2011-11-10T12:04:47-06:00 2010-12-31 PLANTE & MORAN PLLC 65 EAST STATE ST SUITE 600 COLUMBUS OH 43215 990 2010-01-01 331031454 BERGER HEALTH FOUNDATION BERG 7404208209 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 DAVID PAUGH 7404208209 2011-10-28 1 BERNIE OSTROWSKI 6148493000 2010 2016-03-07 17:11:31Z LARRY HALM 600 N PICKAWAY STREET CIRCLEVILLE OH 43113 977121 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 11 2 161 0 0 464797 865225 0 0 44313 4422 104246 53779 613356 923426 16956 656367 0 0 172478 142831 0 0 41497 145301 367480 334735 1166678 278621 -243252 1907282 1902614 43544 68283 1863738 1834331 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 17671 0 0 RAINBOW FUND - BRADLEY CANCER CENTER PATIENT SUPPORT 280000 150000 DIGITAL MAMMOGRAPHY - PURCHASE OF EQUIPMENT FOR BERGER HEALTH SYSTEM 7630 PICKAWAY COUNTRY CLUB BREAST CANCER FUND - BREAST CANCER SCREENINGS 704354 126367 704354 126367 1009655 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 2 1 0 0 0 0 0 1 1 0 0 0 0 X 18 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 OH X DAVID PAUGH 7404208404 1180 N COURT ST CIRCLEVILLE OH 43113 X CHARLES BRADLEY 1.00 X X 0 0 0 JON VEITH 1.00 X X 0 213607 17874 TODD STEVENS 1.00 X X 0 0 0 GUNHILD LONG 1.00 X X 0 83554 18572 SISTER MONICA JUSTINGER 1.00 X 0 119288 24081 LARRY ELLIOT 1.00 X 0 0 0 ROBERT SNEED 1.00 X 0 0 0 GARY GILLEN MD 1.00 X 0 92620 31128 SUSAN STRAWSER 1.00 X 0 69160 17155 JEAN DROSTE 1.00 X 0 0 0 DEE DAVIS 1.00 X 0 0 0 DORIS GILLESPIE 1.00 X 0 0 0 MIKE HESS 1.00 X 0 0 0 DIANE HILL 1.00 X 0 0 0 HEWITT HARMOUNT 1.00 X 0 0 0 CONNIE LEWIS 1.00 X 0 0 0 PATRICIA HUGHEY 1.00 X 0 65898 16080 TIM COLBURN 3.00 X X 0 220002 32307 LARRY HALM 40.00 X 92502 0 21476 DAVID PAUGH 3.00 X 0 143998 38034 92502 1008127 216707 0 0 1 0 0 33925 130995 700305 865225 4422 4422 13913 13913 13913 13913 93561 33925 53695 39866 39866 923426 0 0 58201 656367 656367 119692 39898 39897 39897 8775 6143 2632 4932 3452 1480 9432 6602 2830 200 200 2925 2925 2408 808 1600 8884 8884 11791 11791 596 596 1980 1980 USE OF RESTRICTED ASSET 297193 297193 41503 41503 1166678 1009655 115526 41497 171974 633101 870737 336908 52345 30400 9623 3032 385967 385967 385967 438280 439661 30701 21200 1907282 1902614 43544 68283 43544 68283 X 1477771 1448364 385967 385967 0 0 1863738 1834331 1907282 1902614 X -243252 213845 X X 0 1 0 X 0 X 111396 161509 112410 261399 734230 1380944 111396 161509 112410 261399 734230 1380944 360437 1020507 6045 8108 9233 8106 4422 35914 1315 1315 1418173 554095 0.71960 0.73190 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 385967 385967 385967 OTHER INVESTMENTS 439661 F 439661 GOLF OUTING 91831 29000 62831 20328 21034 LADIES NIGHT OUT 35655 4925 30730 5681 4177 2475 127486 33925 93561 26009 4177 23509 53695 39866 1 BERGER HOSPITAL 600 N PICKAWAY ST CIRCLEVILLE OH 43113 316400103 CITY OF CIRCLEVILLE 656367 N/A N/A TRANSFER OF CASH FOR VARIOUS DONATIONS RECEIVED. X X X 0 0 0 0 0 0 0 0 0 JON VEITH 0 213607 0 0 0 0 0 0 0 17874 0 231481 0 0 TIM COLBURN 0 220002 0 0 0 0 0 30800 0 1507 0 252309 0 0 DAVID PAUGH 0 143998 0 0 0 0 0 20160 0 17874 0 182032 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE 2010 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. 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. 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 WHEN THIS VOTE IS TAKEN. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S COMPENSATION FOR THE EXECUTIVE DIRECTOR AND OTHER OFFICERS IS DETERMINED BY THE GOVERNING BOARD'S USE OF COMPARABLE DATA. THE CFO AND SECRETARY'S COMPENSATION IS REVIEWED AND APPROVED BY THE PRESIDENT/CEO OF BERGER HEALTH SYSTEM. DOCUMENTATION AND RECORDKEEPING WITH RESPECT TO DELIBERATION AND DECISIONS IS KEPT CONTEMPORANEOUSLY; THIS PROCESS WAS LAST COMPLETED IN 2010. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 1023 AND 990 ARE AVAILABLE UPON REQUEST. 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 VII ESTIMATE OF OFFICERS' ALLOCATION OF HOURS WORKED FOR BERGER HEALTH FOUNDATION RELATED ENTITIES: PICKAWAY HEALTH SERVICES: -TIM COLBURN: 4 -DAVID PAUGH: 4 PICKAWAY PROFESSIONAL SERVICES, INC.: -TIM COLBURN: 2 -DAVID PAUGH: 2 BERGER HEALTH FOUNDATION VENTURES: -TIM COLBURN: 1 -DAVID PAUGH: 1 BERGER HOSPITAL: -TIM COLBURN: 30 -DAVID PAUGH: 30 CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: DISTRIBUTIONS RECEIVED FROM BERGER HEALTH FOUNDATION VENTURES 213,845. TOTAL TO FORM 990, PART XI, LINE 5: 213,845. FORM 990, PART XI, LINE 2C: THE MANAGING HEALTH SYSTEM, BERGER HEALTH SYSTEM, ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPEDENT ACCOUNTANT. 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) 509(A)(3), TYPE III N/A 0 PICKAWAY PROFESSIONAL SERVICES INC 600 N PICKAWAY ST CIRCLEVILLE OH 43113 611408162 ANESTHESIOLOGISTS OH N/A C BERGER HEALTH FOUNDATION VENTURES 1204 N COURT ST CIRCLEVILLE OH 43113 412218009 MEDICAL SERVICES OH N/A C 191715 205327 1.00000 0 1 1 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 BERGER HOSPITAL C 130995 CASH TRANSACTION BERGER HOSPITAL B 656367 CASH TRANSACTION BERGER HEALTH FOUNDATION VENTURES C 213845 CASH TRANSACTION