2025-08-15T09:27:51-05:00 2024-09-30 390758449 WIPFLI LLP 170 N RADNOR-CHESTER RD SUITE 200 RADNOR PA 19087 990 2023-10-01 391397028 FORT MEMORIAL HOSPITAL FOUNDATION INC FORT 9205685000 611 SHERMAN AVENUE EAST FORT ATKINSON WI 535381998 JAMES NELSON ASSISTANT TREASURER 9205685000 2025-08-14 1 1 SOLOMON MARDAKHAEV P01806552 6105653930 2025-08-07 2023 2025-03-06 01:10:19Z JAMES NELSON 611 SHERMAN AVENUE EAST FORT ATKINSON WI 535381998 1567012 0 X N/A X 1981 WI THE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED SOLELY FOR CHARITABLE PURPOSES EXCLUSIVELY FOR THE BENEFIT OF FORT ATKINSON MEMORIAL HOSPITAL, THE HOSPITAL OPERATED BY FORT HEALTHCARE, INC., AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, INCLUDING THE CARRYING ON OF SUCH PROGRAMS AS THE BOARD OF DIRECTORS OF THIS CORPORATION FROM TIME TO TIME DEEMS TO BE SUITABLE AND APPROPRIATE. 10 6 0 11 0 0 97185 140950 0 0 236821 299767 0 0 334006 440717 83575 77645 0 0 0 0 0 0 313374 53327 313374 136902 391019 197104 49698 8979321 10923743 141747 378141 8837574 10545602 X THE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED SOLELY FOR CHARITABLE PURPOSES EXCLUSIVELY FOR THE BENEFIT OF FORT ATKINSON MEMORIAL HOSPITAL, THE HOSPITAL OPERATED BY FORT HEALTHCARE, INC., AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, INCLUDING THE CARRYING ON OF SUCH PROGRAMS AS THE BOARD OF DIRECTORS OF THIS CORPORATION FROM TIME TO TIME DEEMS TO BE SUITABLE AND APPROPRIATE. 0 0 60000 60000 0 ADVANCING CAREERS IN HEALTHCARE INCLUDES SCHOLARSHIPS AND TRAINING FOR EMPLOYEES. 17645 17645 0 FORT MEMORIAL HOSPITAL FOUNDATION WAS CREATED FOR THE SOLE BENEFIT OF FORT HEALTHCARE. FOUR AREAS OF STRATEGIC FOCUS GUIDE OUR FUNDRAISING AND GRANTING PROCESS. BENEVOLENT CARE INCLUDES PROGRAM FUNDING TO ASSIST PATIENTS WHO CANNOT AFFORD CARE. PROVIDING EXCEPTIONAL CARE INCLUDES FUNDING FOR EQUIPMENT, TECHNOLOGY AND SERVICES THAT ENHANCE THE QUALITY OF CARE AND PATIENT SATISFACTION. LIVING HEALTHIER INCLUDES SERVICES FOCUSED ON COMMUNITY WELLNESS INITIATIVES. 77645 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 10 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 WI X JAMES NELSON 9205685000 611 SHERMAN AVENUE EAST FORT ATKINSON WI 535381998 MICHAEL ANDERSON MD BOARD MEMBER 1.00 40.00 X 0 815683 46915 MICHAEL WALLACE BOARD MEMBER 1.00 40.00 X 0 655083 47401 MARY BECK METZGER SECRETARY 1.00 24.00 X X 0 67470 16023 DONALD WILLIAMS MD BOARD MEMBER 1.00 X 0 33909 3730 CAROL BURROWS PRESIDENT 1.00 X X 0 0 0 ROY BUDLONG BOARD MEMBER 1.00 3.00 X 0 0 0 ANDY DIDION BOARD MEMBER 1.00 X 0 0 0 JAMES FITZPATRICK PHD BOARD MEMBER 1.00 3.00 X 0 0 0 CHRISTI OTT BOARD MEMBER 1.00 3.00 X 0 0 0 THOMAS VINZ BOARD MEMBER 1.00 3.00 X 0 0 0 JAMES NELSON ASSISTANT TREASURER 1.00 40.00 X 0 355156 49391 0 1927301 163460 0 0 1 0 0 140950 140950 213126 213126 1212936 1126295 86641 86641 86641 440717 0 0 299767 X 17645 17645 60000 60000 298148 298148 1350 1350 13876 13876 391019 77645 0 313374 362431 392682 8616890 10531061 8979321 10923743 68189 304584 73558 73557 141747 378141 X 8504644 10164825 332930 380777 8837574 10545602 8979321 10923743 49698 1658330 0 X 0 1 X 1 0 X X 1 FORT HEALTHCARE INC 390286215 3 1 17645 0 1 17645 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 GIFT ANNUITY DONOR RESERVES 73557 73557 2099047 1658330 1658330 440717 0 440717 391019 0 391019 0 391019 1 FORT HEALTHCARE INC 611 SHERMAN AVENUE EAST FORT ATKINSON WI 53538 390286215 501 (C)(3) 17645 0 HOSPITAL SUPPORT 1 0 SCHOLARSHIPS 62 60000 PART I, LINE 2: THE FORT MEMORIAL HOSPITAL FOUNDATION (FMHF) PROVIDES PHILANTHROPIC FUNDING TO FORT HEALTHCARE (FHC) TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. FMHF GRANTS ARE ALIGNED WITH FHC'S STRATEGIC GOALS, SUPPORT OPERATIONAL EXCELLENCE AND HELP FHC ADOPT INNOVATIVE TECHNOLOGY AND PATIENT CARE PRACTICES. THE FOUNDATION HAS CHOSEN FOUR PRIORITIES FOR FUNDING. PROPOSALS FOR FUNDING MUST FIT WITHIN ONE OF THESE FOCUS AREAS; BENEVOLENT CARE, KEEPING YOUR FAMILY HEALTHY, PROVIDE THE BEST HEALTH CARE POSSIBLE, EDUCATE PEOPLE FOR CAREERS IN HEALTHCARE. DEPARTMENTS RECEIVING GRANTS ARE RESPONSIBLE TO REPORT THE USE OF FUNDS, OUTCOMES AND ANECDOTAL STORIES THAT ILLUSTRATE THE IMPACT OF THE GRANT. REPORTING REQUIREMENTS WILL BE DETERMINED COLLABORATIVELY PRIOR TO A FINAL FUNDING DECISION. THE SCHOLARSHIP CRITERIA ARE DETERMINED BY AGREEMENT WITH THE DONOR AT THE TIME OF THEIR CONTRIBUTION. THE FOUNDATION HAS TWO CATEGORIES OF DOCUMENTATION FOR THE SCHOLARSHIPS: 1) SCHOLARSHIPS ESTABLISHED THROUGH A TRUST OR ESTATE DOCUMENT; 2) SCHOLARSHIPS ESTABLISHED BY LIVING DONORS FOR WHICH THERE IS WRITTEN GUIDANCE. 0 0 0 0 0 0 0 0 0 MICHAEL ANDERSON MD BOARD MEMBER 0 764441 0 40000 0 11242 0 13200 0 33715 0 862598 0 0 MICHAEL WALLACE BOARD MEMBER 0 246348 0 391961 0 16774 0 13200 0 34201 0 702484 0 0 JAMES NELSON ASSISTANT TREASURER 0 279993 0 70031 0 5132 0 13200 0 36191 0 404547 0 0 PART I, LINE 3 THE TOP MANAGEMENT OFFICIAL IS COMPENSATED BY FORT HEALTHCARE, INC., A RELATED ORGANIZATION OF FORT MEMORIAL HOSPITAL FOUNDATION, INC. FORT HEALTHCARE, INC. ESTABLISHED THE COMPENSATION OF THE TOP MANAGEMENT OFFICIAL USING THE COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE METHODS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S ACCOUNTING MANAGER AND CFO. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. 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. BOARD MEMBERS WITH A CONFLICT OF INTEREST ABSTAIN FROM VOTING ON THE MATTERS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G ADMINISTRATIVE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 298,148. TOTAL EXPENSES 298,148. FORT HEALTHCARE INC 611 SHERMAN AVENUE EAST FORT ATKINSON WI 53538 390286215 HEALTH CARE WI 501(C)(3) LINE 3 N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0