FORT HEALTHCARE INC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- FORT HEALTHCARE INC (EIN 39-0286215)
- Tax period
- 2012-10-01 to 2013-09-30
- Filed
- 2014-08-15
- IRS object ID
- 201402279349303950
- Schema version
- 2012v2.1
- 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) |
|---|---|---|
| Timestamp | 2014-08-15T14:05:02-05:00 | Timestamp |
| Tax Period End Date | 2013-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 390758449 | EIN |
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 DRIVE 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 | 2012-10-01 | 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 | 2014-08-15 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAY ADKISSON CPA | Name |
| PTIN | P01360892 | PTIN |
| Phone | 4144319300 | Phone |
| Date Prepared | 2014-08-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | 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 | 142815894 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| 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 IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1118 | TotalNbrEmployees |
| Total Nbr Volunteers | 235 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 255640 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 247708 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 126825803 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 123986248 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2752384 | InvestmentIncomePriorYear |
| Investment Income Current Year | 2849115 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1381141 | OtherRevenuePriorYear |
| Other Revenue Current Year | 630843 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 131214968 | TotalRevenuePriorYear |
| Total Revenue Current Year | 127713914 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 53960425 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 55560529 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 75883556 | OtherExpensePriorYear |
| Other Expenses Current Year | 74413567 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 129843981 | TotalExpensesPriorYear |
| Total Expenses Current Year | 129974096 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1370987 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -2260182 | RevenuesLessExpensesCY |
| Total Assets BOY | 179070478 | TotalAssetsBOY |
| Total Assets EOY | 172497721 | TotalAssetsEOY |
| Total Liabilities BOY | 85133939 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 79461059 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 93936539 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 93036662 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | OUR MISSION AT FORT HEALTHCARE IS TO IMPROVE THE HEALTH AND WELL-BEING OF OUR COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 80916525 | Expense |
| Revenue | 93790157 | 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 | 33622484 | Expense |
| Revenue | 27966493 | Revenue |
| Description | OPERATION OF PHYSICIAN CLINICS WITH OUTREACH INTO THE SURROUNDING COMMUNITIES | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2043667 | Expense |
| Revenue | 2229598 | Revenue |
| Description | OPERATION OF A HOME HEALTH AGENCY TO CARE FOR HOMEBOUND SENIORS AND OTHERS IN THE COMMUNITY | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Revenue | 352678 | Revenue |
| Description | RELATED RENTAL AND INVESTMENT INCOME | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Rev | 352678 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 116582676 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 1 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| 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 |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| 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 |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 155 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 1118 | 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 |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | 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 | 0 | 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 (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| MICHAEL WALLACE | ||||||||
| PRESIDENT/CEO | 40.00 | X | X | 376110 | 0 | 35164 | ||
| JONATHAN MCLAUGHLIN MD | ||||||||
| CHAIR | 3.00 | X | X | 0 | 592895 | 37436 | ||
| SHARON SCHMELING | ||||||||
| VICE CHAIR | 3.00 | X | X | 0 | 0 | 0 | ||
| DEAN JOHNSON | ||||||||
| TREASURER | 3.00 | X | X | 0 | 0 | 0 | ||
| MICHAEL ANDERSON MD | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 554806 | 36315 | 40.00 | ||
| MICHAEL RUMPF | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| DONALD WILLIAMS MD | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 263801 | 33903 | 40.00 | ||
| BARRY CASH MD | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| CAROL WARD KNOX | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| THOMAS NORDLAND MD | ||||||||
| BOARD MEMBER THRU 12/31/12 | 3.00 | X | 0 | 665395 | 35729 | 40.00 | ||
| ERIC RUNEZ | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| ROBERT SCHRAMM PHD | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| GREGORY WATERS | ||||||||
| BOARD MEMBER | 3.00 | X | 0 | 0 | 0 | |||
| WADE WOELFLE MD | ||||||||
| BOARD MEMBER BEGINING 1/1/13 | 3.00 | X | 0 | 0 | 0 | |||
| JAMES J NELSON | ||||||||
| SR. VICE PRESIDENT & CFO | 40.00 | X | 215412 | 0 | 35200 | |||
| ISIDORO ZAMBRANO MD | ||||||||
| PHYSICIAN | 1.00 | 0 | 902006 | 35436 | 40.00 | X | ||
| RANDALL JENNINGS MD | ||||||||
| PHYSICIAN | 1.00 | 0 | 617934 | 34916 | 40.00 | X | ||
| MARC ERICKSON MD | ||||||||
| PHYSICIAN | 1.00 | 0 | 593455 | 36436 | 40.00 | X | ||
| BILLIE KONTNY MD | ||||||||
| PHYSICIAN | 1.00 | 0 | 593220 | 37563 | 40.00 | X | ||
| ALAN DETWILER MD | ||||||||
| PHYSICIAN | 1.00 | 0 | 551332 | 16048 | 40.00 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 591522 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 5334844 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 374146 | TotalOtherCompensation |
| Number Individuals GT100 K | 32 | NumberIndividualsGT100K |
| Formers Listed | 0 | 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 EAST | FORT ATKINSON | WI | 53538 | PHYSICIAN SERVICES | 12184570 |
| CERNER CORPORATION | |||||
| PO BOX 412702 | KANSAS CITY | OH | 64141 | PROFESSIONAL SERVICES | 6647626 |
| UW MEDICAL FOUNDATION - RADIOLOGY | |||||
| 600 HIGHLAND AVE | MADISON | WI | 53792 | RADIOLOGY SERVICES | 1484860 |
| MEDICUS HOSPITALIST SERVICES LLC | |||||
| 7 INDUSTRIAL WAY UNIT 5 | SALEM | NH | 03079 | HOSPITALIST (PHYSICIAN) SERVICES | 1167493 |
| CERNER HEALTH PLAN SERVICES | |||||
| 2800 ROCKCREEK PARKWAY | KANSAS CITY | MO | 64117 | ADMINISTRATIVE SERVICES | 980293 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 35 | NumberOfContractorsGT100K |
| Related Organizations | 57667 | RelatedOrganizations |
| All Other Contributions | 190041 | AllOtherContributions |
| Total Contributions | 247708 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (4 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| HOSPITAL SERVICES | 623000 | 86684079 | 86684079 |
| PHYSICIAN CLINIC REVENUE | 621110 | 27188297 | 27188297 |
| OTHER OPERATING REVENUE | 623990 | 7884274 | 7884274 |
| HOME HEALTH AGENCY | 621610 | 2229598 | 2229598 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 123986248 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1264679 | TotalRevenueColumn |
| Exclusion | $1,264,679 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 913733 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 907374 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 6359 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6359 | TotalRevenueColumn |
| Exclusion | $6,359 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 15336261 | Securities |
| Other | 442781 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 14104932 | Securities |
| Other | 89674 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1231329 | Securities |
| Other | 353107 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1584436 | TotalRevenueColumn |
| Exclusion | $1,584,436 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INVESTMENT INCOME | Description |
| Business Code | 623000 | BusinessCode |
| Total Revenue Column | 624484 | TotalRevenueColumn |
| Related Or Exempt Function Income | 352678 | RelatedOrExemptFunctionIncome |
| Exclusion | $271,806 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 624484 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 127713914 | TotalRevenueColumn |
| Related Or Exempt Function Income | 124338926 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $3,127,280 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 591522 | Total |
| Program Services | 532209 | ProgramServices |
| Management And General | 59313 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41528098 | Total |
| Program Services | 37363988 | ProgramServices |
| Management And General | 4164110 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1475094 | Total |
| Program Services | 1327183 | ProgramServices |
| Management And General | 147911 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8946176 | Total |
| Program Services | 8049124 | ProgramServices |
| Management And General | 897052 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3019639 | Total |
| Program Services | 2716853 | ProgramServices |
| Management And General | 302786 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 445565 | Total |
| Management And General | 445565 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 216108 | Total |
| Management And General | 216108 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27047699 | Total |
| Program Services | 25159436 | ProgramServices |
| Management And General | 1888263 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 838706 | Total |
| Program Services | 224189 | ProgramServices |
| Management And General | 614517 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11667569 | Total |
| Program Services | 11369110 | ProgramServices |
| Management And General | 298459 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4250387 | Total |
| Program Services | 4250387 | ProgramServices |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5932986 | Total |
| Program Services | 4636419 | ProgramServices |
| Management And General | 1296567 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 127890 | Total |
| Program Services | 123593 | ProgramServices |
| Management And General | 4297 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3726516 | Total |
| Program Services | 3726516 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7998624 | Total |
| Program Services | 7947654 | ProgramServices |
| Management And General | 50970 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 244083 | Total |
| Program Services | 196458 | ProgramServices |
| Management And General | 47625 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | 5432761 | 5432761 | 0 |
| DUES | 2708507 | 109634 | 2598873 |
| EQUIPMENT | 756730 | 752728 | 4002 |
| LAUNDRY/CLEANING | 698521 | 698521 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2320915 | Total |
| Program Services | 1965913 | ProgramServices |
| Management And General | 355002 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 129974096 | Total |
| Program Services | 116582676 | ProgramServices |
| Management And General | 13391420 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4508519 | BOY |
| EOY | 4312285 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25328684 | BOY |
| EOY | 18740001 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7475 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1969648 | BOY |
| EOY | 1957817 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1379892 | BOY |
| EOY | 1720136 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 166098479 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 95621710 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 74404088 | BOY |
| EOY | 70476769 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 58156153 | BOY |
| EOY | 63066317 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8874849 | BOY |
| EOY | 7796618 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4441170 | BOY |
| EOY | 4427778 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 179070478 | BOY |
| EOY | 172497721 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15620699 | BOY |
| EOY | 14190829 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55276463 | BOY |
| EOY | 51484425 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14236777 | BOY |
| EOY | 13785805 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 85133939 | BOY |
| EOY | 79461059 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93936539 | BOY |
| EOY | 93036662 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 93936539 | BOY |
| EOY | 93036662 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 179070478 | BOY |
| EOY | 172497721 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -2260182 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 1360305 | ReconciliationUnrealizedInvest |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | Volunteers |
| Paid Staff Or Management | 0 | PaidStaffOrManagement |
| Media Advertisements | 0 | MediaAdvertisements |
| Mailings Members | 0 | MailingsMembers |
| Publications Or Broadcast | 0 | PublicationsOrBroadcast |
| Grants Other Organizations | 0 | GrantsOtherOrganizations |
| Direct Contact Legislators | 0 | DirectContactLegislators |
| Rallies Demonstrations | 0 | RalliesDemonstrations |
| Other Activities | 1 | OtherActivities |
| Other Activities | $8,931 | OtherActivitiesAmount |
| Total Lobbying Expenditures IIB | 8931 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | 0 | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | EXPLANATION OF LOBBYING ACTIVITIES: | Identifier |
| Return Reference | PART II-B, LINE 1: | ReturnReference |
| Explanation | LOBBYING PORTION OF DUES PAID TO WHA AND AHA. | Explanation |
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 | 64304867 | OtherCostOrOtherBasis |
| Depreciation | 32081918 | Depreciation |
| Book Value | 32222949 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 99997161 | OtherCostOrOtherBasis |
| Depreciation | 63539792 | Depreciation |
| Book Value | 36457369 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1160296 | OtherCostOrOtherBasis |
| Book Value | 1160296 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 70476769 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (4 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| DEFERRED COMPENSATION | $482,659 |
| CAPITOL LEASE OBLIGATIONS | $10,080,542 |
| DEFERRED GAIN OF SALE-LEASEBACK | $2,677,434 |
| RELATED PARTY PAYABLE | $545,170 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 13785805 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 124548832 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1360305 | NetUnrealizedGainsInvestments |
| Other Revenues | -4525387 | OtherRevenues |
| Revenue Not Rptd F990 | -3165082 | RevenueNotRptdF990 |
| Revenue Subtotal | 127713914 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 127713914 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 125448709 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 907374 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 907374 | ExpensesNotRptdF990 |
| Expenses Subtotal | 124541335 | ExpensesSubtotal |
| Other Expenses Not Included | 5432761 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 5432761 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 129974096 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X, LINE 2: | 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 2013 AND 2012. TAX RETURNS FOR TAX YEARS 2009 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE APPLICABLE TAXING AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT INCLUDED IN EXPENSES -5,432,761. RENTAL EXPENSES 907,374. | |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 907,374. | |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT INCLUDED IN EXPENSES 5,432,761. |
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 | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| 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 | 1925040 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1925040 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01550 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 14820572 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3913998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10906574 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08760 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 16745612 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3913998 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 12831614 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10310 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1457132 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 387240 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1069892 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00860 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 154205 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 154204 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1611337 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 387241 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1224096 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00980 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18356949 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4301239 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14055710 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11290 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $5,432,761 | BadDebtExpenseAmount |
| Amount Attributable To | 380293 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 11095215 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 15383749 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -4288534 | 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 | 1 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
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 V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT HEALTHCARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 1 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| All Needs Addressed | 0 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 150.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 300.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORT HEALTHCARE HOME HEALTH | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 SHERMAN AVENUE EAST | AddressLine1 |
| City | FORT ATKINSON | City |
| State | WI | State |
| ZIP Code | 53538 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | HOME HEALTH AGENCY | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: OVERALL COST TO CHARGE RATIO | ||
| PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES DID NOT INCLUDE ANY PHYSICIAN CLINICS. | ||
| 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 $ 5432761. | ||
| PART II: FORT HEALTHCARE GIVES GENEROUSLY TO AREA COMMUNITY ORGANIZATIONS. IN FY 2012, MORE THAN $60,000 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 $2.15 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. THE COMMUNITY HEALTH & 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. FOR SEVERAL COMMUNITIES IN JEFFERSON COUNTY, KEY LEADERS HAVE BEEN IDENTIFIED TO REPRESENT THE HEALTHIEST COMMUNITIES COALITION IN THEIR RESPECTIVE CITIES. COALITION MEMBERSHIP INCLUDES REPRESENTATIVES FROM LOCAL SCHOOLS, CHURCHES, GOVERNMENT AGENCIES, BUSINESSES, COMMUNITY ORGANIZATIONS AND INTERESTED INDIVIDUALS. ALL 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 ON THE FOLLOWING PRIORITIES:-INCREASE ACCESS TO HEALTHY FOOD OPTIONS-APPLY INCENTIVES TO IMPROVE NUTRITION-INSTITUTE WORKPLACE INCENTIVES TO REWARD INCREASED PHYSICAL ACTIVITY-EDUCATE AND INFORM THE PUBLIC ABOUT SERVING SIZES AND NUTRITIONAL CONTENT OF FOOD OPTIONS AVAILABLE IN PUBLIC AREAS-IMPLEMENT COMPREHENSIVE PROGRAMS THAT PROMOTE PHYSICAL ACTIVITY AND NUTRITION-INCREASE ACCESS TO OPPORTUNITIES AND FACILITIES THAT PROMOTE PHYSICAL ACTIVITY | ||
| 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-OFFS 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 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 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. | ||
| PART V, SECTION B, LINE 3: 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 4: BEAVER DAM HOSPITAL AND WATERTOWN HOSPITAL | FORT HEALTHCARE INC. | |
| PART V, SECTION B, LINE 7: MENTAL HEALTH - CURRENTLY RESTRUCTURING THE WAY MENTAL HEALTH SERVICES ARE PROVIDED.ALCOHOL USE - PLAN TO ADDRESS IN FUTURE.TOBACCO USE - PLAN TO ADDRESS IN FUTURE. | FORT HEALTHCARE INC. | |
| PART V, SECTION B, LINE 12H: SERVICES ARE NOT ELECTIVE. | FORT HEALTHCARE INC. | |
| PART V, SECTION B, LINE 20D: WE USED OUR OVERALL AVERAGE INSURANCE RATE. | FORT HEALTHCARE INC. | |
| 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 COMMUNITY HEALTH ASSESSMENT IS ALSO IMPLEMENTED. THE PRIMARY RESEARCH TOOL IS A DOOR-TO-DOOR SURVEY OF 400+ RESIDENTS IN THE SERVICE AREA. MANY QUESTIONS RELATE SPECIFICALLY TO HEALTH NEEDS, CONCERNS, BEHAVIORS AND CONCERNS. THE SURVEY IS ADMINISTERED BY AN INDEPENDENT RESEARCH COMPANY AFFILIATED WITH THE UNIVERSITY OF WISCONSIN-WHITEWATER. FURTHERMORE, FORT HEALTHCARE HAS CREATED COMMUNITY HEALTH COALITIONS THROUGHOUT THE SERVICE AREA. CONCERNED RESIDENTS AND COMMUNITY LEADERS, WITH THE ASSISTANCE OF FORT HEALTHCARE STAFF ARE DEVELOPING SPECIFIC COMMUNITY-RELEVANT STRATEGIES TO ADDRESS OBESITY, PHYSICAL ACTIVITY, NUTRITION AND INCREASED CONSUMPTION OF WATER VS. SWEETENED BEVERAGES. | ||
| 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), 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. | ||
| PART VI, LINE 6: FORT HEALTHCARE IS AN INDEPENDENT, NON-PROFIT ORGANIZATION. THERE ARE NO AFFILIATED ORGANIZATIONS. | ||
| WI | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 1 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | 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 (11 entries)
| TitleTitle | 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 WALLACE | ||||||||||||||
| PRESIDENT/CEO | 348115 | 0 | 16353 | 0 | 11642 | 0 | 10000 | 0 | 25164 | 0 | 411274 | 0 | 60000 | 0 |
| JONATHAN MCLAUGHLIN MD | ||||||||||||||
| CHAIR | 0 | 431191 | 0 | 160462 | 0 | 1242 | 0 | 10000 | 0 | 27436 | 0 | 630331 | 0 | 0 |
| MICHAEL ANDERSON MD | ||||||||||||||
| BOARD MEMBER | 0 | 425000 | 0 | 129266 | 0 | 540 | 0 | 10000 | 0 | 26315 | 0 | 591121 | 0 | 0 |
| DONALD WILLIAMS MD | ||||||||||||||
| BOARD MEMBER | 0 | 233964 | 0 | 26666 | 0 | 3171 | 0 | 10000 | 0 | 23903 | 0 | 297704 | 0 | 0 |
| THOMAS NORDLAND MD | ||||||||||||||
| BOARD MEMBER THRU 12/31/12 | 0 | 660869 | 0 | 2204 | 0 | 2322 | 0 | 10000 | 0 | 25729 | 0 | 701124 | 0 | 0 |
| JAMES J NELSON | ||||||||||||||
| SR. VICE PRESIDENT & CFO | 207284 | 0 | 7476 | 0 | 652 | 0 | 8629 | 0 | 26571 | 0 | 250612 | 0 | 0 | 0 |
| ISIDORO ZAMBRANO MD | ||||||||||||||
| PHYSICIAN | 0 | 849283 | 0 | 52183 | 0 | 540 | 0 | 10000 | 0 | 25436 | 0 | 937442 | 0 | 0 |
| RANDALL JENNINGS MD | ||||||||||||||
| PHYSICIAN | 0 | 607108 | 0 | 10016 | 0 | 810 | 0 | 10000 | 0 | 24916 | 0 | 652850 | 0 | 0 |
| MARC ERICKSON MD | ||||||||||||||
| PHYSICIAN | 0 | 432183 | 0 | 160462 | 0 | 810 | 0 | 10000 | 0 | 26436 | 0 | 629891 | 0 | 0 |
| BILLIE KONTNY MD | ||||||||||||||
| PHYSICIAN | 0 | 431516 | 0 | 160462 | 0 | 1242 | 0 | 10000 | 0 | 27563 | 0 | 630783 | 0 | 0 |
| ALAN DETWILER MD | ||||||||||||||
| PHYSICIAN | 0 | 548402 | 0 | 0 | 0 | 2930 | 0 | 10000 | 0 | 6048 | 0 | 567380 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| PART I, LINE 4B | MICHAEL WALLACE WAS AWARDED A SERP RETENTION BONUS FOR FY2013 IN THE AMOUNT OF $60,000 |
| PART I, LINE 5 | PHYSICIAN COMPENSATION IS TIED TO THE NET REVENUES OF THEIR PRACTICE |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Bond ReferenceBondReferenceCd | Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|---|
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| A | 391337855 | 97710VTU2 | 2004-05-18 | 40072037 | CONSTRUCTION & EQUIPMENT | 0 | 0 | 0 |
| WISCONSIN HEALTH & EDUCATIONAL FACILITIES AUTHORITY | ||||||||
| B | 391337855 | 97710V4Q8 | 2007-09-20 | 26000000 | CONSTRUCTION & EQUIPMENT & REFUNDING PRIOR ISSUE | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Bond ReferenceBondReferenceCd | Amount RetiredAmountRetired | 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 | Refunding EscrowRefundingEscrow | Credit EnhancementCreditEnhancement |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| A | 5372037 | 40072037 | 2926311 | 320000 | 36825725 | 2006 | 0 | 0 | 1 | 1 | ||
| B | 6955000 | 26000000 | 391832 | 16058833 | 2010 | 0 | 1 | 1 | 1 | 9548835 | 500 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest | Change In Use Bond Financed PropChangeInUseBondFinancedProp | Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs |
|---|---|---|---|---|---|---|---|---|---|---|
| A | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
| B | 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 0 | 0 | 0 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiled | Rebate Not Due YetRebateNotDueYet | Exception To RebateExceptionToRebate | No Rebate DueNoRebateDue | 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 | Written Proc To Monitor ReqsWrittenProcToMonitorReqs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| XL ASSET FUNDING | ||||||||||||
| A | 0 | 1 | 0 | 0 | 0 | 0 | 1 | COMPANY | 2.500000000000 | 1 | 0 | 0 |
| (no name) | ||||||||||||
| B | 0 | 1 | 0 | 0 | 1 | 0 | 0 | 0 | 0 | |||
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| Bond ReferenceBondReferenceCd | Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction |
|---|---|
| A | 1 |
| B | 1 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (4 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| 500 MCMILLEN GROUP LLP | |||
| PARTNERSHIP OWNED BY DONALD WILLIAMS CURRENT BOARD DIRECTOR | 349179 | RENT FOR THE LEASE OF OFFICE SPACE | 0 |
| JULIE MOKHTAR MD | |||
| WIFE OF OFFICER EDWIN FISCHER | 420275 | EMPLOYEE | 0 |
| MELANIE RUMPF | |||
| WIFE OF BOARD MEMBER MICHAEL RUMPH | 46958 | EMPLOYEE | 0 |
| MEDICAL HEALTH BUILDING GROUP | |||
| PARTNERSHIP OWNED BY BILLIE KONTNY, TOP 5 PAID EMPLOYEES | 1876739 | RENT FOR THE LEASE OF OFFICE SPACE | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE 990 IS SENT TO EACH OF THE BOARD OF DIRECTORS 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. | |
| 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 | PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 23,849,654. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 23,849,654. ADMINISTRATIVE PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,888,263. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,888,263. MEDICAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,309,782. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,309,782. | OTHER FEES |
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 | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| FORT MEMORIAL HOSPITAL FOUNDATION | ||||||||||
| 611 SHERMAN AVE EAST | FORT ATKINSON | WI | 53538 | 391397028 | FOUNDATION | WI | 501(C)(3) | LINE 11A, I | FORT HEALTHCARE INC | 1 |
| FORT HEALTHCARE PARTNERS | ||||||||||
| 611 SHERMAN AVE EAST | FORT ATKINSON | WI | 53538 | 391040145 | VOLUNTEERS | WI | 501(C)(3) | LINE 3 | FORT HEALTHCARE INC | 1 |
Form990 Schedule R Part III Form990ScheduleRPartIII (4 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Direct Controlling Entity NADirectControllingEntityNA | Predominant Income TypePredominantIncomeType | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Disproportionate AllocationsDisproportionateAllocations | General Or Managing PartnerGeneralOrManagingPartner | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| UW CANCER CENTER JOHNSON CREEK LLC | |||||||||||||
| 250 DOCTORS COURT | JOHNSON CREEK | WI | 53038 | 200341996 | CANCER CARE CENTER | WI | N/A | RELATED | -24048 | 340675 | 0 | 0 | 0.33300 |
| MEDICAL HEALTH BUILDING GROUP LLC | |||||||||||||
| 43 SOUTH WATER STREET EAST | FORT ATKINSON | WI | 53538 | 611571669 | HOLD REAL ESTATE FOR MEDICAL PRACTICES | WI | N/A | RELATED | 276176 | 2589019 | 0 | 0 | 0.20000 |
| PAIN CENTERS OF WISCONSIN - FORT ATKINSON LLC | |||||||||||||
| 4131 WEST LOOMIS ROAD | GREENFIELD | WI | 53221 | 900777376 | PROVIDE PAIN MANAGEMENT SERVICES | WI | N/A | RELATED | 361745 | 340675 | 0 | 0 | 0.49000 |
| FORT MEDICAL EQUIPMENT LLC | |||||||||||||
| 306 WASHINGTON ST | FORT ATKINSON | WI | 53538 | 392042387 | PROVIDE DURABLE MEDICAL EQUIPMENT | WI | N/A | RELATED | -4370 | 33106 | 0 | 0 | 0.30000 |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership | Controlled OrgControlledOrg | Share Of Total IncomeShareOfTotalIncome |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FORT MEDICAL GROUP INC | ||||||||||||
| 611 SHERMAN AVE EAST | FORT ATKINSON | WI | 53538 | 391736513 | PROVIDE PHYSICIAN SERVICES | WI | FORT HEALTHCARE INC | C | 2784237 | 1.00000 | 0 | |
| FORT CARE INC | ||||||||||||
| 611 SHERMAN AVE EAST | FORT ATKINSON | WI | 53538 | 391725831 | PREFERRED PROVIDER ORGANIZATION | WI | FORT HEALTHCARE INC | C | 96269 | 1.00000 | 0 | -14981 |
| 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 |
| Dividends Related Organization | 0 | DividendsRelatedOrganization |
| 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 (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| FORT MEMORIAL HOSPITAL FOUNDATION | ||
| C | 121533 | FAIR MARKET VALUE |
| FORT HEALTHCARE PARTNERS | ||
| C | 58563 | FAIR MARKET VALUE |
| FORT MEMORIAL HOSPITAL FOUNDATION | ||
| Q | 15976424 | FAIR MARKET VALUE |