FORT HEALTHCARE INC: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- FORT HEALTHCARE INC (EIN 39-0286215)
- Tax period
- 2009-10-01 to 2010-09-30
- Filed
- 2011-05-11
- IRS object ID
- 201131319349302268
- Schema version
- 2009v1.7
- 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 H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-05-11T16:33:06-05:00 | Timestamp |
| Tax Period End Date | 2010-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10000 INNOVATION DR SUITE 250 | AddressLine1 |
| City | MILWAUKEE | City |
| State | WI | State |
| ZIP Code | 532264837 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2009-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390286215 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort HealthCare Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | FORT | NameControl |
| Phone | 8004214677 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 E Sherman Avenue | AddressLine1 |
| City | Fort Atkinson | City |
| State | WI | State |
| ZIP Code | 53538 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | James Nelson | Name |
| Title | Senior Vice President | Title |
| Phone | 8004214677 | Phone |
| Date Signed | 2011-05-11 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAY ADKISSON | Name |
| Phone | 4144319300 | Phone |
| Date Prepared | 2011-05-09 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2009 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | James Nelson | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 E Sherman Avenue | AddressLine1 |
| City | Fort Atkinson | City |
| State | WI | State |
| ZIP Code | 53538 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 127281501 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | www.forthealthcare.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1942 | YearFormation |
| State Legal Domicile | WI | StateLegalDomicile |
| Activity Or Mission Description | OUR MISSION AT FORT HEALTHCARE IS TO PROVIDE EXCELLENT, COMPASSIONATE CARE FOR THE PEOPLE OF OUR COMMUNITIES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1123 | TotalNbrEmployees |
| Total Nbr Volunteers | 310 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 324936 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 201172 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 119968537 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 122401567 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -1703553 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3449727 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 1090272 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 118589920 | TotalRevenuePriorYear |
| Total Revenue Current Year | 127142738 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 52344882 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 50834906 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 66376704 | OtherExpensePriorYear |
| Other Expenses Current Year | 69335448 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 118721586 | TotalExpensesPriorYear |
| Total Expenses Current Year | 120170354 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -131666 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 6972384 | RevenuesLessExpensesCY |
| Total Assets BOY | 167138311 | TotalAssetsBOY |
| Total Assets EOY | 172806943 | TotalAssetsEOY |
| Total Liabilities BOY | 86932076 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 83116500 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 80206235 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 89690443 | NetAssetsOrFundBalancesEOY |
| Mission Description | Our Mission at Fort HealthCare is to provide excellent, compassionate care for the people of our communities. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 72372470 | Expense |
| Revenue | 88652811 | Revenue |
| Description | Operation of a 72-bed acute care facility with an emergency room and full complement of ancillary services. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 28160208 | Expense |
| Revenue | 29612184 | Revenue |
| Description | Operation of physician clinics with outreach into the surrounding communities | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 3047592 | Expense |
| Revenue | 2923252 | Revenue |
| Description | Operation of a 28-bed subacute unit to care for the frail and elderly | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1525306 | Expense |
| Revenue | 1213320 | Revenue |
| Description | Operation of a home health agency to care for homebound seniors and others in the community | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 1525306 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 1213320 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 105105576 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Balance Sheet Amounts Reported | 1 | BalanceSheetAmountsReported |
| 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 | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | 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 |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 165 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 1123 | 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 | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | 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 | WI | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James Nelson | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 9205685000 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 E Sherman Avenue | AddressLine1 |
| City | Fort Atkinson | City |
| State | WI | State |
| ZIP Code | 53538 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | FormerFormer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| Michael S Wallace | ||||||||
| President/Director | 40.00 | X | 295716 | 0 | 32438 | |||
| Jonathan McLaughlin MD | ||||||||
| Chair | 3.00 | X | 0 | 502427 | 29403 | X | ||
| Sharon Schmeling | ||||||||
| Vice Chair | 3.00 | X | 0 | 0 | 0 | X | ||
| F Bradford Meyers MD | ||||||||
| Secretary | 3.00 | X | 0 | 264168 | 25847 | X | ||
| Dean Johnson | ||||||||
| Treasurer | 3.00 | X | 0 | 0 | 0 | X | ||
| Carol Knox | ||||||||
| Director | 3.00 | X | 0 | 0 | 0 | |||
| Richard Martin | ||||||||
| Director | 3.00 | X | 0 | 0 | 0 | |||
| Thomas Norland MD | ||||||||
| Director | 3.00 | X | 0 | 677288 | 30003 | |||
| Jeffrey McGuire MD | ||||||||
| Director | 3.00 | X | 0 | 0 | 0 | |||
| Michael Rumpf | ||||||||
| Director | 3.00 | X | 0 | 0 | 0 | |||
| Robert Schramm | ||||||||
| Director | 3.00 | X | 0 | 0 | 0 | |||
| DONALD WILLIAMS MD | ||||||||
| Director | 3.00 | X | 0 | 219774 | 19446 | |||
| Mary Kay Diderrich | ||||||||
| VP Nursing Services | 40.00 | 116422 | 0 | 3362 | X | |||
| Gary Fiedler | ||||||||
| Former VP Human Resources | 40.00 | 143955 | 0 | 17032 | X | |||
| Edwin Fischer MD | ||||||||
| Medical Director/Physician | 40.00 | 0 | 298970 | 30003 | X | |||
| James J Nelson | ||||||||
| Sr. Vice President | 40.00 | 189723 | 0 | 30305 | X | |||
| Kay E Wipperfurth | ||||||||
| VP Ancillary & Support Ser | 40.00 | 156422 | 0 | 27434 | X | |||
| Sarah S Sisbach | ||||||||
| Exec Dir of Physicians Services | 40.00 | 155016 | 0 | 7637 | X | |||
| Michael Anderson | ||||||||
| Physician | 40.00 | 0 | 640763 | 29403 | X | |||
| Randall Jennings | ||||||||
| Physician | 40.00 | 0 | 1009363 | 30003 | X | |||
| Edgardo Jiongco | ||||||||
| Physician | 40.00 | 0 | 1300043 | 11521 | X | |||
| Craig Kozler | ||||||||
| Physician | 40.00 | 0 | 544541 | 30003 | X | |||
| Isidoro Zambrano | ||||||||
| Physician | 40.00 | 0 | 580105 | 24160 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1057254 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 6037442 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 378000 | TotalOtherCompensation |
| Number Individuals GT100 K | 33 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Fort medical Group | |||||
| 611 E Sherman Avenue | Fort Atkinson | WI | 53538 | Physician Services | 17493179 |
| Dynacare Laboratories | |||||
| 9200 W Wisconsin Avenue | Milwaukee | WI | 53226 | Laboratory Services | 572838 |
| Aramark Corporation | |||||
| 22506 Network Place | Chicago | IL | 606731225 | Support Service Management | 495300 |
| St Mary's Hospital Medical Ctr | |||||
| 700 S Park Street | Madison | WI | 53715 | Laboratory Testing | 450772 |
| Diversified Clinical Services | |||||
| PO Box 850001 | Orlando | FL | 328850248 | Services | 234733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| All Other Contributions | 201172 | AllOtherContributions |
| Total Contributions | 201172 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Hospital services | 623000 | 84451671 | 84451671 |
| physician clinic reven | 621110 | 29555800 | 29555800 |
| other OPERATING REVENU | 623990 | 4257524 | 4257524 |
| subacute unit revenue | 623000 | 2923252 | 2923252 |
| Home Health Agency | 621610 | 1213320 | 1213320 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 122401567 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1536120 | TotalRevenueColumn |
| Exclusion | $1,536,120 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 805614 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 805614 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 805614 | TotalRevenueColumn |
| Exclusion | $805,614 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1746328 | Securities |
| Other | 306042 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 138763 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1746328 | Securities |
| Other | 167279 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1913607 | TotalRevenueColumn |
| Exclusion | $1,913,607 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| Equity Income in nonco | 623000 | 277246 | $277,246 |
| Fort Care Income | 623000 | 7412 | $7,412 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 284658 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 127142738 | TotalRevenueColumn |
| Related Or Exempt Function Income | 122401567 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $4,539,999 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39494108 | Total |
| Program Services | 34711862 | ProgramServices |
| Management And General | 4782246 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1360192 | Total |
| Program Services | 1195490 | ProgramServices |
| Management And General | 164702 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7186397 | Total |
| Program Services | 6316214 | ProgramServices |
| Management And General | 870183 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2794209 | Total |
| Program Services | 2455865 | ProgramServices |
| Management And General | 338344 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1133077 | Total |
| Program Services | 609881 | ProgramServices |
| Management And General | 523196 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11792056 | Total |
| Program Services | 11771724 | ProgramServices |
| Management And General | 20332 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3553834 | Total |
| Program Services | 3056297 | ProgramServices |
| Management And General | 497537 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 96743 | Total |
| Program Services | 93676 | ProgramServices |
| Management And General | 3067 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3726442 | Total |
| Program Services | 3204740 | ProgramServices |
| Management And General | 521702 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7810754 | Total |
| Program Services | 6717248 | ProgramServices |
| Management And General | 1093506 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 390305 | Total |
| Program Services | 335662 | ProgramServices |
| Management And General | 54643 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| professional fees | 16375972 | 16175004 | 200968 |
| PURCHASED SERVICES | 9960351 | 7229339 | 2731012 |
| Provision for Bad Debts | 6095501 | 6095501 | |
| Other expenses | 5511964 | 4887562 | 624402 |
| dues | 2772020 | 162437 | 2609583 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116429 | Total |
| Program Services | 87074 | ProgramServices |
| Management And General | 29355 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120170354 | Total |
| Program Services | 105105576 | ProgramServices |
| Management And General | 15064778 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8669 | BOY |
| EOY | 9809 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12977456 | BOY |
| EOY | 5756189 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18218543 | BOY |
| EOY | 19922257 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1811600 | BOY |
| EOY | 1799462 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 790827 | BOY |
| EOY | 1352801 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 150037256 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 74279888 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 73275818 | BOY |
| EOY | 75757368 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 41014073 | BOY |
| EOY | 51050969 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15260559 | BOY |
| EOY | 13126343 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3780766 | BOY |
| EOY | 4031745 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167138311 | BOY |
| EOY | 172806943 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11026799 | BOY |
| EOY | 9506369 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 62375000 | BOY |
| EOY | 60416629 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59030 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13471247 | BOY |
| EOY | 13193502 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 86932076 | BOY |
| EOY | 83116500 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80206235 | BOY |
| EOY | 89690443 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 80206235 | BOY |
| EOY | 89690443 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 167138311 | BOY |
| EOY | 172806943 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
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
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 636155 | OtherCostOrOtherBasis |
| Book Value | 636155 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 61649558 | OtherCostOrOtherBasis |
| Depreciation | 24592757 | Depreciation |
| Book Value | 37056801 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1639157 | OtherCostOrOtherBasis |
| Depreciation | 1360690 | Depreciation |
| Book Value | 278467 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 86112386 | OtherCostOrOtherBasis |
| Depreciation | 48326441 | Depreciation |
| Book Value | 37785945 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 75757368 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| Money Market Funds | 4946751 | F |
| CERTIFICATES OF DEPOSIT | 8179592 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 13126343 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION | $268,558 |
| Capitol Lease obligations | $9,425,926 |
| Deferred gain of sale-leaseback | $3,499,018 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13193502 | TotalOfAmounts |
| Total Revenue | 127142738 | TotalRevenue |
| Total Expenses | 120170354 | TotalExpenses |
| Excess Or Deficit For Year | 6972384 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 2511824 | NetUnrealizedGLOnInvestments |
| Total Adjustments | 2511824 | TotalAdjustments |
| Excess Or Deficit Per FS | 9484208 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 127142738 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 127142738 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 127142738 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 120170354 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 120170354 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 120170354 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part X: | Identifier |
| Return Reference | Description of Uncertain Tax Positions Under FIN 48: | ReturnReference |
| Explanation | Part X: In order to account for any uncertain tax positions, the System determines whether it is more likely than not that a tax position will be sustained upon examination on the technical merits of the position, assuming the taxing authority has full knowledge of all information. If the tax position does not meet the more likely than not recognition threshold, the benefit of that position is not recognized in the financial statements. The System recorded no assets or liabilities related to uncertain tax positions in 2010 and 2009. Tax returns for the years ended September 30, 2009, 2008, and 2007 remain subject to examination by the applicable taxing authorities. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 848028 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 848028 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00740 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13905589 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3612761 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10292828 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09020 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14753617 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3612761 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11140856 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09760 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 736492 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 312168 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 424324 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00370 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2406786 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2194030 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 212756 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00190 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 186083 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 186082 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3329361 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2506199 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 823162 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00720 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18082978 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6118960 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 11964018 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10480 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $2,787,556 | BadDebtExpenseAmount |
| Amount Attributable To | 418000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 20941492 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 23937003 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2995511 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Medical Health Building Group | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | Rental of medical buildings | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.20000 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.25000 | PhysicansProfitOrOwnership |
Form990 Schedule H Part V Form990ScheduleHPartV
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort Healthcare Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 Sherman Avenue East | AddressLine1 |
| City | Fort Atkinson | City |
| State | WI | State |
| ZIP Code | 53538 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | Part I, Line 7: Overall cost to charge ratio | CostingMethodUsed |
| Percent Of Total Expense Expln | Part I, Line 7f: | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | Part III, Line 4: The carrying amounts of accounts receivable are reduced by allowances that reflect management's best estimate of the amounts that will not be collected. Management provides for contractual adjustments under terms of third-party reimbursement agreements through a reduction of gross revenue and a credit to patient receivables. In addition, management provides for probable uncollectible amounts, primarily uninsured patients and amounts patients are personally responsible for, through a charge to operations and a credit to a valuation allowance based on its assessment of historical collection likelihood and the current status of individual accounts. Balances that are still outstanding after management has used reasonable collection efforts are written off through a charge to the valuation allowance and a credit to patient accounts receivable.Costing methodology - overall cost to charge ratio. Rationale for including bad debt amounts in community benefit- We are the only hospital in our service area and patients would have to travel to another community to receive care. | BadDebtFootnote |
| Debt Collection Policy | Part III, Line 9b: Persons whose income is less than 150% of the Federal Poverty Guidelines, but not more than 300% of the guidelines, shall be eligible for Community Care on a reduced charge basis. Persons whose income is less than 150% of the guidelines will be considered for complete forgiveness of their outstanding charges. | DebtCollectionPolicy |
| Needs Assessment | Part VI, Line 2: Fort HealthCare performs regular market research to assess the healthcare needs and concerns of the community. Focus groups with current patients and non-patients have helped us improve the quality of clinic based services. An annual mailed questionnaire (5,000 samples size, randomly selected) is also implemented. Many questions relate specifically to health needs, concerns, behaviors and concerns. The survey also assesses satisfaction with Fort HealthCare services and hospital of preference for a variety of medical and hospital based services. | NeedsAssessment |
| Patient Education Assistance | Part VI, Line 3: Information is available on the patient statement, in monthly newsletters and on the organizations website. An annual Community Benefit report is filed with the Wisconsin Hospital Association. A printed report is prepared and delivered to 48,000 households within the primary service area as an insert into the HealthSource Community Magazine. | PatientEducationAssistance |
| Community Information | Part VI, Line 4: Fort HealthCare's primary service area constitutes an eight zip code region comprised of the communities of Fort Atkinson, Jefferson, Johnson Creek, Helenville, Whitewater, Cambridge, Lake Mills and Palmyra. There are approximately 75,000 persons living in the region. Fort Memorial Hospital is the only hospital within the primary service area. The region is not considered a medically underserved region. | CommunityInformation |
| Community Building Activities | Part VI, Line 5: | CommunityBuildingActivities |
| Other Information | Part VI, Line 6: The Fort HealthCare Board of Directors is a community oriented board, with representatives solicited directly from the majority of communities in the primary service area. The majority of representatives are not employees, contractors or relatives of Fort HealthCare staff. The members are not compensated for their service. The Fort Memorial Hospital operates with an 'open' medical staff. Physicians unaffiliated with the organization may request privileges at any time. The Planning Committee determines need for specialty care according to a well established medical manpower plan that includes community need for services. Physicians are granted medical staff status based on need. The medical staff is represented by members of Fort Medical Group (owned by Fort HealthCare), Dean/St. Mary's Regional Clinics, UW Health and others. Fort HealthCare is a non-profit organization and net revenues are used for improvements in the status of Fort HealthCare. Funds are used to purchase capital equipment, enhance physical facilities and improve patient services. Fort HealthCare gives generously to area community organizations. In FY 2010, more than $65,000 was provided in direct support of community events. In addition, Fort HealthCare resources were expended to support those activities- including significant staff time, volunteer time, medical supplies, giveaway items and more. Approximately $1.8 million was provided in charity care. Fort HealthCare staff serve on the board of directors for a number of local non-profit agencies. Fort HealthCare is very supportive of United Way, Tomorrow's Hope, Relay for Life and many other fundraising causes in the community. | OtherInformation |
| Affiliated Health Care System | Part VI, Line 7: Fort HealthCare is an independent, non-profit organization. There are no affiliated organizations. | AffiliatedHealthCareSystem |
| Reports Filed With States | WI | ReportsFiledWithStates |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | 1 | SubstantiationRequired |
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| 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 | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 1 | 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 (15 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael S Wallace | |||||||||||||
| 295716 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 22638 | 0 | 328154 | 0 | 0 | 0 |
| Jonathan McLaughlin MD | |||||||||||||
| 0 | 485314 | 0 | 17113 | 0 | 0 | 0 | 9800 | 0 | 19603 | 0 | 531830 | 0 | 0 |
| F Bradford Meyers MD | |||||||||||||
| 0 | 264168 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 16047 | 0 | 290015 | 0 | 0 |
| Thomas Norland MD | |||||||||||||
| 0 | 658054 | 0 | 19234 | 0 | 0 | 0 | 9800 | 0 | 20203 | 0 | 707291 | 0 | 0 |
| DONALD WILLIAMS MD | |||||||||||||
| 0 | 219774 | 0 | 0 | 0 | 0 | 0 | 334 | 0 | 19112 | 0 | 239220 | 0 | 0 |
| Gary Fiedler | |||||||||||||
| 143955 | 0 | 0 | 0 | 0 | 0 | 5260 | 0 | 11772 | 0 | 160987 | 0 | 0 | 0 |
| Edwin Fischer MD | |||||||||||||
| 0 | 298970 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 20203 | 0 | 328973 | 0 | 0 |
| James J Nelson | |||||||||||||
| 189723 | 0 | 0 | 0 | 0 | 0 | 7667 | 0 | 22638 | 0 | 220028 | 0 | 0 | 0 |
| Kay E Wipperfurth | |||||||||||||
| 156422 | 0 | 0 | 0 | 0 | 0 | 6291 | 0 | 21143 | 0 | 183856 | 0 | 0 | 0 |
| Sarah S Sisbach | |||||||||||||
| 155016 | 0 | 0 | 0 | 0 | 0 | 6148 | 0 | 1489 | 0 | 162653 | 0 | 0 | 0 |
| Michael Anderson | |||||||||||||
| 0 | 443573 | 0 | 197190 | 0 | 0 | 0 | 9800 | 0 | 19603 | 0 | 670166 | 0 | 0 |
| Randall Jennings | |||||||||||||
| 0 | 773838 | 0 | 235525 | 0 | 0 | 0 | 9800 | 0 | 20203 | 0 | 1039366 | 0 | 0 |
| Edgardo Jiongco | |||||||||||||
| 0 | 1300043 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 1721 | 0 | 1311564 | 0 | 0 |
| Craig Kozler | |||||||||||||
| 0 | 544541 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 20203 | 0 | 574544 | 0 | 0 |
| Isidoro Zambrano | |||||||||||||
| 0 | 580105 | 0 | 0 | 0 | 0 | 0 | 9800 | 0 | 14360 | 0 | 604265 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 4a | Gary Fiedler Severance Pay $40,272 |
| Part I, Line 5 | Executive pay increases and bonuses have an element relating to the financial performance of the organization and related organizations. Physicians compensation is tied to net revenues of their practices. |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer |
|---|---|---|---|---|---|---|
| Wisconsin Health & Educational Facilities Authority | ||||||
| 391337855 | 97710VTU2 | 2004-05-18 | 40072037 | Construction & Equipment | 0 | 0 |
| Wisconsin Health & Educational Facilities Authority | ||||||
| 391337855 | 97710V4Q8 | 2007-09-20 | 26000000 | Construction & Equipment & refunding prior issue | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Amount DefeasedAmountDefeased |
|---|---|---|---|---|---|---|---|---|---|
| 40072037 | 3000700 | 320000 | 36751337 | 2006 | 0 | 0 | 1 | 1 | |
| 26000000 | 481154 | 391832 | 15577679 | 2010 | 0 | 1 | 1 | 1 | 9548835 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Bond Counsel Routinely EngagedBondCounselRoutinelyEngaged | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 0 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Business Name Line2NameOfGICProvider/BusinessNameLine2 | Term Of GICTermOfGIC | Regulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfied | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|---|---|---|
| XL Asset Funding | ||||||||
| 0 | 0 | 0 | 1 | Company LLC | 2.670000000000 | 1 | 0 | 0 |
| (no name) | ||||||||
| 0 | 1 | 0 | 0 | 0 | 0 | |||
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| 500 McMillen Group LLP | |||
| Partnership in which current director Donald Williams is a partner | 316468 | Rent for the lease of office space | 0 |
| Cambridge State Bank | |||
| Employer of Former Board Member David Keleher | 1000000 | Filing organization has certificates of deposits with the bank | 0 |
| Julie Mokhtar MD | |||
| Wife of Edwin Fischer | 484817 | Employee | 1 |
| Johnson Bank | |||
| Board member Dean Johnson is a director of the Johnson Bank Advisory Board | 1000000 | Certificates of deposit | 0 |
| Melanie Rumpf | |||
| Wife of Board Member Michael Rumpf | 46018 | Employee | 0 |
| Cambridge State Bank | |||
| Board member Michael Rumpf is a Board member of Cambridge State Bank | 1000000 | Filing organization has certificates of deposits with the bank | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | ExplanationExplanation |
|---|---|
| Form 990, Part VI, Section A, line 4 | The organization created a compensation committee whose voting members do not receive any compensation from the organization. Compensation matters were previously handled by the Executive Committee. |
| Form 990, Part VI, Section B, line 11 | A copy of Form 990 is given to the Board members for review. It is approved by the Board of Directors before filing. |
| Form 990, Part VI, Section B, line 12c | Each board member of the entity and related entities annually complete a conflict of interest questionnaire disclosing their conflicts of interest. A summary of conflicts are distributed to the chairman of the board and to administrative support personnel. Board members are coached on how to manage their conflicts. |
| Form 990, Part VI, Section B, line 15 | Other organizations are used as benchmarks to determine compensation. Independent reviews of compensation are also done periodically. |
| Form 990, Part VI, Section C, line 19 | All documents are available to the public upon request. Summaries of financial statements are available to the public via an annual report that Fort Healthcare publishes. The annual report is direct mailed to households and is also available to the public on Fort Healthcare's website. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 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 |
|---|---|---|---|---|---|---|---|---|---|
| Fort Memorial Hospital Foundation | |||||||||
| 611 Sherman Ave East | Fort Atkinson | WI | 53538 | 391397028 | Foundation | WI | 501(c)(3) | Line 11a, I | N/A |
| Fort Healthcare Partners | |||||||||
| 611 Sherman Ave East | Fort Atkinson | WI | 53538 | 391040145 | Volunteers | WI | 501(c)(3) | Line 3 | N/A |
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 | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Share Of Total IncomeShareOfTotalIncome |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Fort Medical Group Inc | |||||||||||
| 611 Sherman Ave East | Fort Atkinson | WI | 53538 | 391736513 | Provide physician services | WI | N/A | C | 2511606 | 1.00000 | |
| Fort Care Inc | |||||||||||
| 611 Sherman Ave East | Fort Atkinson | WI | 53538 | 391725831 | Preferred Provider Organization | WI | N/A | C | 65888 | 1.00000 | 7412 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| 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 | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Fort Memorial Hospital Foundation | |
| C | 63749 |
| Fort HealthCare Partners | |
| C | 88031 |
| Fort Medical Group | |
| O | 17493179 |
| Fort Care Inc | |
| P | 78343 |