FORT HEALTHCARE INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- FORT HEALTHCARE INC (EIN 39-0286215)
- Tax period
- 2016-10-01 to 2017-09-30
- Filed
- 2018-08-15
- IRS object ID
- 201802279349300540
- Schema version
- 2016v3.0
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-08-15T08:10:09-05:00 | ReturnTs |
| Tax Period End | 2017-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wipfli LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 12237 | AddressLine1Txt |
| City | Green Bay | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390286215 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort HealthCare Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FORT | BusinessNameControlTxt |
| Phone | 8004214677 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 Sherman Avenue East | AddressLine1Txt |
| City | Fort Atkinson | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53538 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | James Nelson | PersonNm |
| Person Title | Senior Vice President | PersonTitleTxt |
| Phone | 8004214677 | PhoneNum |
| Signature | 2018-08-06 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Terri Rexrode CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2018-07-17 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | James Nelson | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 Sherman Avenue East | AddressLine1Txt |
| City | Fort Atkinson | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53538 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $242,620,963 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.forthealthcare.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1942 | FormationYr |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Activity Or Mission | OUR MISSION AT FORT HEALTHCARE IS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 979 | TotalEmployeeCnt |
| Total Volunteers | 201 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $78,031 | PYContributionsGrantsAmt |
| CY Contributions Grants | $202,361 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $124,383,435 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $122,773,725 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,921,232 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,659,204 | CYInvestmentIncomeAmt |
| PY Other Revenue | $1,085,506 | PYOtherRevenueAmt |
| CY Other Revenue | $1,065,138 | CYOtherRevenueAmt |
| PY Total Revenue | $127,468,204 | PYTotalRevenueAmt |
| CY Total Revenue | $131,700,428 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $49,006,823 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $47,438,266 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $71,092,390 | PYOtherExpensesAmt |
| CY Other Expenses | $72,501,304 | CYOtherExpensesAmt |
| PY Total Expenses | $120,099,213 | PYTotalExpensesAmt |
| CY Total Expenses | $119,939,570 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,368,991 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $11,760,858 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $189,234,846 | TotalAssetsBOYAmt |
| Total Assets EOY | $200,331,339 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $67,386,024 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $67,177,917 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $121,848,822 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $133,153,422 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Our Mission at Fort HealthCare is to improve the Health and Well-being of our community. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $71,727,584 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $89,225,996 | RevenueAmt |
| Desc | Operation of a 72-bed acute care facility with an emergency room and full complement of ancillary services. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $35,722,684 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $33,547,729 | RevenueAmt |
| Desc | Operation of physician clinics with outreach into the surrounding communities. | Desc |
Prog Srvc Accom Acty Other ProgSrvcAccomActyOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $0 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $768,759 | RevenueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Revenue | $768,759 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $107,450,268 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (1) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 140 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 979 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (1) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (1) | WrittenPolicyOrProcedureInd |
| States Where Copy Of Return Is Fld | WI | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | James Nelson | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9205685000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 Sherman Avenue East | AddressLine1Txt |
| City | Fort Atkinson | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53538 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Michael Anderson MD | ||||||||
| Medical Director | 3.00 | 40.00 | Yes (X) | $0 | $830,510 | $42,868 | ||
| Mary Beck Metzger | ||||||||
| Board Member | 40.00 | 1.00 | Yes (X) | $54,052 | $0 | $17,916 | ||
| Roy Budlong | ||||||||
| Board Member | 3.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Kathi Cauley | ||||||||
| Board Member | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| James Fitzpatrick PhD | ||||||||
| Board Member | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Billie Kontny MD | ||||||||
| Chief of Staff - Thru 12/31/16 | 3.00 | 40.00 | Yes (X) | $0 | $497,621 | $45,235 | ||
| Craig Kozler MD | ||||||||
| Board Member | 3.00 | 40.00 | Yes (X) | $0 | $534,207 | $43,440 | ||
| Shauna Meyer | ||||||||
| Chief of Staff | 3.00 | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| Jonathan McLaughlin MD | ||||||||
| Board Member - Thru 12/31/16 | 3.00 | 40.00 | Yes (X) | $0 | $496,265 | $45,418 | ||
| Sharon Schmeling | ||||||||
| Board Member | 3.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Michael Wallace | ||||||||
| President/CEO | 40.00 | 1.00 | Yes (X) | $496,508 | $0 | $45,418 | Yes (X) | |
| Michael Rumpf | ||||||||
| Chair | 3.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Mary Behling | ||||||||
| Vice Chair | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Barry Cash MD | ||||||||
| Secretary | 3.00 | 0.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Dean Johnson | ||||||||
| Treasurer | 3.00 | 1.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| James Nelson | ||||||||
| Sr. Vice President / CFO | 40.00 | 0.00 | $267,292 | $0 | $45,299 | Yes (X) | ||
| Kay Wipperfurth | ||||||||
| VP Ancillary & Support Serv. - Thru 5/12/17 | 40.00 | 0.00 | $211,457 | $0 | $41,371 | Yes (X) | ||
| Renee Clark | ||||||||
| VP Nursing Services - Thru 6/3/17 | 40.00 | 0.00 | $171,124 | $0 | $40,986 | Yes (X) | ||
| Thomas Nordland MD | ||||||||
| Medical Director - Thru 4/28/17 | 0.00 | 40.00 | $0 | $556,187 | $41,241 | Yes (X) | ||
| Marc Erickson MD | ||||||||
| Physician | 0.00 | 40.00 | $0 | $496,021 | $40,004 | Yes (X) | ||
| Christopher Manakas MD | ||||||||
| Physician | 0.00 | 40.00 | $0 | $592,314 | $44,290 | Yes (X) | ||
| Julie Mokhtar DO | ||||||||
| Physician | 0.00 | 40.00 | $0 | $451,306 | $43,514 | Yes (X) | ||
| Paul Schuppner MD | ||||||||
| Physician | 0.00 | 40.00 | $0 | $530,813 | $22,864 | Yes (X) | ||
| Isidoro Zambrano MD | ||||||||
| Physician | 0.00 | 40.00 | $0 | $901,689 | $41,740 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,200,433 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $5,886,933 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $601,604 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 29 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Fort Medical Group | |||||
| 611 Sherman Avenue East | Fort Atkinson | WI | 53538 | Physician Services | $16,956,138 |
| Cerner Corporation | |||||
| PO Box 959156 | St Louis | MO | 63195 | Professional Services | $5,455,755 |
| UW Medical Foundation | |||||
| 600 Highland Ave | Madison | WI | 53792 | Radiology Services | $1,786,785 |
| GE Medical Systems | |||||
| PO Box 96483 | Chicago | IL | 60693 | Equipment Maintenance | $696,536 |
| Cardon Outreach | |||||
| PO Box 4950 | The Woodlands | TX | 77387 | Professional Services | $637,864 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 20 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $77,757 | RelatedOrganizationsAmt |
| All Other Contributions | $124,604 | AllOtherContributionsAmt |
| Total Contributions | $202,361 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Hospital services | 623000 | $80,968,856 | $80,968,856 |
| physician clinic revenue | 621110 | $30,230,184 | $30,230,184 |
| Other Operating Revenue | 623990 | $11,361,481 | $11,361,481 |
| Rental Income - Specialty clinic | 621610 | $213,204 | $213,204 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $122,773,725 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,688,248 | TotalRevenueColumnAmt |
| Exclusion | $1,688,248 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $81,810 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $97,765 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$15,955 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$15,955 | TotalRevenueColumnAmt |
| Exclusion | -$15,955 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $116,500,022 | SecuritiesAmt |
| Other | $293,704 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $110,755,550 | SecuritiesAmt |
| Other | $67,220 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,744,472 | SecuritiesAmt |
| Other | $226,484 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,970,956 | TotalRevenueColumnAmt |
| Exclusion | $5,970,956 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Equity Income | Desc |
| Business | 623000 | BusinessCd |
| Total Revenue Column | $1,081,093 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $768,759 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $312,334 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,081,093 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $131,700,428 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $123,542,484 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $7,955,583 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,319,455 | TotalAmt |
| Management And General | $1,319,455 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $36,151,147 | TotalAmt |
| Program Services | $32,889,823 | ProgramServicesAmt |
| Management And General | $3,261,324 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,363,524 | TotalAmt |
| Program Services | $1,234,708 | ProgramServicesAmt |
| Management And General | $128,816 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,998,717 | TotalAmt |
| Program Services | $5,410,107 | ProgramServicesAmt |
| Management And General | $588,610 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,605,423 | TotalAmt |
| Program Services | $2,297,522 | ProgramServicesAmt |
| Management And General | $307,901 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,860,175 | TotalAmt |
| Management And General | $1,860,175 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,615 | TotalAmt |
| Management And General | $164,615 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,996,221 | TotalAmt |
| Program Services | $29,504,945 | ProgramServicesAmt |
| Management And General | $1,491,276 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $498,868 | TotalAmt |
| Program Services | $91,875 | ProgramServicesAmt |
| Management And General | $406,993 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,824,714 | TotalAmt |
| Program Services | $11,693,483 | ProgramServicesAmt |
| Management And General | $131,231 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,184,744 | TotalAmt |
| Program Services | $4,184,744 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,075,283 | TotalAmt |
| Program Services | $4,008,885 | ProgramServicesAmt |
| Management And General | $66,398 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,822 | TotalAmt |
| Program Services | $59,681 | ProgramServicesAmt |
| Management And General | $141 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,708,577 | TotalAmt |
| Program Services | $2,708,577 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,879,519 | TotalAmt |
| Program Services | $6,841,756 | ProgramServicesAmt |
| Management And General | $37,763 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,519 | TotalAmt |
| Program Services | $197,614 | ProgramServicesAmt |
| Management And General | $47,905 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Provision for Bad Debts | $2,706,349 | $2,706,349 | |
| Hospital Assessment | $2,141,855 | $2,141,855 | |
| EAR Project | $955,586 | $955,586 | |
| Leased Equipment | $454,600 | $370,972 | $83,628 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,744,857 | TotalAmt |
| Program Services | $2,293,641 | ProgramServicesAmt |
| Management And General | $451,216 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,939,570 | TotalAmt |
| Program Services | $107,450,268 | ProgramServicesAmt |
| Management And General | $12,489,302 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,963,307 | BOYAmt |
| EOY | $16,007,972 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,371,919 | BOYAmt |
| EOY | $13,886,488 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,181,497 | BOYAmt |
| EOY | $2,320,500 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,035,467 | BOYAmt |
| EOY | $1,570,910 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $172,617,838 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $117,868,108 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,909,307 | BOYAmt |
| EOY | $54,749,730 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,230,224 | BOYAmt |
| EOY | $103,773,069 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,212,418 | BOYAmt |
| EOY | $3,814,476 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,330,707 | BOYAmt |
| EOY | $4,208,194 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $189,234,846 | BOYAmt |
| EOY | $200,331,339 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,649,998 | BOYAmt |
| EOY | $12,213,213 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,292,449 | BOYAmt |
| EOY | $42,205,170 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,830 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,323,747 | BOYAmt |
| EOY | $12,759,534 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $67,386,024 | BOYAmt |
| EOY | $67,177,917 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,848,822 | BOYAmt |
| EOY | $133,153,422 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,848,822 | BOYAmt |
| EOY | $133,153,422 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $189,234,846 | BOYAmt |
| EOY | $200,331,339 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $11,760,858 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$456,258 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $8,984 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $8,984 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Lobbying Portion of dues paid to WHA and AHA. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,752,926 | OtherCostOrOtherBasisAmt |
| Book Value | $1,752,926 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $65,963,681 | OtherCostOrOtherBasisAmt |
| Depreciation | $39,252,915 | DepreciationAmt |
| Book Value | $26,710,766 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $100,884,505 | OtherCostOrOtherBasisAmt |
| Depreciation | $78,615,193 | DepreciationAmt |
| Book Value | $22,269,312 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,016,726 | OtherCostOrOtherBasisAmt |
| Book Value | $4,016,726 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $54,749,730 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| DEFERRED COMPENSATION | $1,217,538 |
| Capitol Lease obligations | $8,860,936 |
| Deferred gain of sale-leaseback | $1,614,888 |
| Related Party Payable | $1,066,172 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $12,759,534 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $130,452,026 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$456,258 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$2,608,584 | OtherRevenueAmt |
| Revenue Not Reported | -$3,064,842 | RevenueNotReportedAmt |
| Revenue Subtotal | $133,516,868 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$1,816,440 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$1,816,440 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $131,700,428 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $119,147,426 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $97,765 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $97,765 | ExpensesNotReportedAmt |
| Expenses Subtotal | $119,049,661 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $889,909 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $889,909 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $119,939,570 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | Fort Medical Group provides for income taxes on a liability method whereby deferred tax assets are recognized for deductible temporary differences, operating losses, and tax credit carryforwards and deferred tax liabilities are recognized for taxable temporary differences. Both are calculated using enacted tax rates when the differences are realized or settled. Temporary differences are the differences between the reported amounts of assets and liabilities and their tax bases. Deferred tax assets are reduced by a valuation allowance when, in the opinion of management, it is more likely than not that some portion or all of the deferred tax assets will not be realized. |
| Part XI, Line 2d - Other Adjustments: | Bad Debt included in expenses -2,706,349. Rental Expenses 97,765. |
| Part XI, Line 4b - Other Adjustments: | Rental Income -1,816,440. |
| Part XII, Line 2d - Other Adjustments: | Rental Expenses 97,765. |
| Part XII, Line 4b - Other Adjustments: | Bad Debt included in expenses 2,706,349. Rental Income -1,816,440. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $599,816 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $599,816 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,641,187 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,541,893 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,099,294 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10320 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,241,003 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,541,893 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $12,699,110 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10830 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,845,836 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $580,164 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,265,672 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01080 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $176,903 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $176,902 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,022,739 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $580,165 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,442,574 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01230 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,263,742 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,122,058 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $14,141,684 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,706,349 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $189,444 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $19,004,691 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $24,334,327 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$5,329,636 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 Medical Health Building Group | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | Rental of Medical buildings | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.20000 | OrgProfitOrOwnershipPct |
| Physicians Profit Or Ownership | 0.25000 | PhysiciansProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort Healthcare Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 Sherman Avenue East | AddressLine1Txt |
| City | Fort Atkinson | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53538 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | https://www.forthealthcare.com/ | WebsiteAddressTxt |
| State License | 1908-800 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort Healthcare Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See statement for line 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | https://www.forthealthcare.com/about-us/mission-vision-strategic-plan/ | StrategyWebsiteURLTxt |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | https://www.forthealthcare.com/patient-info/financial-aid/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | https://www.forthealthcare.com/patient-info/financial-aid/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | https://www.forthealthcare.com/patient-info/financial-aid/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Fort Healthcare, Inc. | Part V, Section B, Line 5: Two feedback sessions open to the public were held. Based on the feedback the top rated items were discussed and will be the focus of Community Health Improvement Plan and Process. |
| Fort Healthcare, Inc. | Part V, Section B, Line 6a: Watertown Regional Medical Center |
| Fort Healthcare, Inc. | Part V, Section B, Line 6b: Dodge and Jefferson County Healthier Communities Partnership |
| Fort Healthcare, Inc. | Part V, Section B, Line 7d: https://www.forthealthcare.com/community-health-needs-assessment/ |
| Fort Healthcare, Inc. | Part V, Section B, Line 11: Fort HealthCare continues to support the work of the Rock River Free Clinic, which offers free services to those who live in our service area. Additionaly, we continue to address obesity and lack of physical activity through targeted community programs offered in all of the communities we serve. Fort HealthCare continues to offer free weight management programs, such as the slimdown challenge, to educate the general public on safe and effective long term weight loss management strategies. With regard to physical activity we continue to offer our rock the walk step challenge, free to all community members, in an effort to increase knowledge regarding the benefits of regular physical activity. |
| Fort Healthcare, Inc. | Part V, Section B, Line 13h: Services are not elective. |
| Fort Healthcare, Inc. | Part V, Section B, Line 16j: THE FINANCIAL ASSISTANCE POLICY IS PUBLICIZED IN ALL FORT HEALTHCARE LOCATIONS and discussed with patients at time of admit and on follow up calls. |
| Fort Healthcare, Inc. | Part V, Section B, Line 20e: Generate at least 4 monthly statements to guarantor on file. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 13 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (13 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Orthopaedic Associates | ||||
| 1504 Madison Avenue | Fort Atkinson | WI | 53538 | Orthopaedic |
| 2 - Surgical Associates | ||||
| 212 Milwaukee Avenue West | Fort Atkinson | WI | 53538 | Surgical - General |
| 3 - Internal Medicine & Pediatrics | ||||
| 500 McMillen Street | Fort Atkinson | WI | 53538 | Internal medicine & pediatrics, behavioral health |
| 4 - Center for Women's Health | ||||
| 650 McMillen Street | Fort Atkinson | WI | 53538 | Obstetrics and Gynecology |
| 5 - Ear Nose & Throat Specialists | ||||
| 512 Wilcox Street | Fort Atkinson | WI | 53538 | ENT |
| 6 - Lake Mills Clinic | ||||
| 200 East Tyranena Park Road | Lake Mills | WI | 53551 | Family Practice, behavioral health, orthopaedic |
| 7 - Integrated Family Care | ||||
| 1520 Madison Avenue | Fort Atkinson | WI | 53538 | Family Practice, behavioral health |
| 8 - Urology Associates | ||||
| 520 Handeyside Lane Suite 2 | Fort Atkinson | WI | 53538 | Urology |
| 9 - Dermatology | ||||
| 611 Sherman Avenue East 3rd Floor | Fort Atkinson | WI | 53538 | Dermatology |
| 10 - Johnson Creek | ||||
| 400 Doctors Court | Johnson Creek | WI | 53038 | Family Practice, wound & edema |
| 11 - Cambridge Clinic | ||||
| 704 Katie Court | Cambridge | WI | 53523 | Family Practice, behavioral health, orthopaedic |
| 12 - Whitewater | ||||
| 1461 West Main Street | Whitewater | WI | 53190 | Obstetrics & Gynecology, internal medicine & pediatrics, ear, nose & throat |
| 13 - Jefferson | ||||
| 840 West Racine Street | Jefferson | WI | 53549 | Family Practice, orthopaedic |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Overall cost to charge ratio |
| Part I, Line 7, Column (f): | The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 2,706,349. |
| Part II, Community Building Activities: | FORT HEALTHCARE GIVES GENEROUSLY TO AREA COMMUNITY ORGANIZATIONS. FORT HEALTHCARE PROVIDES FUNDS IN DIRECT SUPPPORT OF COMMUNITY EVENTS. FORT HEALTHCARE IS ACTIVELY ENGAGING THE COMMUNITY TO BUILD COLLABORATIVE RELATIONSHIPS WITH THE GOAL OF AFFECTING OBESITY, ACCESS TO CARE, DIET, FITNESS, NUTRITION, MENTAL HEALTH AND OVERALL HEALTH NEEDS. FORT HEALTHCARE'S RESOURCES TO SUPPORT THESE ACTIVITIEIS INCLUDE SIGNIFICANT STAFF TIME, VOLUNTEER TIME, MEDICAL SUPPLIES, GIVEAWAY ITEMS AND MORE. FORT HEALTHCARE'S STAFF SERVE ON THE BOARD OF DIRECTORS FOR A NUMBER OF LOCAL NON-PROFIT AGENCIES. FORT HEALTHCARE IS SUPPORTIVE OF UNITED WAY, TOMORROW'S HOPE, RAINBOW HOSPICE AND MANY OTHER FUNDRAISING CAUSES IN THE COMMUNITY. THE COMMUNITY HEALTH AND WELLNESS DEPARTMENT IS ACTIVELY ENGAGING NON-PROFIT ENTITIES IN AREA COMMUNITIES TO BUILD COLLABORATIVE RELATIONSHIPS WITH THE GOAL OF AFFECTING OBESITY, ACCESS TO CARE, DIET, FITNESS AND NUTRITION. THE COALITIONS ARE ENGAGED IN A CONCERTED EFFORT TO REDUCE THE OBESITY RATE IN JEFFERSON COUNTY. EACH COALITION IS ACTIVELY DEVELOPING STRATEGIES TO IMPLEMENT IN THEIR LOCAL COMMUNITIES, FOCUSING THE PRIORITIES ON INCREASING ACCESS TO HEALTHY FOODS, PROMOTING PHYSICAL ACTIVITITY AND NUTRITION. |
| Part III, Line 2: | 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. |
| Part III, Line 3: | 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. |
| 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 - Based on a percentage of community care write-offs to overall self pay write-offsRationale 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. |
| Part III, Line 8: | WE ARE THE ONLY HOSPITAL IN OUR SERVICE AREA & PATIENTS WOULD HAVE TO TRAVEL TO ANOTHER COMMUNITY TO RECEIVE CARE.INPATIENT COSTS COME FROM WORKSHEET D-1 PART II & OUTPATIENT COSTS ARE BASED ON THE COST TO CHARGE RATIO OF THE MEDICARE CHARGES ON WORKSHEET D PART V.SUBACUTE COSTS ARE FROM WORKSHEET D-1 PART III. HOME HEALTH IS FROM WORKSHEET H-6 PART I. |
| Part III, Line 9b: | Persons whose income is more than 200% of the Federal Poverty Guidelines, but not more than 400% of the guidelines, shall be eligible for Community Care on a reduced charge basis. Persons whose income is less than 200% of the guidelines will be considered for complete forgiveness of their outstanding charges. |
| Part VI, Line 2: | Fort HealthCare performs regular market research to assess the healthcare needs and concerns of the community. An annual Community Health Assessment is implemented. The primary research tools are surveys, community focus groups and meetings. Many questions relate specifically to health needs, concerns, behaviors and concerns. The survey is administered by an independent research company. Fort HealthCare has created community health coalitions throughout the service area and continues to work closely with those. Concerned residents and community leaders, with the assistance of Fort HealthCare staff are developing specific community-relevant strategies to address obesity, physical activity, nutrition, advance directives, cancer and diabetic screenings and mental/behaviorial health. |
| Part VI, Line 3: | Information is available on the patient statement, in monthly newsletters and on the organization's 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 Health365 community magazine. The Fort HealthCare website contains links and information specific to the policy on charity care, financial aid and reduced payment option for self-pay patients. Information is also available on the website and in all Fort HealthCare locations regarding the Rock River Free Clinic, a free and reduced care clinic funded in a significant manner by Fort HealthCare including full funding for a 1.0 FTE physician and subsidized lab and radiology services. Financial Aid counselor is available at Fort Memorial Hospital to assist patients with completing paperwork for government assistance programs, with contact information also available on the website and in admission packets. |
| 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, Helenvile, 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. |
| Part VI, Line 5: | 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), SSM 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. |
| Part VI, Line 6: | Fort HealthCare is an independent, non-profit organization. There are no affiliated organizations. |
| Part VI, Line 7, Reports Filed With States | WI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | Yes (1) | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (14 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michael Anderson MD | ||||||||||||||
| Medical Director | $0 | $480,784 | $0 | $349,186 | $0 | $540 | $0 | $10,600 | $0 | $32,268 | $0 | $873,378 | $0 | $0 |
| Billie Kontny MD | ||||||||||||||
| Chief of Staff - Thru 12/31/16 | $0 | $472,331 | $0 | $22,968 | $0 | $2,322 | $0 | $10,600 | $0 | $34,635 | $0 | $542,856 | $0 | $0 |
| Craig Kozler MD | ||||||||||||||
| Board Member | $0 | $519,818 | $0 | $13,579 | $0 | $810 | $0 | $10,600 | $0 | $32,840 | $0 | $577,647 | $0 | $0 |
| Jonathan McLaughlin MD | ||||||||||||||
| Board Member - Thru 12/31/16 | $0 | $464,433 | $0 | $29,510 | $0 | $2,322 | $0 | $10,600 | $0 | $34,818 | $0 | $541,683 | $0 | $0 |
| Michael Wallace | ||||||||||||||
| President/CEO | $377,710 | $0 | $107,156 | $0 | $11,642 | $0 | $10,600 | $0 | $34,818 | $0 | $541,926 | $0 | $0 | $0 |
| James Nelson | ||||||||||||||
| Sr. Vice President / CFO | $223,483 | $0 | $42,713 | $0 | $1,096 | $0 | $10,600 | $0 | $34,699 | $0 | $312,591 | $0 | $0 | $0 |
| Kay Wipperfurth | ||||||||||||||
| VP Ancillary & Support Serv. - Thru | $207,037 | $0 | $0 | $0 | $4,420 | $0 | $8,354 | $0 | $33,017 | $0 | $252,828 | $0 | $0 | $0 |
| Renee Clark | ||||||||||||||
| VP Nursing Services - Thru 6/3/17 | $142,762 | $0 | $28,066 | $0 | $296 | $0 | $7,099 | $0 | $33,887 | $0 | $212,110 | $0 | $0 | $0 |
| Thomas Nordland MD | ||||||||||||||
| Medical Director - Thru 4/28/17 | $0 | $499,456 | $0 | $53,167 | $0 | $3,564 | $0 | $10,600 | $0 | $30,641 | $0 | $597,428 | $0 | $0 |
| Marc Erickson MD | ||||||||||||||
| Physician | $0 | $466,719 | $0 | $28,060 | $0 | $1,242 | $0 | $6,864 | $0 | $33,140 | $0 | $536,025 | $0 | $0 |
| Christopher Manakas MD | ||||||||||||||
| Physician | $0 | $575,500 | $0 | $16,328 | $0 | $486 | $0 | $10,600 | $0 | $33,690 | $0 | $636,604 | $0 | $0 |
| Julie Mokhtar DO | ||||||||||||||
| Physician | $0 | $349,732 | $0 | $100,332 | $0 | $1,242 | $0 | $10,600 | $0 | $32,914 | $0 | $494,820 | $0 | $0 |
| Paul Schuppner MD | ||||||||||||||
| Physician | $0 | $429,648 | $0 | $100,679 | $0 | $486 | $0 | $10,600 | $0 | $12,264 | $0 | $553,677 | $0 | $0 |
| Isidoro Zambrano MD | ||||||||||||||
| Physician | $0 | $692,999 | $0 | $207,880 | $0 | $810 | $0 | $10,600 | $0 | $31,140 | $0 | $943,429 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 5 | FormAndLineReferenceDesc |
| Explanation | Physician compensation is tied to the net revenues of their practice. | ExplanationTxt |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | CUSIPCUSIPNum | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|---|
| Wisconsin Health & Educational Facilities Authority | ||||||||
| A | 391337855 | 97712DJH0 | 2014-12-01 | $28,195,000 | Construction & Equipment | 0 | 0 | 0 |
| Wisconsin Health & Educational Facilities Authority | ||||||||
| B | 391337855 | 97710V4Q8 | 2015-06-30 | $16,480,000 | Construction & Equipment & refunding prior issue | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | In Reserve FundInReserveFundAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,085,000 | $28,195,000 | $4,497,804 | $350,383 | $23,346,813 | 2014 | 0 | Yes (1) | Yes (1) | Yes (1) |
| B | $745,000 | $16,480,000 | $180,000 | $16,300,000 | 2014 | 0 | Yes (1) | Yes (1) | Yes (1) |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd |
|---|---|---|---|---|---|---|---|---|---|
| A | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| B | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | Yes (1) |
| B | Yes (1) |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| 500 McMillen Group LLP | |||
| Partnership owned by former board member Donald Williams | $390,184 | Rent for the lease of office space | 0 |
| Melanie Rumpf | |||
| Wife of Board Member Michael Rumpf | $44,634 | Employee | 0 |
| Medical Health Building Group | |||
| Partnership owned by board member Billie Kontny | $2,062,216 | Rent for the lease of office space | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section B, line 11b | The 990 is reviewed by the organization's Accounting Manager and CFO. A copy of the 990 is provided to the Finance Committee for review and approval prior to 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. Board members with a conflict of interest abstain from voting on the matters. |
| 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. |
| Form 990, Part IX, line 11g | Medical & Physician Services: Program service expenses 29,504,945. Management and general expenses 0. Fundraising expenses 0. Total expenses 29,504,945. Admin Purchased Services: Program service expenses 0. Management and general expenses 1,491,276. Fundraising expenses 0. Total expenses 1,491,276. |
| Part XII, Line 2c | THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort Memorial Hospital Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 611 Sherman Avenue East | AddressLine1Txt |
| City | Fort Atkinson | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53538 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 391397028 | EIN |
| Primary Activities | Foundation | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 12a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Fort HealthCare Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UW Cancer Center Johnson Creek LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 125 Hospital Drive | AddressLine1Txt |
| City | Watertown | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 53098 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 200341996 | EIN |
| Primary Activities | Cancer center | PrimaryActivitiesTxt |
| Legal Domicile State | WI | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Predominant Income Type | Related | PredominantIncomeTypeTxt |
| Share Of Total Income | $319,617 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $945,690 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.33330 | OwnershipPct |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Share Of EOY AssetsShareOfEOYAssetsAmt | OwnershipOwnershipPct | Controlled OrganizationControlledOrganizationInd | Share Of Total IncomeShareOfTotalIncomeAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Fort Medical Group Inc | ||||||||||||
| 611 Sherman Avenue East | Fort Atkinson | WI | 53538 | 391736513 | Provide physician services | WI | Fort Healthcare Inc | C | $2,521,593 | 1.00000 | Yes (1) | |
| Fort Care Inc | ||||||||||||
| 611 Sherman Avenue East | Fort Atkinson | WI | 53538 | 391725831 | Preferred Provider Organization | WI | Fort Healthcare Inc | C | $94,216 | 1.00000 | Yes (1) | $1,133 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| Fort Memorial Hospital Foundation Inc | ||
| C | $101,110 | fair Market Value |
| Fort Memorial Hospital Foundation Inc | ||
| Q | $148,465 | fair Market Value |
| Fort Medical Group Inc | ||
| P | $16,956,138 | Fair Market Value |