2013-11-13T13:58:07-06:00 2012-12-31 381357951 PLANTE & MORAN PLLC 65 EAST STATE ST SUITE 600 COLUMBUS OH 43215 990 2012-01-01 331031454 BERGER HEALTH FOUNDATION BERG 7404208209 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 THOMAS SCHERER 7404208209 2013-11-01 1 BERNIE OSTROWSKI P00366367 6148493000 2012 2016-02-25 16:41:14Z LARRY HALM 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 482068 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. 14 10 3 100 0 0 878569 365664 0 0 3713 6497 70779 72390 953061 444551 599260 347399 0 0 154316 177130 0 0 100791 90074 107369 843650 631898 109411 -187347 2019118 2001107 259503 79748 1759615 1921359 X 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 42179 42179 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 34891 34891 0 TACKLING CANCER- FUNDS SPLIT BETWEEN CHARITIES TO HELP CANCER PATIENTS 27098 27098 0 SUSAN G. KOMEN- HELP LOW INCOME OR UNDER INSURED WOMEN WITH MAMMOGRAM FEES AND FOLLOW-UP TESTING IF NEEDED 278656 243231 0 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. 278656 243231 382824 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 1 0 0 0 0 0 0 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 3 1 0 0 0 0 0 1 1 0 0 0 0 X 14 10 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 OH X THOMAS SCHERER 7404208002 1180 N COURT ST CIRCLEVILLE OH 43113 CHARLES BRADLEY 1.00 1.00 X X 0 0 0 JON VEITH 1.00 39.00 X X 0 216314 16596 GUNHILD LONG 1.00 0.00 X X 0 0 0 JEAN DROSTE 1.00 0.00 X 0 0 0 NELSON EMBREY 1.00 0.00 X 0 0 0 MIKE HESS 1.00 0.00 X 0 0 0 DIANE HILL 1.00 0.00 X 0 0 0 PATRICIA HUGHEY 1.00 39.00 X 0 72196 25278 ANGELA KLETT 1.00 0.00 X 0 0 0 CONNIE LEWIS 1.00 0.00 X X 0 0 0 ROBERT SNEED 1.00 0.00 X 0 0 0 SUSAN STRAWSER 1.00 39.00 X 0 72758 9906 JOY LEVERICH MD 1.00 39.00 X 0 262946 30078 JOHN HOFFMAN 1.00 0.00 X 0 0 0 STAN SUMMERS 1.00 0.00 X 0 0 0 DAVID PAUGH 2.50 37.50 X 0 163007 26490 LARRY HALM 40.00 0.00 X 100270 0 20327 SR MONICA JUSTINGER 1.00 39.00 X 0 121672 23999 THOMAS SCHERER 5.00 35.00 X 0 97083 13840 100270 1005976 166514 1 0 1 0 0 26350 339314 365664 6497 6497 10959 0 10959 10959 10959 98948 26350 37517 61431 61431 444551 0 0 78887 243231 243231 104168 104168 120597 24119 24119 72359 38826 7765 11648 19413 2580 516 774 1290 915 183 275 457 14212 2842 4264 7106 200 200 75 75 63165 62999 166 23568 23568 15554 15554 4080 4080 727 727 631898 382824 148283 100791 672737 749327 386430 439743 1413 28993 385967 385967 385967 551092 396870 21479 207 2019118 2001107 259503 79748 259503 79748 X 1373648 1535392 385967 385967 0 0 1759615 1921359 2019118 2001107 X -187347 366 348725 X X 0 1 X 1 0 X 250919 261399 734230 878569 437079 2562196 250919 261399 734230 878569 437079 2562196 614823 1947373 9233 21824 18335 15000 17456 81848 146212 93561 102801 98948 441522 3085566 334393 0.63110 0.65050 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 114898 8758 123656 114868 30 114898 1.00000 0 0 385967 385967 385967 OTHER INVESTMENTS 396870 F 396870 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: $123,656 OF THE ENDOWMENT IS PERMANTELY RESTRICTED AND TO BE USED FOR NURSING EDUCATION. GOLF OUTING 97672 22500 75172 14800 13771 LADIES NIGHT OUT 27626 3850 23776 5827 3119 125298 26350 98948 20627 3119 13771 37517 61431 1 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 1 3 CASH ASSISTANCE: BERGER ASSISTANCE, RAINBOW FUND, KOMEN 87 104168 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. X X X X 1 0 0 0 0 0 0 0 0 JON VEITH 0 216314 0 0 0 0 0 0 0 16596 0 232910 0 0 JOY LEVERICH MD 0 262946 0 0 0 0 0 22500 0 7578 0 293024 0 0 DAVID PAUGH 0 86552 0 5000 0 71455 0 18532 0 7958 0 189497 0 0 PART I, LINE 4A DAVID PAUGH RECEIVED SALARY CONTINUATION PAYMENTS IN 2012 OF $71,455. 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. CHANGES IN NET ASSETS OR FUND BALANCES: 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. 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. 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 HEALTH SYSTEM 600 N PICKAWAY ST CIRCLEVILLE OH 43113 262545110 INACTIVE ACUTE CARE HOSPITAL OH 501(C)(3) LINE 3 N/A 0 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 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 77015 201483 1.00000 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 BERGER HOSPITAL B 186126 CASH TRANSACTION