WELL-BEING FOUNDATION OF PICKAWAY COUNTY: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- WELL-BEING FOUNDATION OF PICKAWAY COUNTY (EIN 33-1031454)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-13
- IRS object ID
- 201333179349304173
- Schema version
- 2012v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-13T13:58:07-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 381357951 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLANTE & MORAN PLLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 65 EAST STATE ST SUITE 600 | AddressLine1 |
| City | COLUMBUS | City |
| State | OH | State |
| ZIP Code | 43215 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 331031454 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BERGER HEALTH FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BERG | NameControl |
| Phone | 7404208209 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 N PICKAWAY STREET | AddressLine1 |
| City | CIRCLEVILLE | City |
| State | OH | State |
| ZIP Code | 43113 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | THOMAS SCHERER | Name |
| Title | VP OF FINANCE | Title |
| Phone | 7404208209 | Phone |
| Date Signed | 2013-11-01 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BERNIE OSTROWSKI | Name |
| PTIN | P00366367 | PTIN |
| Phone | 6148493000 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | LARRY HALM | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 600 N PICKAWAY STREET | AddressLine1 |
| City | CIRCLEVILLE | City |
| State | OH | State |
| ZIP Code | 43113 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 482068 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.BERGERFOUNDATION.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2002 | YearFormation |
| State Legal Domicile | OH | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 14 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 3 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 878569 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 365664 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 3713 | InvestmentIncomePriorYear |
| Investment Income Current Year | 6497 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 70779 | OtherRevenuePriorYear |
| Other Revenue Current Year | 72390 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 953061 | TotalRevenuePriorYear |
| Total Revenue Current Year | 444551 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 599260 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 347399 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 154316 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 177130 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 100791 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 90074 | OtherExpensePriorYear |
| Other Expenses Current Year | 107369 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 843650 | TotalExpensesPriorYear |
| Total Expenses Current Year | 631898 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 109411 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -187347 | RevenuesLessExpensesCY |
| Total Assets BOY | 2019118 | TotalAssetsBOY |
| Total Assets EOY | 2001107 | TotalAssetsEOY |
| Total Liabilities BOY | 259503 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 79748 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1759615 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1921359 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | 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. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 42179 | Expense |
| Grants | 42179 | Grants |
| Revenue | 0 | Revenue |
| Description | 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 | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 34891 | Expense |
| Grants | 34891 | Grants |
| Revenue | 0 | Revenue |
| Description | TACKLING CANCER- FUNDS SPLIT BETWEEN CHARITIES TO HELP CANCER PATIENTS | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 27098 | Expense |
| Grants | 27098 | Grants |
| Revenue | 0 | Revenue |
| Description | SUSAN G. KOMEN- HELP LOW INCOME OR UNDER INSURED WOMEN WITH MAMMOGRAM FEES AND FOLLOW-UP TESTING IF NEEDED | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 278656 | Expense |
| Grants | 243231 | Grants |
| Revenue | 0 | Revenue |
| Description | 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. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 278656 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 243231 | TotalOfOtherProgramServiceGrnt |
| Total Program Service Expense | 382824 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 3 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 1 | QuidProQuoContributions |
| Quid Pro Quo Disclosure | 1 | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 14 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 1 | InvestmentInJointVenture |
| Written Policy Or Procedure | 1 | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | OH | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THOMAS SCHERER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 7404208002 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1180 N COURT ST | AddressLine1 |
| City | CIRCLEVILLE | City |
| State | OH | State |
| ZIP Code | 43113 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|---|
| CHARLES BRADLEY | |||||||
| PRESIDENT | 1.00 | 1.00 | X | X | 0 | 0 | 0 |
| JON VEITH | |||||||
| VICE PRESIDENT | 1.00 | 39.00 | X | X | 0 | 216314 | 16596 |
| GUNHILD LONG | |||||||
| SECRETARY | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| JEAN DROSTE | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| NELSON EMBREY | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| MIKE HESS | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| DIANE HILL | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| PATRICIA HUGHEY | |||||||
| DIRECTOR | 1.00 | 39.00 | X | 0 | 72196 | 25278 | |
| ANGELA KLETT | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| CONNIE LEWIS | |||||||
| TREASURER | 1.00 | 0.00 | X | X | 0 | 0 | 0 |
| ROBERT SNEED | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| SUSAN STRAWSER | |||||||
| DIRECTOR | 1.00 | 39.00 | X | 0 | 72758 | 9906 | |
| JOY LEVERICH MD | |||||||
| DIRECTOR | 1.00 | 39.00 | X | 0 | 262946 | 30078 | |
| JOHN HOFFMAN | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| STAN SUMMERS | |||||||
| DIRECTOR | 1.00 | 0.00 | X | 0 | 0 | 0 | |
| DAVID PAUGH | |||||||
| CFO BERGER HEALTH SYSTEM | 2.50 | 37.50 | X | 0 | 163007 | 26490 | |
| LARRY HALM | |||||||
| EXECUTIVE DIRECTOR | 40.00 | 0.00 | X | 100270 | 0 | 20327 | |
| SR MONICA JUSTINGER | |||||||
| EXECUTIVE DIRECTOR (HOSPICE) | 1.00 | 39.00 | X | 0 | 121672 | 23999 | |
| THOMAS SCHERER | |||||||
| VICE PRESIDENT-FINANCE BHS | 5.00 | 35.00 | X | 0 | 97083 | 13840 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 100270 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1005976 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 166514 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Fundraising Events | 26350 | FundraisingEvents |
| All Other Contributions | 339314 | AllOtherContributions |
| Total Contributions | 365664 | TotalContributions |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6497 | TotalRevenueColumn |
| Exclusion | $6,497 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10959 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 10959 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10959 | TotalRevenueColumn |
| Exclusion | $10,959 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 98948 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 26350 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 37517 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 61431 | TotalRevenueColumn |
| Exclusion | $61,431 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 444551 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $78,887 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 243231 | Total |
| Program Services | 243231 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 104168 | Total |
| Program Services | 104168 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120597 | Total |
| Program Services | 24119 | ProgramServices |
| Management And General | 24119 | ManagementAndGeneral |
| Fundraising | 72359 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38826 | Total |
| Program Services | 7765 | ProgramServices |
| Management And General | 11648 | ManagementAndGeneral |
| Fundraising | 19413 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2580 | Total |
| Program Services | 516 | ProgramServices |
| Management And General | 774 | ManagementAndGeneral |
| Fundraising | 1290 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 915 | Total |
| Program Services | 183 | ProgramServices |
| Management And General | 275 | ManagementAndGeneral |
| Fundraising | 457 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14212 | Total |
| Program Services | 2842 | ProgramServices |
| Management And General | 4264 | ManagementAndGeneral |
| Fundraising | 7106 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200 | Total |
| Management And General | 200 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 75 | Total |
| Management And General | 75 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63165 | Total |
| Management And General | 62999 | ManagementAndGeneral |
| Fundraising | 166 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23568 | Total |
| Management And General | 23568 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15554 | Total |
| Management And General | 15554 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4080 | Total |
| Management And General | 4080 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 727 | Total |
| Management And General | 727 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 631898 | Total |
| Program Services | 382824 | ProgramServices |
| Management And General | 148283 | ManagementAndGeneral |
| Fundraising | 100791 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 672737 | BOY |
| EOY | 749327 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 386430 | BOY |
| EOY | 439743 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1413 | BOY |
| EOY | 28993 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 385967 | LandBuildingsEquipmentBasis |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 385967 | BOY |
| EOY | 385967 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 551092 | BOY |
| EOY | 396870 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21479 | BOY |
| EOY | 207 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2019118 | BOY |
| EOY | 2001107 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 259503 | BOY |
| EOY | 79748 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 259503 | BOY |
| EOY | 79748 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Do Not Follow SFAS117 | X | DoNotFollowSFAS117 |
Cap Stck Trst Prin Current Funds CapStckTrstPrinCurrentFunds
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1373648 | BOY |
| EOY | 1535392 | EOY |
Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 385967 | BOY |
| EOY | 385967 | EOY |
Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1759615 | BOY |
| EOY | 1921359 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2019118 | BOY |
| EOY | 2001107 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -187347 | ReconcilationRevenueExpenses |
| Reconcilation Prior Adjustment | 366 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 348725 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 250919 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 261399 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 734230 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 878569 | CurrentTaxYearMinus1Year |
| Current Tax Year | 437079 | CurrentTaxYear |
| Total | 2562196 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 250919 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 261399 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 734230 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 878569 | CurrentTaxYearMinus1Year |
| Current Tax Year | 437079 | CurrentTaxYear |
| Total | 2562196 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amounts Subst Contributors Total | 614823 | AmountsSubstContributorsTotal |
| Public Support Total170 | 1947373 | PublicSupportTotal170 |
Gross Investment Income170 GrossInvestmentIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 9233 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 21824 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 18335 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 15000 | CurrentTaxYearMinus1Year |
| Current Tax Year | 17456 | CurrentTaxYear |
| Total | 81848 | Total |
Other Income170 OtherIncome170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 146212 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 93561 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 102801 | CurrentTaxYearMinus1Year |
| Current Tax Year | 98948 | CurrentTaxYear |
| Total | 441522 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Support | 3085566 | TotalSupport |
| Gross Receipts From Admissions Etc | 334393 | GrossReceiptsFromAdmissionsEtc |
| Public Support Pertcentage170 | 0.63110 | PublicSupportPertcentage170 |
| Public Support Pertcent Prior Year | 0.65050 | PublicSupportPertcentPriorYear |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 114898 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 8758 | InvestmentEarningsOrLosses |
| End Of Year Balance | 123656 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | 114868 | Contributions |
| Investment Earnings Or Losses | 30 | InvestmentEarningsOrLosses |
| End Of Year Balance | 114898 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 0 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 385967 | InvestmentCostOrOtherBasis |
| Book Value | 385967 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 385967 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER INVESTMENTS | Description |
| Book Value | 396870 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 396870 | TotalOfBookValueProgramRelated |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | Identifier |
| Return Reference | PART V, LINE 4: | ReturnReference |
| Explanation | $123,656 OF THE ENDOWMENT IS PERMANTELY RESTRICTED AND TO BE USED FOR NURSING EDUCATION. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF OUTING | NameOfEvent1 |
| Gross Receipts Event1 | 97672 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 22500 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 75172 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 14800 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 13771 | OtherDirectExpensesEvent1 |
| Name Of Event2 | LADIES NIGHT OUT | NameOfEvent2 |
| Gross Receipts Event2 | 27626 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 3850 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 23776 | GrossRevenueEvent2 |
| Rent Facility Costs Event2 | 5827 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 3119 | FoodAndBeverageEvent2 |
| Gross Receipts Total | 125298 | GrossReceiptsTotal |
| Charitable Contributions Total | 26350 | CharitableContributionsTotal |
| Gross Revenue Total Events | 98948 | GrossRevenueTotalEvents |
| Rent Facility Costs Total Events | 20627 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 3119 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 13771 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 37517 | DirectExpenseSummaryEvents |
| Net Income Summary | 61431 | NetIncomeSummary |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|---|---|
| BERGER HOSPITAL | |||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 316400103 | GOVT HOSPITAL | 186125 | N/A | N/A | TRANSFER OF CASH FOR VARIOUS DONATIONS RECEIVED. |
| MARY VIRGINIA CRITES HANNAN PARK | |||||||||
| 104 EAST FRANKLIN STREET | CIRCLEVILLE | OH | 43113 | 311777036 | 501(C)3 | 20000 | N/A | N/A | TRANSFER OF DONATIONS PLEDGED TO PARK. |
| WILLIAMSPORT FIRE DEPARTMENT | |||||||||
| 107 GREEN STREET | WILLIAMSPORT | OH | 43164 | GOVT | 20000 | N/A | N/A | AED THAT TRANSMITS TO BERGER ER | |
| ALTERNATIVE HEALTHCARE SOLUTIONS | |||||||||
| 36200 EUCLID AVENUE SUITE 5 | WILLOUGHBY | OH | 44094 | 341893258 | 5000 | N/A | N/A | PHYSICAL THERAPY FOR NEW PATIENTS | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 3 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | CASH ASSISTANCE: BERGER ASSISTANCE, RAINBOW FUND, KOMEN | TypeOfGrant |
| Number Of Recipients | 87 | NumberOfRecipients |
| Amount Of Cash Grant | 104168 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 1 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JON VEITH | ||||||||||||||
| VICE PRESIDENT | 0 | 216314 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 16596 | 0 | 232910 | 0 | 0 |
| JOY LEVERICH MD | ||||||||||||||
| DIRECTOR | 0 | 262946 | 0 | 0 | 0 | 0 | 0 | 22500 | 0 | 7578 | 0 | 293024 | 0 | 0 |
| DAVID PAUGH | ||||||||||||||
| CFO BERGER HEALTH SYSTEM | 0 | 86552 | 0 | 5000 | 0 | 71455 | 0 | 18532 | 0 | 7958 | 0 | 189497 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Reference | PART I, LINE 4A | ReturnReference |
| Explanation | DAVID PAUGH RECEIVED SALARY CONTINUATION PAYMENTS IN 2012 OF $71,455. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| 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 2012 FORM 990 IS REVIEWED FOR COMPLETENESS AND ACCURACY BY THE VP OF FINANCE, 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 15 | 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 2013. | |
| 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 178,990. EQUITY TRANSFERS 169,735. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| 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. | |
| FORM 990, PART VII AND SCHEDULE J, PART II | THOMAS SCHERER SERVED AS INTERIM VICE PRESIDENT OF FINANCE FROM APRIL 2012 THROUGHOUT THE END OF THE YEAR. HE IS INCLUDED FOR DISCLOSURE PURPOSES ON THE 990 DUE TO THE FACT HE OPERATED AS THE TOP FINANCIAL OFFICER FOR THE ORGANIZATION IN THIS TIME FRAME. THE SALARY AMOUNTS DISCLOSED INCLUDE THE TIME FRAME IN WHICH HE DID NOT OPERATE AS THE INTERIM VICE PRESIDENT OF FINANCE. DAVID PAUGH SERVED AS CHIEF FINANCIAL OFFICER FROM JANUARY 2012 APRIL 2012, AT THIS TIME HE LEFT THE ORGANIZATION AND RECEIVED SALARY CONTINUATION PAYMENTS FOR THE REMAINDER OF THE YEAR. THE FULL YEAR SALARY AMOUNTS ARE INCLUDED ON SCHEDULE J. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Direct Controlling Entity NADirectControllingEntityNA | Controlled OrgControlledOrg | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 1 | BERGER HOSPITAL | |
| BERGER HEALTH SYSTEM | |||||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 262545110 | INACTIVE ACUTE CARE HOSPITAL | OH | 501(C)(3) | LINE 3 | N/A | 0 | |
Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BERGER ACUTE SERVICES LLC | |||||||||||||
| 332 CONGRESS PARK DR | DAYTON | OH | 45459 | 451450450 | MEDICAL SERVICES | OH | BERGER HEALTH FOUNDATION VENTURES | RELATED | 191156 | 108311 | 0 | 0 | 0.60000 |
| PICKAWAY DIALYSIS CENTER LLC | |||||||||||||
| 66 CHERRY HILL DRIVE | BEVERLY | MA | 01915 | 562614118 | DIALYSIS | MA | BERGER HEALTH FOUNDATION VENTURES | RELATED | 423243 | 45509 | 0 | 1 | 0.19000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Type Of EntityTypeOfEntity | Controlled OrgControlledOrg | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| PICKAWAY PROFESSIONAL SERVICES INC | ||||||||||||
| 600 N PICKAWAY ST | CIRCLEVILLE | OH | 43113 | 611408162 | ANESTHESIOLOGISTS | OH | N/A | C | 0 | |||
| BERGER HEALTH FOUNDATION VENTURES | ||||||||||||
| 1204 N COURT ST | CIRCLEVILLE | OH | 43113 | 412218009 | MEDICAL SERVICES | OH | N/A | C | 0 | 77015 | 201483 | 1.00000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 1 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 0 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 0 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BERGER HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | B | TransactionType |
| Amount Involved | 186126 | AmountInvolved |
| Method Of Amt Determination | CASH TRANSACTION | MethodOfAmtDetermination |
Comments