmt
EOY$2,663,123EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$5,425,673BOYAmt
EOY$4,650,994EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$19,065BOYAmt
EOY$43,383EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$19,065BOYAmt
EOY$43,383EOYAmt
FieldValueIRS element (for citing)
Org Does Not Follow SFAS117Yes (X)OrgDoesNotFollowSFAS117Ind

Cap Stk Tr Prin Current Funds CapStkTrPrinCurrentFundsGrp

FieldValueIRS element (for citing)
BOY$5,020,641BOYAmt
EOY$4,221,644EOYAmt

Pd In Cap Srpls Land Bldg Eqp Fund PdInCapSrplsLandBldgEqpFundGrp

FieldValueIRS element (for citing)
BOY$385,967BOYAmt
EOY$385,967EOYAmt

Rtn Earn Endowment Incm Oth Fnds RtnEarnEndowmentIncmOthFndsGrp

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

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,406,608BOYAmt
EOY$4,607,611EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$5,425,673BOYAmt
EOY$4,650,994EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$798,997ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
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)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$365,664CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,423,156CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,870,939CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,644,075CurrentTaxYearMinus1YearAmt
Current Tax Year$516,889CurrentTaxYearAmt
Total$5,820,723TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$365,664CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$1,423,156CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$1,870,939CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$1,644,075CurrentTaxYearMinus1YearAmt
Current Tax Year$516,889CurrentTaxYearAmt
Total$5,820,723TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$5,820,723PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$17,456CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$57,259CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$94,578CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,711CurrentTaxYearMinus1YearAmt
Current Tax Year$94,144CurrentTaxYearAmt
Total$267,148TotalAmt

Other Income170 OtherIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$98,948CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$41,520CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$12,559CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$15,898CurrentTaxYearMinus1YearAmt
Current Tax Year$136,352CurrentTaxYearAmt
Total$305,277TotalAmt
FieldValueIRS element (for citing)
Total Support$6,393,148TotalSupportAmt
Public Support CY1700.91050PublicSupportCY170Pct
Public Support PY1700.78240PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

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

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$215,054BeginningYearBalanceAmt
Contributions$2,001ContributionsAmt
Investment Earnings Or Losses$11,514InvestmentEarningsOrLossesAmt
Grants Or Scholarships-$5,225GrantsOrScholarshipsAmt
Administrative Expenses-$915AdministrativeExpensesAmt
End Year Balance$234,709EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$215,054BeginningYearBalanceAmt
End Year Balance$215,054EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$215,054BeginningYearBalanceAmt
End Year Balance$215,054EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$123,656BeginningYearBalanceAmt
Contributions$76,451ContributionsAmt
Investment Earnings Or Losses$25,678InvestmentEarningsOrLossesAmt
Grants Or Scholarships$10,731GrantsOrScholarshipsAmt
End Year Balance$215,054EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$114,898BeginningYearBalanceAmt
Investment Earnings Or Losses$8,758InvestmentEarningsOrLossesAmt
End Year Balance$123,656EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.13870BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.86130PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$385,967OtherCostOrOtherBasisAmt
Book Value$385,967BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$385,967TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp

FieldValueIRS element (for citing)
Descother investmentsDesc
Book Value$2,663,123BookValueAmt
Method ValuationFMethodValuationCd
FieldValueIRS element (for citing)
Total Book Value Program Rltd$2,663,123TotalBookValueProgramRltdAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line Referencepart V, Line 4FormAndLineReferenceDesc
Explanation$144,109 of the endowment is permanently restricted and to be used for nursing education.ExplanationTxt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1golf outingEvent1Nm
Gross Receipts Event1$79,993GrossReceiptsEvent1Amt
Gross Revenue Event1$79,993GrossRevenueEvent1Amt
Other Direct Expenses Event1$28,406OtherDirectExpensesEvent1Amt
Event2Ladies Night OutEvent2Nm
Gross Receipts Event2$20,283GrossReceiptsEvent2Amt
Gross Revenue Event2$20,283GrossRevenueEvent2Amt
Other Direct Expenses Event2$9,477OtherDirectExpensesEvent2Amt
Gross Receipts Total$100,276GrossReceiptsTotalAmt
Gross Revenue Total Events$100,276GrossRevenueTotalEventsAmt
Oth Direct Expnss Total Events$37,883OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$37,883DirectExpenseSummaryEventsAmt
Net Income Summary$62,393NetIncomeSummaryAmt

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdRecipient EINRecipientEINIRC SectionIRCSectionDescCash GrantCashGrantAmtNon Cash AssistanceNonCashAssistanceDescPurpose Of GrantPurposeOfGrantTxt
Haven House
1180 N Court StciRCLEVILLEOH43113311367577501(c)(3)$16,667battered women assistanceCOMMUNITY ASSISTANCE
Pickaway County Community Foundation
po box 3ciRCLEVILLEOH43113311777036501(c)(3)$30,000opiate addiction committeeCOMMUNITY ASSISTANCE
KB HEALTHCARE
1412 Pinnacle Club Drivegrove cityOH43123474935135501(c)(3)$37,721services for opiate addiciton committeeDrug Addiction Committee
BERGER HOSPITAL
600 N PICKAWAY STCIRCLEVILLEOH43113316400103GOVT$1,100,964hospital renovation, healthcare servicesHOSPITAL RENOVATIONS, HEALTHCARE SERVICES
FieldValueIRS element (for citing)
Total501c3 Org4Total501c3OrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp

FieldValueIRS element (for citing)
Grant TypeEDUCATION REIMBURSEMENTGrantTypeTxt
Recipient1RecipientCnt
Cash Grant$15,094CashGrantAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationTHE 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.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
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

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6Berger 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 7aBerger Health Foundation Board of Directors are confirmed by Berger Health System's Board of Directors.
Form 990, Part VI, Section B, line 11bTHE 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 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 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 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 KEPT 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 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.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
BERGER HOSPITAL
600 N PICKAWAY STCIRCLEVILLEOH43113316400103ACUTE CARE HOSPITALOHgovernmental hospitaN/A0
PICKAWAY HEALTH SERVICES
600 N PICKAWAY STCIRCLEVILLEOH43113311438107PHYSICIAN GROUPOH501(C)(3)Yes (1)Line 7BERGER HOSPITAL
BERGER HEALTH SYSTEM
600 N PICKAWAY STCIRCLEVILLEOH43113262545110INACTIVE ACUTE CARE HOSPITALOH501(C)(3)N/A0

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPct
PICKAWAY PROFESSIONAL SERVICES INC
600 N PICKAWAY STCIRCLEVILLEOH43113641408162ANESTHESIOLOGISTSOHCYes (1)
BERGER HEALTH FOUNDATION VENTURES
1204 N COURT STCIRCLEVILLEOH43113412218009MEDICAL SERVICESOHCYes (1)$100,5241.00000
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
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

Transactions Related Org TransactionsRelatedOrgGrp

Other Organization Name OtherOrganizationName

FieldValueIRS element (for citing)
Business Name Line1BERGER HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Transaction TypeBTransactionTypeTxt
Involved$1,100,964InvolvedAmt
Method Of Amount DeterminationACCOUNTS PAYABLEMethodOfAmountDeterminationTxt