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← FORT MEMORIAL HOSPITAL FOUNDATION INC

Form 990 for tax year 2022

Filed by FORT MEMORIAL HOSPITAL FOUNDATION INC.

Totals

Total revenue
$334,006
Total expenses
$136,902
Contributions and grants received
$97,185
Grants paid
$83,575
Program service revenue
$0
Investment income
$236,821
Other revenue
$0
Total assets, end of year
$8,979,321
Total liabilities, end of year
$141,747
Net assets or fund balances, end of year
$8,837,574
Program services expenses (Part IX)
$83,575
Management and general expenses
$0
Fundraising expenses
$53,327
Program service expenses (Part III)
$83,575

Program services were 61.0% of total expenses calculated — Part IX's program-services column over total expenses, both as filed.

Line items

Every line the filer filed in Parts VIII, IX and X, as filed and in filed order. Blank columns are left out, and the lines are not forced to add up to the totals above.

Revenue

Part VIII, the statement of revenue.

  • 1f · All other contributions, gifts and grants

    $97,185

  • 3 · Investment income

    total $154,752 · excluded $154,752

  • 7a · Gross sales of assets other than inventory

    securities $290,730

  • 7b · Less cost or other basis and sales expenses

    securities $208,661

  • 7c · Gain or loss

    securities $82,069

  • 7d · Net gain or loss

    total $82,069 · excluded $82,069

Functional expenses

Part IX, the statement of functional expenses.

  • 1 · Grants to domestic organizations and governments

    total $54,075 · program services $54,075

  • 2 · Grants to domestic individuals

    total $29,500 · program services $29,500

  • 11g · Fees: other

    total $41,235 · fundraising $41,235

  • 20 · Interest

    total $1,147 · fundraising $1,147

  • 24e · All other expenses

    total $10,945 · fundraising $10,945

Balance sheet

Part X, book values.

  • 1 · Cash, non-interest-bearing

    beginning of year $367,754 · end of year $362,431

  • 11 · Investments: publicly traded securities

    beginning of year $7,608,775 · end of year $8,616,890

  • 17 · Accounts payable and accrued expenses

    beginning of year $52,079 · end of year $68,189

  • 25 · Other liabilities

    beginning of year $73,558 · end of year $73,558

  • 27 · Net assets without donor restrictions

    beginning of year $7,532,471 · end of year $8,504,644

  • 28 · Net assets with donor restrictions

    beginning of year $318,421 · end of year $332,930

Mission and programs · 2022

Mission

THE FOUNDATION IS ORGANIZED AND SHALL BE OPERATED SOLELY FOR CHARITABLE PURPOSES EXCLUSIVELY FOR THE BENEFIT OF FORT ATKINSON MEMORIAL HOSPITAL, THE HOSPITAL OPERATED BY FORT HEALTHCARE, INC., AN INTEGRATED HEALTH CARE DELIVERY SYSTEM, INCLUDING THE CARRYING ON OF SUCH PROGRAMS AS THE BOARD OF DIRECTORS OF THIS CORPORATION FROM TIME TO TIME DEEMS TO BE SUITABLE AND APPROPRIATE.

  • FORT MEMORIAL HOSPITAL FOUNDATION WAS CREATED FOR THE SOLE BENEFIT OF FORT HEALTHCARE. FOUR AREAS OF STRATEGIC FOCUS GUIDE OUR FUNDRAISING AND GRANTING PROCESS. BENEVOLENT CARE INCLUDES PROGRAM FUNDING TO ASSIST PATIENTS WHO CANNOT AFFORD CARE. PROVIDING EXCEPTIONAL CARE INCLUDES FUNDING FOR EQUIPMENT, TECHNOLOGY AND SERVICES THAT ENHANCE THE QUALITY OF CARE AND PATIENT SATISFACTION. LIVING HEALTHIER INCLUDES SERVICES FOCUSED ON COMMUNITY WELLNESS INITIATIVES.

    Expenses $54,075 · Grants $54,075

  • ADVANCING CAREERS IN HEALTHCARE INCLUDES SCHOLARSHIPS AND TRAINING FOR EMPLOYEES.

    Expenses $29,500 · Grants $29,500

As filed on the 2022 return. The filer continues this part on Schedule O, which is not shown here.

Listed in Part VII

  • Michael Anderson MD

    BOARD MEMBER

    Total calculated
    $1,639,837
    From this org
    $0
    From related orgs
    $1,595,636
    Other
    $44,201
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $627,061 related
    Bonus
    $0 + $408,271 related
    Other
    $0 + $560,304 related
    Deferred
    $0 + $12,839 related
    Nontaxable benefits
    $0 + $31,362 related
    Filer's total
    $0 + $1,639,837 related

  • Michael Wallace

    SENIOR ADVISOR

    Total calculated
    $682,805
    From this org
    $0
    From related orgs
    $637,198
    Other
    $45,607
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $463,044 related
    Bonus
    $0 + $167,455 related
    Other
    $0 + $6,699 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $33,407 related
    Filer's total
    $0 + $682,805 related

  • Mary Beck Metzger

    SECRETARY

    Total calculated
    $81,677
    From this org
    $0
    From related orgs
    $65,927
    Other
    $15,750
    Hours/week
    1 + 40 related

  • Donald Williams MD

    BOARD MEMBER

    Total calculated
    $30,885
    From this org
    $0
    From related orgs
    $29,479
    Other
    $1,406
    Hours/week
    1

  • Carol Burrows

    PRESIDENT

    Total calculated
    $0
    Hours/week
    1

  • Roy Budlong

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Andy Didion

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • James Fitzpatrick PhD

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Christi Ott

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • Thomas Vinz

    BOARD MEMBER

    Total calculated
    $0
    Hours/week
    1 + 3 related

  • James Nelson

    ASSISTANT TREASURER

    Total calculated
    $408,967
    From this org
    $0
    From related orgs
    $363,506
    Other
    $45,461
    Hours/week
    1 + 40 related

    Schedule J breakdown matched by us

    Base
    $0 + $273,841 related
    Bonus
    $0 + $84,208 related
    Other
    $0 + $5,457 related
    Deferred
    $0 + $12,200 related
    Nontaxable benefits
    $0 + $33,261 related
    Filer's total
    $0 + $408,967 related

Compensation is as filed in Part VII: reportable pay from this organization and from related organizations, other compensation, and hours per week. The total, marked calculated, is our sum of the three dollar columns, with a blank column counted as $0; the form itself has no total. On a Form 990-EZ the columns are Part IV's instead, and on a Form 990-PF Part VIII's — compensation, contributions to benefit plans, and expense account — and the total sums those. A Schedule J breakdown is as filed: base pay, bonus, other, deferred compensation and nontaxable benefits from this organization, with any from related organizations beside each, and the filer's own total. It is shown with the Part VII listing of the same name on the same return. The form gives no key between the two, so that pairing is ours, and is marked matched by us.

Schedule J

Answered yes

None.

Answered no

  • 4a · Severance or change-of-control payment
  • 4b · Supplemental nonqualified retirement plan
  • 4c · Equity-based compensation arrangement
  • 5a · Pay contingent on this organization's revenues
  • 5b · Pay contingent on a related organization's revenues
  • 6a · Pay contingent on this organization's net earnings
  • 6b · Pay contingent on a related organization's net earnings
  • 7 · Other non-fixed payments
  • 8 · Paid under the initial-contract exception

Part I's answers as filed. A line not listed was left unanswered; on lines 1a and 3 that means the box was not checked.

Grants on this return

Related organizations on this return

Schedule R Part II: tax-exempt organizations related to the filer by control. It does not record shared board members or money.

Taxable family on this return

Schedule R Parts I, III and IV, as filed. These record ownership and control, not shared board members or money moved.

Disregarded entities

Part I: entities that legally are the filer and file no return of their own.

  • PAIN CENTERS OF WISCONSIN - FORT ATKINSON LLC

    HEALTH CARE SERVICES · WI · income $445,366 · assets $938,957

    Directly controlled by FORT HEALTHCARE INC

Related corporations and trusts

Part IV: related organizations taxable as a corporation or trust.

  • FORTCARE INC

    C · PREFERRED PROVIDER ORGANIZATION · WI · controlled entity

Provenance

Return type
form_990
Tax year
2022
Filed
29 July 2024
IRS schema version
2022v5.0
Source object
202412209349301476

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