2015-11-05T08:56:57-06:00 2014-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST SUITE 600 COLUMBUS OH 43215 990 2014-01-01 331031454 BERGER HEALTH FOUNDATION BERG 7404208209 1280 N COURT STREET CIRCLEVILLE OH 43113 RICHARD FILLER CFO 7404208209 2015-11-03 1 BERNIE OSTROWSKI P00366367 6148493000 2014 2016-04-25 22:37:26Z LARRY HALM 1280 N COURT STREET CIRCLEVILLE OH 43113 1978076 0 X WWW.BERGERFOUNDATION.ORG X 2002 OH BERGER HEALTH FOUNDATION ACHIEVES ITS MISSION THROUGH A VARIETY OF ENDEAVORS. IT'S 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 INITIATIVE THAT BENEFIT PATIENT CARE AND ENHANCE COMMUNITY RESOURCES. ALL FUNDS RAISED ARE USED TO ASSIST IN MEETING HEALTH RELATED NEEDS OF THE COMMUNITY. 18 13 8 100 0 0 1432156 1870939 0 0 45371 83864 18103 -17018 1495630 1937785 225080 314000 0 0 189560 153923 130138 116958 202427 66724 164545 611502 749426 884128 1188359 3268737 4405990 117530 14921 3151207 4391069 THE MISSION OF BERGER HEALTH FOUNDATION IS TO ENCOURAGE, RECEIVE AND BE RESPONSIBLE FOR CHARITABLE GIFTS THAT SUPPORT THE DEVELOPMENT AND HEALTH-RELATED SERVICES AT BERGER HEALTH SYSTEM FOR THE RESIDENTS OF PICKAWAY COUNTY AND THE SURROUNDING AREA. 0 0 110000 110000 0 RAINBOW FUND - BRADLEY CANCER CENTER PATIENT SUPPORT - SUPPORTS THE FREE CLINIC, AND HELPS THE BRADLEY CANCER PATIENTS WITH EXPENSES SUCH AS RENT, UTILITIES AND GROCERIES.TACKLING CANCER- FUNDS SPLIT BETWEEN CHARITIES TO HELP CANCER PATIENTS.THE WOMENS HEALTH FUND - SUPPORTS ACTIVITIES RELATED TO WOMEN'S HEALTH, SUCH AS MAMMOGRAM SCREENING PROGRAMS. 330936 204000 0 EFFORTS PROVIDE PROGRAM SUPPORT FOR BERGER HOSPICE AND CIRCLE OF CARING FAITH-IN-ACTION PROGRAMS; 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. 440936 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 1 0 0 0 0 0 1 1 0 0 1 1 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 18 13 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 OH X RICHARD FILLER 7404208089 600 N PICKAWAT ST CIRCLEVILLE OH 43113 JON VEITH PRESIDENT 2.00 38.00 X X 0 190493 28678 DIANE HILL VICE PRESIDENT 2.00 0.00 X X 0 0 0 CONNIE LEWIS TREASURER 2.00 0.00 X X 0 0 0 MIKE HESS SECRETARY 2.00 0.00 X X 0 0 0 SCOTT ALLEN DIRECTOR 2.00 0.00 X 0 0 0 RANDY BEACH DIRECTOR 2.00 0.00 X 0 0 0 JEAN DROSTE DIRECTOR 2.00 0.00 X 0 0 0 SEREANA DRESBACH PHD DIRECTOR 2.00 0.00 X 0 0 0 NELSON EMBREY DIRECTOR 2.00 0.00 X 0 0 0 RICHARD FISHER DIRECTOR 2.00 0.00 X 0 0 0 KRISTIN GARDNER RN DIRECTOR 2.00 38.00 X 0 92002 16699 PAM HILL DIRECTOR 2.00 0.00 X 0 0 0 JOHN HOFFMAN DIRECTOR 2.00 0.00 X 0 0 0 SISTER MONICA JUSTINGER CSA DIRECTOR 2.00 38.00 X 0 91827 35877 DR JOY LEVERICH DIRECTOR 2.00 38.00 X 0 256129 4718 BETHANY REID DIRECTOR 2.00 0.00 X 0 0 0 STAN SUMMERS DIRECTOR 2.00 0.00 X 0 0 0 LARRY HALM EXECUTIVE DIRECTOR 40.00 0.00 X 86117 0 22128 86117 630451 108100 0 0 1 0 0 80944 60103 500000 1229892 1870939 83864 83864 10714 0 10714 10714 10714 12266 80944 40291 -28025 -28025 MEALS REVENUE 900099 293 293 293 1937785 0 0 66846 204000 204000 110000 110000 142449 28490 28490 85469 11474 11474 116958 116958 40197 40197 25902 25902 BAD DEBT 98446 98446 749426 440936 106063 202427 751711 949929 354389 25631 955850 1217551 145823 76565 385967 385967 385967 673696 1750347 1301 0 3268737 4405990 117530 14921 117530 14921 X 2765240 4005102 385967 385967 0 0 3151207 4391069 3268737 4405990 X 1188359 51503 X X 0 1 X 1 0 X 734230 878569 437079 1423156 1870939 5343973 734230 878569 437079 1423156 1870939 5343973 1014237 4329736 18335 15000 17456 57259 94578 202628 93561 102801 98948 41364 12559 349233 5895834 130995 0.73440 0.70120 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 215054 215054 123656 76451 25678 10731 215054 114898 8758 123656 114868 30 114898 0.13870 0.86130 0.00000 0 0 385967 385967 385967 OTHER INVESTMENTS 1750347 F 1750347 PART V, LINE 4: $144,109 OF THE ENDOWMENT IS PERMANTELY RESTRICTED AND TO BE USED FOR NURSING EDUCATION. X X X X X 1 CAPITAL QUEST INC 4662 GRAVELLY HILLS ROAD LOUISVILLE TN 37777 CAPITAL CAMPAIGN CONSULTANT 0 0 116958 116958 116958 116958 GOLF OUTING 70220 57954 12266 16200 12266 2388 0 855 LADIES NIGHT OUT 22990 22990 1974 1870 3390 1348 93210 80944 12266 16200 14240 4258 3390 2203 40291 -28025 1 BERGER HOSPITAL 600 N PICKAWAY ST CIRCLEVILLE OH 43113 316400103 GOVT 200000 N/A N/A HOSPITAL PROGRAMS, EQUIPMENT AND SERVICES. 1 0 CASH ASSISTANCE: BERGER ASSISTANCE, RAINBOW FUND, KOMEN, ONCOLOGY 75 110000 ASSISTANCE FOR LOW INCOME PATIENTS WHO NEED HELP WITH MEDICINES, BILLS AND MEDICAL PROCEDURES. 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. SCHEDULE I, PART III: CASH ASSISTANCE ONCE AN INDIVIDUAL IS QUALIFIED UNDER THE PROGRAMS FOR CASH ASSISTANCE, ANY PAYMENT FOR MEDICAL OR OTHER BILLS ARE PAID ON THE BEHALF OF THE INDIVIDUAL BY THE FOUNDATION. THE FLOW OF CASH ASSISTANCE IS THUS MONITORED BY WORKING DIRECTLY WITH THE BILLER VERSUS THE INDIVIDUAL WHO QUALIFIED FOR THE ASSISTANCE. X X X X 0 0 0 0 0 0 0 0 0 JON VEITH PRESIDENT 0 190493 0 0 0 0 0 22984 0 5694 0 219171 0 0 DR JOY LEVERICH DIRECTOR 0 256129 0 0 0 0 0 2300 0 2418 0 260847 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 11 THE 2014 FORM 990 IS REVIEWED FOR COMPLETENESS AND ACCURACY BY THE CFO, EXECUTIVE DIRECTOR OF BERGER HEALTH FOUNDATION, AND PRESIDENT/CEO OF BERGER HEALTH SYSTEM. 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. IF THE SITUATION ARISES, NEW BOARD MEMBERS WILL COMPLETE THE CONFLICT OF INTEREST QUESTIONNAIRE WHEN THEY FIRST JOIN AS WELL. THE QUESTIONNAIRES MUST BE SIGNED AND RETURNED TO BE REVIEWED BY BERGER HEALTH FOUNDATION'S BOARD OF DIRECTORS AND THE CORPORATE COMPLIANCE OFFICER BEFORE BEING FURTHER REVIEWED BY THE PRESIDENT/CEO OF BERGER HEALTH SYSTEM. AT ANY TIME THAT AN ACTUAL, APPARENT, OR A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED TO THE RESPECTIVE BOARDS, 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 QUESTIONS 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 THE VOTE IS TAKEN. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION'S COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER OFFICERS IS DETERMINED BASED ON THE RESULTS OF AN INDEPENDENT COMPENSATION CONSULTANT 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. THIS PROCESS WAS LAST COMPLETED IN 2014. 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 XI, LINE 9: TRANSFER OUT OF BHFV'S NET ASSETS TO BE REPORTED ON FORM 1120 54,334. RECONCILIATION OF FUNDRAISING ACTIVITIES -2,831. FORM 990, PART XII, LINE 2C: BERGER HEALTH SYSTEM ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPEDENT 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 N/A 0 PICKAWAY HEALTH SERVICES 600 N PICKAWAY ST CIRCLEVILLE OH 43113 311438107 PHYSICIAN GROUP OH 501(C)(3) LINE 11A, I BERGER HOSPITAL 1 BERGER ACUTE SERVICES LLC 332 CONGRESS PARK DR DAYTON OH 45459 451450450 MEDICAL SERVICES OH BERGER HEALTH FOUNDATION VENTURES RELATED -4829 4172 0 0 0.60000 PICKAWAY PROFESSIONAL SERVICES INC 600 N PICKAWAY ST CIRCLEVILLE OH 43113 611408162 ANESTHESIOLOGISTS OH N/A C 1 BERGER HEALTH FOUNDATION VENTURES 1204 N COURT ST CIRCLEVILLE OH 43113 412218009 MEDICAL SERVICES OH BERGER HEALTH FOUNDATION C 7572 106696 1.00000 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 BERGER HOSPITAL B 200000 ACCOUNTS PAYABLE